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1.
Selcen Yuksel Selim Ayhan Vugar Nabiyev Montse Domingo-Sabat Alba Vila-Casademunt Ibrahim Obeid Francisco Sanchez Perez-Grueso Emre Acaroglu 《The spine journal》2019,19(1):71-78
BACKGROUND CONTEXT
Health-related quality of life (HRQOL) parameters have been shown to be reliable and valid in patients with adult spinal deformity (ASD). Minimum clinically important difference (MCID) has become increasingly important to clinicians in evaluating patients with a threshold of improvement that is clinically relevant.PURPOSE
To calculate MCID and minimum detectable change (MDC) values of total scores of the Core Outcome Measures Index (COMI), Oswestry Disability Index (ODI), Physical Component Summary (PCS), Mental Component Summary (MCS) of the Short Form 36 (SF-36), and Scoliosis Research Society 22R (SRS-22R) in surgically and nonsurgically treated ASD patients who have completed an anchor question at pretreatment and 1-year follow-up.STUDY DESIGN/SETTING
Prospective cohort.PATIENT SAMPLE
Surgical and nonsurgical patients from a multicenter ASD database.OUTCOME MEASURES
Self-reported HRQOL measures (COMI, ODI, SF-36, SRS-22R, and anchor question).METHODS
A total of 185 surgical and 86 nonsurgical patients from a multicenter ASD database who completed pretreatment and 1-year follow-up HRQOL scales and the anchor question at the first year follow-up were included. The anchor question was used to determine MCID for each HRQOL measure. MCIDs were calculated by an anchor-based method using latent class analysis (LCA) and MDCs by a distribution-based method.RESULTS
All differences between means of baseline and first year postoperative total score measures for all scales demonstrated statistically significant improvements in the overall population as well as the surgically treated patients but not in the nonsurgical group. The calculated MDC and MCID values of HRQOL parameters in the entire study population were 1.34 and 2.62 for COMI, 10.65 and 14.31 for ODI, 6.09 and 7.33 for SF-36 PCS, 6.14 and 4.37 for SF-36 MCS, and 0.42 and 0.71 for SRS-22R. The calculated MCID values for surgical and non-surgical treatment groups were 2.76 versus 1.20 for COMI, 14.96 versus 2.45 for ODI, 7.83 versus 2.15 for SF-36 PCS, 5.14 versus 2.03 for SF-36 MCS, and 0.94 versus 0.11 for SRS-22R; the MDC values for surgical and nonsurgical treatment groups were 1.22 versus 1.51 for COMI, 10.27 versus 9.45 for ODI, 5.16 versus 6.77 for SF-36 PCS, 6.05 versus 5.67 for SF-36 MCS, and 0.38 versus 0.43 for SRS-22R.CONCLUSIONS
This study has demonstrated that MCID calculations for the HRQOL scales in ASD using LCA yield values comparable to other studies that had used different methodologies. The most important finding was the significantly different MCIDs for COMI, ODI, SF-36 PCS and SRS-22 in the surgically and nonsurgically treated cohorts. This finding suggests that a universal MCID value, inherent to a specific HRQOL for an entire cohort of ASD may not exist. Use of different MCIDs for surgical and nonsurgical patients may be warranted. 相似文献2.
3.
Colette S. Inaba Christina Y. Koh Sarath Sujatha-Bhaskar Marija Pejcinovska Ninh T. Nguyen 《Surgery for obesity and related diseases》2018,14(10):1448-1453
Background
Laparoscopic sleeve gastrectomy (LSG) is associated with low morbidity and mortality and a short length of stay. Studies on the safety of same-day discharge after LSG are limited.Objective
To compare outcomes between same-day versus first-postoperative-day (POD1) discharge after LSG.Setting
Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program national database.Methods
The 2015 to 2016 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database was analyzed for elective LSG cases with same-day or POD1 discharge. Open, revisional, and converted cases were excluded. Multivariate analysis was performed to compare adjusted 30-day mortality, morbidity, readmission, and reoperation for same-day versus POD1 discharge.Results
We examined 85,321 LSG cases, including 4728 same-day discharges and 80,593 POD1 discharges. Compared with POD1 discharges, same-day discharges were associated with higher overall morbidity (1.31% versus .84%, respectively; adjusted odds ratio [AOR] 1.72; P?=?.0002), a higher readmission rate (2.14% versus 1.64%, respectively; AOR 1.40; P?=?0.0034), and a higher reoperation rate (.61% versus .27%, respectively; AOR 2.35; P < .0001). There was no difference in mortality (.08% versus .04%, respectively; AOR 2.62; P?=?.0923).Conclusion
Same-day discharge after LSG is associated with increased complications, readmissions, and reoperations compared with POD1 discharge. Further studies are needed to examine objective criteria for safe same-day discharge after LSG. 相似文献4.
