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Schipper HS, de Ferranti S. Atherosclerotic Cardiovascular Risk as an Emerging Priority in Pediatrics. Pediatrics 2022; 150:189711. [PMID: 36217888 DOI: 10.1542/peds.2022-057956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2022] [Indexed: 12/05/2022] Open
Abstract
Over the last decades, childhood and adolescence have emerged as an important window of opportunity to prevent atherosclerotic cardiovascular disease (ASCVD) later in life. Here, we discuss the underlying advances in the field. First, atherosclerosis development starts as early as childhood. Atherogenesis initiates in the iliac arteries and abdominal aorta and subsequently develops in higher regions of the arterial tree, as has been demonstrated in nonhuman primate studies and human autopsy studies. Obesity, hypertension, hyperlipidemia, and hyperglycemia at a young age can accelerate atherogenesis. Children and adolescents with obesity have a relative risk of ∼ 2.5 for ASCVD mortality later in life, compared to peers with a normal weight. Conversely, early prevention improves long-term cardiovascular outcomes. Second, we review disease-associated factors that add to the traditional risk factors. Various pediatric disorders carry similar or even higher risks of ASCVD than obesity, including chronic inflammatory disorders, organ transplant recipients, familial hypercholesterolemia, endocrine disorders, childhood cancer survivors, chronic kidney diseases, congenital heart diseases, and premature birth, especially after fetal growth restriction. The involved disease-associated factors that fuel atherogenesis are diverse and include inflammation, vascular, and endothelial factors. The diverse and growing list of pediatric groups at risk underscores that cardiovascular risk management has solidly entered the realm of general pediatrics. In a second review in this series, we will, therefore, focus on recent advances in cardiovascular risk assessment and management and their implications for pediatric practice.
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Affiliation(s)
- Henk S Schipper
- Department of Pediatric Cardiology.,Center for Translational Immunology, Wilhelmina Children's Hospital and University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sarah de Ferranti
- Department of Cardiology, Boston Children's Hospital and Harvard University Medical School, Boston, Massachusetts
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2
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Tu T, Alba MM, Datta AA, Hong H, Hua B, Jia Y, Khan J, Nguyen P, Niu X, Pammidimukkala P, Slarve I, Tang Q, Xu C, Zhou Y, Stiles BL. Hepatic macrophage mediated immune response in liver steatosis driven carcinogenesis. Front Oncol 2022; 12:958696. [PMID: 36276076 PMCID: PMC9581256 DOI: 10.3389/fonc.2022.958696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/17/2022] [Indexed: 12/02/2022] Open
Abstract
Obesity confers an independent risk for carcinogenesis. Classically viewed as a genetic disease, owing to the discovery of tumor suppressors and oncogenes, genetic events alone are not sufficient to explain the progression and development of cancers. Tumor development is often associated with metabolic and immunological changes. In particular, obesity is found to significantly increase the mortality rate of liver cancer. As its role is not defined, a fundamental question is whether and how metabolic changes drive the development of cancer. In this review, we will dissect the current literature demonstrating that liver lipid dysfunction is a critical component driving the progression of cancer. We will discuss the involvement of inflammation in lipid dysfunction driven liver cancer development with a focus on the involvement of liver macrophages. We will first discuss the association of steatosis with liver cancer. This will be followed with a literature summary demonstrating the importance of inflammation and particularly macrophages in the progression of liver steatosis and highlighting the evidence that macrophages and macrophage produced inflammatory mediators are critical for liver cancer development. We will then discuss the specific inflammatory mediators and their roles in steatosis driven liver cancer development. Finally, we will summarize the molecular pattern (PAMP and DAMP) as well as lipid particle signals that are involved in the activation, infiltration and reprogramming of liver macrophages. We will also discuss some of the therapies that may interfere with lipid metabolism and also affect liver cancer development.
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Affiliation(s)
- Taojian Tu
- Pharmacology and Pharmaceutical Sciences, School of Pharmacy, University of Southern California, Los Angeles, CA, United States
| | - Mario M. Alba
- Pharmacology and Pharmaceutical Sciences, School of Pharmacy, University of Southern California, Los Angeles, CA, United States
| | - Aditi A. Datta
- Pharmacology and Pharmaceutical Sciences, School of Pharmacy, University of Southern California, Los Angeles, CA, United States
| | - Handan Hong
- Pharmacology and Pharmaceutical Sciences, School of Pharmacy, University of Southern California, Los Angeles, CA, United States
| | - Brittney Hua
- Pharmacology and Pharmaceutical Sciences, School of Pharmacy, University of Southern California, Los Angeles, CA, United States
| | - Yunyi Jia
- Pharmacology and Pharmaceutical Sciences, School of Pharmacy, University of Southern California, Los Angeles, CA, United States
| | - Jared Khan
- Pharmacology and Pharmaceutical Sciences, School of Pharmacy, University of Southern California, Los Angeles, CA, United States
| | - Phillip Nguyen
- Pharmacology and Pharmaceutical Sciences, School of Pharmacy, University of Southern California, Los Angeles, CA, United States
| | - Xiatoeng Niu
- Pharmacology and Pharmaceutical Sciences, School of Pharmacy, University of Southern California, Los Angeles, CA, United States
| | - Pranav Pammidimukkala
- Pharmacology and Pharmaceutical Sciences, School of Pharmacy, University of Southern California, Los Angeles, CA, United States
| | - Ielyzaveta Slarve
- Pharmacology and Pharmaceutical Sciences, School of Pharmacy, University of Southern California, Los Angeles, CA, United States
| | - Qi Tang
- Pharmacology and Pharmaceutical Sciences, School of Pharmacy, University of Southern California, Los Angeles, CA, United States
| | - Chenxi Xu
- Pharmacology and Pharmaceutical Sciences, School of Pharmacy, University of Southern California, Los Angeles, CA, United States
| | - Yiren Zhou
- Pharmacology and Pharmaceutical Sciences, School of Pharmacy, University of Southern California, Los Angeles, CA, United States
| | - Bangyan L. Stiles
- Pharmacology and Pharmaceutical Sciences, School of Pharmacy, University of Southern California, Los Angeles, CA, United States
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- *Correspondence: Bangyan L. Stiles,
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Steele C, Nowak K. Obesity, Weight Loss, Lifestyle Interventions, and Autosomal Dominant Polycystic Kidney Disease. KIDNEY AND DIALYSIS 2022; 2:106-122. [PMID: 35350649 PMCID: PMC8959086 DOI: 10.3390/kidneydial2010013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Obesity remains a growing public health concern in industrialized countries around the world. The prevalence of obesity has also continued to rise in those with chronic kidney disease. Epidemiological data suggests those with overweight and obesity, measured by body mass index, have an increased risk for rapid kidney disease progression. Autosomal dominant polycystic kidney disease causes growth and proliferation of kidney cysts resulting in a reduction in kidney function in the majority of adults. An accumulation of adipose tissue may further exacerbate the metabolic defects that have been associated with ADPKD by affecting various cell signaling pathways. Lifestyle interventions inducing weight loss might help delay disease progression by reducing adipose tissue and systematic inflammation. Further research is needed to determine the mechanistic influence of adipose tissue on disease progression.
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Affiliation(s)
- Cortney Steele
- Division of Renal Diseases and Hypertension, Anschutz Medical Campus, University of Colorado, Aurora, CO 80045, USA
| | - Kristen Nowak
- Division of Renal Diseases and Hypertension, Anschutz Medical Campus, University of Colorado, Aurora, CO 80045, USA
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Novel clinical and radiological measures of lower limb obesity. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:1311-1320. [PMID: 33484345 DOI: 10.1007/s00590-020-02865-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Abstract
Osteoarthritis of the knee is strongly associated with central obesity, and the prevalence of obesity in patients undergoing knee arthroplasty procedures is expected to increase. Central obesity is associated with multiple adverse outcomes after knee arthroplasty, but the impact of obesity specifically around the operated knee is poorly understood. One reason for this is the absence of a standardized measure, analogous to BMI for central obesity, to facilitate research. The aim of this study was to develop a radiological limb obesity scoring system which reliably corresponds with anthropometric measurements. Detailed anthropometric and radiological measurements were taken from patients undergoing total and unicompartmental knee replacement. Anthropometric measurements were combined into a composite score using principal components analysis. Different radiological scoring methods were evaluated against the anthropometric measure using correlation and regression analyses. Intraclass correlation coefficients were used to evaluate intra- and inter-observer reliability of the radiographic measurements. Measurements were obtained from fifty patients. There was a significant correlation between the composite anthropometric score and unadjusted radiological soft tissue width at the level of the femoral condyles (p < 0.001). There was also a significant correlation with the ratio of tissue to bone widths at the same level (p < 0.001), and fit was improved by including variables coding for soft tissues overlapping the medial or lateral boundaries of the radiograph. We have demonstrated a methodology for producing standardized radiological limb obesity scores which are strongly correlated with anthropometric measurements, and which can be easily applied in diverse clinical and research settings.
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Kwon HM, Han CD, Yang IH, Lee WS, Kim CW, Park KK. Being Underweight Is Associated with Worse Surgical Outcomes of Total Knee Arthroplasty Compared to Normal Body Mass Index in Elderly Patients. Orthop Res Rev 2020; 12:53-60. [PMID: 32308506 PMCID: PMC7148415 DOI: 10.2147/orr.s243444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/24/2020] [Indexed: 12/14/2022] Open
Abstract
Purpose Being underweight has never been studied in relation to the radiologic and clinical outcomes of total knee arthroplasty (TKA) in elderly patients. The aim of this study was to determine the effect of being underweight on TKA radiological and clinical outcomes and to investigate whether being underweight influences postoperative complications compared to normal body mass index (BMI) in elderly patients. Patients and Methods A total of 118 female patients aged 65 years or older with BMI < 25 kg/m2 who underwent primary TKA were divided into two groups based on BMI: group A: 18.5 kg/m2 < BMI < 25 kg/m2; group B: BMI < 18.5 kg/m2. The radiologic and clinical outcomes were evaluated at follow-up of 6, 12, and 24 months after surgery such as the hip-knee-ankle angle, the American Knee Society (AKS) score, Western Ontario and McMaster University score (WOMAC), and patellofemoral (PF) scale. Moreover, postoperative complications during follow-up were investigated. Results Preoperative clinical scores did not differ significantly between the two groups. Postoperative WOMAC pain (1.8 ± 1.9 versus 3.4 ± 2.6, p = 0.02), WOMAC function (12.4 ± 8.1 versus 16.5 ± 8.5, p = 0.012) and PF scales (26.1 ± 3.6 versus 23.7 ± 4.1, p = 0.002) were worse in the underweight group at 12 and 24 months after surgery. The frequency of postoperative complications did not differ significantly between groups. In multivariate linear regression analysis, underweight patient group was significantly associated with worse postoperative WOMAC and PF scores (p = 0.002, 0.005). Conclusion Although postoperative complications of TKA did not differ between groups, underweight patients had worse clinical outcomes of TKA compared to patients with normal BMI in elderly patients. Therefore, care should be taken when performing TKA in elderly underweight patients.
