Prevalence of sarcopenia in Japanese women with osteopenia and osteoporosis

Sarcopenia and osteoporosis are both significant health burdens among postmenopausal women. This study examined associations between sarcopenia and osteopenia/osteoporosis in Japanese women and evaluated the prevalence of sarcopenia in women with osteopenia and osteoporosis. A total of 2400 Japanese women aged 40–88 years underwent dual-energy x-ray absorptiometry (DXA) scans of the whole body, lumbar spine, and total hip. Osteopenia and osteoporosis were defined according to World Health Organization criteria using bone mineral density (BMD) of the lumbar spine or hip. Sarcopenia was defined as a relative skeletal muscle index (RSMI) more than 2 standard deviations below the mean for a young adult reference population, calculated as the appendicular skeletal muscle mass (ASM) obtained from whole-body DXA divided by height in meters squared (RSMI = ASM/height²). Significant and marginal/moderate positive correlations were observed between RSMI and lumbar spine/total hip BMDs (r = 0.197 and r = 0.274, respectively; p < 0.0001 each). The BMDs of the lumbar spine and total hip showed significant moderate negative correlations with age (r = ?0.270 and r = ?0.375, respectively; p < 0.0001 each), but RSMI showed no association with age in this population (r = 0.056). When osteopenia/osteoporosis was defined using lumbar spine BMD, prevalences of sarcopenia in subjects with normal BMD, osteopenia and osteoporosis were 10.4, 16.8, and 20.4 %, respectively. When osteopenia/osteoporosis was defined using total hip BMD, the prevalences of sarcopenia in these subjects were 9.0, 17.8, and 29.7 %, respectively. A Chi-square test for independence showed a significant association between sarcopenia and osteopenia/osteoporosis (p < 0.0001). These results indicate that sarcopenia is significantly associated with osteopenia and osteoporosis in Japanese women.     

IL-17A-mediated sRANK ligand elevation involved in postmenopausal osteoporosis

Summary

The role of proinflammatory IL-17 cytokine was studied in postmenopausal bone loss between 31 osteopenic and 41 osteoporotic women. The effect of serum IL-17A, soluble receptor activator of NF-κB (sRANK) ligand, and osteoprotegerin (OPG) levels on lumbar bone mineral densities was measured. The results demonstrated an increased IL-17A-mediated sRANK ligand elevation in postmenopausal osteoporotic bone loss.

Introduction

IL-17 proinflammatory cytokine is a new inducer of bone loss. Postmenopausal osteoporosis represents a cross talk between estrogen deprivation and increased immune reactivity. The role of IL-17 was studied in the bone loss of postmenopausal osteoporosis.

Methods

Serum IL-17A, sRANK ligand, and OPG levels were investigated on bone mineral densities (BMDs) in the total lumbar (L1–L4) region in 18 pre- and 72 postmenopausal women. IL-17A, sRANK ligand, OPG levels, and BMDs were measured with enzyme-linked immunosorbent assay (ELISA) and dual-energy X-ray absorptiometry (DXA).

Results

Increased serum IL-17A, sRANK ligand, and OPG levels were demonstrated in postmenopausal osteoporotic women compared to osteopenic women (3.65?±?0.61 vs 3.31?±?0.43 ng/ml for IL-17A, P?<?0.007; 2.88?±?0.84 vs 2.49?±?0.61 ng/ml for sRANK ligand, P?<?0.027; and 1.43?±?0.07 vs 1.39?±?0.07 ng/ml for OPG, P?<?0.038). In postmenopausal women, IL-17A levels correlated inversely with total lumbar BMDs (P?<?0.008, r?=??0.279) and positively with sRANK ligand levels (P?<?0.0001, r?=?0.387) or the ratio of sRANK ligand and OPG (P?<?0.013, r?=?0.261), but did not with OPG levels alone.

Conclusion

Increased IL-17A levels are involved in postmenopausal osteoporosis, playing a role in the bone-resorpting processes.     