Natascha J. H. Broers Remy J. H. Martens Bernard Canaud Tom Cornelis Tom Dejagere Nanda M. P. Diederen Marc M. H. Hermans Constantijn J. A. M. Konings Frank Stifft Joris J. J. M. Wirtz Karel M. L. Leunissen Frank M. van der Sande Jeroen P. Kooman 《International urology and nephrology》2018,50(6):1131-1142
Background/aims
Prevalent dialysis patients have low scores of health-related quality of life (HRQOL) which are associated with increased risk of hospitalization and mortality. Also in CKD-5 non-dialysis patients, HRQOL scores seem to be lower as compared with the general population. This study firstly aimed to compare HRQOL between CKD-5 non-dialysis and prevalent dialysis patients in a cross-sectional analysis and to assess longitudinal changes over 1 year after the dialysis initiation. Secondly, the correlation between HRQOL and physical activity (PA) was explored.Methods
Cross-sectional 44 CKD-5 non-dialysis, 29 prevalent dialysis, and 20 healthy controls were included. HRQOL was measured by Short Form-36 questionnaires to measure physical and mental domains of health expressed by the physical component summary (PCS) and mental component summary (MCS) scores. PA was measured by a SenseWear? pro3. Longitudinally, HRQOL was assessed in 38 CKD-5 non-dialysis patients (who were also part of the cross-sectional analysis), before dialysis initiation until 1 year after dialysis initiation.Results
PCS scores were significantly lower both in CKD-5 non-dialysis patients and in prevalent dialysis patients as compared with healthy controls (p?<?0.001). MCS scores were significantly lower in both CKD-5 non-dialysis patients (p?=?0.003), and in dialysis patients (p?=?0.022), as compared with healthy controls. HRQOL scores did not change significantly from the CKD-5 non-dialysis phase into the first year after dialysis initiation. PA was significantly related to PCS in both CKD-5 non-dialysis patients (r?=?0.580; p?<?0.001), and dialysis patients (r?=?0.476; p?=?0.009).Conclusions
HRQOL is already low in the CKD-5 non-dialysis phase. In the first year after dialysis initiation, HRQOL did not change significantly. Given the correlation between PCS score and PA, physical activity programs may be potential tools to improve HRQOL in both CKD-5 non-dialysis as well as in prevalent dialysis patients.5.
Phuong D. Nguyen David Y. Khechoyan John H. Phillips Christopher R. Forrest 《Journal of plastic, reconstructive & aesthetic surgery》2018,71(11):1609-1617
Background
CAD-CAM patient-specific implants offer cerebral protection and improved facial balance without the disadvantages of autologous bone grafting such as donor site morbidity and unpredictable resorption. Several alloplastic materials are available, but titanium, polymethylmethacrylate (PMMA), and polyetheretherketone (PEEK) are the current popular choices. We reviewed our experience of applying different alloplastic CAD-CAM materials in the reconstruction of complex pediatric craniofacial deformities.Methods
A retrospective review was performed of all pediatric patients who underwent a complex inlay or onlay implant craniofacial reconstruction using CAD-CAM PEEK, PMMA, or titanium implants at a single institution. Demographics, cost, operative time, complications, and outcomes were assessed.Results
Between 2003 and 2014, 136 patients (69 male; 67 female; mean age 11.5 years (3–22 years); mean follow-up 30 months) had custom patient-specific craniofacial reconstruction with PEEK (n?=?72), PMMA (n?=?42), and titanium (n?=?22) implants (inlay?=?93; onlay?=?43). Indications included congenital anomalies (26.5%), decompressive craniectomies (25.0%), craniofacial syndromes (25.7%), tumor defects (14.0%), and post-trauma (6.6%). Implant cost varied significantly for PEEK ($7703 CAD) and PMMA ($8328 CAD) compared with that for titanium ($11,980 CAD) (p?<?0.0005). Six patients (4.4%) required surgery due to infection consisting of irrigation and antibiotic administration with successful implant salvage in three patients. All infections occurred in the PEEK group. Five patients (3.7%) ultimately had implants removed due to infection (n?=?3), late exposure (titanium; n?=?1), or late fracture (PMMA; n?=?1).Conclusions
CAD-CAM alloplast reconstruction in the management of complex pediatric craniofacial deformities is effective although expensive. Implant infection does not always require explantation. A reconstruction algorithm is presented. 相似文献6.