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Affiliation(s)
- Hyuck Min Kwon
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Dong Han
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Ick-Hwan Yang
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Woo-Suk Lee
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Chan Woo Kim
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Kwan Kyu Park
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
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External validation of the relative fat mass (RFM) index in adults from north-west Mexico using different reference methods. PLoS One 2019; 14:e0226767. [PMID: 31891616 PMCID: PMC6938316 DOI: 10.1371/journal.pone.0226767] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 12/03/2019] [Indexed: 12/14/2022] Open
Abstract
Background Analysis of body composition is becoming increasingly important for the assessment, understanding and monitoring of multiple health issues. The body mass index (BMI) has been questioned as a tool to estimate whole-body fat percentage (FM%). Recently, a simple equation described as relative fat mass (RFM) was proposed by Woolcott & Bergman. This equation estimates FM% using two anthropometric measurements: height and waist circumference (WC). The authors state that due to its simplicity and better performance than BMI, RFM could be used in daily clinical practice as a tool for the evaluation of body composition. The aim of this study was to externally validate the equation of Woolcott & Bergman to estimate FM% among adults from north-west Mexico compared with Dual-energy X-ray absorptiometry (DXA) as an alternative to BMI and secondly, to make the same comparison using air displacement plethysmography (ADP), Bioelectrical Impedance Analysis (BIA) and a 4-compartment model (4C model). Methods Weight, height and WC were measured following standard procedures. The RFM index was calculated for each of the 61 participating subjects (29 females and 32 males, ages 20–37 years). The RFM was then regressed against each of the four body composition methods for estimating FM%. Results Compared with BMI, RFM was a better predictor of FM% determined by each of the body composition methods. In terms of precision the best equation was RFM regressed against DXA (y = 1.12 + 0.99 x; R2 = 0.84 p<0.001). Accuracy (represented by the closeness to the zero-intercept) was 1.12 (95% CI: -2.44, to 4.68) and thus, not significantly different from zero. For the rest of the methods, precision in the prediction of FM% was improved compared to BMI, with significant increases in the R2 and reduction of the root mean squared error (RMSE). However, the intercepts of each regression did not show accuracy since they were different from zero, for ADP: -9.95 (95%CI: -15.7 to -4.14), for BIA: -12.6 (95%CI: -17.5 to -7.74) and for the 4C model: -13.6 (95%CI: -18.6 to -8.60). Irrespectively, FM% measured by each of the body composition methods was higher for DXA than the other three methods (p<0.001). Conclusions This external validation proved that the performance of the RFM equation used in this study to estimate FM% was more consistent than BMI in this Mexican population, showing a stronger correlation with DXA than with the other body composition methods.
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The Effect of Bariatric Surgery Prior to Lower-Extremity Total Joint Arthroplasty: A Systematic Review. HSS J 2019; 15:190-200. [PMID: 31327952 PMCID: PMC6609675 DOI: 10.1007/s11420-019-09674-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 01/22/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Obesity is an independent risk factor for osteoarthritis and has been associated with increased rate of complications following lower-extremity total joint arthroplasty (TJA). Bariatric surgery (BS) is a surgical option for weight loss and for reducing obesity-related comorbidities in morbidly obese patients. PURPOSE/QUESTIONS The goal of this systematic review was to answer the following questions: (1) Does BS prior to TJA correlate with lower post-operative complication rates in morbidly obese patients undergoing TJA? (2) Does BS have an impact on revision rates following TJA? METHODS Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and checklist, a systematic review of medical databases (PubMed/ MEDLINE, Cochrane Library, Web of Science, and Clinicaltrials.gov) was undertaken for articles published in English from January 1990 to September 2018. Inclusion criteria were studies that included at least ten patients who underwent BS prior to TJA, collected data on complications or other outcomes, and followed patients for at least 90 days after TJA. A descriptive and critical analysis of the results was performed. RESULTS From 799 studies, 13 met inclusion criteria. A total of 11,770 patients who had undergone bariatric surgery prior to TJA were analyzed. The quality of the evidence ranged between moderate and high. There was no consensus on the effect of previous BS on early- to short-term outcomes reported after TJA. CONCLUSION The literature remains conflicted on the impact of BS prior to TJA on early, short-term, and long-term complications after TJA. Additional well-matched, observational studies may further our understanding of the impact of BS prior to TJA on outcomes. In particular the effect of various types of BS prior to TJA on outcomes has yet to be elucidated. Ideally, prospective studies with higher level of evidence will be more definitive on the effects of BS prior to TJA.Prospero Registration Number: CRD42016043025.
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Di F, Liu J, Li S, Hong Y, Chen ZJ, Du Y. Activating transcriptional factor 4 correlated with obesity and insulin resistance in polycystic ovary syndrome. Gynecol Endocrinol 2019; 35:351-355. [PMID: 30382797 DOI: 10.1080/09513590.2018.1527307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
PCOS is a systemic disorder that is commonly characterized by insulin resistance (IR). ATF4 participates in the regulation of energy homeostasis and glucose metabolism, but its role in PCOS remains unclear. In this study, we found that ATF4 was highly expressed in human granulosa cells (hGCs) of PCOS patients with obesity and IR. Thus, we performed Spearman's correlation analysis to further investigate the correlation between ATF4 expression and obesity, lipometabolic disorders, or IR in PCOS. We found that increased ATF4 was an important trigger for lipid accumulation and abnormal insulin signal transduction in PCOS. In cultured KGN cells, insulin positively regulated the mRNA and protein abundance of ATF4. Overexpression of ATF4 significantly impaired insulin-stimulated phosphorylation of AKT. Collectively, our findings provided a novel insight into the molecular mechanisms underlying the occurrence and development of PCOS, implying that ATF4 may be a new molecular target for PCOS therapy.
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Affiliation(s)
- Fangfang Di
- a Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine , Shanghai Jiao Tong University , Shanghai , China
- b Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics , Shanghai , China
| | - Jiansheng Liu
- a Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine , Shanghai Jiao Tong University , Shanghai , China
- b Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics , Shanghai , China
| | - Shang Li
- a Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine , Shanghai Jiao Tong University , Shanghai , China
- b Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics , Shanghai , China
| | - Yan Hong
- a Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine , Shanghai Jiao Tong University , Shanghai , China
- b Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics , Shanghai , China
| | - Zi-Jiang Chen
- a Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine , Shanghai Jiao Tong University , Shanghai , China
- b Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics , Shanghai , China
- c National Research Center for Assisted Reproductive Technology and Reproductive Genetics, The Key Laboratory for Reproductive Endocrinology of Ministry of Education, Shandong Provincial Hospital , Shandong University , Jinan , China
- d Shandong Provincial Key Laboratory of Reproductive Medicine, Center for Reproductive Medicine, Shandong Provincial Hospital , Shandong University , Jinan , China
| | - Yanzhi Du
- a Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine , Shanghai Jiao Tong University , Shanghai , China
- b Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics , Shanghai , China
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Kass-Iliyya A, Hashim H. Nocturnal polyuria: Literature review of definition, pathophysiology, investigations and treatment. JOURNAL OF CLINICAL UROLOGY 2019. [DOI: 10.1177/2051415818756792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Nocturnal polyuria (NP) is characterised by increased urine production overnight in comparison to daytime. It has significant adverse events in adults including reduced quality of life, increased risk of falls and increased mortality.Although NP can be a manifestation of other significant conditions like heart failure and sleep apnoea, there are lots of unanswered questions about NP. What is the underlying pathophysiology? Is NP a physiological manifestation of ageing? Is the circadian change of vasopressin release the primary pathology? Or is it a secondary phenomenon to a low diurnal production of urine? Is the primary pathology at the kidney level or is there another humoral, cardiac, or endovascular element? In this article, we summarise the available English-language literature on the subject of NP, including its epidemiology, pathogenesis, diagnosis and treatment.Level of evidence: Not applicable for this multicentre audit.
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Affiliation(s)
- Antoine Kass-Iliyya
- Urology Department, Bristol Urological Institute, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Hashim Hashim
- Urology Department, Bristol Urological Institute, Southmead Hospital, Bristol, BS10 5NB, UK
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Burke SJ, Batdorf HM, Burk DH, Noland RC, Eder AE, Boulos MS, Karlstad MD, Collier JJ. db/ db Mice Exhibit Features of Human Type 2 Diabetes That Are Not Present in Weight-Matched C57BL/6J Mice Fed a Western Diet. J Diabetes Res 2017; 2017:8503754. [PMID: 29038790 PMCID: PMC5606106 DOI: 10.1155/2017/8503754] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/24/2017] [Accepted: 07/25/2017] [Indexed: 12/19/2022] Open
Abstract
To understand features of human obesity and type 2 diabetes mellitus (T2D) that can be recapitulated in the mouse, we compared C57BL/6J mice fed a Western-style diet (WD) to weight-matched genetically obese leptin receptor-deficient mice (db/db). All mice were monitored for changes in body composition, glycemia, and total body mass. To objectively compare diet-induced and genetic models of obesity, tissue analyses were conducted using mice with similar body mass. We found that adipose tissue inflammation was present in both models of obesity. In addition, distinct alterations in metabolic flexibility were evident between WD-fed mice and db/db mice. Circulating insulin levels are elevated in each model of obesity, while glucagon was increased only in the db/db mice. Although both WD-fed and db/db mice exhibited adaptive increases in islet size, the db/db mice also displayed augmented islet expression of the dedifferentiation marker Aldh1a3 and reduced nuclear presence of the transcription factor Nkx6.1. Based on the collective results put forth herein, we conclude that db/db mice capture key features of human T2D that do not occur in WD-fed C57BL/6J mice of comparable body mass.
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Affiliation(s)
- Susan J. Burke
- Laboratory of Immunogenetics, Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA
| | - Heidi M. Batdorf
- Laboratory of Islet Biology and Inflammation, Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA
- Skeletal Muscle Metabolism Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA
| | - David H. Burk
- Cell Biology and Bioimaging Core Facility, Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA
| | - Robert C. Noland
- Skeletal Muscle Metabolism Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA
| | - Adrianna E. Eder
- Department of Surgery, Graduate School of Medicine, University of Tennessee Health Science Center, Knoxville, TN 37920, USA
| | - Matthew S. Boulos
- Department of Surgery, Graduate School of Medicine, University of Tennessee Health Science Center, Knoxville, TN 37920, USA
| | - Michael D. Karlstad
- Department of Surgery, Graduate School of Medicine, University of Tennessee Health Science Center, Knoxville, TN 37920, USA
| | - J. Jason Collier
- Laboratory of Islet Biology and Inflammation, Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA
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Cheng X, Wu JW, Sun P, Song ZF, Zheng QC. Initial 12-h operative fluid volume is an independent risk factor for pleural effusion after hepatectomy. ACTA ACUST UNITED AC 2016; 36:859-864. [PMID: 27924511 DOI: 10.1007/s11596-016-1675-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 06/28/2016] [Indexed: 11/28/2022]
Abstract
Pleural effusion after hepatectomy is associated with significant morbidity and prolonged hospital stays. Several studies have addressed the risk factors for postoperative pleural effusion. However, there are no researches concerning the role of the initial 12-h operative fluid volume. The aim of this study was to evaluate whether the initial 12-h operative fluid volume during liver resection is an independent risk factor for pleural effusion after hepatectomy. In this study, we retrospectively analyzed clinical data of 470 patients consecutively undergoing elective hepatectomy between January 2011 and December 2012. We prospectively collected and retrospectively analyzed baseline and clinical data, including preoperative, intraoperative, and postoperative variables. Univariate and multivariate analyses were carried out to identify whether the initial 12-h operative fluid volume was an independent risk factor for pleural effusion after hepatectomy. The multivariate analysis identified 2 independent risk factors for pleural effusion: operative time [odds ratio (OR)=10.2] and initial 12-h operative fluid volume (OR=1.0003). Threshold effect analyses revealed that the initial 12 h operative fluid volume was positively correlated with the incidence of pleural effusion when the initial 12-h operative fluid volume exceeded 4636 mL. We conclude that the initial 12-h operative fluid volume during liver resection and operative time are independent risk factors for pleural effusion after hepatectomy. Perioperative intravenous fluids should be restricted properly.
