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21.
Mohammad H. Eslami Zein Saadeddin Denis V. Rybin Gheorghe Doros Jeffrey J. Siracuse Alik Farber 《Journal of vascular surgery》2019,69(3):863-874.e1
Objective
The frailty index has been linked to adverse outcomes after surgical procedures. In this study, we evaluated the association between frailty index and outcomes after elective lower extremity bypass (LEB) for lower extremity ischemia.Methods
The American College of Surgeons National Surgical Quality Improvement Program data set (2005-2012) was used to identify patients who underwent elective LEB using diagnostic and procedure Current Procedural Terminology codes. Modified frailty index (mFI) scores, derived from the Canadian Study of Health and Aging, were categorized into three groups: low, medium, and high. Association of mFI with 30-day postoperative death (POD), myocardial infarction (MI), cardiopulmonary events (CPEs), deep tissue surgical site infection (SSI), and graft failure (GF) was evaluated. Both univariate and multivariable regression analyses—adjusted for age, sex, American Society of Anesthesiologists class, body mass index, and creatinine levels—were used to assess the effect of frailty on each outcome.Results
Of 12,677 patients (mean age, 67.7 ± 11.1 years) identified who underwent elective LEB, POD occurred in 265 (2.1% overall). Postoperative MI, SSI, CPEs, and GF occurred in 1.6%, 2.5%, 3.1%, and 4.3%, respectively. The mean mFI of the entire sample was 0.3 ± 0.1. Adjusted odds ratio for development of any morbidity in the group with the highest mFI was 1.36 (95% confidence interval, 1.08-1.72; P = .010) compared with the low frailty group. Patients with higher mFI were more likely to develop MI and CPEs but not SSI or GF. Univariate and multivariable analyses showed a significantly increased risk of POD among those in the highest mFI tertile. Female sex and age, increased American Society of Anesthesiologists class and creatinine levels, and decreased body mass index independently predicted increased mortality. The addition of categorical mFI improved models with these variables.Conclusions
Higher mFI is independently associated with higher mortality and morbidity. Preoperative mFI assessment may be considered an additional screening tool for risk stratification among patients undergoing LEB. 相似文献22.
B. Kowall N. Lehmann A.A. Mahabadi S. Moebus R. Erbel K.H. Jöckel A. Stang 《Nutrition, metabolism, and cardiovascular diseases : NMCD》2019,29(3):228-235
Background and aims
There is controversy on the potentially benign nature of metabolically healthy obesity (MHO), i.e., obese persons with few or no metabolic abnormalities. So far, associations between MHO and coronary artery calcification (CAC), a measure of subclinical atherosclerosis, have mainly been studied cross-sectionally in Asian populations. We assessed cross-sectional and longitudinal MHO CAC associations in a Caucasian population.Methods and results
In the Heinz Nixdorf Recall Study, a population-based cohort study in Germany, CAC was assessed by electron-beam tomography at baseline and at 5-year follow-up. For cross-sectional and longitudinal analyses, we included 1585 participants free of coronary heart disease at baseline, with CAC measurements at baseline and at follow-up, and with either normal weight (BMI 18.5–24.9 kg/m2) or obesity (BMI ≥30.0 kg/m2) at baseline. We used four definitions of MHO. In our main analysis, we defined obese persons as metabolically healthy if they met ≤1 of the NCEP ATP III criteria for the definition of the metabolic syndrome – waist circumference was not taken into account because of collinearity with BMI.Persons with MHO had a higher prevalence of CAC than metabolically healthy normal weight (MHNW) persons (prevalence ratio = 1.59 (95% confidence interval 1.38–1.84) for the main analysis). Persons with MHO had slightly larger odds of CAC progression than persons with MHNW (odds ratios ranged from 1.17 (0.69–1.99) to 1.48 (1.02–2.13) depending on MHO definition and statistical approach).Conclusion
Our analyses on MHO CAC associations add to the evidence that MHO is not a purely benign health condition. 相似文献23.
24.