Ronette L. Kolotkin Jaewhan Kim Lance E. Davidson Ross D. Crosby Steven C. Hunt Ted D. Adams 《Surgery for obesity and related diseases》2018,14(9):1359-1365
Background
Few prospective studies compare long-term health-related quality of life (HRQOL) outcomes between bariatric surgery patients and individuals with severe obesity who do not undergo bariatric surgery.Objectives
This 12-year, prospective study evaluated the trajectory and durability of HRQOL changes in gastric bypass patients (surgery group; n?=?418) and compared these changes to 2 nonsurgical groups. The nonsurgery group 1 (n?=?417) sought but did not have surgery; nonsurgery group 2 (n?=?321) had severe obesity but did not seek surgery.Setting
Bariatric surgery center.Methods
Weight-related (impact of weight on quality of life-lite [IWQOL-Lite]) and general (short-form health survey-36 [SF-36]) HRQOL questionnaires were administered at baseline and 2, 6, and 12 years postsurgery.Results
At 12 years, the surgery group showed greatly improved weight-related HRQOL (IWQOL-Lite) and physical HRQOL (physical component summary of short-form health survey-36) from baseline, and differences between the surgery group and both nonsurgery groups were significant for IWQOL-Lite and physical component summary. IWQOL-Lite and physical component summary scores peaked at 2 years, followed by declines from 2 to 6 and 6 to 12 years. Small improvements in mental/psychosocial aspects of HRQOL (mental component summary of short-form health survey-36) seen in the surgery group at 2 years were not maintained at either 6 or 12 years.Conclusions
Gastric bypass patients demonstrated significantly higher weight-related and physical HRQOL at 12 years compared with their very low baseline scores, with the trajectory peaking at 2 years. Despite declining HRQOL between 2 and 12 years, the magnitude of improvement supports the clinical relevance of bariatric surgery for enhancing patients’ quality of life. 相似文献7.
Amitabh Thacoor Muholan Kanapathy Jana Torres-Grau Jagdeep Chana 《Journal of plastic, reconstructive & aesthetic surgery》2018,71(8):1103-1107
Background
The deep inferior epigastric perforator (DIEP) flap is widely regarded as the Gold Standard in autologous breast reconstruction. Although drain-free abdominoplasty is performed in many centres, there is a paucity of evidence comparing outcomes when applied to DIEP breast reconstruction.Method
A retrospective review of patients who underwent DIEP breast reconstruction without abdominal drain insertion at Royal Free Hospital between Jan 2012-Nov 2016 was undertaken. Results were compared to previously published data from our centre on patients undergoing DIEP breast reconstruction with abdominal drains between Jan 2011-Jul 2012.Results
Thirty-five patients underwent abdominal drain-free reconstruction (GroupA). Of 74 patients who previously underwent reconstruction with abdominal drains, 33 patients underwent drain removal by postoperative day (POD)3 regardless of output (GroupB) and 41 underwent drain removal after POD3 following instructions on drainage volume/24?h (GroupC). There was no significant difference in the length of stay between patients in Group A and B (3.6?vs. 3.9 days; p?=?0.204). Length of stay in Group C was significantly higher than Group A and B (p?=?0.001, p?=?0.001). There were no statistically significant differences in total (11.43% vs. 12.12% vs 17.07%, p?=?0.780) or specific complications: Seroma: 2.86% vs. 0% vs. 4.88% (p?=?0.774); Wound dehiscence: 8.57% vs. 9.09% vs. 4.88% (p?=?0.728); Haematoma: 0% vs. 3.00% vs. 7.32% (p?=?0.316) between Groups A, B and C, respectively.Conclusion
Our data suggests that drain-free abdominal closure in DIEP reconstruction can be safely achieved without increased postoperative complications. These conclusions support existing evidence on the use of a drain-free approach in cosmetic abdominoplasty. 相似文献8.