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Affiliation(s)
- Xiang Cheng
- Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Jia-Wei Wu
- Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Ping Sun
- Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Zi-Fang Song
- Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Qi-Chang Zheng
- Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Villard C, Eriksson P, Kronqvist M, Lengquist M, Jorns C, Hartman J, Roy J, Hultgren R. Differential expression of sex hormone receptors in abdominal aortic aneurysms. Maturitas 2016; 96:39-44. [PMID: 28041593 DOI: 10.1016/j.maturitas.2016.11.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 10/30/2016] [Accepted: 11/08/2016] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Male sex is a significant risk factor for abdominal aortic aneurysm (AAA). Female sex hormones have been reported to prevent aneurysm formation in animal models. The study aims to describe the expression profile of sex hormone receptors in the aneurysm wall of men and women with AAA and compare with unaffected controls. METHODS Aneurysm wall biopsies were obtained during elective open repair of AAA in men and women (n=16+16). Aortic vessel wall from controls were obtained at organ donation (n=6). Western blot-, mRNA expression- and immunohistochemical analyses were performed to assess the expression profile of the sex hormone receptors - androgen receptor (AR), progesterone receptor (PR), estrogen receptor α (ERα) and β (ERβ). RESULTS The mRNA- and protein expression levels of AR were higher in AAA compared with control aorta (7.26 vs. 5.14, P=0.001). mRNA- and protein expression levels of ERβ were lower in AAA compared with control aorta (9.15 vs. 12.29, P<0.001). mRNA expression levels of PR were higher in AAA compared with control aorta (8.73 vs. 6.21, P=0.003), but could not be confirmed on protein level. The expression profile of sex hormone receptors in men and women with AAA was similar. CONCLUSION Expression of sex hormone receptors differs in the aneurysmal aorta compared with unaffected aorta in men and women. A higher expression of AR and a lower expression of ERβ suggest that sex hormone activity could be associated with aneurysm development.
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Affiliation(s)
- Christina Villard
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden.
| | - Per Eriksson
- Atherosclerosis Research Unit, Center for Molecular Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Malin Kronqvist
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Mariette Lengquist
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Carl Jorns
- Department of Transplant Surgery, CLINTEC, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Johan Hartman
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Joy Roy
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Rebecka Hultgren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
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13
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O’Neill SC, Butler JS, Daly A, Lui DF, Kenny P. Effect of body mass index on functional outcome in primary total knee arthroplasty - a single institution analysis of 2180 primary total knee replacements. World J Orthop 2016; 7:664-669. [PMID: 27795948 PMCID: PMC5065673 DOI: 10.5312/wjo.v7.i10.664] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 06/20/2016] [Accepted: 08/15/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the effect of body mass index (BMI) on short-term functional outcome and complications in primary total knee arthroplasty.
METHODS All patients undergoing primary total knee arthroplasty at a single institution between 2007 and 2013 were identified from a prospective arthroplasty database. 2180 patients were included in the study. Age, gender, BMI, pre- and post-operative functional scores [Western Ontario and McMaster University Arthritis Index (WOMAC) and SF-36], complications and revision rate were recorded. Patients were grouped according to the WHO BMI classification. The functional outcome of the normal weight cohort (BMI < 25) was compared to the overweight and obese (BMI ≥ 25) cohort. A separate sub-group analysis was performed comparing all five WHO BMI groups; Normal weight, overweight, class 1 obese, class 2 obese and class 3 obese.
RESULTS With a mean age of 67.89 (28-92), 2180 primary total knee replacements were included. 64.36% (1403) were female. The mean BMI was 31.86 (18-52). Ninty-three percent of patients were either overweight or obese. Mean follow-up 19.33 mo (6-60 mo). There was no significant difference in pre or post-operative WOMAC score in the normal weight (BMI < 25) cohort compared to patients with a BMI ≥ 25 (P > 0.05). Sub-group analysis revealed significantly worse WOMAC scores in class 2 obese 30.80 compared to overweight 25.80 (P < 0.01) and class 1 obese 25.50 (P < 0.01). Similarly, there were significantly worse SF-36 scores in class 2 obese 58.16 compared to overweight 63.93 (P < 0.01) and class 1 obese 63.65 (P < 0.01) There were 32 (1.47%) superficial infections, 9 (0.41%) deep infections and 19 (0.87%) revisions overall with no complications or revisions in the normal weight cohort (BMI < 25).
CONCLUSION Post-operative functional outcome was not influenced by BMI comparing normal weight individuals with BMI > 25. Patients should not be denied total knee arthroplasty based solely on weight alone.
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Grano GF, Pavlidou M, Todesco A, Palermo A, Molfetta L. A new anterolateral surgical approach for total hip replacement. JOINTS 2016; 4:148-152. [PMID: 27900306 DOI: 10.11138/jts/2016.4.3.148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE the purpose of the present paper is to present the short-term results of a "detachment-free" (DF) anterolateral approach for primary total hip replacement (THR) performed in a large series of patients. METHODS two hundred patients submitted to primary THR were retrospectively reviewed for the present study. In all cases, the surgery was performed using a minimally invasive DF anterolateral approach, which entails no disconnection of tendons and no muscle damage. The study population consisted of 96 men (48%) and 104 women (52%), with an average age of 69.4 years (range 38-75). Clinical and radiographic follow-up was performed after 12 months. RESULTS the clinical results, evaluated using the Harris Hip Score, were excellent in 95% of the cases and good in 5%; no cases had fair or poor results. X-rays taken at 3, 6 and 12 months after surgery did not show heterotopic ossification, mobilization of the prosthetic components, or hip dislocation. No infections, deep vein thrombosis, or failure of the gluteal muscles were reported. CONCLUSIONS the DF anterolateral approach for THR proved safe and provided effective results at short-term follow-up. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Giovanni F Grano
- Orthopaedic Unit and Regional Hip Surgery Center, Hospital of Cittadella, Italy
| | - Maria Pavlidou
- Orthopaedic Unit and Regional Hip Surgery Center, Hospital of Cittadella, Italy
| | - Alberto Todesco
- Orthopaedic Unit and Regional Hip Surgery Center, Hospital of Cittadella, Italy
| | | | - Luigi Molfetta
- School of Medical and Pharmacological Sciences, Research Center of Osteoporosis and Osteoarticular Diseases, University of Genova, Genova, Italy
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Cypel YS, Hamlett-Berry K, Barth SK, Christofferson DE, Davey VJ, Eber S, Schneiderman AI, Bossarte RM. Cigarette Smoking and Sociodemographic, Military, and Health Characteristics of Operation Enduring Freedom and Operation Iraqi Freedom Veterans: 2009-2011 National Health Study for a New Generation of US Veterans. Public Health Rep 2016; 131:714-727. [PMID: 28123213 DOI: 10.1177/0033354916664864] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE We examined the sociodemographic, military, and health characteristics of current cigarette smokers, former smokers, and nonsmokers among Operation Enduring Freedom (OEF) / Operation Iraqi Freedom (OIF) veterans and estimated smoking prevalence to better understand cigarette use in this population. METHODS We analyzed data from the US Department of Veterans Affairs (VA) 2009-2011 National Health Study for a New Generation of US Veterans. On the basis of a stratified random sample of 60 000 OEF/OIF veterans, we sought responses to a 72-item questionnaire via mail, telephone, or Internet. Cigarette smoking status was based on self-reported cigarette use in the past year. We used multinomial logistic regression to evaluate associations between smoking status and sociodemographic, military, and health characteristics. RESULTS Among 19 911 veterans who provided information on cigarette smoking, 5581 were current smokers (weighted percentage: 32.5%, 95% confidence interval [CI]: 31.7-33.2). Current smokers were more likely than nonsmokers or former smokers to be younger, to have less education or income, to be separated/divorced or never married/single, and to have served on active duty or in the army. Comparing current smokers and nonsmokers, some significant associations from adjusted analyses included the following: having a Mental Component Summary score (a measure of overall mental health) above the mean of the US population relative to below the mean (adjusted odds ratio [aOR] = 0.81, 95% CI: 0.73-0.90); having physician-diagnosed depression (aOR = 1.52, 95% CI: 1.33-1.74), respiratory conditions (aOR = 1.16, 95% CI: 1.04-1.30), or repeated seizures/blackouts/convulsions (aOR = 1.80, 95% CI: 1.22-2.67); heavy alcohol use vs never use (aOR = 5.49, 95% CI: 4.57-6.59); a poor vs excellent perception of overall health (aOR = 3.79, 95% CI: 2.60-5.52); and being deployed vs nondeployed (aOR = 0.87, 95% CI: 0.78-0.96). Using health care services from the VA protected against current smoking. CONCLUSION Mental and physical health, substance use, and military service characteristics shape cigarette-smoking patterns in OEF/OIF veterans.
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Affiliation(s)
- Yasmin S Cypel
- US Department of Veterans Affairs, Veterans Health Administration, Office of Patient Care Services, Post-Deployment Health Services, Washington, DC, USA
| | - Kim Hamlett-Berry
- US Department of Veterans Affairs, Veterans Health Administration, Office of Patient Care Services, Mental Health Services, Washington, DC, USA
| | - Shannon K Barth
- US Department of Veterans Affairs, Veterans Health Administration, Office of Patient Care Services, Post-Deployment Health Services, Washington, DC, USA
| | - Dana E Christofferson
- US Department of Veterans Affairs, Veterans Health Administration, Office of Patient Care Services, Mental Health Services, Washington, DC, USA
| | - Victoria J Davey
- US Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Washington, DC, USA
| | - Stephanie Eber
- US Department of Veterans Affairs, Veterans Health Administration, Office of Patient Care Services, Post-Deployment Health Services, Washington, DC, USA
| | - Aaron I Schneiderman
- US Department of Veterans Affairs, Veterans Health Administration, Office of Patient Care Services, Post-Deployment Health Services, Washington, DC, USA
| | - Robert M Bossarte
- US Department of Veterans Affairs, Veterans Health Administration, Office of Patient Care Services, Post-Deployment Health Services, Washington, DC, USA
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Intrapair Comparison of Life-Course Appetite and Physical Activity in Elderly Danish Twins: Reliability and Association With Subsequent Survival. Twin Res Hum Genet 2016; 19:447-55. [PMID: 27485765 DOI: 10.1017/thg.2016.56] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Avoiding overeating and being physically active is associated with healthy aging, but methodological issues challenge the quantification of the association. Intrapair comparison of twins is a study design that attempts to minimize social norm-driven biased self-reporting of lifestyle factors. We aimed to investigate the association between self-reported lifestyle factors and subsequent survival in 347 Danish twin pairs aged 70 years and older and, additionally, to investigate the reliability of these self-reports. The twins were interviewed in 2003 and followed for mortality until 2015. They were asked to compare their appetite and physical activity to that of their co-twins in different stages of life. On an individual level, we found a positive association between current self-reported physical activity and late-life survival for elderly twins. This was supported by the intrapair analyses, which revealed a positive association between midlife and current physical activity and late-life survival. A positive association between lower appetite and late-life survival was found generally over the life course in the individual level analyses but not in the intrapair analyses. Kappa values for the inter-twin agreement on who ate the most were 0.16 to 0.34 in different life stages, and for physical activity 0.19 to 0.26, corresponding to a slight-to-fair agreement. Approximately, 50% of the twin pairs were not in agreement regarding physical activity, and of these twins 75% (95% CI: 67-82%) considered themselves the most active twin. These findings indicate a still-existing tendency of answering according to social norms, even in a twin study designed to minimize this.
