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1.
Gena C. Dunivan AnnaMarie Connolly Mary L. Jannelli Ellen C. Wells Elizabeth J. Geller 《International urogynecology journal》2009,20(9):1127-1131
Introduction and hypothesis This study aims to investigate whether body mass index (BMI) is a risk factor for cystotomy during sling placement via suprapubic
approach for stress urinary incontinence.
Methods Retrospective chart review was performed for suprapubic mid-urethral sling placement between June 2005 and October 2007. Data
collected included demographics, BMI, and history of prior and concomitant procedures. Primary outcome was cystotomy during
sling placement.
Results Of 198 women identified, 129 had a BMI < 30 kg/m2 and 69 had a BMI ≥ 30 kg/m2. There were 18 (14.0%) cystotomies in the BMI < 30 kg/m2 group and three (4.3%) in the BMI ≥ 30 kg/m2 group (p = 0.04). BMI < 30 kg/m2 remained a risk factor for cystotomy after controlling for confounders (OR 4.63, 95% CI 1.20–17.86), as did prior anti-incontinence
surgery (OR 3.55, 95% CI 1.01–12.50).
Conclusions BMI < 30 kg/m2 may be a risk factor for cystotomy during sling placement utilizing the suprapubic approach.
Poster Presentation at the 2008 American Urogynecologic Society Annual Meeting, Chicago, IL, September 4–6, 2008 相似文献
2.
Stephen H. Gray Catherine C. Vick Laura A. Graham Kelly R. Finan Leigh A. Neumayer Mary T. Hawn 《Journal of gastrointestinal surgery》2008,12(4):675-681
Objective This study was undertaken to examine the effect of cirrhosis on elective and emergent umbilical herniorrhapy outcomes.
Methods Procedures were identified from the Veterans’ Affairs National Surgical Quality Improvement Program at 16 hospitals. Medical
records and operative reports were physician abstracted to obtain preoperative and intraoperative variables.
Results Of the 1,421 cases reviewed, 127 (8.9%) had cirrhosis. Cirrhotics were more likely to undergo emergent repair (26.0% vs. 4.8%,
p < 0.0001), concomitant bowel resection (8.7% vs. 0.8%, p < 0.0001), return to operating room (7.9% vs. 2.5%, p = 0.0006), and increased postoperative length of stay (4.0 vs. 2.0 days, p = 0.01). Best-fit regression models found cirrhosis was not a significant predictor of postoperative complications. Significant
predictors of complications were emergent case (OR 5.4; 95% CI 3.1–9.4), diabetes (OR 2.1; 95% CI 1.2–3.8), congestive heart
failure (OR 4.0; 95% CI 1.4–11.4), and chronic obstructive pulmonary disease (OR 2.0; 95% CI 1.1–3.6). Among emergent repairs,
cirrhosis (OR 4.4; 95% CI 1.3–14.3) was strongly associated with postoperative complications.
Conclusion Elective repair in cirrhotics is associated with similar outcomes as in patients without cirrhosis. Emergent repair in cirrhotics
is associated with worse outcomes. Early elective repair may improve the overall outcomes for patients with cirrhosis. 相似文献
3.
4.
David J. Askenazi Russell Griffin Gerald McGwin Waldemar Carlo Namasivayam Ambalavanan 《Pediatric nephrology (Berlin, Germany)》2009,24(5):991-997
The independent impact of acute kidney injury (AKI) on survival in very low birthweight (VLBW; ≤1,500 g) critically ill infants
has not been studied. Cases (non-survivors n = 68) were matched to, at most, two controls (survivors n = 127) by incidence density sampling with replacement, birthweight (± 50 g), gestational age (± 1 week), and availability
of serum creatinine (SCr) levels before the index patient’s time of death. Maternal/infant demographic characteristics, co-morbidities,
complications and interventions were explored. No difference existed between patients and controls in mean gestational age
and birthweight (the matching variables), race, or gender. Compared with the controls, cases had younger mothers, less placental
separation, fewer occurrences of hyponatremia, more intra-ventricular hemorrhage, and received chest compressions and cardiac
drugs. A 1 mg/dl increase in SCr was associated with almost two-times higher odds of death [odds ratio (OR) = 1.94, 95% confidence
interval (95% CI) 1.13–3.32]. OR increased when confounding variables were adjusted (adjusted OR 3.44, 95% CI 1.23–9.61).