A susceptibility haplotype within the endothelial nitric oxide synthase gene influences bone mineral density in hypertensive women

The influence of the coordinated effect of various single-nucleotide polymorphisms (SNPs) within the endothelial nitric oxide synthase (eNOS) gene on the risk of osteoporosis in hypertension has remained undetermined. Four pertinent SNPs of the eNOS gene, rs2070774, rs1799983, rs1800780 and rs3918181, were examined for the risk of osteoporosis in 313 hypertensive postmenopausal women in Northwest India. All the hypertensive women were verified with dual energy X-ray absorptiometry and categorized as 150 with osteoporosis and 163 without osteoporosis. The minor allele (T) of rs1799983 exerts a statistically significant risk for osteoporosis both in dominant [odds ratio (OR) 3.71, 95 % confidence interval (CI) 2.12–6.49, P < 0.001] and recessive mode (OR 5.75, 95 % CI 1.24–26.69, P = 0.036) after Bonferroni correction. Bone mineral density (BMD) values (corrected for the effects of risk variables) according to eNOS SNP genotypes revealed a significant association with rs1799983 at both the lumbar spine (P = 0.001) and femoral neck (P = 0.023). Risk association analyses revealed a susceptibility haplotype TTAG which influences the risk of osteoporosis (OR 2.02, 95 % CI 1.05–3.39, P = 0.042) in hypertension after adjusting for the effects of risk factors. Furthermore, this haplotype was significantly associated with BMD at the lumbar spine (P = 0.029) and femoral neck (P = 0.021) in a dose-dependent manner. The results suggest that possession of the TTAG haplotype of the eNOS gene may increase the risk of osteoporosis two-fold in hypertensive postmenopausal women in Northwest India.     

Trabecular Bone Score Is a Useful Parameter for the Prediction of Vertebral Fractures in Patients With Polymyalgia Rheumatica

Introduction: Polymyalgia rheumatica (PMR), a benign rheumatic disorder, requires long-term glucocorticoid therapy, which could be associated with osteoporosis. In the present study, we compared bone mineral density (BMD), trabecular bone score (TBS) and frequencies of vertebral fracture (VF) among patients with PMR or rheumatoid arthritis (RA) and controls. Methods: Fifty-three postmenopausal women with PMR aged 50 yr or older were eligible for inclusion in this study. Subjects in RA (n = 106) and control (n = 106) groups were selected by propensity score matching with controlling age, body mass index and use of anti-osteoporotic agents. Results: The frequency of VF in patients with PMR (30.2%) was significantly higher than those in patients with RA (13.2 %) and controls (13.2%, p = 0.017). The mean TBS of patients with PMR (1.317 ± 0.092) was significantly lower than those of patients with RA (1.336 ± 0.089) and the controls (1.373 ± 0.073, p < 0.001). In receiver operating characteristic analysis for VF in patients with PMR, the area under the curve (AUC) was 0.759 (95% confidence interval [CI] = 0.601–0.918, p < 0.001) for TBS and 0.618 (95% CI = 0.442–0.795, p < 0.001) for L-spine BMD. The AUCs were 0.760 (95% CI = 0.630–0.891, p ≤ 0.001) and 0.767 (95% CI 0.627–0.907, p < 0.001) for femur neck and total hip BMD, respectively. Multivariate analysis identified the factor associated with VF of patients with PMR as a lower TBS (Odds ratio: 0.000, 95% CI: 0.000, 0.754, p = 0.043). Conclusion: TBS could be a supplementary tool for discriminating osteoporotic fractures in postmenopausal patients with PMR.     

The effect of gender on outcomes after lower extremity revascularization

Objective

The effect of gender on outcomes after lower extremity revascularization is controversial. The aim of our systemic review and meta-analysis was to evaluate the gender-related outcomes after peripheral vascular interventions.