Timo Jaakkola Harto Hakonen Anna Kankaanpää Laura Joensuu Janne Kulmala Jouni Kallio Anthony Watt Tuija H. Tammelin 《Journal of Science and Medicine in Sport》2019,22(1):85-90
Objectives
This study aimed to investigate cross-lagged associations of leaping skill and throwing–catching skills with objectively measured moderate-to-vigorous physical activity (MVPA) and sedentary time (ST) during school transition from upper primary (Grade 6) to lower secondary school (Grade 7).Design
This study is a one-year prospective follow-up study within Finnish school settings. Students’ MVPA, ST, leaping skill and throwing–catching skills were measured at Grade 6 and subsequently at Grade 7.Methods
A sample of 336 students (163 girls, 173 boys; M age = 12.0 years, SD = 0.4 at Grade 6 participated in the study. Students’ MVPA and ST were measured objectively by hip-worn accelerometers. Leaping skill was measured by 5-leaps test. Throwing and catching skills were measured by throwing–catching combination test. Cross-lagged structural equation modeling was conducted to evaluate the associations between MVPA, ST, leaping skill, and throwing–catching skills at Grade 6 and Grade 7.Results
Results demonstrated three significant cross-lagged associations among girls: (1) leaping skill measured at Grade 6 was negatively associated with ST at Grade 7; (2) objectively measured MVPA at Grade 6 associated positively with leaping skill at Grade 7; and (3) throwing–catching skills measured at Grade 6 associated positively with leaping skill measured at Grade 7. There were no statistically significant cross-lagged associations between the study variables for the sample of boys.Conclusions
The results of this study indicated that supporting opportunities for girls’ engagement in both MVPA and leaping skill development activities during their primary school education is strongly recommended. 相似文献25.
Peyman Sardari Nia Jean H.T. Daemen Jos G. Maessen 《The Journal of thoracic and cardiovascular surgery》2019,157(4):1567-1574
Objectives
The aim of this study was to develop a high-fidelity minimally invasive mitral valve surgery (MIMVS) simulator.Methods
The process of industrial serial design was applied based on pre-set requirements, acquired by interviewing experienced mitral surgeons. A thoracic torso with endoscopic and robotic access and disposable silicone mitral valve apparatus with a feedback system was developed. The feedback system was based on 4 cameras around the silicone valve and an edge detection algorithm to calculate suture depth and width. Validity of simulator measurements was assessed by comparing simulator-generated values with measurements done manually on 3-dimensional reconstructed micro-computed tomography scan of the same sutures. Independent surgeons tested the simulator between 2014 and 2018, whereupon an evaluation was done through a questionnaire.Results
The feedback system was able to provide width and depth measurements, which were subsequently scored by comparison to pre-set target values. Depth did not significantly differ between simulator and micro-computed tomography scan measurements (P = .139). Width differed significantly (P = .001), whereupon a significant regression equation was found (P < .0001) to calibrate the simulator. After calibration, no significant difference was found (P = .865). In total, 99 surgeons tested the simulator and more than agreed with the statements that the simulator is a good method for training MIMVS, and that the mitral valve and suture placement looked and felt realistic.Conclusions
We successfully developed a high-fidelity MIMVS simulator for endoscopic and robotic approaches. The simulator provides a platform to train skills in an objective and reproducible manner. Future studies are needed to provide evidence for its application in training surgeons. 相似文献26.
David C. Johnson Steven S. Raman Sohrab A. Mirak Lorna Kwan Amirhossein M. Bajgiran William Hsu Cleo K. Maehara Preeti Ahuja Izak Faiena Aydin Pooli Amirali Salmasi Anthony Sisk Ely R. Felker David S.K. Lu Robert E. Reiter 《European urology》2019,75(5):712-720
Background
Multiparametric magnetic resonance imaging (mpMRI) undoubtedly affects the diagnosis and treatment of localized prostate cancer (CaP). However, clinicians need a better understanding of its accuracy and limitations in detecting individual CaP foci to optimize management.Objective
To determine the per-lesion detection rate for CaP foci by mpMRI and identify predictors of tumor detection.Design, setting, and participants
We carried out a retrospective analysis of a prospectively managed database correlating lesion-specific results from mpMRI co-registered with whole-mount pathology (WMP) prostatectomy specimens from June 2010 to February 2018. Participants include 588 consecutive patients with biopsy-proven CaP undergoing 3-T mpMRI before radical prostatectomy at a single tertiary institution.Outcome measurements and statistical analysis
We measured mpMRI sensitivity in detecting individual CaP and clinically significant (any Gleason score ≥7) CaP foci and predictors of tumor detection using multivariate analysis.Results and limitations
The final analysis included 1213 pathologically confirmed tumor foci in 588 patients with primarily intermediate- (75%) or high-risk (12%) CaP. mpMRI detected 45% of all lesions (95% confidence interval [CI] 42–47%), including 65% of clinically significant lesions (95% CI 61–69%) and nearly 80% of high-grade tumors. Some 74% and 31% of missed solitary and multifocal tumors, respectively, were clinically significant. The majority of missed lesions were small (61.1% ≤1 cm); 28.3% were between 1 and 2 cm, and 10.4% were >2 cm. mpMRI missed at least one clinically significant focus in 34% of patients overall, and in 45% of men with multifocal lesions. On multivariate analysis, smaller, low-grade, multifocal, nonindex tumors with lower prostate-specific antigen density were more likely to be missed. Limitations include selection bias in a prostatectomy cohort, lack of specificity data, an imperfect co-registration process, and uncertain clinical significance for undetected lesions.Conclusions
mpMRI detects less than half of all and less than two-thirds of clinically significant CaP foci. The moderate per-lesion sensitivity and significant proportion of men with undetected tumor foci demonstrate the current limitations of mpMRI.Patient summary
Magnetic resonance imaging of the prostate before surgical removal for prostate cancer finds less than half of all individual prostate cancer tumors. Large, solitary, aggressive tumors are more likely to be visualized on imaging. 相似文献27.