Similarly, a 100% increase in SCr from trough level was associated with an increased OR = 1.53 (95% CI 1.14–2.04) and became
stronger, after adjustment of variables (adjusted OR = 1.90, 95% CI 1.10–3.27). After confounding variables had been controlled
for, AKI was independently associated with mortality in VLBW infants. Further prospective multi-center studies are needed
to determine whether this association exists. 相似文献
5.
Background: Bariatric surgery may be associated with surgical complications. The aim of the study was to identify significant
risk factors for postoperative complications in patients undergoing Roux-en-Y gastric bypass (RYGBP). Methods: The study consisted
of 75 consecutive patients undergoing RYGBP. Full medical examination was performed, and the following parameters were assessed
in the fasting state: plasma glucose, insulin, leptin, serum lipids, liver function tests, and lipoprotein Lp(a). All subjects
had oral 75 g glucose tolerance test before the surgery. All complications occurring within 6 months after the RYGBP were
recorded. The patients were divided into Group 1 - patients in whom complications occurred, and Group 2 - patients with no
complications in the 6-month period. Results: Postoperative complications occurred in 16 patients (wound infection, hernia,
splenic injury, gastro-jejunal obstruction, duodenal ulcer, lower limb deep vein thrombosis). 3 significant risk factors for
postoperative complications within 6 months after gastric bypass were found: 1) fasting plasma glucose ≥ 6.0 mmol/l (OR 11.0;
95% confidence interval (CI) 2.1-77.3), 2) age ≥40 years (OR 5.89, 95% CI 1.35-29.4), and 3) BMI ≥45 kg/m2 (OR 4.1, 95% CI 1.04-17.2). Conclusion: RYGBP is associated with increased risk of developing early postoperative complications
in subjects with even slightly elevated fasting plasma glucose, age ≥40 and BMI ≥45 kg/m2. 相似文献
6.
Background Conception is discouraged during the period of maximal weight loss following Roux-en-Y gastric bypass (RYGB) because of speculative
maternal and fetal concerns. We therefore performed a retrospective cohort study of obstetrical and neonatal outcomes by surgery-to-conception
interval.
Methods Women with RYGB were stratified into two groups by surgery-to-conception interval of ≤18 or >18 months. Pregnancy and newborn
outcomes excluding miscarriages were compared using the chi-square or unpaired t-test for dichotomous and continuous variables, respectively.
Results Twenty subjects conceived ≤18 months (11.4 ± 5.0) and 32 conceived >18 months (47.5 ± 41) after RYGB, p < .05. Maternal age, parity, body mass index, and weight gain were similar by group. There were no statistically significant
differences in adverse obstetrical outcomes (preterm premature membrane rupture, gestational diabetes, oligohydramnios, intrauterine
growth restriction, preterm or post-term delivery) or adverse newborn outcomes (5-min Apgar score < 7, intensive care admission,
or birth defect).
Conclusion Obstetrical and neonatal outcomes are similar in women conceiving during or after the period of maximal weight loss following
RYGB. 相似文献
7.
Association between iron overload and osteoporosis in patients with hereditary hemochromatosis 总被引:1,自引:0,他引:1
L. Valenti M. Varenna A. L. Fracanzani V. Rossi S. Fargion L. Sinigaglia 《Osteoporosis international》2009,20(4):549-555
Summary In 87 patients with hereditary hemochromatosis, osteoporosis was detected in 25%, and osteopenia in 41%. Bone mineral density
was independently associated with BMI, ALP levels, hypogonadism/menopause, and the amount of iron removed to reach depletion,
but not with cirrhosis. Osteoporosis is influenced by iron overload in hemochromatosis.
Introduction To analyze prevalence, clinical characteristics and genetic background associated with osteoporosis in a retrospective study
in Italian patients with hereditary hemochromatosis (HHC).
Methods In 87 consecutive patients with HHC, bone mineral density was systematically evaluated by dual energy x-ray absorptiometry
of the lumbar spine (n = 87) and femoral neck (n = 66).
