Associations of the infancy body mass index peak with anthropometry and cardiometabolic risk in Mexican adolescents

Background: Early-life growth dynamics are associated with future health. Little is known regarding timing and magnitude of the infancy body mass index (BMI) peak with adiposity and metabolic biomarkers during adolescence.

Aim: To examine associations of the infancy BMI peak with anthropometry and cardiometabolic risk during peripuberty.

Methods: Among 163 ELEMENT participants, this study estimated age and magnitude of the infancy BMI peak from eight anthropometric measurements from birth–36?months using Newton’s Growth Models, an acceleration-based process model. Associations were examined of the infancy milestones with anthropometry and cardiometabolic risk at 8–14?years using linear regression models that accounted for maternal calcium supplementation and age; child’s birthweight, sex, and age; and the other infancy milestone.

Results: Median age at the infancy BMI peak was 9.6?months, and median peak BMI was 16.5?kg/m². Later age and larger magnitude of the peak predicted higher BMI z-score, waist circumference, and skinfold thicknesses; i.e. each 1?month of age at peak and each 1?kg/m² of peak BMI corresponded with 0.04 (0.01–0.07) and 0.33 (0.17–0.48) units of higher BMI z-score, respectively. Later age at peak was also a determinant of worse glycaemia and higher blood pressure.

Conclusion: Later age and larger magnitude of the infancy BMI peak are associated with higher adiposity at 8–14?years of age. Later age but not magnitude of the BMI peak are related to a worse cardiometabolic profile during peripuberty.     

Dipeptidyl Peptidase 10, a Novel Prognostic Marker in Colorectal Cancer

Purpose

The dipeptidyl peptidase IV (DPPIV) gene family exhibits multiple functions and is involved in the pathogenesis of various diseases. It has attracted pharmaceutical interest in the areas of metabolic disorders as well as cancer. However, clinicopathologic significance of DPPIV family in colorectal cancer is not fully understood.

Materials and Methods

The clinical relevance of DPPIV and DPP10 expression was determined by immunohistochemical staining, and by assessing its clinicopathologic correlation in 383 colorectal cancer patients with known clinical outcomes.

Results

DPPIV was not expressed in normal colon mucosa, but it showed luminal expression in 52 of the 383 colorectal cancers (13.5%). DPPIV expression in tumors was associated with right-sided location of the colon (p=0.010) and more advanced tumor stage (p=0.045). DPP10 was expressed in normal colonic mucosa, but its expression varied in primary colorectal cancer tissues. Loss of DPP10 expression was found in 11 colorectal cancers (CRCs) (2.9%), and multivariate analysis showed that loss of DPP10 expression was an independent factor for poor patient prognosis (p=0.008).

Conclusion

DPP10 may play a role in disease progression of colorectal cancer and loss of DPP10 expression in primary CRC is significantly associated with poor survival outcomes.     

Quality Indicators for Evaluating the Health Care of Patients with Rheumatoid Arthritis: a Korean Expert Consensus

BackgroundThere is increasing interest in the quality of health care and considerable efforts are being made to improve it. Rheumatoid arthritis (RA) is a disease that can result in favorable outcomes when appropriate diagnosis and treatment are provided. However, several studies have shown that RA is often managed inappropriately. Therefore, the Korean College of Rheumatology aimed to develop quality indicators (QIs) to evaluate and improve the health care of patients with RA.MethodsPreliminary QIs were derived based on the existing guidelines and QIs for RA. The final QIs were determined through two separate consensus meetings of experts. The consensus was achieved through a panel of experts who voted using the modified Delphi method.ResultsFourteen final QIs were selected among 70 preliminary QIs. These included early referral to and regular follow-up with a rheumatologist, radiographs of the hands and feet, early initiation and maintenance of disease-modifying anti-rheumatic drug (DMARD) therapy, periodic assessment of disease activity, screening for drug safety and comorbidities, including viral hepatitis and tuberculosis before biologic DMARD therapy, periodic laboratory testing, supplementation with folic acid, assessment of the risk for cervical spine instability before general anesthesia, patient education, and specialized nurse.ConclusionThese QIs can be used to assess and improve the quality of health care for patients with RA.     

Treatment of Post-Ablation Bronchopleural Fistula Using Percutaneous Synthetic Hydrogel Surgical Sealant: Initial Experience of Safety and Efficacy

CardioVascular and Interventional Radiology - Purpose Bronchopleural fistula is a rare but serious complication of lung ablation, as it is difficult to treat and is associated with a high mortality...     