Mae Lynn Reyes-Rodríguez Hunna J. Watson Concepción Barrio Donald H. Baucom Yormeri Silva Kiara L. Luna-Reyes 《Eating disorders》2019,27(2):205-229
ABSTRACTLatinos are less likely to seek health care for eating disorders and more likely to drop out of treatment than members of other ethnic groups, highlighting existing challenges to engagement in traditional mental health care. This study explored the role of family in the treatment of adult Latinas with eating disorders through content analysis of family sessions adjunctive to cognitive behavioral therapy. This study yielded insight into the experiences of 10 Latinas with eating disorders (M age = 39.90 years) and 10 relatives (M age = 39.50) from the Promoviendo una Alimentación Saludable trial who were randomly selected to receive six family enhancement sessions. Data from 53 sessions were analyzed using a qualitative content analysis approach. Family intervention might serve as a valuable adjunct to conventional treatment by positively influencing social, family, and emotional support for Latinas with eating disorders. 相似文献
28.
Neuroinflammation is initiated as a result of traumatic brain injury and can exacerbate evolving tissue pathology. Immune cells respond to acute signals from damaged cells, initiate neuroinflammation, and drive the pathological consequences over time. Importantly, the mechanism(s) of injury, the location of the immune cells within the brain, and the animal species all contribute to immune cell behavior following traumatic brain injury. Understanding the signals that initiate neuroinflammation and the context in which they appear may be critical for understanding immune cell contributions to pathology and regeneration.Within this paper, we review a number of factors that could affect immune cell behavior acutely following traumatic brain injury. 相似文献
29.
S. Fatahi M. Pezeshki S.M. Mousavi A. Teymouri J. Rahmani H. Kord Varkaneh E. Ghaedi 《Nutrition, metabolism, and cardiovascular diseases : NMCD》2019,29(5):432-439
Background and aim
Given the contradictory results of previous randomized controlled trials (RCTs), we performed a systematic review and meta-analysis to quantify and summarize the effects of folic acid supplementation on C-reactive protein (CRP).Methods and results
We performed a systematic search of all available RCTs conducted up to October 2018 in the following databases: PubMed, Scopus, and Cochrane. RCTs that investigated the effect of folate on CRP were included in the present study. Data were combined with the use of generic inverse-variance random-effects models. Statistical heterogeneity between studies was evaluated using Cochran's Q-test. Ten RCTs (1179 subjects) were included in the present meta-analysis. Pooled analysis results showed that folate supplementation significantly lowered the serum CRP level (weighted mean difference (WMD): ?0.685 mg/l, 95% CI: ?1.053, ?0.318, p < 0.001). However, heterogeneity was significant (I2 = 96.7%, p = 0.000). Stratified analyses indicated that sex, intervention period, and type of study population were sources of heterogeneity. Following analysis, results revealed that the greatest impact was observed in women (WMD: ?0.967 mg/l, 95% CI: ?1.101, ?0.833, p = 0.000), patients with type 2 diabetes mellitus (WMD: ?1.764 mg/l, 95% CI: ?2.002, ?1.526, p = 0.000), and intervention period less than 12 weeks (WMD: ?0.742 mg/l, 95% CI: ?0.834, ?0.650, p = 0.000).Conclusion
This meta-analysis suggested that folic acid supplementation could significantly lower the serum CRP level. Folic acid leads to greater CRP lowering effect in women, patients with T2DM, and those with less than 12-week intervention. 相似文献30.