The association between bone mineral density and metabolic syndrome: a Korean population-based study

This study was conducted to investigate the association between the metabolic syndrome (MS), which includes a cluster of major risk factors for cardiovascular diseases, and bone mineral density (BMD) from a population-based study. This cross-sectional study was based on a nationwide representative survey data from the Korean National Health and Nutrition Examination Survey (KNHANES) 2008. A total of 3,207 subjects were included from the KNHANES 2008 and composed of men (mean age 48.4 years), premenopausal women (mean age 36.5 years) and postmenopausal women (mean age 64.8 years). The MS was identified according to the new criteria from a joint scientific statement endorsed by major organizations including the National Heart, Lung, and Blood Institute. The mean age of study participants was significantly different according to MS status (58.2 years in the MS group vs. 45.7 years in the non-MS group, P < 0.001). The association between MS and BMD at the lumbar spine and proximal femur was analyzed with adjustment for potential confounders. Although the adjusted BMD at all skeletal sites was not significantly different between participants with and without MS, an increased number of MS components was associated with low adjusted femoral neck (FN) BMD only in men (P = 0.01). After adjusting confounding factors, the triglyceride component of MS was related to low FN BMD in men, but to high BMD at all of the skeletal sites measured in postmenopausal women. The glucose component of MS showed an association with high adjusted BMD at total hip in men. Men with MS had significantly higher odds for pooled osteopenia and osteoporosis (odds ratio: 1.49, 95 % confidence interval: 1.04–2.14). In conclusion, low BMD is associated with MS in Korean men, and the association between the MS component and the BMD is different according to gender.     

Phenotype Presentation of Hypophosphatemic Rickets in Adults

Hypophosphatemic rickets (HR) is a group of rare disorders caused by excessive renal phosphate wasting. The purpose of this cross-sectional study of 38 HR patients was to characterize the phenotype of adult HR patients. Moreover, skeletal and endodontic severity scores were defined to assess possible gender differences in disease severity in patients with genetically verified X-linked HR. Compared to normal reference data, i.e., z = 0, HR patients had significantly lower final height, with a mean difference in z-score of ?1.9 (95% CI ?2.4 to ?1.4, P < 0.001). Compared to paired z-scores of final height, z-scores of leg length were significantly lower and those of sitting height were significantly higher (P < 0.001), resulting in disproportion as indicated by the significantly elevated sitting height ratio, mean difference in z-score of 2.6 (95% CI 2.1–3.1, P < 0.001). Z-scores of head circumference (median 1.4, range ?0.4 to 5.5, P < 0.001) and z-scores of bone mineral density (BMD) of the lumbar spine (median 1.9, range ?1.5 to 8.6, P < 0.001) were significantly elevated compared to normal reference data. The relative risk (RR) of fracture was reduced (RR = 0.34, 95% CI 0.20–0.57, P < 0.001). The skeletal severity score tended to be higher in males compared to females (P = 0.07), and no gender difference in endodontic severity was found. In conclusion, adult HR patients were characterized by short stature and were disproportioned. They had elevated BMD of the lumbar spine and a reduced risk of fractures. We found a tendency for males to be more severely affected than females.     

Higher circulating hsCRP levels are associated with lower bone mineral density in healthy pre- and postmenopausal women: evidence for a link between systemic inflammation and osteoporosis

Factors involved in inflammation are linked with those critical for bone remodeling. We examined the association between serum high sensitivity C-reactive protein (hsCRP) levels and bone mineral density (BMD) in healthy women. Serum concentrations of hsCRP and total alkaline phosphatase (ALP) were measured in premenopausal ( n =3,662) and postmenopausal ( n =1,031) women aged 30 years or older. BMD was measured at the femoral neck and lumbar spine using dual energy X-ray absorptiometry. According to the WHO definition, osteopenia was diagnosed at –2.5< T -score <–1.0 SD, and osteoporosis was diagnosed at T -score –2.5 SD at any sites. Compared with normal subjects, log-transformed serum hsCRP levels were higher in osteopenic and osteoporotic subjects (all, P <0.001) with linearity ( P for trend <0.001), after adjustment for age, BMI and menopausal status. Menopausal status did not have a significant interaction on the association ( P =0.457). In both premenopausal and postmenopausal women, serum total ALP levels were higher in the subjects with higher hsCRP quintiles than those with the lowest quintile (all, P for trend <0.001). Multivariate-adjusted odds ratio (OR) for osteoporosis and osteopenia were 1.35 (95% CI, 1.08 to 1.68) in the highest hsCRP quintile of premenopausal women, and OR for osteoporosis was 1.54 (95% CI, 1.10 to 2.53) in the highest hsCRP quintile of postmenopausal women. These findings suggest that subclinical systemic inflammation may be associated with bone turnover rate and bone mass in healthy women.     

