Impact of Body Mass Index on the Clinical Outcomes after Percutaneous Coronary Intervention in Patients ≥75 Years Old

Background:

The impact of body mass index (BMI) on the clinical outcomes after percutaneous coronary intervention (PCI) in patients ≥75 years old remained unclear.

Methods:

A total of 1098 elderly patients undergoing PCI with stent implantation were recruited. Patients were divided into four groups by the value of BMI: Underweight (≤20.0 kg/m²), normal weight (20.0–24.9 kg/m²), overweight (25.0–29.9 kg/m²) and obese (≥30.0 kg/m²). Major clinical outcomes after PCI were compared between the groups. The primary endpoint was defined as in-hospital major adverse cardiovascular events (MACEs), which included death, myocardial infarction (MI) and target vessel revascularization. The secondary endpoint was defined as 1 year death. Logistic regression analysis was performed to adjust for the potential confounders.

Results:

Totally, 1077 elderly patients with available BMIs were included in the analysis. Patients of underweight, normal weight, overweight and obese accounted for 5.6%, 45.4%, 41.5% and 7.5% of the population, respectively. Underweight patients were more likely to attract ST-segment elevation MI, and get accompanied with anemia or renal dysfunction. Meanwhile, they were less likely to achieve thrombolysis in MI 3 grade flow after PCI, and receive beta-blocker, angiotensin converting enzyme inhibitor or angiotensin receptor blocker after discharge. In underweight, normal weight, overweight and obese patients, in-hospital MACE were 1.7%, 2.7%, 3.8%, and 3.7% respectively (P = 0.68), and 1 year mortality rates were 5.0%, 3.9%, 5.1% and 3.7% (P = 0.80), without significant difference between the groups. Multivariate regression analysis showed that the value of BMI was not associated with in-hospital MACE in patients at 75 years old.

Conclusions:

The BMI “obese paradox” was not found in patients ≥75 years old. It was suggested that BMI may not be a sensitive predictor of adverse cardiovascular events in elderly patients.     

Position of Increased Signal Intensity in the Spinal Cord on MR Images: Does It Predict the Outcome of Cervical Spondylotic Myelopathy?

Background Increased signal intensity （ISI） in the spinal cord on T2-weighted MR images has been reported in some previous researches, however no study focused on the position of the ISI in the spinal cord and its potential value. The aim of this study was to investigate the correlation between ISI position and the outcome of surgical treatment for cervical spondylotic myelopathy （CSM） patients. Methods A retrospective study was conducted. Pre- and post-operative clinical status was evaluated by modified Japanese Orthopaedic Association （JOA） score. ISI was evaluated according to the T2-weighted sequences. The JOA score and the recovery ratios among patients with ISI in gray matter （group A）, in both gray and white matter （group B）, and ISI-negative group were compared. Results Totally 64 patients were enrolled in this retrospective study. Preoperative JOA score of ISI positive and negative group had significant difference, but the recovery ratios had no significant difference （the recovery ratios of the two groups in week 1, week 26, and week 104 were （21.54±14.65）%, （50.56±14.76）%, （59.23±13.08）% and （20.25±14.32）%, （54.46±3.16）% and （61.26±29.4）%, respectively; P 〉0.05）. The recovery ratios of negative group and group A in week 104 were superior to group B （the recovery ratios of negative group, group A, and group B in week 104 were （61.26±29.49）%, （65.35±11.36）%, and （50.33±10.20）%, respectively; P 〈0.05）. Conclusions Patients with ISI in the gray matter alone on T2-weighted MR images did not have significantly different surgical outcomes compared with those without ISI. Patients with ISI in both gray and white matter had surgical outcomes that were worse than those without ISI.     

Is Acupuncture Actually Not Effective for Polycystic Ovary Syndrome?——Analysis of the Trial Published in JAMA

In recent years, acupuncture has been applied to treat more and more patients suffering from polycystic ovary syndrome(PCOS). On June 27, 2017 a paper titled "Effect of acupuncture and clomiphene in Chinese women with polycystic ovary syndrome: a randomized clinical trial" was published in Journal of the American Medical Association(JAMA). The results did not support acupuncture as an effective therapy for improving the live births in PCOS. The aim of this article was to analyze the therapeutic regimen and design of the clinical trial. The primary outcome and the conclusion of the paper were discussed as well. There are 5 doubts in the paper.(1) The therapeutic regimen decided by trigger points in the paper was different from that of the traditional Chinese acupuncture.(2) The live birth as the primary outcome was limited during the PCOS recovery.(3) In addition the period of the treatment was too short to reflect the therapeutic effect.(4) Although there was no significant difference between active acupuncture and control acupuncture, the conclusion that acupuncture was not effective for PCOS was not confirmed because the control acupuncture plus clomiphene was also more effective than that of clomiphene alone.(5) The proposal and the statistics were not in accordance with the one planned before. Therefore the result was worth to be discussed so as to provide some suggestions and references for improving the clinical research of acupuncture.     