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17
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Bagsby DT, Issa K, Smith LS, Elmallah RK, Mast LE, Harwin SF, Mont MA, Bhimani SJ, Malkani AL. Cemented vs Cementless Total Knee Arthroplasty in Morbidly Obese Patients. J Arthroplasty 2016; 31:1727-31. [PMID: 26895823 DOI: 10.1016/j.arth.2016.01.025] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 01/04/2016] [Accepted: 01/11/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Primary total knee arthroplasty (TKA) in morbidly obese patients has been associated with greater postoperative complications. Cementless TKA has the potential for biologic fixation which may provide more durable long-term stability. METHODS This was a multicenter review of 298 TKAs in 292 morbidly obese patients (body mass index, >40) undergoing TKA, with 154 TKAs (149 patients) in the cemented and 144 TKAs (143 patients) in the cementless group. RESULTS There were significantly more revisions in the cemented group (n = 20) than in the cementless group (n = 1; 13.0% vs 0.7%). There was a significantly higher incidence of aseptic loosening in the cemented cohort vs the cementless cohort (9 vs 0 TKAs). All revisions in the cementless cohort were due to infection (0.7%). CONCLUSION Cementless fixation may be an alternative in the morbidly obese patient undergoing primary TKA.
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Affiliation(s)
- Deren T Bagsby
- Department of Orthopedics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Kimona Issa
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Langan S Smith
- Jewish Physicians Group, KentuckyOne Health, Louisville, Kentucky
| | - Randa K Elmallah
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Logan E Mast
- Department of Orthopedics, University of Louisville, Louisville, Kentucky
| | | | - Michael A Mont
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | | | - Arthur L Malkani
- Department of Orthopedics, University of Louisville, Louisville, Kentucky
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18
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Al Snih S, Ray L, Markides KS. Prevalence of Self-Reported Arthritis Among Elders From Latin America and the Caribbean and Among Mexican Americans From the Southwestern United States. J Aging Health 2016; 18:207-23. [PMID: 16614341 DOI: 10.1177/0898264305285661] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study examines the prevalence of self-reported arthritis and arthritis symptoms and their relationship to functional limitations in elders from Latin America and the Caribbean and in Mexican Americans from the southwestern United States. This study includes 8,122 elderly aged 60 and older from seven Latin America and Caribbean countries and 2,580 noninstitutionalized Mexican Americans aged 65 or older residing in the southwestern United States. The estimated prevalence of self-reported arthritis ranged from 23.8% in Mexico City to 55.6% in Havana. The prevalence of self-reported pain among arthritic subjects across all countries ranged from 30.7% in older Mexican Americans to 83.7% in Santiago. Arthritis was independently associated with any Activities of Daily Living and any Instrumental Activities of Daily Living limitation across the eight countries after controlling for relevant factors. Self-reported arthritis and arthritis symptoms are highly prevalent among elders from Latin America and the Caribbean and older Mexican Americans and is a significant cause of disability in all studied populations.
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Affiliation(s)
- Soham Al Snih
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX 77555-0460, USA.
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19
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Pal S, Egger G, Wright G. Dealing with Obesity: An Australian Perspective. Asia Pac J Public Health 2016; 15 Suppl:S33-6. [PMID: 18924539 DOI: 10.1177/101053950301500s09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Over half of all Australians are classified as overweight or obese and this is increasing by 1% of the population per year. Obesity is linked with a range of health ailments including type 2 diabetes, heart diseases and some cancers. At a population level it is well accepted that obesity is a result of the increasing use of modern technology, resulting in decreased energy expenditure, in combination with easily available high energy density foods, the “obesogenic environment”. In the modern environment, there are two major areas of management to assist the overweight and obese. Both include a change in lifestyle. Future strategies in weight management should include reduction in energy density and increase in daily physical activity.
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Affiliation(s)
- S Pal
- Department of Nutrition, Dietetics and Food Sciences, Curtin University of Technology, Perth, Western Australia
| | - G Egger
- School of Health Sciences, Deakin University, Melbourne, Australia
| | - G Wright
- Lifechoice Clinic, Perth Australia
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20
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Daniilidis K, Yao D, Gosheger G, Berssen C, Budny T, Dieckmann R, Höll S. Does BMI influence clinical outcomes after total knee arthroplasty? Technol Health Care 2016; 24:367-75. [DOI: 10.3233/thc-151128] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Kiriakos Daniilidis
- Department of Orthopaedic Surgery, Annastift Hannover (Medical School Hannover, MHH), Germany
| | - Daiwei Yao
- Department of Orthopaedic Surgery, Annastift Hannover (Medical School Hannover, MHH), Germany
| | - Georg Gosheger
- Department of General Orthopaedics, Tumororthopaedics University Hospital Muenster, Germany
| | - Corinna Berssen
- Department of General Orthopaedics, Tumororthopaedics University Hospital Muenster, Germany
| | - Tymoteusz Budny
- Department of General Orthopaedics, Tumororthopaedics University Hospital Muenster, Germany
| | - Ralf Dieckmann
- Department of General Orthopaedics, Tumororthopaedics University Hospital Muenster, Germany
| | - Steffen Höll
- Department of General Orthopaedics, Paracelsus Hospital Osnabrück, Germany
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21
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Consistency between Self-Reported and Recorded Values for Clinical Measures. Cardiol Res Pract 2016; 2016:4364761. [PMID: 26942034 PMCID: PMC4752969 DOI: 10.1155/2016/4364761] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 12/31/2015] [Indexed: 01/22/2023] Open
Abstract
Objectives. This study evaluated consistency between self-reported values for clinical measures and recorded clinical measures. Methods. Self-reported values were collected for the clinical measures: systolic blood pressure, diastolic blood pressure, glucose level, height, weight, and cholesterol from health risk assessments completed by enrollees in a privately insured cohort. Body mass index (BMI) was computed from reported height and weight. Practitioner recorded values for the clinical measures were obtained from health screenings. We used bivariate Pearson correlation analysis and descriptive statistics to evaluate consistency between self-reported data and recorded clinic measurements. Results. There was high correlation between self-reported clinical values and recorded clinical measures for diastolic blood pressure (r = 0.91, P = <0.0001), systolic blood pressure (r = 0.93, P = <0.0001), cholesterol (r = 0.97, P = <0.0001), body mass index (r = 0.96, P = <0.0001), glucose (r = 0.96, P = <0.0001), weight (r = 0.98, P = <0.0001), and height (r = 0.89, P = <0.0001). Conclusions. Self-reported clinical values for each of the eight clinical measures examined had good consistency with practitioner recorded data.
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22
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Briana DD, Baka S, Boutsikou M, Boutsikou T, Xagorari M, Gourgiotis D, Malamitsi-Puchner A. Cord blood copeptin concentrations in fetal macrosomia. Metabolism 2016; 65:89-94. [PMID: 26477270 DOI: 10.1016/j.metabol.2015.09.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 09/12/2015] [Accepted: 09/19/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND/AIM Excessive fetal growth is associated with increased adiposity and reduced insulin sensitivity at birth. Copeptin, a surrogate marker of arginine vasopressin (AVP) secretion, is upregulated in states of hyperinsulinemia and is considered one of the mediators of insulin resistance. We aimed to investigate cord blood concentrations of copeptin (C-terminal fragment of AVP pro-hormone) in healthy large-for-gestational-age (LGA) infants at term. METHODS This prospective study was conducted on 30 LGA (n=30) and 20 appropriate-for-gestational-age (AGA, n=20) singleton full-term healthy infants. Cord blood copeptin and insulin concentrations were determined by ELISA and IRMA, respectively. Infants were classified as LGA or AGA, based on customized birth-weight standards adjusted for significant determinants of fetal growth. RESULTS Cord blood copeptin concentrations were similar in LGA cases, compared to AGA controls, after adjusting for delivery mode. However, in the LGA group, cord blood copeptin concentrations positively correlated with birth-weight (r=0.422, p=0.020). In the AGA group, cord blood copeptin concentrations were elevated in cases of vaginal delivery vs elective cesarean section (p=0.003). Cord blood insulin concentrations were higher in LGA cases, compared to AGA controls (p=0.036). No association was recorded between cord blood copeptin concentrations and maternal age, parity, gestational age or fetal gender in both groups. CONCLUSIONS Cord blood copeptin concentrations may not be up-regulated in non-distressed LGA infants. However, the positive correlation between cord blood copeptin concentrations and birth-weight in the LGA group may point to the documented association between AVP release and increased fat deposition. Vaginal delivery vs elective cesarean section is accompanied by a marked stress-related increase of cord blood copeptin concentrations.
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Affiliation(s)
- Despina D Briana
- Department of Neonatology, Athens University Medical School, Athens, Greece
| | - Stavroula Baka
- Department of Neonatology, Athens University Medical School, Athens, Greece
| | - Maria Boutsikou
- Department of Neonatology, Athens University Medical School, Athens, Greece
| | - Theodora Boutsikou
- Department of Neonatology, Athens University Medical School, Athens, Greece
| | - Marieta Xagorari
- Laboratory of Clinical Biochemistry-Molecular Diagnostics, 2nd Department of Pediatrics, Athens University Medical School, Athens, Greece
| | - Dimitrios Gourgiotis
- Laboratory of Clinical Biochemistry-Molecular Diagnostics, 2nd Department of Pediatrics, Athens University Medical School, Athens, Greece
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23
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The Utility of Increased Constraint in Primary Total Knee Arthroplasty for Obese Patients. Orthop Clin North Am 2016; 47:51-5. [PMID: 26614920 DOI: 10.1016/j.ocl.2015.08.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Total knee arthroplasty (TKA) for obese patient entails more preoperative comorbidities and complications, and shorter longevity. This article is a retrospective review comparing longevity of the constrained implant with a standard prosthesis. Patient-specific data, Knee Society Scores, complications, and revisions were recorded and compared. No statistical differences were found. The constrained condylar knee for obese patients improves the intramedullary alignment of the prosthesis and supports the surrounding soft tissues. The clinical results are similar to a standard implant in the nonobese with similar longevity at midterm follow-up.
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24
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Tabak RG, Hipp JA, Marx CM, Yang L, Brownson RC. Which worksite supports for healthy weight do employees use? ENVIRONMENT AND BEHAVIOR 2016; 48:131-149. [PMID: 26924850 PMCID: PMC4767399 DOI: 10.1177/0013916515607311] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This paper explores factors associated with employee use of available supports for improving nutrition and activity behaviors. A cross-sectional telephone-survey assessed presence and use of available program, facility, and policy supports. Logistic regression was used to explore associations between job characteristics (e.g., supervising others) and use of available supports, adjusting for demographic characteristics. After adjustment, most supports were associated with at least one job-related factor. Participants supervising others were more likely to utilize eight supports including personal services for fitness, indoor exercise and shower facilities, and flextime for physical activity. The programs and facilities associated with the most factors were health fairs (e.g., increased likelihood with increased hours worked/week) and indoor exercise and shower facilities (e.g., increased likelihood with increased flexibility at work), respectively. Policies were associated with fewer factors. Since use of many programs and facilities differed based on job-related factors, employers might target supports based on job-related factors.