Genetic risk score based on the lifetime prevalence of femoral fracture in 924 consecutive autopsies of Japanese males

A genetic risk score (GRS) was developed for predicting fracture risk based on lifetime prevalence of femoral fractures in 924 consecutive autopsies of Japanese males. A total of 922 non-synonymous single nucleotide polymorphisms (SNPs) located in 62 osteoporosis susceptibility genes were genotyped and evaluated for their association with the prevalence of femoral fracture in autopsy cases. GRS values were calculated as the sum of risk allele counts (unweighted GRS) or the sum of weighted scores estimated from logistic regression coefficients (weighted GRS). Five SNPs (α-?-iduronidase rs3755955, C7orf58 rs190543052, homeobox C4 rs75256744, G patch domain-containing gene 1 rs2287679, and Werner syndrome rs2230009) showed a significant association (P < 0.05) with the prevalence of femoral fracture in 924 male subjects. Both the unweighted and weighted GRS adequately predicted fracture prevalence; areas under receiver-operating characteristic curves were 0.750 [95 % confidence interval (CI) 0.660–0.840] and 0.770 (95 % CI 0.681–0.859), respectively. Multiple logistic regression analysis revealed that the odds ratio (OR) for the association between fracture prevalence and unweighted GRS ≥3 (n = 124) was 8.39 (95 % CI 4.22–16.69, P < 0.001) relative to a score <3 (n = 797). Likewise, the OR for a weighted GRS of 6–15 (n = 135) was 7.73 (95 % CI 3.89–15.36, P < 0.001) relative to scores of 0–5 (n = 786). The GRS based on risk allele profiles of the five SNPs could help identify at-risk individuals and enable implementation of preventive measures for femoral fracture.     

Hyperhomocysteinemia Due to Levodopa Treatment as a Risk Factor for Osteoporosis in Patients with Parkinson’s Disease

Parkinson’s disease (PD) patients have been reported to have lower bone mineral density (BMD) and higher fracture risk than individuals without PD. We assessed the association between hyperhomocysteinemia due to levodopa intake and BMD in PD patients. We measured serum homocysteine (Hcy) concentrations and BMD in the proximal femur and lumbar spine of PD patients aged 55 years or older (n = 95) and three age-/gender-matched control subjects (n = 285). The prevalence of osteoporosis was higher in both men (2.5-fold) and women (1.7-fold) with PD than in controls, and adjusted odds ratios for osteoporosis were 3.57 (95% confidence interval [CI], 1.25–10.20) for men and 2.54 for women (95% CI, 1.31–4.93) with PD. Serum Hcy concentrations were significantly higher in PD patients (median = 13.0 μmol/l) than controls (median = 11.5 μmol/l) (P = 0.005). Serum Hcy concentrations were independently associated with BMD values at all proximal femur sites in all subjects (P = 0.005 to 0.012). In PD patients, higher serum Hcy concentrations were independently associated with higher fracture risk (P = 0.029). PD patients taking higher doses of levodopa had significantly higher serum Hcy concentrations (P = 0.013), and greater levodopa intake was associated with lower BMD values in some areas (P = 0.008 to 0.029). In conclusion, these findings indicate that hyperhomocysteinemia due to levodopa intake may be one additional risk factor for osteoporosis and fracture in PD patients. Reducing Hcy may be a therapeutic modality for treating osteoporosis in PD patients taking levodopa.     

Relationships between serum adipocyte hormones (adiponectin,leptin, resistin), bone mineral density and bone metabolic markers in osteoporosis patients

