Validity of BMI based on self-reported weight and height in adolescents

Aim:  To assess in a subset of a nationally representative sample of Portuguese adolescents, the validity of Body Mass Index (BMI) based on self-reported weight and height.
Methods:  This study included 462 students in grades 6, 8 and 10 (mean age 14.0 ± 1.9 years) from 12 public schools randomly selected from the list of schools which took part in the 2006 Health Behaviour in School Aged Children Portuguese survey, corresponding to approximately 10% of the sample. Self-reported weight and height were recorded and then measured.
Results:  Prevalence of normal weight, overweight and obesity based on self-report compared with that of measured values was not significantly different for boys and girls, and among age groups. BMI based on measured weight and height was underestimated compared with BMI based on self-reported data, both among girls and boys. Larger limits of agreement were found for boys, indicating a higher variability of self-reported BMI in estimating measured BMI, specifically below the age of 14 years.
Conclusion:  These data suggest that BMI based on self-reported weight and height is not accurate for BMI prediction at an individual level. However, self-reported BMI may be used as a simple and valid tool for BMI estimates of overweight and obesity in epidemiological studies.     

Complications during pregnancy in women with epilepsy: population-based cohort study

Objective  To investigate whether women with epilepsy have an increased risk of complications during pregnancy and to explore the impact of antiepileptic drug (AED) use.
Design  Population-based cohort study.
Setting  Data from Medical Birth Registry of Norway based on all births in Norway 1999–2005.
Population  All births ( n  = 372 128) delivered in Norway, ensured through linkage with the National Population Registry run by Statistics Norway. All singleton births and the first child in multiple pregnancies were included, leaving 365 107 pregnancies for analyses.
Main outcome measures  Pre-eclampsia (mild and severe), gestational hypertension, eclampsia, vaginal bleeding (early and late) and preterm birth.
Results  We compared 2805 pregnancies in women with a current or past history of epilepsy (0.8%) and 362 302 pregnancies in women without a history of epilepsy. Women with epilepsy had an increased risk of mild pre-eclampsia, [odds ratio 1.3: 95% confidence interval (1.1–1.5)] and delivery before week 34 [1.2: (1.0–1.5)].
Antiepileptic drugs were used in 33.6% ( n  = 942) of the pregnant women with epilepsy. Compared to women without epilepsy, women with epilepsy and AED use had an increased risk of mild pre-eclampsia [1.8: (1.3–2.4)], gestational hypertension [1.5: (1.0–2.2)], vaginal bleeding late in pregnancy [1.9: (1.1–3.2)], and delivery before 34 weeks of gestation [1.5: (1.1–2.0)]. No significant increase in the risk of these complications was observed in women with epilepsy not using AED. These results remained unchanged after exclusion of multiple pregnancies.
Conclusion  Women with epilepsy have a low complication rate, but special attention should be paid to those using AED during pregnancy.     

小切口开胸39例体会

1 临床资料小切口开胸39(男24,女15)例,年龄16～75(平均50.5)岁. 肺癌12,其中中央型肺癌3例,周围型肺癌9例;肺结核瘤2例;恶性胸水8例;自发性气胸肺大疱10例;食管裂孔疝3例,贲门失弛缓症4例. 术前准备同常规开胸手术. 采用单腔或双腔管气管内插管、全身静脉复合麻醉. 采用标准开胸的健侧卧位. 切口自锁骨中线至肩胛下线之间的范围沿肋间走行,长约8～12 cm,以病变的部位选择锁骨中线至腋中线或腋前线至腋后线或腋中线至肩胛线的相应肋间,依次切开皮肤、皮下组织,将背阔肌及胸大肌游离而不切断,沿欲切开之肋间将前锯肌纤维钝性分开,紧贴下位肋骨上缘切断肋间肌及壁层胸膜,用两副开胸器交叉撑开即可暴露术野进行操作. 关胸时,用10号丝线绕切口上下肋骨间隙缝合3针,关闭胸腔,逐层缝合切口各层组织,其中皮肤层以可吸收线行皮内连续缝合. 应用小切口进行肺叶切除11例;取活检1例;肺楔形切除2例;胸膜固定术8例;肺大疱切除10例;食管裂孔疝修补3例,贲门失弛缓症贲门胃底肌层切开膈肌瓣成形术4例. 开胸时间8～12(平均10)min. 关胸时间15～20(平均17.5)min. 开胸过程中出血量10～20 mL. 术后胸腔引流量70～200(平均130)mL/d. 术后伤口疼痛较标准开胸切口者明显减轻,均不用止痛剂. 术后术侧上肢活动无明显受限,肩关节活动在1 wk内均恢复正常,可耐受大范围的活动. 本组病例中,患者切口7～9 d拆线,全部I期愈合.     

