Relationships between anthropometric adiposity indexes and bone mineral density in a cross-sectional Chinese study

Background ContextPrevious studies have reported conflicting results for the relationships between anthropometric adiposity indexes and bone mineral density, based on dual-energy X-ray absorptiometry (DXA). However, few studies were published based on quantitative computed tomography (QCT), especially for Chinese population.PurposeTo evaluate the associations of spine bone mineral density (BMD) with body mass index (BMI), waist circumstance (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and a body shape index (ABSI) using QCT.Study Design/SettingA Cross-sectional study.Patient SampleAround 3,457 participants in multiple communities across 7 administrative regions of China.Outcome MeasuresSpine BMD was measured using QCT, and the classification of osteoporosis was defined as follows: 1) osteoporosis if BMD <80mg/cm³, 2) osteopenia if BMD 80–119 mg/cm³, and 3) normal bone mass if BMD≥120 mg/cm³.MethodsThis study was conducted using convenient sampling between 2013 and 2017. Multivariable linear regression model and logistic regression models were used for the associations of continuous and categorical BMD, respectively.ResultsAround 3,405 participants were included in the final analyses, including 1,272 males and 2,133 females, with spine BMD of 111.00±35.47 mg/cm³ and 99.38±40.60 mg/cm³, respectively. Spine BMD decreased significantly with the increase of ABSI in females (adjusted β, ?5.74; 95% confidence interval [CI], ?8.50 to ?2.98), and this trend also was kept in females aged at less than 60 years (adjusted β, ?14.54; 95% CI, ?20.40 to ?8.68), and females with age ≥60 years (adjusted β, ?7.59; 95% CI, ?10.91 to ?4.28). However, this inverse association was observed only in males with age ≥ 60 years (adjusted β, ?5.19; 95% CI, ?10.08 to ?0.29). Except ABSI, negative associations of Spine BMD with WC (adjusted β, ?0.46; 95% CI, ?0.77 to ?0.15), WHR (adjusted β, ?6.25; 95% CI, ?10.63 to ?1.86), WHtR (adjusted β, ?6.80; 95% CI, ?11.63 to ?1.97) were shown in females aged at <60 years, and positive association with BMI in males with age ≥60 years (adjusted β, 0.92; 95% CI, 0.29–1.55).ConclusionsABSI had more remarkable association with spine BMD, compared with the other four indexes.     

Eating patterns and unhealthy weight control behaviors are associated with loss-of-control eating following bariatric surgery

BackgroundLoss-of-control (LOC) eating is associated with poor weight-loss outcomes following bariatric surgery. It is not clear whether eating patterns (e.g., total number of daily meals/snacks, eating after suppertime, eating when not hungry) and unhealthy weight control behaviors (e.g., smoking, using laxatives) are associated with or predictive of LOC eating.ObjectivesTo examine whether eating patterns and unhealthy weight-control behaviors are associated with LOC eating and, if so, whether they predict LOC eating in bariatric patients.SettingMulticenter study, United States.MethodsThis is a secondary analysis of the Longitudinal Assessment of Bariatric Surgery–2 study. Assessments were conducted before surgery and at 12, 24, 36, 48, 60, and 84 months after surgery. Logistic mixed models were used to examine the longitudinal associations between eating patterns, unhealthy weight-control behaviors, and LOC eating. Time-lag techniques were applied to examine whether the associated patterns and behaviors predict LOC eating.ResultsThe participants (n = 1477) were mostly women (80%), white (86.9%), and married (62.5%). At the time of surgery, the mean age was 45.4 ± 11.0 years and the mean body mass index was 47.8 ± 7.5 kg/m². The total number of daily meals/snacks, food intake after suppertime, eating when not hungry, eating when feeling full, and use of any unhealthy weight-control behaviors were positively associated with LOC eating (P < .05). Food intake after suppertime, eating when not hungry, and eating when feeling full predicted LOC eating (P < .05).ConclusionMeal patterns and unhealthy weight control behaviors may be important intervention targets for addressing LOC eating after bariatric surgery.     