Small Increases in Plasma Sodium Are Associated with Higher Risk of Mortality in a Healthy Population

Elevated blood pressure (BP) is the most common cause of cardiovascular disease. Salt intake has a strong influence on BP, and plasma sodium (pNa) is increased with progressive increases in salt intake. However, the associations with pNa and BP had been reported inconsistently. We evaluated the association between pNa and BP, and estimated the risks of all-cause-mortality according to pNa levels. On the basis of data collected from health checkups during 1995-2009, 97,009 adult subjects were included. Positive correlations between pNa and systolic BP, diastolic BP, and pulse pressure (PP) were noted in participants with pNa ≥138 mM/L (P<0.001). In participants aged ≥50 yr, SBP, DBP, and PP were positively associated with pNa. In participants with metabolic syndrome components, the differences in SBP and DBP according to pNa were greater (P<0.001). A cumulative incidence of mortality was increased with increasing pNa in women aged ≥50 yr during the median 4.2-yr-follow-up (P<0.001). In women, unadjusted risks for mortality were increased according to sodium levels. After adjustment, pNa ≥145 mM/L was related to mortality. The positive correlation between pNa and BP is stronger in older subjects, women, and subjects with metabolic syndrome components. The incidence and adjusted risks of mortality increase with increasing pNa in women aged ≥50 yr.     

Usefulness of 3-Dimensional-Printed Breast Surgical Guides for Undetectable Ductal Carcinoma In Situ on Ultrasonography: A Report of 2 Cases

Tumor localization is challenging in the context of ductal carcinoma in situ (DCIS) treated with breast-conserving surgery. Conventional localization methods are generally performed under the guidance of ultrasonography or mammography and are rarely performed with magnetic resonance imaging (MRI), which is more sensitive than the aforementioned modalities in detecting DCIS. Here, we report the application of MRI-based individualized 3-dimensional (3D)-printed breast surgical guides (BSGs) for patients with breast cancer. We successfully resected indeterminate and suspicious lesions that were only detected using preoperative MRI, and the final histopathologic results confirmed DCIS with clear resection margins. MRI guidance combined with 3D-printed BSGs can be used for DCIS localization, especially for lesions easily detectable using MRI only.     

A study of user requests regarding the fully electronic health record system at Seoul National University Bundang Hospital: Challenges for future electronic health record systems

ObjectiveAlthough the adoption rates for Electronic Health Records (EHRs) are growing, significant opportunities for further advances in EHR system design remain. The goal of this study was to identify issues that should be considered in the design process for the successful development of future systems by analyzing end users’ service requests gathered during a recent three-year period after a comprehensive EHR system was implemented at Seoul National University's Bundang Hospital in South Korea.MethodsData on 11,400 service requests from end users of the EHR system made from 2008 through 2010 were used in this study. The requests were categorized as program modification/development, data request, insurance-fee identification/generation, patient-record merging, or other. The authors further subcategorized the requests for program modification/development into the following nine areas of concern: (1) indicators and statistics, (2) patient safety and quality of care, (3) special task-oriented functionalities, (4) ease of use and user interface, (5) system speed, (6) interoperability and integration, (7) privacy and security, (8) customer service, and (9) miscellaneous. The system users were divided into four groups—direct care, care support, administrative/insurance, and general management—to identify each group's needs and concerns.ResultsThe service requests for program modification/development, data request, insurance-fee identification/generation, patient-record merging, and other issues constituted approximately 49.2%, 33.9%, 11.4%, 4.0%, and 1.5% of the total data set, respectively. The number of data-request service requests grew over the three years studied. Different groups of users were found to have different concerns according to their activities and tasks. Within the program-modification/development category, end users were most frequently concerned with ease of use and user interface (38.1% of the total) and special task-oriented functionalities (29.3% of the total) in their use of the EHR system, with increasing numbers of requests in both categories over the three years. Users in the direct-care group differed from the other groups in that they most frequently submitted requests related to ease of use and user interface, followed by special functionalities, patient safety and quality care, and customer service, while users in other groups submitted requests concerning ease of use and user interface and special functionalities with a similarly high frequency.ConclusionsUsers have continued to make suggestions about their needs and requirements, and the EHR system has evolved to optimize ease of use and special functionalities for particular groups of users and particular subspecialties. Based on our experiences and the lessons we have learned in the course of maintaining full-EHR systems, we suggest that the key goals to be considered for future EHR systems include innovative new user-interface technologies; special extended functions for each user group's specific task-oriented requirements; powerful, easy-to-use functions to support research; new flexible system architecture; and patient-directed functions.