Results Osteoporosis was detected in 22 (25.3%), and osteopenia in 36 (41.4%) patients. Mean Z scores were −0.92 ± 1.42 at lumbar
spine and −0.35 ± 1.41 at femoral neck. Lumbar spine T-score was independently associated with total ALP (p = 0.002), hypogonadism/menopause (p = 0.026), and iron overload (p = 0.033 for ferritin and p = 0.017 for iron removed). We observed a borderline significance for BMI (p = 0.069) and smoking status (p = 0.086). Lumbar spine osteoporosis was independently associated with lower BMI (OR 0.73, 95% CI 0.54–0.94), total ALP (OR
1.17, 95% CI 1–1.39 per 10 unit increase) and the amount of iron removed (OR 1.53, 95% CI 1–2.5 per 5 g increase). HFE genotypes
did not differ between patients with and without osteoporosis.
Conclusions Osteoporosis is observed in a quarter of unselected patients with HHC, independently of the genetic background, and is associated
with ALP, hypogonadism, body weight, and severity of iron overload. 相似文献
8.
Mustafa Mumtaz Mazicioglu Bektas Murat Yalcin Ahmet Ozturk Hasan Basri Ustunbas Selim Kurtoglu 《Pediatric nephrology (Berlin, Germany)》2010,25(11):2327-2334
To investigate the relationship between anthropometric parameters and elevated blood pressure in adolescents, we measured
blood pressure (BP), height, weight, triceps skinfold (TSF) thickness, waist circumference (WC), and mid-upper-arm circumference
(MUAC) in 2,860 student volunteers aged 11–17 years in Kayseri, Turkey. Waist-to-height ratio (WHtR), waist-to-arm-span ratio
(WASR), body mass index (BMI), arm-fat area (AFA), and fat percentage (FP) were also calculated. Participants were divided
into two groups: hypertensive [systolic blood pressure (SBP) or diastolic blood pressure (DBP) ≥ 95th percentiles, n = 246] and normotensives (SBP or DBP < 95th percentiles, n = 2614). Multiple logistic regression models were produced within these groups for the examined risk factors, and cutoff
points were investigated for SBP or DBP ≥ 95th percentiles using receiver operating characteristics (ROC) analysis. BMI, WC,
WHtR, WASR, MUAC, and BMI had statistically significant cutoffs among boys. Whereas BMI, WHtR, WASR, WC, MUAC, AFA, and TSF
were statistically significant for girls younger than 15, only BMI and WC were statistically significant for participants
older than 15. The independent risk factors for elevated BP were determined according to BMI and WC. Although several anthropometric
measurements were significant in our participants, BMI and WC were significant among all participants irrespective of age
and sex. 相似文献
9.
Mashaal Dhir Elizabeth A. Montgomery Sabine C. Glöckner Kornel E. Schuebel Craig M. Hooker James G. Herman Stephen B. Baylin Susan L. Gearhart Nita Ahuja 《Journal of gastrointestinal surgery》2008,12(10):1745-1753
Introduction WNT signaling pathway dysregulation is an important event in the pathogenesis of colorectal cancer (CRC) with APC mutations seen in more than 80% of sporadic CRC. However, such mutations in the WNT signaling pathway genes are rare in inflammatory
bowel disease (IBD) associated neoplasia (dysplasia and cancer). This study examined the role of epigenetic silencing of WNT
signaling pathway genes in the pathogenesis of IBD-associated neoplasia.
Methods Paraffin-embedded tissue samples were obtained and methylation of ten WNT signaling pathway genes, including APC1A, APC2, SFRP1, SFRP2, SFRP4, SFRP5, DKK1, DKK3, WIF1 and LKB1, was analyzed. Methylation analysis was performed on 41 IBD samples, 27 normal colon samples (NCs), and 24 sporadic CRC samples.