Early steroid withdrawal in HIV-infected kidney transplant recipients: Utilization and outcomes

Kidney transplant (KT) outcomes for HIV-infected (HIV+) persons are excellent, yet acute rejection (AR) is common and optimal immunosuppressive regimens remain unclear. Early steroid withdrawal (ESW) is associated with AR in other populations, but its utilization and impact are unknown in HIV+ KT. Using SRTR, we identified 1225 HIV+ KT recipients between January 1, 2000, and December 31, 2017, without AR, graft failure, or mortality during KT admission, and compared those with ESW with those with steroid continuation (SC). We quantified associations between ESW and AR using multivariable logistic regression and interval-censored survival analysis, as well as with graft failure and mortality using Cox regression, adjusting for donor, recipient, and immunologic factors. ESW utilization was 20.4%, with more zero HLA mismatch (8% vs 4%), living donors (26% vs 20%), and lymphodepleting induction (64% vs 46%) compared to the SC group. ESW utilization varied widely across 129 centers, with less use at high- versus moderate-volume centers (6% vs 21%, P < .001). AR was more common with ESW by 1 year (18.4% vs 12.3%; aOR: _1.081.61_2.41, P = .04) and over the study period (aHR: _1.021.39_1.90, P = .03), without difference in death-censored graft failure (aHR _0.600.91_1.36, P = .33) or mortality (aHR: _0.751.15_1.77, P = .45). To reduce AR after HIV+ KT, tailoring of ESW utilization is reasonable.     

单孔+1腹腔镜全胃切除、D2淋巴结清扫术

因技术难度大、操作复杂及缺乏三角牵拉等原因,单孔+1腹腔镜全胃切除+D2淋巴结清扫+食管空肠吻合术存在技术上的挑战,目前尚未得到广泛应用。在此报道单孔+1腹腔镜全胃切除、D2淋巴结清扫术的初步经验。采用之前报道的单孔多通道通加1个戳孔(5 mm)的方式进行手术。全胃切除、D2淋巴结清扫的手术过程与传统腹腔镜手术方法相同。通过绕脐切口取出标本,使用体外空肠空肠吻合术和体内食管空肠吻合术完成Roux-en-Y重建(overlap)。手术时间198 min,出血量30 ml,没有观察到术中和术后并发症,清扫淋巴结数目50枚。术后排气时间、恢复流质饮食和住院时间分别为第2、4、7天。     

基于三维重建的腹腔镜下胃癌根治术临床效果

目的探讨三维重建模型在腹腔镜下胃癌根治术(LAG)中的临床效果。方法采用随机数字表法将2018年6月至2019年12月间行LAG的84例胃癌患者分为三维组(n=42)和CT组(n=42)。CT组使用CT图像进行术前规划和术中应用,三维组依据CT数据采用Mimics 17.0软件进行患者三维腹腔血管重建,利用三维模型进行术前规划和术中应用。采用SPSS18.0软件进行统计学分析。围术期相关指标等计量资料以(±s)表示,采用独立t检验;术后并发症等计数资料采用χ²检验分析;以P<0.05表示差异有统计学意义。结果与CT组相比,三维组可明显缩短腹腔镜下胃癌根治术的手术时间、平均住院时间,减少术中出血量及术中输血,增加术中清除淋巴结个数,差异均具统计学意义(P<0.05)。而两组术后首次排气时间、术后并发症发生率差异均无统计学意义(P>0.05)。结论三维腹腔血管重建技术应用于LAG术中准确评估患者腹腔血管的分型及变异情况,在术中提供重要决策作用,具有明显优势,值得临床推广。     