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Affiliation(s)
- Rachel G. Tabak
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, Missouri, United States of America
| | - J. Aaron Hipp
- Department of Parks, Recreation, and Tourism Management, College of Natural Resources, North Carolina State University, Raleigh, North Carolina, United States of America
| | - Christine M. Marx
- Division of Public Health Sciences, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Lin Yang
- Division of Public Health Sciences, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Ross C. Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, Missouri, United States of America
- Division of Public Health Sciences and Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, United States of America
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25
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Baka S, Malamitsi-Puchner A, Boutsikou T, Boutsikou M, Marmarinos A, Hassiakos D, Gourgiotis D, Briana DD. Cord blood irisin at the extremes of fetal growth. Metabolism 2015; 64:1515-20. [PMID: 26307660 DOI: 10.1016/j.metabol.2015.07.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 07/19/2015] [Accepted: 07/23/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND/AIMS Irisin, a novel myokine with antiobesity properties, drives brown-fat-like conversion of white adipose tissue, thus increasing energy expenditure and improving glucose tolerance. We aimed to investigate circulating irisin concentrations in large-for-gestational-age (LGA) and intrauterine-growth-restricted (IUGR) fetuses, both associated with metabolic dysregulation and long-term susceptibility to obesity and metabolic syndrome development. METHODS Plasma irisin and insulin concentrations were determined by ELISA and IRMA, respectively, in 80 mixed arteriovenous cord blood samples from LGA (n=30), IUGR (n=30) and appropriate-for-gestational-age (AGA, n=20) singleton full-term pregnancies. Fetuses were classified as LGA, IUGR or AGA, based on customized birth-weight standards adjusted for significant determinants of fetal growth. RESULTS Fetal irisin concentrations were lower in IUGR cases than AGA controls (p=0.031). Cord blood irisin concentrations were similar in LGA and AGA groups and positively correlated with birth-weight, as well as customized centiles (r=0.245, p=0.029 and r=0.247, p=0.027, respectively). Insulin concentrations were higher in LGA, compared to AGA fetuses (p=0.036). In the LGA group, fetal irisin concentrations positively correlated with fetal insulin concentrations (r=0.374, p=0.042). CONCLUSIONS Impaired skeletal muscle metabolism in IUGR fetuses may account for their irisin deficiency, which may be part of the fetal programming process, leading to increased susceptibility to later metabolic syndrome development. Furthermore, irisin down-regulation may predispose IUGR infants to hypothermia at birth, by inducing less "browning" of their adipose tissue and consequently less non-shivering thermogenesis. Irisin upregulation with increasing birth-weight may contribute to a slower fat gain during early infancy ("catch-down"), by promoting higher total energy expenditure. The positive correlation between irisin and insulin in the LGA group may reflect a counterbalance of the documented hyperinsulinemia, which is partly responsible for the excessive fat deposition in the LGA fetus.
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Affiliation(s)
- Stavroula Baka
- Department of Neonatology, Athens University Medical School, Athens, Greece
| | | | - Theodora Boutsikou
- Department of Neonatology, Athens University Medical School, Athens, Greece
| | - Maria Boutsikou
- Department of Neonatology, Athens University Medical School, Athens, Greece
| | - Antonios Marmarinos
- Laboratory of Clinical Biochemistry-Molecular Diagnostics, 2nd Department of Pediatrics, Athens University Medical School, Athens, Greece
| | | | - Dimitrios Gourgiotis
- Laboratory of Clinical Biochemistry-Molecular Diagnostics, 2nd Department of Pediatrics, Athens University Medical School, Athens, Greece
| | - Despina D Briana
- Department of Neonatology, Athens University Medical School, Athens, Greece
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Kokudo T, Uldry E, Demartines N, Halkic N. Risk factors for incisional and organ space surgical site infections after liver resection are different. World J Surg 2015; 39:1185-92. [PMID: 25561190 DOI: 10.1007/s00268-014-2922-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Surgical site infection (SSI) is a common cause of major morbidity after liver resection. This study aimed to identify the risk factors for incisional and organ/space SSIs after liver resection. METHODS Our liver surgery database was retrospectively analyzed for patients treated between January 2009 and November 2012 in a tertiary care Swiss hospital. Univariate and multivariate analyses were conducted on preoperative, intraoperative, and postoperative variables to identify risk factors for incisional and organ/space SSIs. RESULTS In a total of 226 patients, SSI incidences were 12.8 % (incisional), 4.0 % (organ/space), and 1.8 % (both). Univariate analysis showed that incisional SSIs were associated with high American Society of Anesthesiologists (ASA) scores, preoperative anemia, hypoalbuminemia, low prothrombin time, viral or alcoholic chronic hepatitis, liver cirrhosis, and prolonged operation times. Organ/space SSIs were associated with high rates of red blood cell transfusions, concomitant bowel surgery, and prolonged operation times. Multivariate analysis revealed that risk factors for incisional SSIs were anemia [odds ratio (OR) 2.82], high ASA scores (OR 2.88), presence of hepatitis or cirrhosis (OR 5.07), and prolonged operation times (OR 9.61). The only risk factor for organ/space SSIs was concomitant bowel surgery (OR 5.53). Hospital stays were similar in organ/space and incisional SSI groups, but significantly longer for those with both organ/space and incisional SSIs. CONCLUSIONS High ASA scores, anemia, chronic hepatitis or liver cirrhosis, and prolonged operations increased the risk of incisional SSIs; concomitant bowel surgery increased the risk of organ/space SSI. Specific precautions to prevent organ/space and incisional SSIs may shorten hospital stays.
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Affiliation(s)
- Takashi Kokudo
- Department of Visceral Surgery, University Hospital CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland,
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Yang L, Hipp JA, Adlakha D, Marx CM, Tabak RG, Brownson RC. Choice of commuting mode among employees: Do home neighborhood environment, worksite neighborhood environment, and worksite policy and supports matter? JOURNAL OF TRANSPORT & HEALTH 2015; 2:212-218. [PMID: 26085979 PMCID: PMC4465081 DOI: 10.1016/j.jth.2015.02.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
BACKGROUND Promoting the use of public transit and active transport (walking and cycling) instead of car driving is an appealing strategy to increase overall physical activity. PURPOSE To quantify the combined associations between self-reported home and worksite neighborhood environments, worksite support and policies, and employees' commuting modes. METHOD Between 2012 and 2013, participants residing in four Missouri metropolitan areas were interviewed via telephone (n = 1,338) and provided information on socio-demographic characteristics, home and worksite neighborhoods, and worksite support and policies. Commuting mode was self-reported and categorized into car driving, public transit, and active commuting. Commuting distance was calculated using geographic information systems. Commuters providing completed data were included in the analysis. Multivariate logistic regression models were used to examine the correlates of using public transit and active commuting. RESULT The majority of participants reported commuting by driving (88.9%); only 4.9% used public transit and 6.2% used active modes. After multivariate adjustment, having transit stops within 10-15 minutes walking distance from home (p=0.05) and using worksite incentive for public transit (p<0.001) were associated with commuting by public transit. Commuting distance (p<0.001) was negatively associated with active commuting. Having free or low cost recreation facilities around the worksite (p=0.04) and using bike facilities to lock bikes at the worksite (p<0.001) were associated with active commuting. CONCLUSION Both environment features and worksite supports and policies are associated with the choice of commuting mode. Future studies should use longitudinal designs to investigate the potential of promoting alternative commuting modes through worksite efforts that support sustainable commuting behaviors as well as the potential of built environment improvements.
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Affiliation(s)
- Lin Yang
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, USA
| | - J. Aaron Hipp
- Brown School, Washington University in St. Louis, USA
- Prevention Research Center in St. Louis, Washington University in St. Louis, USA
| | | | - Christine M. Marx
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, USA
| | - Rachel G. Tabak
- Brown School, Washington University in St. Louis, USA
- Prevention Research Center in St. Louis, Washington University in St. Louis, USA
| | - Ross C. Brownson
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, USA
- Brown School, Washington University in St. Louis, USA
- Prevention Research Center in St. Louis, Washington University in St. Louis, USA
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, USA
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Tabak RG, Hipp JA, Marx CM, Brownson RC. Workplace social and organizational environments and healthy-weight behaviors. PLoS One 2015; 10:e0125424. [PMID: 25919659 PMCID: PMC4412705 DOI: 10.1371/journal.pone.0125424] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 03/17/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The workplace is an important setting for health promotion including nutrition and physical activity behaviors to prevent obesity. This paper explores the relationship between workplace social environment and cultural factors and diet and physical activity (PA) behaviors and obesity among employees. METHODS Between 2012 and 2013, telephone interviews were conducted with participants residing in four Missouri metropolitan areas. Questions included demographic characteristics, workplace socio/organizational factors related to activity and diet, and individual diet and PA behaviors, and obesity. Multivariate logistic regression was used to examine associations between the workplace socio/organizational environment and nutrition, PA, and obesity. RESULTS There were differences in reported health behaviors and socio/organizational environment by gender, race, age, income, and worksite size. For example, agreement with the statement the 'company values my health' was highest among Whites, older employees, and higher income workers. As worksite size increased, the frequency of reporting seeing co-workers doing several types of healthy behaviors (eat fruits and vegetables, doing PA, and doing PA on breaks at work) increased. In adjusted analyses, employees agreeing the company values my health were more likely to engage in higher PA levels (aOR=1.54, 95% CI: 1.09-2.16) and less likely to be obese (aOR=0.73, 95% CI: 0.54-0.98). Seeing co-workers eating fruits and vegetables was associated with increased reporting of eating at least one vegetable per day (aOR=1.43, 95% CI: 1.06-1.91) and seeing co-workers being active was associated with higher PA levels (aOR 1.56, 95% CI: 1.19-2.05). CONCLUSIONS This research suggests that social/organizational characteristics of the workplace environment, particularly feeling the company values the workers' health and to seeing co-workers engaging in healthy behaviors, may be related to nutrition and PA behaviors and obesity. These findings point to the potential for intervention targets including environment and policy changes.
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Affiliation(s)
- Rachel G. Tabak
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - J. Aaron Hipp
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Christine M. Marx
- Division of Public Health Sciences, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Ross C. Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, Missouri, United States of America
- Division of Public Health Sciences and Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, United States of America
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Boyko EJ, Trone DW, Peterson AV, Jacobson IG, Littman AJ, Maynard C, Seelig AD, Crum-Cianflone NF, Bricker JB. Longitudinal Investigation of Smoking Initiation and Relapse Among Younger and Older US Military Personnel. Am J Public Health 2015; 105:1220-9. [PMID: 25880953 DOI: 10.2105/ajph.2014.302538] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined whether military service, including deployment and combat experience, were related to smoking initiation and relapse. METHODS We included older (panel 1) and younger (panel 2) participants in the Millennium Cohort Study. Never smokers were followed for 3 to 6 years for smoking initiation, and former smokers were followed for relapse. Complementary log-log regression models estimated the relative risk (RR) of initiation and relapse by military exposure while adjusting for demographic, health, and lifestyle factors. RESULTS Deployment with combat experience predicted higher initiation rate (panel 1: RR = 1.44; 95% confidence interval [CI] = 1.28, 1.62; panel 2: RR = 1.26; 95% CI = 1.04, 1.54) and relapse rate (panel 1 only: RR = 1.48; 95% CI = 1.36, 1.62). Depending on the panel, previous mental health disorders, life stressors, and other military and nonmilitary characteristics independently predicted initiation and relapse. CONCLUSIONS Deployment with combat experience and previous mental disorder may identify military service members in need of intervention to prevent smoking initiation and relapse.
