Evolución del cierre de ileostomía en una unidad de cirugía colorrectal. Análisis comparativo según la técnica

Introduction

The objective of this study is to assess whether the results of loop ileostomy closure in terms of morbidity and hospital stay are influenced by the type of anastomosis and suture used.

Method

All patients who underwent loop ileostomy closure were reviewed. A retrospective cohort study comparing morbidity and hospital stay according to the type of anastomosis (TT/LL) and the type of suture (hand sewn/mechanical) was performed.

Results

From January 2003 to November 2011 a total of 167 loop ileostomy closures were analized. The groups were: type of anastomosis (TT 95/LL 72) and type of suture (manual 105/stapled 62). In 76% of the observed population the underlying disease was cancer. Mortality occurred in one case. The stratified morbidity analysis by type of complications showed no significant differences between the groups in terms of local (7.4% TT, LL 8.3%, 6.7% hand sewn, stapled 9.7%), general (TT 9.5%, 16.7% LL, hand sewn 6.7%, 6.5% stapled) and surgical (TT 15.8%, 19.4% LL, hand sewn 17.1%, 17.7% stapled) complications, nor in the rate of reoperations (TT 6.3%, 6.9% LL, hand sewn 6.7%, 6.5% stapled) and hospital stay in days (TT 7.8, 8 LL, hand sewn 8.6, stapled 6.7)

Conclusions

Closure of loop ileostomy can be performed regardless of the type of suture or anastomosis used, with the same rate of morbidity and hospital stay.     

Assessing the effects of body weight on subchondral bone formation with quantitative 18F-sodium fluoride PET

Annals of Nuclear Medicine - The aim of this study was to quantify subchondral bone remodeling in the elbows, hands, knees, and feet using volumetric and metabolic parameters derived from...     

Impact of Physical Activity on Psychological Distress: A Prospective Analysis of an Australian National Sample

Objectives. We analyzed the individual-level associations between participation in moderate to vigorous physical activity (MVPA) and psychological distress levels using a large, nationally representative, longitudinal sample and multivariable panel regression models.Methods. We used 3 waves of panel data from the Household, Income and Labour Dynamics in Australia Survey, consisting of 34 000 observations from 17 000 individuals and covering 2007, 2009, and 2011. We used fixed-effects panel regression models accounting for observable and unobservable confounders to examine the relationships between the weekly frequency of MVPA and summary measures of psychological distress based on the Kessler Psychological Distress Scale.Results. We found substantial and highly statistically significant associations between the frequency of MVPA and different indicators of psychological distress. Frequent participation in MVPA reduces psychological distress and decreases the likelihood of falling into a high-risk category.Conclusions. Our findings underscore the importance of placing physical activity at the core of health promotion initiatives aimed at preventing and remedying psychological discomfort.Moderate to vigorous physical activity (MVPA) is important to people’s lives, with the World Health Organization as well as national and international bodies recommending frequent participation in it.1,2 Recent analyses of Australian population-level data have endorsed this by showing that MVPA is independently associated not only with general and physical health but also with overall levels of mental health and self-reported life satisfaction.3 However, the relationships between MVPA and other facets of mental health, including levels of psychological distress, have not yet been well established. Psychological distress, understood as the experience of unpleasant feelings or emotions that affect day-to-day functioning, affects a sizable share of the population in developed countries such the United States, the United Kingdom, and Australia4–7 and is known to lead to more severe mental disorders and physical health issues.8,9 Consequently, the financial and human costs of psychological distress are non-negligible, and gaining a deeper understanding of the factors that influence individuals’ distress levels is important for the development of efficient public health policies and the devising of effective palliative interventions.Emerging evidence of an association between MVPA and overall levels of mental health has suggested that associations between MVPA and psychological distress are also likely. Potential effects may run through known physiological, psychological, and social processes. From a physiological point of view, we know that MVPA enhances fitness levels, which in turn regulate physiological stress responses, such as reduced secretion of hormones and lowered blood pressure.10 From a psychological perspective, MVPA has been linked to reduced arousal and mood enhancement through cognitive distraction and biochemical changes, and to positive health behaviors during periods of high stress (e.g., a lower likelihood to smoke and eat unhealthily).11 Additionally, participation in MVPA tends to increase time spent outdoors, as well as the frequency and quality of social interactions and interpersonal relationships.12–14 As a result, we would expect MVPA to have the potential to enhance well-being by reducing psychological distress.Consistent with these theories, results from the limited body of existing empirical research have suggested that there are indeed negative associations between the frequency of MVPA and psychological distress levels. However, these findings have emerged almost exclusively from analyses of small nonprobability samples,15–21 and the few available studies based on nationally representative samples are cross-sectional (e.g., Scotland22 and Singapore23). The small, nonprobability nature of the samples used in these studies means that findings are tentative and cannot be generalized to the population as a whole. Their cross-sectional nature means that longitudinal regression techniques that enable more precise estimation of the associations of interest by examining within-individual change over time and minimizing omitted variable bias attributable to unobservable factors cannot be implemented. In fact, undertaking large-scale prospective analyses is often regarded as a necessary step forward in enhancing current knowledge of the associations between MVPA and psychological distress.6,23In this article, we fill this gap and add to the literature by establishing the population-level associations between the weekly frequency of MVPA and self-reported levels of psychological distress with a nationally representative Australian panel data set and fixed-effect (FE) panel regression models.     