Results Methylation of WNT signaling pathway genes is a frequent and early event in IBD and IBD-associated neoplasia. A progressive
increase in the percentage of methylated genes in the WNT signaling pathway from NCs (4.2%) to IBD colitis (39.7%) to IBD-associated
neoplasia (63.4%) was seen (NCs vs. IBD colitis, p < 0.01; IBD colitis vs. IBD-associated neoplasia, p = 0.01). In the univariate logistic regression model, methylation of APC2 (OR 4.7, 95% CI: 1.1–20.63, p = 0.04), SFRP1 (OR 5.1, 95% CI: 1.1–31.9, p = 0.04), and SFRP2 (OR 5.1, 95% CI: 1.1–32.3, p = 0.04) was associated with progression from IBD colitis to IBD-associated neoplasia, while APC1A methylation was borderline significant (OR 4.1, 95% CI: 0.95–17.5, p = 0.06). In the multivariate logistic regression model, methylation of APC1A and APC2 was more likely to be associated with IBD-associated neoplasia than IBD colitis. (OR APC1A: 6.4, 95% CI: 1.1–37.7 p = 0.04; OR APC2 9.1, 95% CI: 1.3–61.7, p = 0.02).
Summary Methylation of the WNT signaling genes is an early event seen in patients with IBD colitis and there is a progressive increase
in methylation of the WNT signaling genes during development of IBD-associated neoplasia. Moreover, methylation of APC1A, APC2, SFRP1, and SFRP2 appears to mark progression from IBD colitis to IBD-associated neoplasia, and these genes may serve as biomarkers for IBD-associated
neoplasia. 相似文献
10.
Atkinson MA Lestz RM Fivush BA Silverstein DM 《Pediatric nephrology (Berlin, Germany)》2011,26(12):2219-2226
Published data on the comparative achievement of The Kidney Disease Dialysis Outcome Quality Initative (KDOQI) recommended
clinical performance targets between children and young adults on dialysis are scarce. To characterize the achievement of
KDOQI targets among children (<18 years) and young adults (18–24 years) with prevalent end stage renal disease (ESRD), we
performed a cross-sectional analysis of data collected by the Mid-Atlantic Renal Coalition, in conjunction with the 2007 and
2008 ESRD Clinical Performance Measures Projects. Data on all enrolled pediatric dialysis patients, categorized into three
age groups (0–8, 9–12, 13–17 years), and on a random sample of 5% of patients ≥18 years in ESRD Network 5 were examined for
two study periods: hemodialysis (HD) data were collected from October to December 2006 and from October to December 2007 and
peritoneal dialysis (PD) data were collected from October 2006 to March 2007 and from October 2007 to March 2008. In total,
114 unique patients were enrolled the study, of whom 41.2% (47/114) were on HD and 58.8% (67/114) on PD. Compared to the pediatric
patients, young adults were less likely to achieve the KDOQI recommended serum phosphorus levels and serum calcium × phosphorus
product values, with less than one-quarter demonstrating values at or below each goal. Multivariate analysis revealed that
both young adults and 13- to 17-year-olds were less likely to achieve target values for phosphorus [young adults: odds ratio
(OR) 0.04, 95% confidence interval (95% CI) 0.01–0.19, p < 0.001; 13- to 17-year-olds: OR 0.17, 95% CI 0.04–0.77, p = 0.02] and calcium × phosphorus product (young adults: OR 0.01, 95% CI 0.002–0.09, p < 0.001; 13- to 17-year-olds: OR 0.09, 95% CI 0.02–0.56, p = 0.01) than younger children. In summary, there are significant differences in clinical indices between pediatric and young
adult ESRD patients. 相似文献
11.
Introduction Determinants of perioperative risk for RYGB are not well defined.
Methods Retrospective analysis of comorbidities was used to evaluate predictors of perioperative risk in 1,000 consecutive patients
having open RYGB by univariate analyses and logistic regression.
Results One hundred forty-six men, 854 women; average age 38.3 ± 11.2 years; mean BMI 51.8 ± 10.5 (range 24–116) were evaluated. Average
hospital stay (LOS) was 3.8 days; 87% <3 days. 91.3% of procedures were without major complication. The most common complications
were incisional hernia 3.5%, intestinal obstruction 1.9%, and leak 1.6%. 31 patients required reoperation within 30 days (3.1%).
A 30-day mortality was 1.2%. Logistic regression evaluating predictors of operative mortality correlated strongly with coronary
artery disease (CAD) (p < 0.01), sleep apnea (p = 0.03), and age (p = 0.042). BMI > 50 (0.6 vs 2.3%, p = 0.03) and male sex were associated with increased mortality (1.3 vs. 4.0%, p = 0.02). Sex-specific logistic regression demonstrated males with angiographically proven CAD were more likely to die (p = 0.028) than matched cohorts. Age (p = 0.033) and sleep apnea (p = 0.040) were significant predictors of death for women.
