Clustering of cardiovascular risk factors and stroke: a prospective cohort study in Inner Mongolia

Objective: This study aimed to evaluate the effect of clustering of cardiovascular risk factors (CVRF) on stroke incidence and find some high predictive clusters among Inner Mongolians in China.

Methods: A prospective cohort study was conducted among 2589 participants aged 20 and older from Inner Mongolia, China. The participants were divided into four groups according to the number of CVRFs and followed up from June 2002 to July 2012. Cox proportional hazards model was used to evaluate the clustering of CVRFs on the incidence of stroke. Area under curve was used to compare the effect of every cluster on stroke and find those having higher predictive value.

Results: A total of 124 stroke occurred during the follow-up period. The incident stroke cases tended to be older and male; had higher prevalence of smoking, drinking, and family history of cardiovascular diseases (FHCVD); had greater waist circumference, higher systolic and diastolic blood pressure, and C-reactive protein levels at baseline compared with those who did not experience stroke. Unadjusted hazard ratio (HR) (95% confidence interval) of stroke in the participants with at least three CVRFs was 5.230 (2.646–10.336), compared with those without CVRF. After multiple adjustments, the result remained statistically significant (HR, 3.388; 95% confidence interval: 1.678–6.840). On the basis of FHCVD, clustering of hypertension with other CVRFs and clustering of diabetes with tachycardia had higher predictive value than other clustering.

Conclusion: The clustering of CVRFs increased the risk of stroke. On the basis of FHCVD, the clustering of hypertension with other CVRFs and the clustering of diabetes with tachycardia had higher predictive value for stroke than other cluster.     

Microbiome changes associated with acute and chronic pancreatitis: A systematic review

BackgroundAltered intestinal microbiota has been reported in pancreatic disorders, however, it remains unclear whether these changes alter the course of disease in patients with acute (AP) and chronic pancreatitis (CP), or whether these disease states alter the environment to enable pathogenic microbial composition changes to occur. We undertook a systematic review to characterize the gut microbiome in pancreatitis patients.MethodsMEDLINE and EMBASE were searched for studies on microbiota in pancreatitis published from January 1, 2000 to June 5, 2020. Animal studies, reviews, case reports, and non-English articles were excluded. A frequency analysis was performed for outcomes reported in ≥2 studies and studies were analyzed for risk of bias and quality of evidence.Results22 papers met inclusion criteria; 15 included AP, 7 included CP. No studies were appropriately designed to assess whether alterations in the gut microbiome exacerbate pancreatitis or develop as a result of pancreatitis. We did identify several patterns of microbiome changes that are associated with pancreatitis. The gut microbiome demonstrated decreased alpha diversity in 3/3 A P studies and 3/3 C P studies. Beta diversity analysis revealed differences in bacterial community composition in the gut microbiome in 2/2 A P studies and 3/3 C P studies. Functionally, gut microbiome changes were associated with infectious pathways in AP and CP. Several studies suffered from high risk of bias and inadequate quality.ConclusionsDetecting differences in microbial composition associated with AP and CP may represent a diagnostic tool. Appropriately controlled longitudinal studies are needed to determine whether microbiome changes are causative or reactive in pancreatitis.     

Severity of bulimia: Relationship with depression and other psychopathology

There were 53 women (35 bulimics and 18 normal controls) who were compared on the Minnesota Multiphasic Personality inventory, the Symptom Checklist-90R, and the Beck Depression Inventory. The bulimics were separated into two groups, high (N = 18) and low (N = 17) frequency purgers, based upon a median split self-monitored purging data. Bulimics who purged less than 3 times per week (M = 1.71) were classified as low frequency purgers, and those who purged more than 3 times per week (M = 9.94) were classified as high frequency purgers. Comparisons of the three groups showed that both groups of bulimics differed from normals on measures of depression, but on other measres, i. e., anxiety interpersonal sensitivity and sociopathic trait, only the high frequency purgers differed from normals. Correlational analyses indicated that these same variables, and especially depression, were positively correlated with purging, suggesting that severity of bulimia may be associated with additional psychopathology. These findings were discussed in terms of the existing literature concerning the psychopathology of bulimia.     

Marital relationships and conflict resolution skills of bulimics

Twelve bulimic couples were compared to 14 maritally distressed couples and 15 normal control couples on measures of relationship satisfaction, conflict resolution styles, and beliefs about intimate relationships. Bulimics reported global relationship dissatisfaction with their marriages similar to that felt by women seeking marital therapy. Bulimics were also similar to females in distressed marriages in their reported use of few problem-solving skills and withdrawal from conflict. Bulimics and maritally distressed females subscribed to the dysfunctional belief that “partners cannot change.” These results provide support for the contention that bulimics experience dissatisfaction with their interpersonal relationships and that this dissatisfaction is accompanied by self-reported deficiencies in conflict resolution skills.     

Intestinalization of pancreatic fragments in dogs: improvement in survival rate after acute segmental pancreatitis

Intestinalization, a new method of pancreatic preservation in which vascularized pancreatic fragments are placed inside a jejunal pouch, has been tested for its effectiveness in the prevention of shock and death due to segmental pancreatitis. Intestinalization of the fragment resulted in the survival of eight of nine animals (89 percent) in which recovery was uneventful, whereas animals with pancreatitis in situ or in a mobilized fragment without intestinalization had a mortality rate of 100 percent within 2 days. We conclude that intestinalization ameliorates the outcome of hemorrhagic pancreatitis in the pancreatic fragment by effectively draining toxic products. The procedure may also be useful in pancreatic transplantation since no reintervention is necessary if graft failure or rejection occurs because the pancreas is accessible by endoscopy.     