The purpose of this study was to investigate the relationship between fasting serum leptin, adiponectin and resistin levels and bone mineral density (BMD) in osteoporosis patients and a non-osteoporosis control group. We studied 81 non-diabetic osteoporosis patients (92 % female, 8 % male; mean age 54.5 ± 15.5 years and body mass index [BMI] 28.2 ± 4.6) and 120 non-diabetic individuals with normal BMD as controls (86 % female, 14 % male; mean age 39.7 ± 10.4 years and BMI 28.8 ± 4.4). BMD was studied by dual-energy X-ray absorptiometry from the lumbar spine (L1–L4) and femoral neck and fasting blood samples were taken for biochemical measurement of fasting blood glucose, leptin, adiponectin and resistin. Fasting levels of plasma adiponectin had a significant negative correlation with BMD of the femoral neck and lumbar spine in the osteoporosis group (r = ?0.478, P = 0.003, r = ?0.513, P = 0.023) but not in the non-osteoporosis group (r = ?0.158, P = 0.057, r = ?0.23, P = 0.465). Fasting plasma levels of resistin were significantly correlated only with femur BMD in the osteoporosis group, and not significantly correlated with lumbar spine BMD (r = ?0.244, P = 0.048 vs r = 0.276, P = 0.56). Leptin did not have a significant correlation with BMD in either the osteoporosis or non-osteoporosis groups (P > 0.05). Adiponectin had a significant negative correlation with BMD of the lumbar spine and femoral neck. The correlation between leptin and resistin are not inconclusive.     

Serum 25-hydroxyvitamin D below 25 ng/mL is a risk factor for long bone fracture comparable to bone mineral density in Japanese postmenopausal women

There is emergent evidence for divergent associations between 25(OH)D levels and fractures by race and ethnicity, but data on Asian populations are sparse. We investigated this association in a primary care cohort of 1470 postmenopausal Japanese women followed for a mean period of 7.2 years and explored a potential threshold of 25(OH)D. Endpoints were incident vertebral, proximal femur, and long bone fractures. Rate ratios were estimated using multivariate Poisson regression adjusted for lumbar or femur bone mineral density (BMD) less than ?2.5 SD of the young adult mean (YAM), age, weight, presence of diabetes mellitus, parathyroid hormone, estimated glomerular filtration rate, prior fracture, back pain, present medications and past medical history. Mean age was 63.7 ± 10.7 years and osteoporosis patients were 41.3 %. The background data of the present participants were almost identical to the subjects participating in the National Health and Nutrition Survey of 2003. Overall, 49.6 % of the subjects had a 25(OH)D value <20 ng/mL and 27.8 % had a 25(OH)D value from 20 to 24 ng/mL. The propensity score for exposure to 25(OH)D < 25 ng/mL in the present and independent community dwelling populations, namely the Miyama and Taiji cohorts, were not significantly different, suggesting no evidence for selection bias. The generalized additive models showed clear decreasing trends in incidence rates of proximal femur and long bone fractures at higher levels of 25(OH)D, and the annual incidence rate of proximal femur fracture was around 0.0005 in women with 25(OH)D > 25 ng/mL, probably leading to the decreasing trend in long bone fracture. Multivariate-adjusted rate ratios of 25(OH)D < 25 ng/mL were 1.01 (95 % confidence interval [CI], 0.84–1.22, p = 0.88) for vertebral fracture, 2.71 (95 % CI 0.94–7.83, p = 0.07) for proximal femur fracture, and 2.20 (95 % CI 1.37–3.53, p < 0.01) for long bone fracture. The respective rate ratios of a BMD level lower than ?2.5 SD of the YAM were 1.61 (95 % CI 1.33–1.94, p < 0.01), 1.52 (95 % CI 0.67–3.45, p = 0.32), and 1.54 (95 % CI 1.02–2.33, p = 0.04). In conclusion, 25(OH)D is a leading risk factor for long bone fracture comparable to BMD in Japanese postmenopausal women. The contribution of 25(OH)D to fracture risks is substantial even below 25 ng/mL and is possibly site-specific. We recommend measuring the serum 25(OH)D level in primary care settings.     

