Caloric beverage drinking patterns are differentially associated with diet quality and adiposity among Spanish girls and boys

The present study assesses the impact of beverage consumption pattern on diet quality and anthropometric proxy measures for abdominal adiposity in Spanish adolescents. Data were obtained from a representative national sample of 1,149 Spanish adolescents aged 10–18 years. Height, weight, and waist circumferences were measured. Dietary assessment was performed with a 24-h recall. Beverage patterns were identified by cluster analysis. Adherence to the Mediterranean diet was measured by the KIDMED index. Three beverage clusters were identified for boys—“whole milk” (62.5 %), “low-fat milk” (17.5 %) and “soft drinks” (20.1 %)—and for girls—^“whole milk” (57.8 %), “low-fat milk” (20.8 %) and juice (21.4 %), accounting for 8.3, 9.6, 13.9, 8.6, 11.5 and 12.9 % of total energy intake, respectively. Each unit of increase in the KIDMED index was associated with a 14.0 % higher (p?=?0.004) and 11.0 % lower (p?=?0.048) probability of membership in the “low-fat milk” and “soft drinks” cluster in girls and boys, respectively, compared with the “whole milk” cluster. Boys in the “soft drinks” cluster had a higher risk of 1-unit increase in BMI z score (29.0 %, p?=?0.040), 1-cm increase in waist circumference regressed on height and age (3.0 %, p?=?0.027) and 0.1-unit increase in waist/height ratio (21.4 %, p?=?0.031) compared with the “whole milk” cluster. Conclusion: A caloric beverage pattern dominated by intake of “soft drinks” is related to general and abdominal adiposity and diet quality in Spanish male adolescents.     

Optimal reproductive competence of oocytes retrieved through follicular flushing in minimal stimulation IVF

The objective of this study was to assess the reproductive competence of oocytes obtained by follicular flushing in poor responder patients. This prospective comparative study, at the University of Paris XI, Assistance Publique des Hopitaux de Paris, INSERM Unit 782, was performed on 165 infertile IVF embryo transfer candidates. A total of 271 consecutive minimal stimulation IVF cycles were studied. Oocyte retrieval was performed 34 h after human chorionic gonadotrophin administration and oocytes were allocated into two groups according to their retrieval method: oocytes obtained in the first follicular aspiration (FA, n = 127); and oocytes retrieved in the subsequent follicular flushing (FF, n = 102). The principal outcome was to evaluate clinical pregnancy and embryo implantation rates. Thus, patient characteristics, fertilization rate and clinical pregnancy rate per oocyte were comparable in both of groups. In contrast, embryo morphology (41 versus 59%, P < 0.01) and implantation rates (20.4 versus 34.8%, P < 0.04) were better in the FF group. In conclusion, an optimal reproductive competence was observed in oocytes retrieved by follicular flushing in minimal stimulation IVF in poor responder patients.     

Enhanced recovery pathway in adult patients undergoing thoracolumbar deformity surgery

BACKGROUND CONTEXTEnhanced recovery (ERAS) pathways can help hospitals maximize the incentives of bundled payment models while maintaining high-quality patient care. A key component of an enhanced recovery pathway is the ability to predictably reduce inpatient length of stay, as this is a critical component of the cost equation.PURPOSETo determine the efficacy of an enhanced recovery pathway on reducing length of stay after thoracolumbar adult deformity surgery.STUDY DESIGNSingle surgeon retrospective review of prospectively-collected data.PATIENT SAMPLEForty adult deformity patients who underwent ≥5 levels of fusion to the pelvis (two to L5) with a single surgeon before and after implementation of an ERAS pathway.METHODSThe pathway involved participation by anesthesiology, hospital medicine, and physical therapy, and was designed to achieve goals previously associated with decreased LOS (eg, EBL<1200 mL, procedure time <4.5 hours, avoidance of ICU postoperatively, and mobilization POD0-1). Patients were propensity-score matched 1:1 to a historical cohort (enhanced recovery [ER] and historical [H] cohorts), based on demographics, medical comorbidities, radiographic alignment parameters, and surgical factors. Outcomes were compared to determine the effect of the enhanced recovery pathway. Primary outcomes included LOS and 90-day complications and readmissions.RESULTSAfter matching, gender, BMI, ASA class, preoperative opioid dependence, day of surgery, sagittal alignment parameters, rate of revision surgery, three-column osteotomies, and interbody fusions were comparable between the cohorts (p>.05). In the ER cohort, there was reduced EBL (920±640 vs. 1437±555, p=.004) and no ER patient went to the ICU immediately following surgery, compared with 30% of H patients (p=.022). The ER cohort also had a greater number of patients ambulating by POD1 compared to the H cohort (100% vs. 55%, p=.010). ER patients had a shorter LOS (4.5±1.3 vs. 7.3±4.4 days, p=.010). A 90-day readmission and complications were comparable between the cohorts (p>.05).CONCLUSIONSThe creation of an ERAS pathway for patients undergoing thoracolumbar adult deformity surgery reduced length of stay without negatively affecting short-term morbidity and complications. Given the specificity of this pathway to a single surgeon and hospital, the resources and staffing changes that were instrumental in creating the pathway may not be generalizable to other centers.     

Efficacy of PPI,levofloxacin and amoxicillin in the eradication of Helicobacter pylori compared to conventional triple therapy at a Venezuelan hospital

Background and study aimsHelicobacter pylori is the main cause of gastritis, gastroduodenal ulcers and gastric cancer. In the past two decades, the recommended treatment for its eradication as a first-line regimen is the standard triple therapy consisting of a proton pump inhibitor (PPI), amoxicillin and clarithromycin or metronidazole. However, the effectiveness of this traditional regime, which initially was 90%, progressively declined in many parts of the world and is currently 57–73%. The aim of this study was to evaluate whether the eradication rate with triple therapy with levofloxacin is superior as first-line therapy to that with treatment using clarithromycin in the population that attended as outpatients at the Hospital of Lídice.Patients and methodsWe designed a prospective study, with two groups of patients presenting dyspeptic symptoms, from October 2010 to October 2011, who underwent upper gastrointestinal endoscopy and whose biopsies were positive for infection with H. pylori. At the end, 81 patients were included in the order of biopsy result arrival to fill the quota of each group. The first group with 42 patients underwent triple therapy with clarithromycin and the second group with 39 patients underwent therapy with levofloxacin, amoxicillin and a PPI. The patients’ age ranged between 23 and 76 years, the average being 49.5. The predominant sex was female, at 72.84%. Both treatments lasted for 10 days and the patients were clinically re-evaluated 15 days after their conclusion and programmed for a second endoscopy to verify H. pylori eradication.ResultsAmong the 42 patients in the control group, there were 14 eradication failures with 33.33% resistance to clarithromycin. Among the 39 patients in the experimental group, two eradication failures with 5.13% resistance to levofloxacin were observed. The χ² value was 6.96.ConclusionsTreatment with levofloxacin was more effective than conventional triple therapy. Triple therapy with levofloxacin can be implemented in populations where resistance to clarithromycin has been observed.