Taryn E. Hassinger J. Hunter Mehaffey Lily E. Johnston Robert B. Hawkins Bruce D. Schirmer Peter T. Hallowell 《Surgery for obesity and related diseases》2018,14(8):1133-1138
Background
Numerous studies have established the effectiveness of Roux-en-Y gastric bypass (RYGB) for weight loss and co-morbidity amelioration. However, its safety and efficacy in elderly patients remains controversial.Objectives
To evaluate outcomes in patients aged ≥60 years who underwent RYGB compared with nonsurgical controls with the hypothesis that RYGB provides weight loss benefits without differences in survival.Setting
University-affiliated tertiary center.Methods
All patients who underwent RYGB from 1985 to 2015 were identified and divided into elderly (age ≥60) and nonelderly (age <60) groups. A nonsurgical elderly control population was identified using a clinical data repository of outpatient visits to propensity match elderly patients 4:1 on demographic characteristics, co-morbidities, and relevant preoperative substance/medication use. Unpaired appropriate univariate analyses compared each stratified group. Kaplan-Meier survival curves were fitted based on social security death data.Results
A total of 2306 patients underwent RYGB. The 107 elderly patients had lower median body mass index (47.0 versus 49.9; P?=?.007) and higher rates of co-morbidities. Rates of complications did not differ between elderly and nonelderly patients. Elderly surgical patients were propensity matched 4:1 (10,044 controls) yielding 428 well-matched nonsurgical controls. The elderly group demonstrated significant percent reduction in excess body mass index compared with the control group (81.8% versus 10.3%; P < .001). Kaplan-Meier survival analysis with log-rank test demonstrated no difference in midterm survival (P?=?.63).Conclusions
A significant weight reduction benefit was identified after RYGB in elderly patients without a difference in midterm survival compared with propensity-matched controls, suggesting RYGB is a safe and efficacious weight loss strategy in the elderly. 相似文献9.
Kuan Wang MD Chenghua Jiang PhD Lejun Wang PhD Huihao Wang MD Wenxin Niu PhD 《The spine journal》2018,18(12):2288-2296
BACKGROUND CONTEXT
Anterior vertebral body osteophytes are common with degeneration but their biomechanical influence on the whole lumbar spine remains unclear.PURPOSE
To investigate the biomechanical influence of anterior vertebral body osteophytes on the whole lumbar spine.STUDY DESIGN/SETTING
This is a study using finite element analysis.OUTCOME MEASURES
Intersegmental rotation, maximum Mises stress, and intradiscal pressure on the intervertebral discs of different lumbar levels were calculated.METHODS
A finite element model of an intact lumbar spine was constructed and validated against in vitro studies. The modified models, which had different degrees of anterior vertebral body osteophyte formation (OF) in combination with disc space narrowing, were applied with physiological loadings.RESULTS
The lumbar levels with various degrees of OF altered the kinematics of these levels, which also affected the whole lumbar spine. In flexion and lateral bending, the segment that was one level inferior to the vertebra with OF showed a trend towards increased range of motion. On the intervertebral discs that were one level inferior to the OF level, a trend towards increase in the maximum von Mises stress was found on the annulus.CONCLUSIONS
Segments adjacent to levels with anterior vertebral body osteophytes showed increased intersegmental rotation and maximum stress. Further clinical observation should be performed to verify the results in vivo. 相似文献10.