Is Acupuncture Actually Not Effective for Polycystic Ovary Syndrome? —Analysis of the Trial Published in JAMA

In recent years, acupuncture has been applied to treat more and more patients suffering from polycystic ovary syndrome (PCOS). On June 27, 2017 a paper titled “Effect of acupuncture and clomiphene in Chinese women with polycystic ovary syndrome: a randomized clinical trial” was published in Journal of the American Medical Association (JAMA). The results did not support acupuncture as an effective therapy for improving the live births in PCOS. The aim of this article was to analyze the therapeutic regimen and design of the clinical trial. The primary outcome and the conclusion of the paper were discussed as well. There are 5 doubts in the paper. (1) The therapeutic regimen decided by trigger points in the paper was different from that of the traditional Chinese acupuncture. (2) The live birth as the primary outcome was limited during the PCOS recovery. (3) In addition the period of the treatment was too short to reflect the therapeutic effect. (4) Although there was no significant difference between active acupuncture and control acupuncture, the conclusion that acupuncture was not effective for PCOS was not confirmed because the control acupuncture plus clomiphene was also more effective than that of clomiphene alone. (5) The proposal and the statistics were not in accordance with the one planned before. Therefore the result was worth to be discussed so as to provide some suggestions and references for improving the clinical research of acupuncture.     

Effects of acetic acid on the viability of Ascaris lumbricoides eggs: Is vinegar reliable enough to clean the vegetables?

Objectives:

To investigate the effects of acetic acid on durable Ascaris lumbricoides (A. lumbricoides) eggs to determine the effective concentration of vinegar and the implementation period to render the consumption of raw vegetables more reliable.

Methods:

This experimental study was performed in May 2015 in the Parasitology Laboratory, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey. The A. lumbricoides eggs were divided into 2 groups. Eggs in the study group were treated with 1, 3, 5, and 10% acetic acid concentrations, and eggs in the control group were treated with Eosin. The eggs’ viability was observed at the following points in time during the experiment: 0, 10, 15, 20, 30, 45, and 60 minutes.

Results:

The 1% acetic acid was determined insufficient on the viability of Ascaris eggs. At the 30th minute, 3% acetic acid demonstrated 95% effectiveness, and at 5% concentration, all eggs lost their viability. Treatment of acetic acid at the ratio of 4.8% in 30 minutes, or a ratio of 4.3% in 60 minutes is required for full success of tretment.

Conclusion:

Since Ascaris eggs have 3 layers and are very resistant, the acetic acid concentration, which can be effective on these eggs are thought to be effective also on many other parasitic agents. In order to attain an active protection, after washing the vegetables, direct treatment with a vinegar containing 5% acetic acid for 30 minutes is essential.Parasitic diseases are witnessed all over the world, it originally emerges in certain areas where people have the habit of defecation in random places; where human stool is used as manure and infrastructure in undeveloped areas. Approximately one billion humans are infected with Ascaris, 800 million humans are infected with Trichuris, 200 million humans are infected with Taenia in the world, and each year, millions of humans lose their lives due to parasitic infections.1-4 Food borne diseases are receiving increasing attention recently.5 One of the important ways that humans are infected of these diseases is the consumption of raw, or poorly washed vegetables.6 Vegetables growing in soil and frequently used in salads, such as lettuce, parsley, radish, cress, garden rocket, green onion, carrot, and cucumber also play an important role in the transmission of parasitic infections, in addition to many bacterial and viral agents. Giardia, Entamoeba, Cryptosporidium, Hymenolepis, Ascaris, Trichuris, Toxocara, Taenia and Fasciola are the parasites on top of the list, which are transmitted by such vegetables.3,6-10Ascaris lumbricoides (A. lumbricoides) is the largest nematode that lives in the human small intestine. The A. lumbricoides eggs are of 2 types: fertilized and unfertilized. Fertilized eggs have an oval shape and a shell of 3 thick layers. The outermost layer is a hackly protein layer, beneath this, is the semipermeable layer, and at the lowermost, there is a non-permeable lipoidal vitellin membrane layer. Fertilized eggs do not have this last layer and have no infection capacity, as well. This layered structure of the egg enables its durability against different chemical and environmental factors. Thus, it could be argued that A. lumbricoides eggs are more resilient than many other parasitic eggs. It has been reported that the A. lumbricoides eggs could carry their infectious disposition when preserved in a refrigerator for 2 years; and that they keep their viability for up to 40 days at temperatures between 18 and 27°C.11-14 The objective of the study was to investigate the effects of acetic acid (CH₃CO₂H) on the viability of durable A. lumbricoides eggs, to determine the effective concentrations of vinegar, and the time required to treat raw vegetables for safe consumption.     