Conclusion Perioperative mortality after RYGB appears to be affected by sex, BMI, age, CAD, and sleep apnea. Strategies employing risk
stratification should be developed for bariatric surgery.
Presented in part at the Annual Meeting of the SSAT, Orlando, FL, May 2003 相似文献
12.
Rebecca M. Hasler Aristomenis K. Exadaktylos Omar Bouamra Lorin M. Benneker Mike Clancy Robert Sieber Heinz Zimmermann Fiona Lecky 《European spine journal》2011,20(12):2174-2180
This is a European cohort study on predictors of spinal injury in adult (≥16 years) major trauma patients, using prospectively
collected data of the Trauma Audit and Research Network from 1988 to 2009. Predictors for spinal fractures/dislocations or
spinal cord injury were determined using univariate and multivariate logistic regression analysis. 250,584 patients were analysed.
24,000 patients (9.6%) sustained spinal fractures/dislocations alone and 4,489 (1.8%) sustained spinal cord injury with or
without fractures/dislocations. Spinal injury patients had a median age of 44.5 years (IQR = 28.8–64.0) and Injury Severity
Score of 9 (IQR = 4–17). 64.9% were male. 45% of patients suffered associated injuries to other body regions. Age <45 years
(≥45 years OR 0.83–0.94), Glasgow Coma Score (GCS) 3–8 (OR 1.10, 95% CI 1.02–1.19), falls >2 m (OR 4.17, 95% CI 3.98–4.37),
sports injuries (OR 2.79, 95% CI 2.41–3.23) and road traffic collisions (RTCs) (OR 1.91, 95% CI 1.83–2.00) were predictors
for spinal fractures/dislocations. Age <45 years (≥45 years OR 0.78–0.90), male gender (female OR 0.78, 95% CI 0.72–0.85),
GCS <15 (OR 1.36–1.93), associated chest injury (OR 1.10, 95% CI 1.01–1.20), sports injuries (OR 3.98, 95% CI 3.04–5.21),
falls >2 m (OR 3.60, 95% CI 3.21–4.04), RTCs (OR 2.20, 95% CI 1.96–2.46) and shooting (OR 1.91, 95% CI 1.21–3.00) were predictors
for spinal cord injury. Multilevel injury was found in 10.4% of fractures/dislocations and in 1.3% of cord injury patients.
As spinal trauma occurred in >10% of major trauma patients, aggressive evaluation of the spine is warranted, especially, in
males, patients <45 years, with a GCS <15, concomitant chest injury and/or dangerous injury mechanisms (falls >2 m, sports
injuries, RTCs and shooting). Diagnostic imaging of the whole spine and a diligent search for associated injuries are substantial. 相似文献
13.
14.
de Goederen-van der Meij S Pierik RG Oudkerk Pool M Gouma DJ Mathus-Vliegen LM 《Obesity surgery》2007,17(1):88-94
Background We studied whether weight loss by intragastric balloon would predict the outcome of subsequent gastric banding with regard
to weight loss and BMI reduction.
Methods A prospective cohort of patients with a body mass index (BMI) >40 kg/m2 received an intragastric balloon for 6 months followed by laparoscopic adjustable gastric banding (LAGB). Successful ballooninduced
weight loss was defined as ≥10% weight loss after 6 months. Successful surgical weight loss was defined as an additional 15%
weight loss in the following 12 months. Patients were divided in group A, losing ≥10% of their initial weight with 6 months’
balloon treatment, and group B, losing <10% of their initial weight.
Results In 40 patients (32 female, 8 male; age 36.6 yr, range 26–54), the mean BMI decreased from 46.5 to 40.5 kg/m2 (P < 0.001) after 6 months of balloon treatment and to 35.2 kg/m2 (P < 0.001) 12 months after LAGB. Group A (25 patients) and group B (15 patients) had a significant difference in BMI decrease,
12.4 vs 9.0 kg/m2 (P < 0.05), after the total study duration of 18 months. However, there was no difference in BMI reduction (4.7 kg/m2 vs 5.8 kg/m2) in the 12 months after LAGB. 6 patients in group A lost ≥10% of their starting weight during 6 months balloon treatment
as well as ≥15% 12 months following LAGB. 6 patients in group B lost <10% of their starting weight after 6 months of BIB,
but also lost ≥15% 12 months following LAGB.