Roux-en-Y gastric bypass surgery in youth with severe obesity: 1-year longitudinal changes in spexin
Seema Kumar MD Jobayer Hossain Thomas Inge P Babu Balagopal 《Surgery for obesity and related diseases》2018,14(10):1537-1543
Background
Spexin is a novel peptide predominantly produced in human white adipose tissue and has recently been implicated as a potential signal in the regulation of body weight, energy homeostasis, and satiety. The effect of bariatric surgery on spexin is unknown.Objectives
To study the effect of Roux-en-Y gastric bypass (RYGB) surgery on endogenous spexin concentration and various risk factors of type 2 diabetes and cardiovascular disease in youth with severe obesity.Setting
University hospital, United StatesMethods
Spexin, body mass index (BMI), insulin, glucose, total and high molecular weight adiponectin, leptin, and high sensitivity C- reactive protein were measured longitudinally (baseline, 6 mo, and 12 mo) after RYGB surgery in girls with severe obesity (n?=?12; age?=?16.7 ± 1.5 years; BMI?=?51.6 ± 2.9 kg/m2).Results
Serum spexin concentration increased (P?=?.01) at 6 months after surgery and stabilized afterward. Spexin level correlated negatively with homeostatic model assessment insulin resistance, HOMA-IR (Spearman correlation r?=??.796, P < .001) and positively with high molecular weight adiponectin (Spearman correlation r?=?.691, P?=?.011). The change in spexin concentration, from baseline to 6 months after surgery, was inversely correlated with the corresponding change in BMI (Spearman correlation r?=??.573, P?=?.051). Furthermore, the 6-month changes in spexin and HOMA-IR were inversely correlated (slope [standard error, SE]?=??.0084 (.0019), P?=?.001)], even after adjusting for the change in BMI.Conclusions
The enhancement of circulating spexin concentration in response to RYGB and correlations with beneficial postoperative changes in various adipokines in youth are novel findings that require further validation. 相似文献11.
Manuel Macías-González Gracia María Martín-Núñez Lourdes Garrido-Sánchez Eduardo García-Fuentes Francisco José Tinahones Sonsoles Morcillo 《Surgery for obesity and related diseases》2018,14(9):1327-1334
Background
Obesity is characterized by a chronic, low-grade inflammation, and bariatric surgery is proposed as an effective treatment for reducing the obesity-related co-morbidities. Epigenetic modifications could be involved in the metabolic improvement after surgery.Objective
The main aim of this study was to evaluate whether DNA methylation pattern from genes related to inflammation and insulin response is associated with the metabolic improvement after bariatric surgery in morbidly obese patients and if these changes depend on the surgical procedure.Setting
University hospital, Spain.Methods
We studied 60 severely obese patients; 31 underwent Roux-en-Y gastric bypass and 29 underwent laparoscopic sleeve gastrectomy. All patients were examined before and at 6 months after bariatric surgery. DNA methylation profile of genes related to the inflammatory response and insulin sensitivity was measured by pyrosequencing.Results
The promoter methylation levels of the NFKB1 gene were increased significantly after surgery (2.16 ± .9 versus 2.8 ± 1.03). The decrease in blood pressure, both systolic and diastolic, after surgery was significantly associated with the changes in the promoter methylation levels of the NFKB1 gene (β?=??.513, P?=?.003 and β?=??.543, P?=?.004, respectively). A decrease in inflammation status, measured by high sensitivity C-reactive protein values, was associated with changes in SLC19A1 methylation levels.Conclusion
Our study shows for the first time an association between NFKB1 methylation levels and blood pressure after bariatric surgery, highlighting the possible function of this gene in the regulation of arterial pressure. Regarding SLC19A1, this gene could position as a potential target linking inflammation and insulin resistance. 相似文献12.