Carbohydrate antigen 19.9 accurately selects patients for laparoscopic assessment to determine resectability of pancreatic malignancy

Background:

Laparoscopy with laparoscopic ultrasonography (L–LUS) may be useful in the selection of patients for surgery to resect peripancreatic malignancy in addition to contrast‐enhanced computed tomography (CE–CT). The present prospective study assessed the strategy of using carbohydrate antigen 19·9 (CA19·9) levels to select patients for L–LUS.

Methods:

Patients with suspected peripancreatic malignancy that appeared resectable on CE–CT were selected for immediate surgery if CA19·9 was low (up to 150 kU/l, or up to 300 kU/l if serum bilirubin was above 35 µmol/l), or to L–LUS if CA19·9 was high (over 150 kU/l, or over 300 kU/l if serum bilirubin was above 35 µmol/l). Data were assessed to determine the clinical utility of this strategy.

Results:

A total of 94 patients went straight to surgery, of whom 65 proved resectable: 63 of 80 with a low CA19·9 level but only two of 14 with a high CA19·9 level and gastric outlet obstruction. From 55 patients with high CA19·9 levels, L–LUS correctly identified 26 of 31 resectable tumours and eight of 24 unresectable tumours.

Conclusion:

Using CA19·9 levels to help select patients with pancreatic malignancy for immediate surgery or L–LUS for further assessment of resectability effectively increased resection rates and reduced unnecessary laparotomies. Copyright © 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.     

Male pseudohermaphroditism secondary to panhypopituitarism

An infant with a 46XY karyotype was born with ambiguous genitalia, including microphallus and perineal hypospadias. A female gender was assigned due to extreme failure of development of the external genitalia. Subsequent investigations demonstrated panhypopituitarism, and it is believed that severe gonadotrophin deficiency was responsible for the intersex state. This case illustrates the need to evaluate the hypothalamic-pituitary axis in selected cases of intersex, and also questions the prevailing assumption that testosterone secretion during embryogenesis is largely pituitary gonadotrophin independent, under the control of human chorionic gonadotrophin.     

Expression in Escherichia coli of the human fibrinogen B beta chain and its cleavage by thrombin

The human fibrinogen B beta chain was expressed in Escherichia coli to study the functions of fibrinogen associated with this subunit. Recombinant B beta chains were expressed at 100 ng/mL in an IPTG- dependent manner. A first cistron sequence, inserted into the expression vector 5' to the B beta chain cDNA, was required to express the protein. Recombinant B beta chains were expressed within five minutes after induction with IPTG and were soluble in physiologic buffers. The recombinant B beta chains migrated on sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) at a rate identical to B beta chains from fibrinogen treated with N-glycanase. Recombinant B beta chains were cleaved by thrombin, as demonstrated by the loss of cross-reactivity with a monoclonal antibody (MoAb) specific for the undigested B beta 1-42 fragment. The levels of expression of the B beta chain were much lower than those reported previously for the gamma chain of fibrinogen expressed in a similar vector in E coli. However, these levels are sufficient to allow further characterization of this fibrinogen subunit.     

Influence of a selective 5HT1-receptor agonist GR43175 on platelet responsiveness

The possible interaction of sumatriptan, a selective 5HT₁-receptor agonist, with platelet responsiveness has been investigated. Stimulation of platelet rich plasma with sumatriptan (1–100 μM) did not induce shape change, aggregation or modification of intraplatelet cytosolic calcium levels. Total inhibition of aggregation induced by 20 μM 5HT was observed in platelets preincubated for 20 min with 100 μM sumatriptan. In the same model, platelet stimulation with 4 μM adenosine 5'-diphosphate (ADP), concentration known to induce an irreversible single-phase curve, determined a decrease of aggregatory response. Concentrations from I μM to 50 μM of sumatriptan did not influence the aggregatory response induced by 5HT and ADP. These effects appear not to be determined by modifications of platelet calcium homeostasis. The possibility to modulate platelet responsiveness by sumatriptan offers a further approach for evaluating the probable link between platelet behaviour and pathophysiology of migraine.