Conclusion Intragastric balloon did not predict the success of subsequent LAGB. 相似文献
15.
N. Boonyaratavej P. Suriyawongpaisal A. Takkinsatien S. Wanvarie R. Rajatanavin P. Apiyasawat 《Osteoporosis international》2001,12(3):244-248
Hip fractures are among the most important causes of ill health and death among elderly people. Several potentially modifiable
risk factors have been reported. Most claimed physical activity as a promising, inexpensive preventive measure for hip fracture.
However, knowledge about risk factors for hip fracture in Asian populations is very limited. We therefore conducted a case–control
study to assess the relationships between physical activity and risk of hip fractures in Thai women. From 14 hospitals in
Thailand, 229 cases with a radiologically confirmed first hip fracture were enrolled. Two hundred and twenty-four controls
were randomly recruited from the same neighborhood and were matched to the cases by age within a 5 year range. Information
on physical activity as well as other potential confounders was obtained through personal interviews. Multivariate logistic
regression revealed that past physical activity was protective in both very active and active women (OR = 0.67, 95% CI = 0.40–1.12
for moderately active women and OR = 0.20, 95% CI = 0.10–0.38 for very active women; p value for trend <0.01). Recent physical activity reduced the risk to about two-thirds (OR = 0.33, 95% CI = 0.19–0.60 and
OR = 0.35, 95% CI = 0.18–0.69 for moderately and very active women respectively). In addition, breastfeeding was identified
to be a protective factor (OR = 0.87, 95% CI = 0.80–0.94). In contrast, the following risk factors were identified: current
use of antihistamine (OR = 13.96, 95% CI = 1.38–141.13) or traditional medicine (OR = 7.66, 95% CI = 2.71–21.63), underlying
cerebrovascular diseases (OR = 6.53, 95% CI = 2.10–20.34), history of fracture (OR = 4.04, 95% CI = 1.26–12.99), parental
Chinese racial background (OR = 2.52, 95% CI = 1.49–4.23), alcohol consumption (OR = 2.30, 95% CI = 1.04–5.09).
Received: 14 April 2000 / Accepted: 17 October 2000 相似文献
16.
Louis Flancbaum MD FACS Joseph S Verducci PhD Patricia S Choban MD FACS 《Obesity surgery》1998,8(4):437-443
Background: Roux-en-Y gastric bypass (RYGB) for clinically severe obesity (CSO) results in a ‘paradoxical’ response of the
measured resting energy expenditure (MREE) in which the MREE remains within the predicted range based upon the Harris-Benedict
(HB) equation, despite a significant decrease in caloric intake to 500-1000 kcal/day. The mechanism for this response is unknown.
A study was undertaken to determine whether the changes in MREE after RYGB are related to limb-length of the gastric bypass.
Methods: A prospective clinical trial of varying limb-lengths based on body mass index (BMI) in patients having RYGB for CSO.
The records of patients who underwent RYGB for CSO and had MREE measured at baseline, 6 months and 12 months postoperation
were reviewed. MREE was performed using a Med Graphics? CCM system after an overnight fast or at least 4 hours after a light
meal, and a 30 minute rest in a supine position in a neutral environment, on the same day of the week between the hours of
10a.m. and 4p.m. Patients were selected for RYGB in accordance with NIH recommendations. RYGB was performed in a standardized
fashion with the Roux limb-length varied as follows: (A) BMI ≤ 51 kg/m2 - 75 cm limb (n = 20); (B) BMI ≤ 51 kg/m2 - 150 cm limb (n = 16); (C) BMI ≥ 51 kg/m2 - 150 cm limb (n = 18); or (D) BMI ≥ 51 kg/m2 - 250 cm limb (n = 6). Results: Data from 60 patients (nine male, 51 female; mean age 39 years; mean baseline BMI 51.5 ± 10 kg/m2; mean baseline weight 145 ± 32 kg) were analyzed. There were no significant differences in MREE or percentage HB-predicted
energy expenditure between the groups. Conclusions: These data suggest that the observed changes in MREE following RYGB for
CSO are not related to the limb-length of the bypass. 相似文献
17.