Peter W. Lundberg Samantha Wolfe Jacqueline Seaone Jill Stoltzfus Leonardo Claros Maher El Chaar 《Surgery for obesity and related diseases》2018,14(9):1240-1245
Background
The use of robotic platforms in performing laparoscopic Roux-en-Y gastric bypass (LRYGB) is increasing, though their safety compared with the conventional laparoscopic approach remains unclear.Objective
The objective of this study was to evaluate perioperative data and 30-day outcomes of conventional and robot-assisted LRYGB using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data registry.Setting
University health network, United States.Methods
We reviewed all conventional and robot-assisted LRYGB cases entered between January 1 and December 31, 2016 in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data registry. Demographic characteristics and 30-day outcomes were analyzed based on separate Mann-Whitney rank sums tests, χ2, or Fisher's exact tests as appropriate, with P ≤ .05 denoting statistical significance with no adjustment for multiple testing.Results
Of the 39,425 patients who underwent LRYGB, 2822 were robot-assisted. The robot-assisted approach required significantly more time (138 versus 108 min, P < .0001). Rates of organ space infection, bleeding, and other significant adverse events after the conventional and robot-assisted approaches were .3% versus .5% (P?=?.13), 1.1% versus .8% (P?=?.11), and 2.3% versus 2.3% (P?=?.96), respectively. There were also no significant differences in the rates of mortality, length of stay, reoperation, or readmission between the 2 groups.Conclusions
Robot-assisted LRYGB is an increasingly popular alternative to the conventional laparoscopic approach. According to the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database, the early safety of these 2 techniques is equal, although the robotic approach requires more operative time. 相似文献13.
14.
Victoria E. Sanborn Mary-Beth Spitznagel Ross Crosby Kristine Steffen James Mitchell John Gunstad 《Surgery for obesity and related diseases》2018,14(9):1396-1401
Background
Both poor quality of life (QoL) and cognitive impairment are common in persons with severe obesity. Work in other patient populations show that cognitive impairment is associated with poorer QoL, though this possibility has not been examined in bariatric surgery candidates.Objectives
We sought to determine the association between cognitive performance and QoL, both total and work related, in a sample of bariatric surgery candidates.Setting
Three sites were used for data collection, including the Neuropsychiatric Research Institute in Fargo, North Dakota, Columbia University in New York, and Cornell University in New York.Methods
Sixty participants from the Longitudinal Assessment of Bariatric Surgery project were assessed at preoperative baseline.Results
Hierarchical regression analyses showed that poorer cognitive function was independently associated with lower total QoL and that both reported and objectively measured cognitive impairment were associated with poorer work-related QoL.Conclusions
These preliminary findings suggest that cognitive impairment may contribute to poorer total and work-related QoL in bariatric surgery candidates. Future studies should examine whether interventions to improve cognitive function can improve QoL and other outcomes in this population. 相似文献15.
Katherine J.P. Schwenger Sandra E. Fischer Timothy Jackson Allan Okrainec Johane P. Allard 《Surgery for obesity and related diseases》2018,14(9):1233-1239
Background
In obese individuals undergoing Roux-en-Y gastric bypass (RYGB), nonalcoholic fatty liver disease (NAFLD) is seen in 75% to 100% of cases. This improves postsurgery, but some patients continue to have persistent NAFLD.Objective
The purpose of this study was to determine the factors associated with persistent NAFLD at 12 months post-RYGB.Setting
University Hospital, Canada, bariatric clinic.Methods
This is a prospective cohort study of 42 patients who underwent RYGB. Liver biopsy, biochemical and clinical parameters were collected pre- and 12 months post-RYGB. Based on histology at 12 months, patients were separated in 2 groups, normal liver (NL) and persistent NAFLD.Results
At baseline, NAFLD was diagnosed in 85.7% of patients and at 12 months post-RYGB, NAFLD was present in 19.1% of patients. Patients who had an NL at baseline remained with NL. RYGB resulted in significant decreases in body mass index, waist circumference, blood pressure, aspartate aminotransferase, alanine aminotransferase, fasting glucose and insulin, glycated hemoglobin, and triglycerides and significant increases in high-density lipoprotein cholesterol. Changes were similar in both groups except for waist circumference, which showed lower changes in those with persistent NAFLD. These patients also had significantly higher (P < .05) fasting glucose and insulin with a higher proportion of patients having insulin resistance compared with those with NL.Conclusions
RYGB resulted in significant improvements in liver histology, biochemical, and clinical parameters. However, despite similar weight loss, persistent NAFLD was associated with less improvement in waist circumference and worse glycemic control. 相似文献16.