Low intraindividual variability of cyclosporin A exposure reduces chronic rejection incidence and health care costs

The present study applied a receiver operating characteristic (ROC) analysis to assess the role of intraindividual variability of cyclosporin A (CsA) drug exposure in predisposing renal transplant recipients to the occurrence of chronic rejection, as well as to increased health care costs using a resource-based economic analysis. Two hundred and four adult renal transplant recipients were treated with tapering doses of prednisone (Pred) and with a concentration-controlled strategy that selected doses of the olive oil-based formulations of CsA (Sandimmune(R)) that achieved target concentrations based on serial pharmacokinetic profiles. The ROC analysis revealed an inflection point of plots of the coefficient of variation (%CV) of CsA exposure versus the risk of chronic rejection at >/=28.4% for the average concentration (C(av)), i.e., the dosing interval-corrected area under the concentration-time curves, and >/=36% for the trough concentration (C(0)). The incidence of chronic rejection over a period of 5 yr was 24% among the less variable (LV) versus 40% among the variable (V) cohort. The economic analysis revealed that the total mean facility and physician costs per patient were $48,789 versus $60,998, respectively (P < 0.01). The degree of variability displayed by any individual could only be predicted by serial measurements of CsA concentrations, and not by demographic features, laboratory determinations, clinical characteristics, individual or mean values of any observed CsA concentration, or other pharmacokinetic parameters calculated following a single drug exposure. Thus, strategies that reduce intrapatient variability of CsA exposure over time may lead to reductions in chronic allograft loss and in treatment costs.     

Transplantation of single pediatric kidneys into adult recipients

AIM: To evaluate the outcome of single pediatric kidneys transplanted into adult recipients. METHODS: A retrospective single-center review was performed of transplants from donors less than 5 years of age. Outcomes were compared with recipients of grafts from donors 18 to 45 years transplanted during the same time period. RESULTS: Thirty single renal transplants from pediatric donors and 117 transplants from adult donors between 18 and 45 years of age were performed during the study period. The mean age of the pediatric donors was 2.9 +/- 0.8 years versus 31.5 +/- 8.9 years for adult donors (P < .001). The mean age of the recipients of pediatric donors was 41.9 +/- 13 years versus 48 +/- 12.6 years for recipients of adult grafts (P = .020). The mean recipient weight of pediatric donors was 55.9 +/- 7.8 kg versus 78.0 +/- 17.7 kg for recipients of adult donors (P < .001). Sixty-six percent of pediatric donor recipients were of female gender compared to only 36% of adult donor recipients (P = .005). Death-censored actuarial graft survivals at 1 and 4 years for recipients of pediatric donor grafts were 90% and 85% compared to 93% and 85% for recipients of adult donor grafts (P = NS). The mean calculated creatinine clearances of adult donor graft recipients at 1 and 4 years posttransplantation were 70.8 +/- 26.5 and 73.7 +/- 27.2 mL/min, respectively, compared to 50.3 +/- 20.1 and 56.3 +/- 21.4 mL/min for pediatric donor grafts (P < .01 at 1 and 4 years). CONCLUSION: The use of single pediatric donor kidneys provides an excellent opportunity to safely expand the donor pool.     

Rabbit antithymocyte globulin: a postoperative risk factor for sirolimus-treated renal transplant patients?

AIMS: Randomized controlled studies suggest an increased incidence of perioperative wound complications among sirolimus-treated renal transplant patients. The present study analyzed the effect of rabbit antithymocyte globulin (rATG) on these postoperative complications. METHODS: Four hundred and twelve renal transplants were performed and managed postoperatively at two University-affiliated hospitals between January 1, 2001, and December 31, 2003. The patients received corticosteroids and Sirolimus, with delayed introduction of cyclosporine when the serum creatinine had decreased below 2.5 mg/dL. Two groups of patients were discriminated: group 1 received Basiliximab 20 mg on day 0 and day 4 (n = 283); group 2 recipients with a high panel of reactive antibody (PRA > 20%) and retransplant patients received rATG for induction (n = 129) for a maximum of 2 weeks postoperatively. The incidence of rejection was 14.5% for group 1 vs. 8.5% for group 2 patients. To avoid confounding variable associated with the rejection treatment, any patient with rejection was excluded for statistical analysis, as were patients with follow- up less than 30 days. The final study group for analysis included 350 patients: 235 with Basiliximab induction (group 1) and 115 rATG induction (group 2). The mean follow-up was 21.8 +/- 11 months. Differences in the incidences of postoperative hernia, wound infections, or lymphoceles requiring any form of drainage were analyzed for statistical significance using the chi-square test. RESULTS: The percentage of patients with wound complications was 26.0% versus 39.1% (P < .025) for group 1 versus group 2, respectively. Incisional hernias occurred in 10.6% versus 18.3% patients (P < .05), wound infections in 11.1% versus 16.5% (P = NS), and lymphoceles in 10.6% versus 15.9% (P = NS) for the two groups, respectively. CONCLUSIONS: rATG-induced renal transplants recipients treated with sirolimus, cyclosporine, and steroids show a significantly increased incidence of postoperative incisional hernias and a trend toward a greater number of lymphocele and wound infection complications.