N. Yoshimura H. Kinoshita T. Takijiri H. Oka S. Muraki A. Mabuchi H. Kawaguchi K. Nakamura T. Nakamura 《Osteoporosis international》2008,19(1):21-28
Introduction The study aimed to clarify associations between height loss, bone loss and the quality of life (QOL) score among general inhabitants
of Miyama, a rural Japanese community. This population-based epidemiological study was conducted in Miyama, a village located
in a mountain area in Wakayama Prefecture, Japan.
Methods A list of all inhabitants comprising 1,543 inhabitants (716 men, 827 women) born in this village between 1910–1949 was compiled.
From the above whole cohort, a subcohort to measure bone mineral density (BMD) was recruited, consisting of 400 participants,
divided into four groups of 50 men and 50 women each, and stratified into age decades by decade of birth-year (1910–1919,
1920–1929, 1930–1939 or 1940–1949). BMD measurement, physical measurements of height (cm) and body weight (kg) were taken,
and body mass index (BMI; kg/m2) were calculated. BMD and anthropometric measurements were repeated on the same participants at 3, 7 and 10 years after baseline
measurement (1993, 1997 and 2000).
Results and discussion Among 299 of 400 participants, changes in height over 10 years for men in their 40s, 50s, 60s and 70s were −0.7 cm, −0.5 cm,
−1.2 cm and −1.5 cm, respectively, compared with −0.7 cm, −1.4 cm, −2.1 cm and −3.7 cm in women, respectively. No significant
relationships between change in height and rate of change in BMD at the lumbar spine and femoral neck after adjustment for
age in men (lumbar spine, β = 0.058, standard error of the mean (SE) = 0.031, P = 0.501, R2 = 0.038; femoral neck, β = 0.100, SE = 0.038, P = 0.228, R2 = 0.121) were identified. By contrast, among women, a significant positive association was identified between height change
and change rate of BMD at the lumbar spine after adjusting for age (β = 0.221, SE = 0.039, P = 0.012, R2 = 0.069), while no significant relationship was found between height change and change rate at the femoral neck (β = 0.107,
SE = 0.039, P = 0.229, R2 = 0.048). No significant relationship was noted between vertebral fractures (VFx) and height at baseline in men and women
(men: odds ratio (OR) 0.93, 95% confidence interval (CI) 0.81–1.05, P = 0.24; women: OR 0.97, 95% CI 0.87–1.08, P = 0.58) or between VFx and height loss (men: OR 1.31, 95% CI 1.00–1.71, P = 0.051; women: OR 1.20, 95% CI 0.94–1.53, P = 0.14). In both men and women, no significant relationship was identified between utility of the EuroQol EQ5D questionnaire
and height at baseline (men: β = −0.148, SE = 0.003, P = 0.202, R2 = 0.076; women: β = 0.127, SE = 0.004, P = 0.235, R2 = 0.048), and height change (men: β = −0.078, SE = 0.008, P = 0.452, R2 = 0.065; women: β = 0.053, SE = 0.010, P = 0.608, R2 = 0.038). 相似文献
18.
Background Conflicting data exist regarding the effect of body mass index (BMI) on postoperative mortality from critical illness. Few
studies have examined this issue in surgical patients specifically. We tested the hypothesis that BMI is associated with mortality
from surgical critical illness.
Methods Consecutive admissions to a university surgical intensive care unit (SICU) were analyzed from January 2005–August 2006. Admission
BMI was analyzed as both a five-level categorical (underweight, < 18.5 kg/m2; normal weight, 18.5–24.9 kg/m2; overweight, 25.0–29.9 kg/m2; obese, 30.0–39.9 kg/m2; morbidly obese, ≥ 40 kg/m2) and dichotomous (≥ 40 kg/m2 vs. < 40 kg/m2) variable among all patients as well as a subgroup of patients with a SICU length of stay (ULOS) ≥ 4 days. Multivariable
logistic regression models were fit to determine the independent effect of BMI group on SICU mortality.