Witigo von Schönfels Jan Henrik Beckmann Markus Ahrens Alexander Hendricks Christoph Röcken Silke Szymczak Jochen Hampe Clemens Schafmayer 《Surgery for obesity and related diseases》2018,14(10):1607-1616
Background
Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disorder in industrialized countries. Nonalcoholic steatohepatitis is the fastest growing cause for liver failure. Bariatric surgery represents a treatment option for NAFLD with an established effect on liver histology.Objectives
We aimed to assess the impact of bariatric surgery on standardized liver histology using the NAFLD activity score.Setting
Retrospective comparison of metabolic data before and after bariatric surgery and comparison of sleeve gastrectomy and Roux-en-Y gastric bypass. The study was performed in an academic center, the university hospital Schleswig-Holstein in Kiel, Germany.Methods
Between 2009 and 2012, bariatric surgery was performed in 257 patients according to the national guidelines, and a liver biopsy was obtained in 150 of these patients during surgery. A follow-up biopsy was available in 53 of these patients at a median of 192 days. Liver histology was analyzed using the NAFLD activity score. In this subgroup of 53 patients an analysis of the metabolic improvement after bariatric surgery and a comparative analysis between the 2 different operative procedures was performed.Results
The study cohort showed improvement of preoperative pathologic liver histology findings after operative procedures took place. Both surgery methods improved the NAFLD activity score significantly, all improvement ?2.0 (confidence interval ?2.5 to ?1.0; P < .001); Roux-en-Y gastric bypass, improvement ?1.0 (confidence interval ?2.0 to ?.0; P?=?.038); sleeve gastrectomy, improvement ?2.5 (confidence interval ?3.5 to ?1.5; P < .001). No differences were found with regard to histologic recovery between gastric bypass and sleeve gastrectomy (P = .22).Conclusions
Bariatric surgery significantly improves NAFLD. 相似文献17.
Hang Xu Ping Tan Xiaonan Zheng Jianzhong Ai Tianhai Lin Xi Jin Lina Gong Haoran Lei Lu Yang Qiang Wei 《Urologic oncology》2019,37(4):291.e19-291.e28
Background
Metabolic syndrome (MetS) has been reported to be associated with adverse outcomes in cancer patients. However, the relationship between MetS and upper tract urothelial carcinoma (UTUC) has yet to be explored.Objectives
To investigate the prognostic value of MetS in UTUC after radical nephroureterectomy.Patients and methods
A total of 644 patients with UTUC after radical nephroureterectomy were identified at West China Hospital from May 2003 to December 2016. MetS was defined as the co-existence of 3 or more of 5 components (obesity, hypertension, elevated fasting glucose, decreased high-density lipoprotein-cholesterol, and hypertriglyceridemia). Logistic and Cox regression analyses were performed to evaluate the associations of MetS with pathological features and survival outcomes. Decision curve analysis and Harrell concordance index were used to determine the clinical utility of the prediction models.Results
Of 644 patients, 157 (24.4%) had MetS. Over a median follow-up of 39 months, 269 (41.8%) experienced disease recurrence, 233 (36.2%) died, and 185 (28.7%) died of UTUC. MetS was independently associated with high-grade disease, advanced pT stage (≥pT3), and lymphovascular invasion (each P < 0.05). Multivariate Cox regression analysis showed that MetS was an independent factor for decreased cancer-specific survival (hazard ratio [HR]: 1.38, 95% confidence intervals [CI]: 1.01–1.89, P?=?0.042) but not for recurrence-free survival (HR: 1.27, 95% CI: 0.97–1.67, P?=?0.078), and overall survival (HR: 1.24, 95% CI: 0.95–1.62, P?=?0.121). The estimated c-index of the multivariate models for cancer-specific survival was 0.763 compared with 0.769 when MetS added.Conclusions
MetS is a negative prognostic factor in UTUC. Further studies of MetS in UTUC are demanded. 相似文献18.