Is the smoking decision an 'informed choice'? Effect of smoking risk factors on smoking beliefs

The argument that people freely choose to smoke assumes that individuals at the point of initiation of smoking (often in adolescence) hold accurate beliefs about smoking. Smoking beliefs and the presence of known smoking risk factors were assessed in interviews with a sample of 895 urban young people. The respondents greatly overestimated the prevalence of adult and peer smoking, negative attitudes of their peers were greatly underestimated, a large proportion believed that they would be less likely than other people to contract a smoking-related illness if they became smokers, and there was a general lack of understanding of the adverse consequences experienced upon smoking cessation. These misperceptions were more common among youngsters who were smokers, who intended to smoke, or who had friends or family members who smoked. Because misinformation among young people is widespread and those at greatest risk for smoking are the most misinformed, the tobacco industry's argument that the decision to smoke reflects an "informed choice" is without merit.     

Is migraine a progressive disorder? Considering the clinical implications of new research data on migraine and brain lesions

Considering the clinical implications of new research data on migraine and brain lesions.     

Is the clock ticking for terminally ill patients in Israel? Preliminary comment on a proposal for a bill of rights for the terminally ill

This paper presents and discusses a recent Israeli proposal to legislate on the rights of the dying patient. A gap exists between elitist biases of the committee proposing the law, and popular values and sentiments. The proposed law divides the dying patients into two groups: "those who wish to go on living" and "those who wish to die". The former will have a right to life prolonging extraordinary care. It is not clear who would foot the bill for this care. Also it is hard to see how this munificence could fail to discriminate against all other patients. Both the secular ethicists and the rabbis involved in drawing up the proposal accepted the assumption that it is good for some terminal patients to die. The rabbis objected, however, to direct and active interventions that shorten life. The solution arrived at was to install timers in the ventilators so as to allow them to expire automatically unless the patient wishes for their resetting.     

Is the amount of trabecular bone-loss dependent on bone mineral Density? A study performed by three centres of osteoporosis using high resolution peripheral quantitative computed tomography

For the risk getting osteoporosis as well as for diagnosis of osteoporosis 3 facts are highly important: bone-mass, the amount of bone-loss and bone-structures (microarchitecture of bone). All three parameters can be validated today with high precision but the amount of bone-loss seems to be the most important one, even for the decision of either antiresorptive or bone-stimulating therapy. But to calculate the amount of bone-loss until now at least two measurements of bone mineral density (BMD) are necessary which have to be performed within a certain period of time, depending on the reproducibility of the method to be used. If on the other hand the amount of bone-loss would be dependent on actual base-line bone-mass the right therapy could be started already after only one measurement of BMD. The aim of this study was therefore to investigate if there is any relation between the amount of bone-loss and base-line volumetric BMD. For this we separately measured trabecular and cortical bone densities of 135 women in three independent centres of osteoporosis in Zurich and Munich using the method of high resolution quantitative computed tomography - pQCT - with the Densiscan 1000, Scanco Medical, Zurich. We did this at least twice and then compared absolute volumetric BMD in the first step before we calculated trabecular and cortical bone loss per year for each woman. We could not only confirm again that bone loss in trabecular bone was significantly higher than in cortical bone and that the non-weight-bearing trabecular bone as could be found in the distal radius seems to be the skeletal site of maximum bone-loss, but moreover - and this is the more important finding - we could show that the amount of relative bone-loss was the higher the lower trabecular base-line volumetric BMD was. According to this the rate of fast-loser (more than 3.5% per year) increased the lower trabecular base-line volumetric BMD was. These results may lead to a new screening-test for the assessment of the individual risk of osteoporosis and for the individual risk of fast bone-loss which now can be evaluated with only one single measurement of BMD, to treat the so classified patients not only earlier but even more rational, dependent if either antiresorptive therapy or stimulation of bone-formation seems to be more important.