Results The total sample size was 946, with 490 patients admitted to the SICU for ≥ 4 days (51.8%). Of the variables tested, age,
acute physiology and chronic health evaluation III score, gender, diabetes mellitus, and need for insulin infusion varied
significantly among the five BMI groups. After adjustment for these variables, BMI was not predictive of mortality when analyzed
as either a five-level categorical or dichotomous variable, regardless of ULOS.
Conclusion BMI is not related to mortality of surgical critical illness. Several factors, including modern ICU care, may mitigate the
risks of obesity in the SICU.
Poster Presentation at the 36th Annual Meeting of the Society of Critical Care Medicine, Orlando, FL, USA, February 17th–21st,
2007. 相似文献
19.
Won-Suk Lee Min Jung Kim Seong Hyeon Yun Ho-Kyung Chun Woo Yong Lee Sung-Joo Kim Seong-Ho Choi Jin-Seok Heo Jae Won Joh Yong Il Kim 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2008,393(1):13-19
Background/aim This study was conducted to devise a prognostic model for patients undergoing simultaneous liver and colorectal resection.
Materials and methods A retrospective analysis was performed on 138 colorectal patients who underwent simultaneous liver and colorectal resection
between September 1994 and September 2005. The primary endpoint of the study was overall survival. Three patients with positive
liver resection margin were excluded from the analysis.
Results At multivariate level, poor prognostic factors were liver resection margin ≤5 mm (P = 0.047; relative risk, 1.684; 95% CI = 1.010–2.809), CEA greater than 5 ng/ml (P = <0.001; relative risk, 2.507; 95% CI = 1.499–4.194), number of liver metastasis > 1 (P = <0.042; relative risk, 1.687; 95% CI = 1.020–2.789), and lymph node ≥ 4 (P = <0.012; relative risk, 1.968; 95% CI = 1.158–3.347). The risk stratification grouping of the 135 patients was performed according to the following criteria: low
risk group, 0–1 factor; intermediate risk group, 2 factors; high-risk group, 3–4 factors. Of 135 patients, 86 patients (63.0%)
were categorized as low-risk group, 36 patients (26.6%) as intermediate risk group, and 14 patients (10.4%) as high-risk group.
Median survival times for low, intermediate, high-risk groups were 68.0, 43.6 (95% CI, 24.7–62.4), and 23.5 months (95% CI,
9.4–31.5), respectively. The high-risk group demonstrated an approximately threefold (relative risk, 3.1; 95% CI, 1.6–6.0)
increased risk of death.
Conclusions A simple risk factor stratification system was proposed to evaluate the chances of cure of patients after simultaneous resection
of liver metastases and primary colorectal carcinoma. The risk factor stratification showed three groups with distinct survival.
The risk stratification may help to predict patient survival after simultaneous liver and colorectal resection. This system
needs further prospective validation. 相似文献
20.
Lithium has been shown to inhibit bone resorption and to interact with Wnt signaling, potentially pointing to bone anabolic
properties. We, therefore, studied the effects of lithium on fracture risk using a case–control study design. Cases were all
subjects including children with any fracture sustained during the year 2000 (n = 124,655). For each case, three controls (n = 373,962) matched according to age and gender was randomly drawn from the background population. Adjustments were made for
use of other psychotropic drugs (neuroleptics, antidepressants, and anxiolytics/sedatives), psychiatric disease (manic depressive
states, schizophrenia, and other psychoses), and other confounders. The effect of dose was examined by stratifying for cumulated
dose (DDD, defined daily dose). In the crude analysis, there was a decreasing relative risk of any fracture with increasing
accumulated dose of lithium. After adjustment for psychotropic drug use, the risk of any fracture was decreased (odds ratio
[OR] 0.74, 95% confidence interval [CI] 0.60–0.92 for 250–849 DDD, and OR 0.67, 95% CI 0.55–0.81 for ≥ 850 DDD of lithium).
For Colles’ fractures and spine fractures, a significant decrease was seen with ≥ 850 DDD (OR 0.57, 95% CI 0.35–0.94 for Colles’
fracture and OR 0.32, 95% CI 0.11–0.95 for spine fractures). For hip fractures, a nonsignificant trend toward a decrease was
seen; however, without a dose-response relationship. Adjustment for further confounders did not change the results. Lithium
treatment was associated with a decreased risk of fractures potentially pointing at bone anabolic properties. 相似文献