The Association Between Osteoporosis and Hypertension: The Role of A Low Dairy Intake

Hypertension and related cardiovascular diseases are reported to be associated with osteoporosis. A nutritional pathway related to dairy intake has been postulated for both diseases. The aim of this study was to assess calcium intake from dairy sources as a possible pathogenic link between osteoporosis and hypertension. This was a cross-sectional observational study performed on 3,301 postmenopausal women referred for a densitometry screening. Osteoporosis was diagnosed by lumbar dual-energy X-ray absorptiometry and hypertension was defined by blood pressure data and/or the use of antihypertensive medication. Dairy food consumption was evaluated using a weekly food-frequency questionnaire. The odds of being affected by osteoporosis, hypertension, or both diseases were calculated for quartiles of dairy intake by logistic regression analyses. Women with hypertension were affected more frequently by osteoporosis (33.2 vs. 23.3 %; p = 0.000), and there was a higher prevalence of hypertension among women with osteoporosis (32.2 vs. 22.5 %; p = 0.000). The proportion of women with hypertension, osteoporosis, and both diseases significantly increased across decreasing quartiles of dairy intake. A dairy intake in the lowest quartile was a significant predictor of osteoporosis [OR (95 % CI): 1.43 (1.12, 1.82)] and hypertension [OR (95 % CI): 1.46 (1.15, 1.85)] when compared to the highest quartile. Similarly, a low dairy intake was associated with increased odds to have both the diseases [OR (95 % CI): 1.60 (1.10, 2.34)]. From these results we conclude that osteoporosis and hypertension are associated in postmenopausal women, and a low dairy intake may increase the risk of both diseases, acting as a possible pathogenic link.     

Liver Three-Dimensional Reconstruction Accurately Predicts Remnant Liver Volume for HBV-Related Hepatocellular Carcinoma Prior to Hepatectomy

Accurate prediction of future remnant liver volume preoperatively is vital to avoid posthepatectomy liver failure (PHLF). In this study, we evaluated the accuracy and efficiency of Myrian software for predicting resected liver volume and future remnant liver volume for hepatitis B virus (HBV)-related hepatocellular carcinoma prior to liver resection. Patients with HBV-related hepatocellular carcinoma undergoing liver three-dimensional CT reconstruction prior to or after hepatectomy were enrolled in this study. All three-dimensional reconstructions were completed by two observers (observers 1 and 2) separately. Resected specimen weights were obtained in the operating room after liver resection. The correlations between resected liver volume and resected specimen weights, planned remnant liver volume (RLV) and actual RLV were analyzed. Bland-Altman plots were used to assess interobserver variability between observers 1 and 2. A total of 42 patients were enrolled in the study, including 32 men and 10 women with a median age of 49 years. The mean time needed to perform complete volumetry in a patient was 20.8 ± 2.9 min and 23.7 ± 3.8 min for observers 1 and 2, respectively. The resected liver volume of observers 1 and 2 measured by Myrian software correlated strongly with the resected specimen weight (P < 0.0001, r = 0.980; P < 0.0001, r = 0.982, respectively). Pearson’s correlation analysis showed that the planned RLV had a strong positive correlation with the actual RLV for observers 1 and 2 (P < 0.0001, r = 0.957; P < 0.0001, r = 0.949, respectively). Low interobserver variability was observed between observers 1 and 2. Liver three-dimensional CT reconstruction can accurately predict resected liver volume and future remnant liver volume for HBV-related hepatocellular carcinoma prior to liver resection.     

Vertebral bone density by quantitative computed tomography mirrors bone structure histomorphometric parameters in hemodialysis patients

Diagnosing low bone mass is of clinical importance for hemodialysis (HD) patients due to its association with fractures and cardiovascular disease. We investigated whether bone density obtained by quantitative computed tomography (QCT) is associated with the histologically determined bone volume and microarchitecture parameters in HD patients. Twenty-six HD patients were studied. Bone biopsy samples were obtained from the iliac crest and trabecular bone volume, thickness, number and separation were evaluated by histomorphometry. Vertebral trabecular bone density (VTBD) was evaluated by QCT. VTBD correlated positively with trabecular bone volume (r = 0.69, p < 0.001), trabecular thickness (r = 0.45, p = 0.022) and trabecular number (r = 0.62, p < 0.001), and negatively with trabecular separation (r = ?0.50, p < 0.01). In the multiple linear regression analysis adjusting for age, gender and diabetes, VTBD remained associated with bone volume by histomorphometry (β = 0.06; 95 % CI 0.02–0.11; p = 0.006; R ² = 0.49). VTBD measured by QCT mirrored bone volume and microarchitecture parameters obtained by histomorphometry in HD patients.     