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Affiliation(s)
- Edward J Boyko
- Edward J. Boyko, Alyson J. Littman, and Amber D. Seelig are with the Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs (VA) Puget Sound Health Care System, WA. Charles Maynard is with the Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research and Development, VA Puget Sound Health Care System, VA Eastern Colorado, Denver. Daniel W. Trone and Isabel G. Jacobson are with the Department of Defense Center for Deployment Health Research, Naval Health Research Center, San Diego, CA. Nancy F. Crum-Cianflone is with the Naval Medical Center, San Diego, CA. Arthur V. Peterson and Jonathan B. Bricker are with the Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
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Hofmeester I, Kollen BJ, Steffens MG, Bosch JLHR, Drake MJ, Weiss JP, Blanker MH. Impact of the International Continence Society (ICS) report on the standardisation of terminology in nocturia on the quality of reports on nocturia and nocturnal polyuria: a systematic review. BJU Int 2015; 115:520-36. [PMID: 24684483 DOI: 10.1111/bju.12753] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To systematically review and evaluate the impact of the International Continence Society (ICS)-2002 report on standardisation of terminology in nocturia, on publications reporting on nocturia and nocturnal polyuria (NP). In 2002, the ICS defined NP as a Nocturnal Polyuria Index (nocturnal urine volume/total 24-h urine volume) of >0.2-0.33, depending on age. MATERIALS AND METHODS In April 2013 the PubMed and Embase databases were searched for studies (in English, German, French or Dutch) based on original data and adult participants, investigating the relationship between nocturia and NP. A methodological quality assessment was performed, including scores on external validity, internal validity and informativeness. Quality scores of items were compared between studies published before and after the ICS-2002 report. RESULTS The search yielded 78 publications based on 66 studies. Quality scores of studies were generally high for internal validity (median 5, interquartile range [IQR] 4-6) but low for external validity. After publication of the ICS-2002 report, external validity showed a significant change from 1 (IQR 1-2) to 2 (IQR 1-2.5; P = 0.019). Nocturia remained undefined in 12 studies. In all, 19 different definitions were used for NP, most often being the ICS (or similar) definition: this covered 52% (n = 11) of studies before and 66% (n = 27) after the ICS-2002 report. Clear definitions of both nocturia and NP were identified in 67% and 76% before, and in 88% and 88% of the studies after the ICS-2002 report, respectively. CONCLUSION The ICS-2002 report on standardisation of terminology in nocturia appears to have had a beneficial impact on reporting definitions of nocturia and NP, enabling better interpretation of results and comparisons between research projects. Because the external validity of most of the 66 studies is considered a problem, the results of these studies may not be validly extrapolated to other populations. The ICS definition of NP is used most often. However, its discriminative value seems limited due to the estimated difference of 0.6 nocturnal voids between individuals with and without NP. Refinement of current definitions based on robust research is required. Based on pathophysiological reasoning, we argue that it may be more appropriate to define NP based on nocturnal urine production or nocturnal voided volumes, rather than on a diurnal urine production pattern.
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Affiliation(s)
- Ilse Hofmeester
- Department of Urology, Isala Clinics, Zwolle, The Netherlands
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Yang L, Hipp JA, Marx CM, Brownson RC. Occupational sitting and weight status in a diverse sample of employees in Midwest metropolitan cities, 2012-2013. Prev Chronic Dis 2014; 11:E203. [PMID: 25412026 PMCID: PMC4241372 DOI: 10.5888/pcd11.140286] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction Few studies have examined the association between occupational sitting and body mass index (BMI). There is a particular lack of evidence among diverse populations. The objective of this study was to quantify the association between self-reported occupational sitting time and BMI by sex and race, independent of levels of occupational and leisure-time physical activity. Methods In 2012 and 2013, participants residing in 4 Missouri metropolitan areas were interviewed via telephone. The interview included questions on sociodemographic characteristics and time spent sitting at work. Multinomial logistic regressions were used to examine the association between occupational sitting and BMI between men and women and between black and white women. Results Overall 1,891 participants (66.9% women, 29.5% black) provided complete data. Median daily time spent by both men and women in occupational sitting was 180 minutes (interquartile range, 30 to 360 minutes); most participants were overweight (32.3%) or obese (33.6%). After adjusting for potential confounders, we found that black women in 3 categories of sitting time (31–180 minutes, 181–360 minutes, and >360 minutes) were approximately 2.5 times as likely (P for trend, .02) to be obese as black women who reported sitting for 30 minutes or less, independent of occupational and leisure-time physical activity. This association was not seen among white women. No significant associations were found among men. Conclusion Occupational sitting is associated with an increased likelihood of obesity among black women, independent of occupational and leisure-time physical activity. Areas of future research include evaluating associations among various occupations and industries, assessing the association in prospective cohorts, and exploring the feasibility of worksite interventions that target sitting.
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Affiliation(s)
- Lin Yang
- Division of Public Health Science, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - J Aaron Hipp
- Brown School of Social Work, Washington University in St. Louis, Goldfarb Hall 352, Campus Box 1196, One Brookings Dr, St. Louis, MO 63130. E-mail:
| | - Christine M Marx
- Division of Public Health Science, Washington University School of Medicine, St. Louis, Missouri
| | - Ross C Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, and Division of Public Health Science and Alvin J. Siteman Cancer Center, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
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Dwyer AJ, Thomas W, Humphry S, Porter P. Enhanced recovery programme for total knee replacement to reduce the length of hospital stay. J Orthop Surg (Hong Kong) 2014; 22:150-4. [PMID: 25163944 DOI: 10.1177/230949901402200206] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To compare the length of hospital stay in patients undergoing primary total knee replacement (TKR) with or without enhanced recovery (ER) programme. METHODS Medical records of 57 and 55 consecutive patients who underwent primary TKR with or without ER programme, respectively, were reviewed. 17 men and 40 women aged 43 to 87 (mean, 70) years with ER programme were compared with 22 men and 33 women aged 53 to 90 (mean, 73) years without ER programme in terms of the preoperative haemoglobin level, American Association of Anesthesiologists (ASA) physical status grading, body mass index (BMI), and length of hospital stay. RESULTS The length of hospital stay was significantly shorter in the ER than non-ER groups in overall patients (6 vs. 7.8 days, p=0.0003), in patients with preoperative haemoglobin level of ≥ 14 g/dl (5.4 vs. 7.7 days, p=0.02), in patients with preoperative haemoglobin level of <14 g/dl (6.2 vs. 7.7 days, p=0.02), in patients with ASA grades 1 and 2 (5.6 vs. 7.6 days, p=0.01), in patients with ASA grade 3 (6.4 vs. 8.2 days, p=0.01), in patients with BMI of <30 kg/m(2) (6 vs. 8.1 days, p=0.0061), and in patients with BMI of ≥ 30 kg/m(2) (5.9 vs. 7.5 days, p=0.0006). Complications were noted in 4 ER patients and 5 non-ER patients. CONCLUSION ER programmes are readily transferable to patients undergoing TKR and significantly reduced the length of hospital stay.
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Affiliation(s)
- Amitabh J Dwyer
- Department of Trauma and Orthopaedic Surgery, Yeovil District Hospital, Somerset, United Kingdom
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Abstract
OBJECTIVE Pulmonary embolism (PE) after major abdominal surgery is a serious and potentially lethal complication. The purpose of the present study was to identify risk factors for postoperative PE after pancreas resection. METHODS Our prospective database for pancreatic surgery was retrospectively analyzed for patients treated between January 2006 and August 2012 in a tertiary care Swiss hospital. Risk factors for PE were identified in univariate and multivariate analyses that included preoperative, intraoperative, and postoperative variables. RESULTS Among 251 patients, 187 underwent pancreato-duodenectomy (PD), 62 underwent distal pancreatectomy, and 2 underwent other types of pancreas resections. PE was diagnosed in 13 patients (7.0%) after PD and none after other procedures. Compared with the non-PE group, the PE group had higher body mass indices (≥25 kg/m, P = 0.04), longer median operation times (P = 0.009), higher rates of severe abdominal complications (P < 0.001), longer median intensive care unit stays (P = 0.003), and longer hospital stays (P = 0.01). Multivariate analyses identified the following independent predictors for PE: a history of thromboembolic events (odds ratio [OR], 22.3), prolonged operation time (OR, 5.76), and major abdominal complications (OR, 10.8). CONCLUSIONS Prolonged operation times and major postoperative abdominal complications were strong risk factors for PE after PD, in both univariate and multivariate analyses.
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Soft tissue reactions in patients with bone anchored hearing aids. Ir J Med Sci 2014; 184:487-91. [PMID: 24913737 DOI: 10.1007/s11845-014-1151-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 05/21/2014] [Indexed: 12/19/2022]
Abstract
AIMS To establish the incidence and correlation between the degree of soft tissue reaction and the body mass index (BMI) according to age and gender after a bone anchored hearing aid (BAHA) implant. METHODS We did a 1-9-year follow-up for the all the patients who underwent surgery in our department with BAHA implant system. Soft tissue reactions were classified in accordance with the Holgers classification on regular patient visits. BMI was calculated for each patient, and changes were recorded at least once a year. RESULTS 47 patients were evaluated. 58% were operated on for chronic otitis with mixed or conductive hearing loss; 20% had unilateral or bilateral atresia and 16% had single sided deafness (SSD); other indications were otosclerosis and syndromic patients. The grade of Holgers classification significantly correlated at a 0.001 level with BMI (Spearmans rho 0.452). Holgers grade also differed significantly between the sexes-skin reactions in females were less frequent. An ANOVA test did not reveal any statistical difference between patients with dissimilar indications for BAHA. CONCLUSION If performed carefully, BAHA surgery produces a favorable outcome. The Holgers grade may change as time passes. If skin reactions appear, they can be treated through local or systemic therapy, and they may turn into a normal grade. Adipose patients should be treated with special care because they are more prone to soft tissue reactions.
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Intra-operative and short term outcome of total knee arthroplasty in morbidly obese patients. Knee 2014; 21:784-8. [PMID: 24637067 DOI: 10.1016/j.knee.2014.02.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 02/12/2014] [Accepted: 02/17/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Longer operation times, poorer patient outcomes and increased early post-operative complications are reasons cited for not undertaking total knee arthroplasty (TKA) on morbidly obese patients. This study tests the hypothesis that there is no difference in intra-operative parameters between morbidly obese and non-obese patients, and no difference in patient outcome. METHODS Intra-operative parameters, post-operative complications, patient outcomes and knee range of motion were compared between morbidly obese patients (BMI>40 kg/m2) and individually age and gender matched non-obese patients (BMI<30 kg/m2) undergoing cementless rotating platform TKA. RESULTS Anaesthetic times and length of hospital stay were not significantly different between the morbidly obese and non-obese patients. Surgical time was significantly greater in morbidly obese patients. Improvements in patient outcomes following TKA were not significantly different between the morbidly obese and non-obese patients at early and short-term follow-up. CONCLUSIONS In contrast to previous studies, post-operative complication rates within three months of surgery and up to one year post-operatively were not significantly higher for morbidly obese patients. LEVEL OF EVIDENCE III.
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Fletcher I. Defining an epidemic: the body mass index in British and US obesity research 1960-2000. SOCIOLOGY OF HEALTH & ILLNESS 2014; 36:338-353. [PMID: 24640951 DOI: 10.1111/1467-9566.12050] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Between the 1970s and the mid-1990s the body mass index (BMI) became the standard means of assessing obesity both in populations and in individuals, replacing previously diverse and contested definitions of excess body weight. This article draws on theoretical approaches from the sociology of standards and science and technology studies to describe the development of this important new standard and the ways in which its adoption facilitated the development of obesity science, that is, knowledge about the causes, health effects and treatments of excess body weight. Using an analysis of policy and healthcare literatures, I argue that the adoption of the BMI, along with associated standard cut-off points defining overweight and obesity, was crucial in the framing of obesity as an epidemic. This is because, I suggest, these measures enabled, firstly, the creation of large data sets tracking population-level changes in average body weight, and, secondly, the construction of visual representations of these changes. The production of these two new techniques of representation made it possible for researchers in this field, and others such as policymakers, to argue credibly that obesity should be described as an epidemic.