Ajay Gopalakrishna Andrew Chang Thomas A. Longo Joseph J. Fantony Michael R. Harrison Paul E. Wischmeyer Brant A. Inman 《Urologic oncology》2018,36(10):469.e21-469.e29
Purpose
A nutritious diet has been associated with better health-related quality of life (HRQOL) in a variety of cancer survivors. However, little is known about dietary habits and its association with HRQOL in bladder cancer survivors. The objective of this cross-sectional study is to describe dietary intake patterns and its relationship to HRQOL in a large cohort of bladder cancer survivors.Methods
Bladder cancer survivors within our institutional database were mailed surveys to assess dietary intake patterns utilizing the Diet History Questionnaire II and assessing HRQOL utilizing the Functional Assessment of Cancer Therapy-Bladder Cancer. Diet quality was assessed via Healthy Eating Index 2010 scores based on subjects’ Diet History Questionnaire II results. Univariate and multivariate analyses of HRQOL based on diet quality were used to evaluate whether diet quality was associated with HRQOL.Results
Four hundred and fifty-nine patients (48%) returned questionnaires. Mean age was 74 years, 81% were male and 28% underwent radical cystectomy. Diet quality and quantity in our cohort was similar to the general older U.S. population and did not differ significantly between those managed conservatively or long-term following cystectomy. Our cohort had low intake of whole grains and fat-soluble vitamins, particularly vitamin D. Diet quality was significantly associated with HRQOL in the univariate analysis but lost statistical significance in our multivariate analysis. Elixhauser Comorbidity Index was significantly associated with HRQOL in the multivariate analysis.Conclusions
This study demonstrates a similar diet quality of bladder cancer survivors to the older general U.S. population that, on average, “needs improvement.” Dietary intake is particularly lacking in whole grain and vitamin D intake. Future studies are warranted to determine the impact on long-term outcome, but bladder cancer survivors should be counseled on the importance and benefits of adherence to dietary guidelines, including its potential contribution toward better HRQOL. 相似文献19.
Lidia Castagneto Gissey James R. Casella Mariolo Alfredo Genco Alfonso Troisi Nicola Basso Giovanni Casella 《Surgery for obesity and related diseases》2018,14(10):1480-1487
Background
Sleeve gastrectomy (SG) has grown into the most popular bariatric operation. Nevertheless, a scarcity of long-term outcomes are available.Objectives
This study aims at evaluating the long-term percent weight loss (%WL), excess weight loss (%EWL), weight regain (WR), and co-morbidity resolution rates in a single-center cohort undergoing SG as a primary procedure, with a minimum 10-year follow-up.Setting
University hospital, Italy.Methods
One hundred eighty-two morbidly obese patients with body mass index (BMI) 46.6 ± 7.3 kg/m2 underwent SG. Obesity-related co-morbidities (type 2 diabetes, hypertension, sleep apnea, gastroesophageal reflux disease) were investigated. Predictors of dichotomous dependent-variable diabetes remission were computed using a binomial logistic regression.Results
Patient retention rate was 77%. Mean %WL was 30.9, %EWL was 52.5%, and WR (≥25% maximum WL) occurred in 10.4%. Baseline BMI significantly (P?=?.001) and linearly predicted %EWL (10 yr %EWL?=?18.951?+?initial BMI × .74); the super-obese subgroup generated substantially greater WL compared with those with BMI <50 kg/m2 (%EWL 48.0 ± 18.5 versus 61.5 ± 23.2; P < .001). Type 2 diabetes remission occurred in 64.7%; 42.9% patients developed de novo gastroesophageal reflux disease symptoms postoperatively (P < .0001).Conclusions
SG generates sustained WL and co-morbidity resolution up to 10 years postoperatively. Although a notable portion of patients experience WR, mean %WL persists to exceed 30%, translating in adequate WL also in the long term. Additionally, WR does not seem to impact negatively on co-morbidity resolution. SG represents a safe and effective bariatric operation, which easily grants the possibility to proceed to revisional bariatric surgery in patients with WR or failure to WL. 相似文献20.
Isabelle Fontanille Adrien Boillot Hélène Rangé Maria Clotilde Carra Silvia Helena de Carvalho Sales-Peres Sebastien Czernichow Philippe Bouchard 《Surgery for obesity and related diseases》2018,14(10):1618-1631