Risk Factors Affecting Graft and Patient Survivals After Transplantation From Deceased Donors in a Developing Country: A Single-Center Experience

Aim

The aim of this study was to evaluate risk factors affecting graft and patient survival after transplantation from deceased donors.

Tubeless versus standard percutaneous nephrolithotomy: an update meta-analysis

Background

To update a previously published systematic review and meta-analysis on the efficacy and safety of tubeless percutaneous nephrolithotomy (PCNL).

Methods

A systematic literature search of EMBASE, PubMed, Web of Science, and the Cochrane Library was performed to confirm relevant studies. The scientific literature was screened in accordance with the predetermined inclusion and exclusion criteria. After quality assessment and data extraction from the eligible studies, a meta-analysis was conducted using Stata SE 12.0.

Results

Fourteen randomized controlled trials (RCTs) involving 1148 patients were included. Combined results demonstrated that tubeless PCNL was significantly associated with shorter operative time (weighted mean difference [WMD], ?3.79 min; 95% confidence interval [CI], ?6.73 to ?0.85; P = 0.012; I² = 53.8%), shorter hospital stay (WMD, ?1.27 days; 95% CI, ?1.65 to ?0.90; P < 0.001; I² = 98.7%), faster time to return to normal activity (WMD, ?4.24 days; 95% CI, ?5.76 to ?2.71; P < 0.001; I² = 97.5%), lower postoperative pain scores (WMD, ?16.55 mm; 95% CI, ?21.60 to ?11.50; P < 0.001; I² = 95.7%), less postoperative analgesia requirements (standard mean difference, ?1.09 mg; 95% CI, ?1.35 to ?0.84; P < 0.001; I² = 46.8%), and lower urine leakage (Relative risk [RR], 0.30; 95% CI 0.15 to 0.59; P = 0.001; I² = 41.2%). There were no significant differences in postoperative hemoglobin reduction (WMD, ?0.02 g/dL; 95% CI, ?0.04 to 0.01; P = 0.172; I² = 41.5%), stone-free rate (RR, 1.01; 95% CI, 0.97 to 1.05; P = 0.776; I² = 0.0%), postoperative fever rate (RR, 1.05; 95% CI, 0.57 to 1.93; P = 0.867; I² = 0.0%), or blood transfusion rate (RR, 0.79; 95% CI, 0.36 to 1.70; P = 0.538; I² = 0.0%). The results of subgroup analysis were consistent with the overall findings. The sensitivity analysis indicated that most results remained constant when total tubeless or partial tubeless or mini-PCNL studies were excluded respectively.

Conclusions

Tubeless PCNL is an available and safe option in carefully evaluated and selected patients. It is significantly associated with the advantages of shorter hospital stay, shorter time to return to normal activity, lower postoperative pain scores, less analgesia requirement, and reduced urine leakage.

     

Corrected right ventricular end-diastolic volume and initial distribution volume of glucose correlate with cardiac output after cardiac surgery

Purpose

Appropriate adjustment of cardiac preload is essential to maintain cardiac output (CO), especially in patients after cardiac surgery. This study was intended to determine whether index of right ventricular end-diastolic volume (RVEDVI), corrected RVEDVI using ejection fraction (cRVEDVI), index of initial distribution volume of glucose (IDVGI), or cardiac filling pressures are correlated with cardiac index (CI) following cardiac surgery in the presence or absence of arrhythmias.

Methods

Eighty-six consecutive cardiac surgical patients were studied. Patients were divided into two groups: the non-arrhythmia (NA) group (n = 72) and the arrhythmia (A) group (n = 14). Three sets of measurements were performed: on admission to the ICU and daily on the first 2 postoperative days. The relationship between each cardiac preload variable and cardiac index (CI) was evaluated. A p value less than 0.05 indicated statistically significant differences.

Results

Each studied variable was not different between the two groups immediately after admission to the ICU. cRVEDVI had a linear correlation with CI in both group (NA group: r = 0.67, n = 216, p < 0.001; A group: r = 0.77, n = 42, p < 0.001), but RVEDVI had a poor correlation with CI (NA group: r = 0.27, n = 216, p < 0.001; A group: r = 0.19, n = 42, p = 0.036). IDVGI had a linear correlation with CI (NA group: r = 0.49, n = 216, p < 0.001; A group: r = 0.61, n = 42, p < 0.001), Cardiac filling pressures had no correlation with CI.