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Total knee replacement in the obese patient: comparing computer assisted and conventional technique. ScientificWorldJournal 2014; 2014:272838. [PMID: 24523634 PMCID: PMC3913015 DOI: 10.1155/2014/272838] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 10/08/2013] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Obesity is being considered a "global epidemic." Surgical procedures are rendered more difficult in obese patients. We aimed to see whether any benefits were evident with use of computer navigation during total knee replacement in these cases. METHODS A retrospective analysis of 287 TKR performed by a single surgeon was undertaken, including 133 TKR undertaken with computer navigation and 154 using standard instrumentation. Each group was further divided into subgroups depending on whether the patients were obese or nonobese. RESULTS We found that TKR in obese patients took longer with standard instruments, but not with computer navigation. A chronological analysis revealed that the surgeon progressively got quicker using computer navigation to the point that there was no difference in time with either of the operative techniques in obese patients. The mid-term clinical outcomes at five years were similar. Computer navigated TKR were more consistently accurately aligned. CONCLUSIONS In obese patients, a dual advantage is provided by computer navigation: better alignment and no time penalty.
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Yamauchi K, Oka R, Yagi K, Hayashi K, Kawashiri MA, Yamagishi M, Shimbo T, Aizawa T. Population impact of increased body mass index and attenuated beta-cell function on worsening of glucose metabolism in subjects with normal glucose tolerance: a pilot study. Acta Diabetol 2014; 51:441-5. [PMID: 24356951 DOI: 10.1007/s00592-013-0535-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Accepted: 11/18/2013] [Indexed: 10/25/2022]
Abstract
The population attributable fraction (PAF) of risk factors for the worsening of glucose metabolism in subjects with normal glucose tolerance (NGT) has not been calculated. Our aim was to obtain the PAF of increased body mass index (BMI) and attenuated beta-cell function (BCF) on worsening of glucose metabolism in subjects with NGT. We longitudinally analyzed 604 Japanese adults. The follow-up glucose tolerance status was determined 3.7 years later: 430 participants remained in the NGT category and 102 had progressed to impaired fasting glucose, 67 to impaired glucose tolerance, and 5 to diabetes mellitus. A product of ISIMatsuda and Stumvoll-1, i.e., oral disposition index (DIO), was used as a measure of BCF. The optimal cutoff baseline BMI and DIO values for the prediction of the worsening of glucose metabolism were > 23.1 and < 7.299 kg/m(2), respectively. Isolated increased BMI (iBMIHIGH), isolated low DI (iDIOLOW), and "BMIHIGH and DIOLOW (BMIHIGH/DIOLOW)" were all independently related to the worsening, and the PAF values (95 % CI) for worsening due to iBMIHIGH, iDIOLOW, and BMIHIGH/DIOLOW were 12.9 (3.2-18.4) %, 10.9 (5.0-13.9) %, and 31.4 (22.7-36.3) %, respectively. As much as 55 % of the worsening of glucose metabolism in the NGT subjects was attributable to increased BMI and/or attenuated BCF. The optimal cutoff for BMI was as low as 23.1 kg/m(2) in this population. We believe that these data should form the basis of future public health strategies for the prevention of diabetes in Japan.
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Affiliation(s)
- Keishi Yamauchi
- Diabetes Center, Aizawa Hospital, 2-5-1 Honjo, Matsumoto, Japan
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Brown PJ. Culture and the evolution of obesity. HUMAN NATURE-AN INTERDISCIPLINARY BIOSOCIAL PERSPECTIVE 2013; 2:31-57. [PMID: 24222189 DOI: 10.1007/bf02692180] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/1990] [Accepted: 09/12/1990] [Indexed: 11/28/2022]
Abstract
Human predispositions to fatness and obesity are best understood in the context of cultural and biological evolution. Both genes and cultural traits that were adaptive in the context of past food scarcities play a role today in the etiology of maladaptive adult obesity. The etiology of obesity must account for the social distribution of the condition with regard to gender, ethnicity, social class, and economic modernization. This distribution, which has changed throughout history, undoubtedly involves cultural factors. A model of culture is presented that has advantages over an undifferentiated concept of the "environment" for hypothesis generation. Cultural predispositions to obesity are found in the productive economy, the mode of reproduction, social structure, and cultural beliefs about food and ideal body size. Cross-cultural comparison can contribute to an understanding of the prevalence of obesity in some modern affluent societies.
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Affiliation(s)
- P J Brown
- Department of Anthropology, Emory University, 30322, Atlanta, GA
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Pessaux P, van den Broek MAJ, Wu T, Olde Damink SWM, Piardi T, Dejong CHC, Ntourakis D, van Dam RM. Identification and validation of risk factors for postoperative infectious complications following hepatectomy. J Gastrointest Surg 2013; 17:1907-16. [PMID: 23661000 DOI: 10.1007/s11605-013-2226-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Accepted: 04/29/2013] [Indexed: 02/07/2023]
Abstract
UNLABELLED Postoperative infectious complications (PICs) are associated with significant morbidity after abdominal surgery. Using multivariate analysis of data from a prospective database, our study focused on the risk factors for PICs and the prevention of these complications after hepatectomy, with the goal of improving outcomes and reducing the length of hospital stays. BACKGROUND PICs following surgery are associated with significant morbidity, increase the length of hospital stays, and have a negative impact on long-term oncological outcome. The aim of this study was to determine the risk factors for PICs following partial hepatectomy and to validate these results with an external database. METHODS Between January 2006 and December 2009, 555 patients underwent elective partial hepatectomy. We prospectively collected and retrospectively analyzed demographic data, pathological variables, associated pathological conditions, and preoperative, intraoperative, and postoperative variables. The dependent variables studied were the occurrence of PICs, defined as development of one or more of the following conditions: pneumonia, sepsis, Central line-associated bloodstream infection, urinary tract infection, wound infection, and infected intra-abdominal fluid collection. PICs were devised in medical (PIMCs) and surgical (PISCs) complications. The incidence of PICs and validation of the predictive score were determined using an external prospective database of 342 patients. RESULTS The multivariate analysis identified three independent risk factors for PICs: the presence of a nasogastric tube (OR = 1.8), blood transfusion (OR = 1.9), and diabetes (OR = 2.4). The multivariate analysis identified only one independent risk factor for PISCs: an associated portal venous resection (OR = 5.5). The multivariate analysis identified four independent risk factors for PIMCs: presence of a biliary drainage (OR = 1.9), blood transfusion (OR = 2.1), diabetes (OR = 2.9), and presence of atrial fibrillation (OR = 3.6). According to the three predictive factors, the observed rates of PICs ranged from 18.8 % to 77.8 % and ranged from 24.2 % to 100 % in the external database. Predicted and observed risks of PICs were not statistically different. CONCLUSIONS The correction of modifiable risk factors among the identified factors could reduce the incidence of PICs and, as a consequence, improve patient outcomes and reduce the length of hospital stays.
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Affiliation(s)
- Patrick Pessaux
- Department of Hepato-Biliary and Pancreatic Surgery, Nouvel Hopital Civil, Université de Strasbourg, IHU MixSurg, IRCAD, 1 place de l'hôpital, 67091, Strasbourg, France,
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Donnelly JE, Goetz J, Gibson C, Sullivan DK, Lee R, Smith BK, Lambourne K, Mayo MS, Hunt S, Lee JH, Honas JJ, Washburn RA. Equivalent weight loss for weight management programs delivered by phone and clinic. Obesity (Silver Spring) 2013; 21:1951-9. [PMID: 23408579 PMCID: PMC4442605 DOI: 10.1002/oby.20334] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 12/08/2012] [Accepted: 12/12/2012] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Face-to-face (FTF) weight management is costly and presents barriers for individuals seeking treatment; thus, alternate delivery systems are needed. The objective of this study was to compare weight management delivered by FTF clinic or group conference calls (phone). DESIGN AND METHODS Randomized equivalency trial in 295 overweight/obese men/women (BMI = 35.1±4.9, Age = 43.8±10.2, Minority = 39.8%). Weight loss (0-6 months) was achieved by reducing energy intake between 1,200 and 1,500 kcal/day and progressing physical activity (PA) to 300 min/week. Weight maintenance (7-18 months) provided adequate energy to maintain weight and continued 300 min/week of PA. Behavioral weight management strategies were delivered weekly for 6 months and gradually reduced during 7-18 months. A cost analysis provided a comparison of expenses between groups. RESULTS Weight change from baseline to 6 months was -13.4 ± 6.7% and -12.3 ± 7.0% for FTF clinic and phone, respectively. Weight change from 6-18 months was 6.4 ± 7.0% and 6.4 ± 5.2%, for FTF clinic and phone, respectively. The cost to FTF participants was $789.58 more per person. CONCLUSIONS Phone delivery provided equivalent weight loss and maintenance and reduced program cost. Ubiquitous access to phones provides a vast reach for this approach.
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Affiliation(s)
- Joseph E. Donnelly
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Jeannine Goetz
- Department of Dietetics and Nutrition, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Cheryl Gibson
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Debra K. Sullivan
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Robert Lee
- Department of Health Policy and Management, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Bryan K. Smith
- Department of Kinesiology and Health Education, Southern Illinois University Edwardsville, Vadalabene Center, Box 1126, Edwardsville, IL, 62026 USA
| | - Kate Lambourne
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Matthew S. Mayo
- Department of Biostatistics, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Suzanne Hunt
- Department of Biostatistics, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Jae Hoon Lee
- Center for Research Methods and Data Analysis, The University of Kansas, 1425 Jayhawk Blvd., Room 470, Lawrence, KS 66045 USA
| | - Jeffrey J. Honas
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Richard A. Washburn
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
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Obesity does not imply poor outcomes in Asians after total knee arthroplasty. Clin Orthop Relat Res 2013; 471:1957-63. [PMID: 23212771 PMCID: PMC3706650 DOI: 10.1007/s11999-012-2721-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 11/14/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND In Asia, obesity has reached epidemic proportions and physicians are likely to face a burden of obesity-related disorders, of which osteoarthritis of the knee is one. However, it is unclear whether obesity affects improvement of conventional TKAs in Asian patients. PURPOSE We therefore asked whether obese patients with a BMI of 30 kg/m(2) or greater would have worse ROM and function after TKA compared with their nonobese counterparts and whether they would have less improvement preoperatively to postoperatively. METHODS We retrospectively reviewed 369 patients who underwent TKAs from 2006 to 2010. We stratified patients into four groups: (1) 98 patients with BMIs less than 25 kg/m(2); (2) 158 patients with BMIs between 25 kg/m(2) and 29.9 kg/m(2); (3) 87 patients with BMIs between 30 kg/m(2) and 34.9 kg/m(2); and (4) 26 patients with BMIs greater than 35 kg/m(2). We then compared ROM, function score, Knee Society score, Oxford Knee Questionnaire, and SF-36 questionnaire(®) across the four groups at 6- and 12-month follow-ups. RESULTS At the 6-month followup, we found a difference only in the ROM. At the 2-year followup, there were no differences in any functional scores across the four groups. Severely obese patients had greater improvement in postoperative ROM than the other groups but did not have any greater improvement in function. CONCLUSION BMI had little clinical impact on short-term outcomes of conventional TKAs in Asian patients. The data suggest that BMI should not be used as a major determinant to exclude obese patients from surgery with the presumption of poorer outcomes.