Widespread Differential Maternal and Paternal Genome Effects on Fetal Bone Phenotype at Mid‐Gestation

Parent‐of‐origin–dependent (epi)genetic factors are important determinants of prenatal development that program adult phenotype. However, data on magnitude and specificity of maternal and paternal genome effects on fetal bone are lacking. We used an outbred bovine model to dissect and quantify effects of parental genomes, fetal sex, and nongenetic maternal effects on the fetal skeleton and analyzed phenotypic and molecular relationships between fetal muscle and bone. Analysis of 51 bone morphometric and weight parameters from 72 fetuses recovered at day 153 gestation (54% term) identified six principal components (PC1–6) that explained 80% of the variation in skeletal parameters. Parental genomes accounted for most of the variation in bone wet weight (PC1, 72.1%), limb ossification (PC2, 99.8%), flat bone size (PC4, 99.7%), and axial skeletal growth (PC5, 96.9%). Limb length showed lesser effects of parental genomes (PC3, 40.8%) and a significant nongenetic maternal effect (gestational weight gain, 29%). Fetal sex affected bone wet weight (PC1, p < 0.0001) and limb length (PC3, p < 0.05). Partitioning of variation explained by parental genomes revealed strong maternal genome effects on bone wet weight (74.1%, p < 0.0001) and axial skeletal growth (93.5%, p < 0.001), whereas paternal genome controlled limb ossification (95.1%, p < 0.0001). Histomorphometric data revealed strong maternal genome effects on growth plate height (98.6%, p < 0.0001) and trabecular thickness (85.5%, p < 0.0001) in distal femur. Parental genome effects on fetal bone were mirrored by maternal genome effects on fetal serum 25‐hydroxyvitamin D (96.9%, p < 0.001) and paternal genome effects on alkaline phosphatase (90.0%, p < 0.001) and their correlations with maternally controlled bone wet weight and paternally controlled limb ossification, respectively. Bone wet weight and flat bone size correlated positively with muscle weight (r = 0.84 and 0.77, p < 0.0001) and negatively with muscle H19 expression (r = –0.34 and –0.31, p < 0.01). Because imprinted maternally expressed H19 regulates growth factors by miRNA interference, this suggests muscle‐bone interaction via epigenetic factors. © 2014 American Society for Bone and Mineral Research.     

On the associations between physical activity and quality of life: findings from an Australian nationally representative panel survey

Purpose

The purpose of this study is to provide a comprehensive analysis of the associations between the frequency of moderate or vigorous physical activity (MVPA) and quality of life (QoL) measures using longitudinal data and panel regression models on a large, representative sample of the Australian population.

Methods

This study used yearly panel data on over 23,000 individuals collected by the Household, Income and Labour Dynamics in Australia Survey between 2001 and 2011. Ordinary least squares and fixed effects regression models were used to examine the associations between the weekly frequency of MVPA and several indicators of QoL, including both measures of health-related QoL (such as those derivable from the SF-36) and global subjective well-being assessments (such as self-reported life satisfaction), controlling for observable and unobservable factors.

Results

Our results provided consistent evidence that the frequency of MVPA is related to QoL and proved to be robust. A higher frequency of MVPA was related to higher scores in each of the outcomes analysed and using either of two different estimation strategies. The most pronounced associations emerged between the frequency of MVPA and the physical and vitality dimensions of the SF-36. A change from undertaking no MVPA at all to undertaking such activity once a week was remarkably associated with higher QoL. The influence of MVPA on global life satisfaction was only partially channelled through physical and mental health.

Conclusion

We provide strong evidence that MVPA is related to QoL, thus adding to the large body of scientific literature demonstrating the benefits of becoming physically active.     

Morphological evolution of the carnivoran sacrum

The sacrum is a key piece of the vertebrate skeleton, since it connects the caudal region with the presacral region of the vertebral column and the hind limbs through the pelvis. Therefore, understanding its form and function is of great relevance in vertebrate ecomorphology. However, it is striking that morphometric studies that quantify its morphological evolution in relation to function are scarce. The main goal of this study is to investigate the morphological evolution of the sacrum in relation to its function in the mammalian order Carnivora, using three-dimensional (3D) geometric morphometrics. Principal component analysis under a phylogenetic background indicated that changes in sacrum morphology are mainly focused on the joint areas where it articulates with other parts of the skeleton allowing resistance to stress at these joints caused by increasing muscle loadings. In addition, we demonstrated that sacrum morphology is related to both the length of the tail relativised to the length of the body, and the length of the body relativised to body mass. We conclude that the sacrum in carnivores has evolved in response to the locomotor requirements of the species analysed, but in locomotion, each family has followed alternative morphological solutions to address the same functional demands.     

Effects of a 12-wk whole-body vibration based intervention to improve type 2 diabetes

Objective

To test the feasibility, safety and effectiveness of a 12-wk whole body vibration (WBV) intervention on glycemic control, lipid-related cardiovascular risk factors and functional capacity among type 2 diabetes mellitus (T2DM) patients in a primary care context.

Methods

Fifty non-insulin dependent T2DM patients were randomized 1:1 to an intervention group that, in addition to standard care, received a 12-wk WBV intervention, and a control group receiving only standard care (from February 2012 through May 2012). Outcomes, including glycated hemoglobin (HbA1c), fasting blood glucose, lipid-related cardiovascular risk factors (i.e., cholesterol, triglycerides, lipoproteins, LDL/HDL and atherogenic index) and functional capacity were measured at baseline and after the 12-wk intervention.

Results

After intervention, there was a reduction in HbA1c and fasting blood glucose when compared to the control group, with a mean difference in change scores between groups of −0.55% (95% CI −0.15 to −0.76) and −33.95 mm/dl (95% CI −51.38 to −3.47), respectively. Similarly, most lipid-related cardiovascular risk factors (i.e., cholesterol, triglycerides and atherogenic index) were also reduced (p < 0.05).

Conclusion

A 12-wk WBV intervention in a primary care context is feasible, safe and effective in improving glycemic profile, lipid-related cardiovascular risk factors and functional capacity among T2DM patients.

Trial number

ACTRN12613000021774.