Conclusion

Our results demonstrated that cRVEDVI and IDVGI were correlated with CI in the presence or absence of arrhythmias. cRVEDVI and IDVGI have potential as indirect cardiac preload markers following cardiac surgery.     

Association of IL-6 G-174C polymorphism with bone mineral density

Functional polymorphisms in the promoter region of interleukin-6 (IL-6) are known to be involved in bone mineral density (BMD) and the development of osteoporosis, but the reported results have been inconsistent. Using the meta-analysis approach, the present study is designed to provide a relatively comprehensive picture of the relationship between bone mineral density (BMD) or osteoporosis and polymorphisms in the promoter region of IL-6 (rs1800795 and rs1800796). The difference of bone mineral density (BMD) values between genotypes was examined by mean difference and 95 % confidence intervals (CIs). Association between IL-6 polymorphism and clinical osteoporosis was evaluated by pooled odds ratios (ORs) and 95 % CIs. A total of 13 articles with 11,499 subjects were included in the present study. For ?174 (rs1800795), we found that individuals with the G/G genotype had a significantly lower BMD value than those with C/C genotype at femoral neck (0.02 g/cm², 95 % CI 0.00–0.03) (p = 0.04) and distal radius (0.01 g/cm², 95 %CI 0.01–0.01) (p < 0.0001). However, we did not find a statistically significant difference of BMD at the spine. When analysis was limited to postmenopausal women, similar results were obtained. We further found that the C/C genotype was associated with a reduced risk of osteoporosis compared to G/G genotype, and the pooled OR was 0.72 (95 % CI 0.54–0.95, p = 0.02). In addition, a significant relationship was found between G-634C (rs1800796) polymorphism and distal radius BMD (CC vs. GG: 0.02 g/cm², 95 % CI 0.01–0.03; GC vs. GG: 0.02 g/cm², 95 % CI 0.00–0.03) in the Asian population. These findings suggest that the CC genotype of IL-6 G-174C polymorphism may be associated with high BMD at femoral neck and distal radius and decreased risk of osteoporosis in the Caucasian population whereas G-634C polymorphism was associated with distal radius BMD in Asians.     

Role of Preoperative Colonoscopy in Patients with Gastric Cancer: A Case Control Study of the Prevalence of Coexisting Colorectal Neoplasms

Background

We evaluated the prevalence of coexisting asymptomatic colorectal neoplasm (CRN) in patients with gastric cancer (GC).

Methods

Preoperative colonoscopic examinations were performed in 495 patients with GC who underwent gastrectomy between January 2009 and December 2010. To compare the prevalence of CRN in these patients with that in a normal population, we selected 495 sex- and age-matched persons who underwent colonoscopies for health screening. Risk factors for CRN were evaluated by univariate and multivariate analyses.

Results

The overall incidence of CRN was 41.8 % (414/990). The prevalence of overall CRN, high-risk CRN, and colorectal carcinoma (CRC) were significantly higher in the GC group than in the control group (overall CRN: 48.9 % vs. 34.7 %; high-risk CRN: 28.3 % vs. 13.5 %; CRC: 2.6 % vs. 0.2 %; all P < 0.001). The presence of GC [odds ratio (OR), 1.82; 95 % confidence interval (CI), 1.4–2.38; P < 0.001], age ≥50 years (OR, 2.58; 95 % CI, 1.75–3.81; P < 0.001), and male sex (OR, 2.28; 95 % CI, 1.72–3.02; P < 0.001) were risk factors for overall CRN. In patients with GC, age ≥40 years (OR, 3.22; 95 % CI, 1.24–8.37; P = 0.016) and male sex (OR, 3.21; 95 % CI, 2.17–4.76; P < 0.001) were risk factors for overall CRN.

Conclusions

The prevalence of coexisting CRN, including CRC, was higher in patients with GC than in the normal population. Preoperative colonoscopy is strongly indicated in patients with GC who are male and/or ≥40 years of age.