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Ye S, Dongyang C, Zhihong X, Dongquan S, Jin D, Jianghui Q, Jizhen Q, Pu Y, Huacheng H, Wei S, Qing J. The incidence of deep venous thrombosis after arthroscopically assisted anterior cruciate ligament reconstruction. Arthroscopy 2013; 29:742-7. [PMID: 23527593 DOI: 10.1016/j.arthro.2013.01.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 01/16/2013] [Accepted: 01/16/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of our study was to retrospectively assess and analyze the incidence of deep venous thrombosis (DVT) after arthroscopically assisted anterior cruciate ligament reconstruction (ACLR) at our institution. METHODS We conducted a retrospective analysis of 249 arthroscopic ACLRs performed in our hospital between February 2009 and February 2012. The surgical procedure was standardized in all the patients and was conducted by the same 2 surgeons. Quadrupled hamstring autograft was used in all the patients. No patient was given nonsteroidal anti-inflammatory drugs for the first 2 weeks after surgery. A unilateral contrast venography examination was performed on the third postoperative day. Patients were confined to bed once DVT was confirmed, followed by therapeutic doses of batroxobin. The proportion of patients with DVT was calculated. The significance of the association between clinical factors and postoperative DVT was determined. RESULTS This study included 171 patients (123 men and 48 women), with a mean age (±SD) of 30.1 ± 10.0 years. DVT was detected in 24 patients (14.0%; 95% confidence interval, 8.8% to 19.3%). Body mass index (BMI), operative time, operator, and duration of tourniquet application were not significant risk factors for DVT. The risk of DVT was significantly higher in patients aged 35 years or older (P < .01). Higher risk for DVT was also identified in female patients (P < .05). Pulmonary embolism did not develop after thrombolytic therapy in any of the 24 patients with DVT after ACLR. CONCLUSIONS The incidence of DVT in patients who underwent arthroscopic ACLR was 14% in this study. Female patients and those aged 35 years or older have a significantly higher risk of DVT developing after ACLR; thus thromboprophylaxis is advocated in these patients. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Sun Ye
- Center for Diagnosis and Treatment of Joint Disease, Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
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Pieroni L, Lanari D, Salmasi L. Food prices and overweight patterns in Italy. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2013; 14:133-151. [PMID: 21935716 DOI: 10.1007/s10198-011-0350-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Accepted: 09/05/2011] [Indexed: 05/31/2023]
Abstract
In this paper, we examine the role of relative food prices in determining the recent increase in body weight in Italy. Cross-price elasticities of unhealthy and healthy foods estimated by a demand system provide a consistent framework to evaluate substitution effects, when a close association is assumed between unhealthy (healthy) foods and more (less) energy-dense foods. We used a dataset constructed from a series of cross-sections of the Italian Household Budget Survey (1997-2005) to obtain the variables of the demand system, which accounts for regional price variability. The relative increase in healthy food prices was found to produce nontrivial elasticities of substitution towards higher relative consumption of unhealthy foods, with effects on weight outcomes. In addition, these changes were unevenly distributed among individuals and were particularly significant for those who were poorer and had less education.
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Affiliation(s)
- L Pieroni
- Department of Economics, Finance and Statistics, University of Perugia, Via Pascoli 20, 06123 Perugia, Italy.
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Isac WE, Autorino R, Hillyer SP, Hernandez AV, Stein RJ, Kaouk JH. The impact of body mass index on surgical outcomes of robotic partial nephrectomy. BJU Int 2012; 110:E997-E1002. [DOI: 10.1111/j.1464-410x.2012.11318.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Role of the mechanical axis of lower limb and body weight in the horizontal tear and root ligament tear of the posterior horn of the medial meniscus. INTERNATIONAL ORTHOPAEDICS 2012; 36:1849-55. [PMID: 22782373 DOI: 10.1007/s00264-012-1596-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 06/05/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE To compare and analyse the relationship between horizontal tear and root ligament tear of the posterior horn of the medial meniscus (PHMM) and the degree of varus in the axis of lower limb and body weight. METHODS One hundred and nineteen patients underwent surgical treatment as they were diagnosed with medial meniscus tear in our hospital from May 2006 to December 2009. Of these, 19 cases (group 1), underwent partial meniscectomy as they were confirmed to solely have horizontal tear of the PHMM on arthroscopic examination and 27 cases (group 2), underwent subtotal meniscectomy as they were confirmed to solely have root ligament tear of the PHMM on arthroscopic examination, were chosen for retrospective study. Standing radiographs were taken of every case prior to arthroscopic surgery to measure varus angle. Also, we checked body mass index (BMI) of two groups. The difference of varus angle and BMI between two groups were statistically verified using the Levene's test, paired t-test. RESULTS Group 1 showed mean value of varus angle of 2.30 ± 0.54, and BMI of 25.32 ± 3.23. Group 2 showed mean value of varus angle of 5.64 ± 0.54, and BMI of 25.67 ± 3.12. The degree of varus of group 2 was statistically significantly higher than group 1 (p = 0.002). Comparison between the BMI of two groups showed no statistical significance (p = 0.053). CONCLUSION Through a comparative study of sole horizontal tear and root ligament tear of the PHMM, the authors have found that sole root ligament tear of the PHMM is more relative to the genu varum than sole horizontal tear of the PHMM. However, body weight was statistically irrelevant to the incidence of the two lesions.
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Jones CA, Cox V, Jhangri GS, Suarez-Almazor ME. Delineating the impact of obesity and its relationship on recovery after total joint arthroplasties. Osteoarthritis Cartilage 2012; 20:511-8. [PMID: 22395039 DOI: 10.1016/j.joca.2012.02.637] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 02/17/2012] [Accepted: 02/27/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The primary aim of this study was to determine the impact of obesity in predicting short and long-term pain relief and functional recovery in total joint arthroplasty (TJA) either as an independent risk factor or a factor mediated by two chronic conditions associated with obesity-cardiac disease and diabetes mellitus. METHOD A prospective observational study of 520 patients with primary joint arthroplasties. Pain and functional outcomes were evaluated with the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index within a month of surgery and then 6 months and 3 years post-operatively. Obesity, cardiac disease and diabetes mellitus were examined as potential risk factors for poor recovery. Patients were classified into four groups based on body mass index (BMI): (normal<25.0 kg/m(2); overweight 25.0-29.9 kg/m(2); obese Class 1 30.0-34.9 kg/m(2); severe obese Class 2&3 35.0 ≥ kg/m(2)). Linear mixed models for each joint type (hip and knee arthroplasty) were developed to examine the pattern of recovery and the effect of obesity. RESULTS Ninety-nine (19%) patients were severely obese, 127 (24%) had cardiac disease and 58 (11%) had diabetes mellitus. Baseline pain and functional scores were similar regardless of BMI classification. Severe obesity was a significant risk factor for worse pain and functional recovery at 6 months but no longer at 3 years following total hip and knee arthroplasty. Cardiac disease predicted a slower recovery after hip arthroplasty. No significant interactions existed between obesity and cardiac disease or diabetes mellitus. DISCUSSION Severe obesity is an independent risk factor for slow recovery over 3 years for both hip and knee arthroplasties.
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Affiliation(s)
- C A Jones
- School of Public Health, University of Alberta, Edmonton, AB, Canada T6G 2G4.
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Weight management by phone conference call: a comparison with a traditional face-to-face clinic. Rationale and design for a randomized equivalence trial. Contemp Clin Trials 2012; 33:1044-55. [PMID: 22664647 DOI: 10.1016/j.cct.2012.05.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 05/18/2012] [Accepted: 05/19/2012] [Indexed: 11/21/2022]
Abstract
State-of-the-art treatment for weight management consists of a behavioral intervention to facilitate decreased energy intake and increased physical activity. These interventions are typically delivered face-to-face (FTF) by a health educator to a small group of participants. There are numerous barriers to participation in FTF clinics including availability, scheduling, the expense and time required to travel to the clinic site, and possible need for dependent care. Weight management clinics delivered by conference call have the potential to diminish or eliminate these barriers. The conference call approach may also reduce burden on providers, who could conduct clinic groups from almost any location without the expenses associated with maintaining FTF clinic space. A randomized trial will be conducted in 395 overweight/obese adults (BMI 25-39.9 kg/m(2)) to determine if weight loss (6 months) and weight maintenance (12 months) are equivalent between weight management interventions utilizing behavioral strategies and pre-packaged meals delivered by either a conference call or the traditional FTF approach. The primary outcome, body weight, will be assessed at baseline, 6, 12 and 18 months. Secondary outcomes including waist circumference, energy and macronutrient intake, and physical activity and will be assessed on the same schedule. In addition, a cost analysis and extensive process evaluation will be completed.
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Abstract
OBJECTIVE To generate the first evaluation of risk factors for postoperative pulmonary complications (PPCs) after hepatectomy. BACKGROUND Postoperative pulmonary complications (PPCs) after surgery are associated with significant morbidity and have been shown to increase the length of hospital stays. Several studies have been conducted to identify the risk factors for PPCs after abdominal surgery. METHODS Between January 2006 and December 2009, 555 patients underwent elective hepatectomy. We prospectively collected and retrospectively analyzed demographic data, pathological variables, associated pathological conditions, and preoperative, intraoperative, and postoperative variables. The dependent variables studied were the occurrence of PPCs, pleural effusion, pneumonia, and pulmonary embolism. RESULTS Multivariate analysis identified 5 independent risk factors for global PPCs: prolonged surgery [odds ratio (OR) = 1], presence of a nasogastric tube (OR = 1.6), intraoperative blood transfusion (OR = 1.7), diabetes mellitus (OR = 2.7), and a transverse subcostal bilateral muscle cutting incision (OR = 3.4). There were 4 independent risk factors for pleural effusion: prolonged surgery (OR = 1), surgery on the right lobe of the liver (OR = 1.6), neoadjuvant chemotherapy (OR = 2), and a transverse subcostal bilateral muscle cutting incision (OR = 2.5). There were 3 independent risk factors for pneumonia: intraoperative blood transfusion (OR = 1.9), diabetes mellitus (OR = 2.2), and atrial fibrillation (OR = 3). For pulmonary embolism, history of previous thromboembolic events was identified as the only risk factor (OR = 8.8). CONCLUSIONS The correction of modifiable risk factors among the identified factors could reduce the incidence of PPCs and, as a consequence, improve patient outcomes and reduce the length of hospital stays.
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Bae KK, Kim H, Cho SI. Trends in body mass index and associations with physical activity among career soldiers in South Korea. J Prev Med Public Health 2012; 44:167-75. [PMID: 21894065 PMCID: PMC3249253 DOI: 10.3961/jpmph.2011.44.4.167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE This study was designed to describe the trends in body mass index (BMI) during 6 years (2002 - 2008) and to identify associations between these trends and the amount of physical activity of South Korean career soldiers. METHOD This study targeted the 40 993 (38 857 men and 2136 women) of the 58 657 career soldiers who had undergone four (2002, 2004, 2006, and 2008) biennial medical examinations conducted by the National Health Insurance Corporation; 17 664 soldiers with missing data on height, weight, and physical activity were excluded. A linear mixed-regression model was used to categorize changes in BMI due to age versus those due to amount of physical activity. RESULTS Career soldiers experienced significant increases in BMI compared with baseline data gathered in 2002. The increases in each age group were as follows: men aged 20-29: 1.16, men aged 30-39: 0.61, men aged 40-49: 0.05, women aged 20-29: 0.35, women aged 30-39: 0.30, women aged 40-49: 0.26, and women aged 50-59: 0.21. However, men aged 50 or older showed significant decreases (as high as 0.5) in BMI compared with baseline data obtained in 2002. They also experienced significant decreases in BMI compared with those who reported no physical activity. The differences between baseline and final BMIs were: 0.02 for men exercising 1-2 times per week, -0.07 for men exercising 3-4 times per week, -0.19 for men exercising 5-6 times per week, -0.21 for men exercising seven times per week, -0.05 for women exercising 1-2 times per week, -0.19 for women exercising 3-4 times per week, -0.30 for women exercising 5-6 times per week, and -0.30 for women exercising seven times per week. CONCLUSIONS Obesity in South Korean career soldiers increased markedly between 2002 and 2008, and our data showed that the amount of physical activity was inversely related to increases in BMI. Policies to prevent obesity are needed to reduce this trend.
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Affiliation(s)
- Kyoung Ki Bae
- School of Public Health, Seoul National University, Seoul, Korea
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