Ultrasound‐Assisted Precise In Situ Decompression for Cubital Tunnel Syndrome

ObjectiveTo explore the effect of locating the ulnar nerve compression sites and guiding the small incision so as to decompress the ulnar nerve in situ on the elbow by high‐frequency ultrasound before operation.MethodsA retrospective analysis was conducted on 56 patients who underwent ultrasound‐assisted in situ decompression for cubital tunnel syndrome from May 2018 to August 2019. The patients'' average age was 51.13 ± 7.35 years, mean duration of symptoms was 6.51 ± 1.96 months, and mean postoperative follow‐up was 6.07 ± 0.82 months. Nine patients had Dellon''s stage mild, 39 had stage moderate, and eight had stage severe. Ultrasound and electromyography were completed in all patients before operation. The presence of ulnar nerve compressive lesion, the specific location, and the reason and extent of compression were determined by ultrasound. A small incision in situ surgery was given to decompress the ulnar nerve according to the pre‐defined compressive sites.ResultsAll patients underwent in situ decompression. The compression sites around the elbow were as follows: two in the arcade of Struthers, one in the medial intermuscular septum, four in the anconeus epitrochlearis muscle, five beside the cyst of the proximal flexor carpi ulnaris (FCU), and the remaining 44 cases were all from the compression between Osborne''s ligament to the two heads of the FCU. The compression localizations diagnosed by ultrasound were confirmed by operations. Preoperative ultrasound confirmed no ulnar nerve subluxation in all cases. The postoperative outcomes were satisfactory. There was no recurrence or aggravation of symptoms in this group of patients according to the modified Bishop scoring system; results showed that 43 cases were excellent, 10 were good, and three were fair.ConclusionsHigh‐frequency ultrasound can accurately and comprehensively evaluate the ulnar nerve compression and the surrounding tissues, thus providing significant guidance for the precise minimally invasive treatment of ulnar nerve compression.     

The role of Ureaplasma parvum serovar-3 or serovar-14 infection in female patients with chronic micturition urethral pain and recurrent microscopic hematuria

BackgroundUreaplasma parvum (UP) is commonly isolated in the genitor-urinary tract and may cause various clinical features, including microscopic hematuria (MH). Some UP serovars are more commonly related with specific urogenital disease, but the evidences have been conflicting. This study primarily aimed to research the possible associations between specific UP serotypes and genito-urinary pathogenicity in female patients showing MH with/without chronic micturition urethral pain (CMP).MethodsThis study retrospectively reviewed 276 female patients having MH with/without CMP, who visited health screening center or female infertility clinic. All patients underwent multiplex polymerase chain reaction (PCR) tests with vaginal and urine samples to evaluate the infection rate and serotypes of UP. The antimicrobial susceptibility of UP and the predictors of CMP among UP infected patients were also analyzed. All patients were followed up at least for 6-months.ResultsForty-nine patients (17.8%) showed urinary UP infection. Urinary UP serotyping showed the prevalence of seorvar-1, -3, -6 and -14 were 24.5%, 30.6%, 18.4% and 26.5%, respectively. 79.6% of the urinary UP positive patients accompanied vaginal UP infection. 22 patients of the cohort (8.0%) had CMP whereas serovars-3 and -14 accompanied CMP in 54.5% and 41.0% cases, respectively. No serovars-6 infection case had CMP. 26.4% of the cohort were infertile whereas 10.9% of these infertile patients were positive for urinary tract infection with UP serotype-3 or -14. Doxycycline, josamycin and pristinamycin were the most active antibiotics with the lowest rate of resistance (0.0%) for treating UP. At 1-month post-initial treatment with doxycycline, all UP serotypes were eradicated and no patient complained of urethral discomfort. However, simultaneous urinary and vaginal reinfection of serovar-3 (5 cases) and serovar-5 (1 case) were confirmed at 3-months post-initial doxycycline therapy. The logistic regression analyses revealed that serovars-3 [hazard ratio (HR) 1.354, P value 0.018] and -14 (HR 1.103, P value 0.046) were significantly associated with CMP in female patients having MH.ConclusionsUP serovars-3 and -14 infections could be associated with CMP in female patients having MH. Doxycycline, josamycin and pristinamycin were effective for treating UP. Serovar-3 showed higher reinfection rate than other serotypes after antibiotics treatment.