Adjustment For Other Variables Research Articles

“Toxic pleasures”: A study of eating out behavior in Arab female university students and its associations with psychological distress and disordered eating

University years are a critical period in which young people establish independence and adopt lasting health behaviors. The aim of this study was to estimate the associations between eating out, psychological distress, and disordered eating behaviors among young Arab females in Qatar a rapidly developing small nation. A cross-sectional probability-based survey of 1615 Qatar University's female students assessed the frequency of eating out (main independent variable) and other eating behaviors in relation to two main dependent variables, disordered eating and psychological distress, which were measured using the Eating Attitudes Test and the Kessler Psychological Distress Scale, respectively. Multivariable logistic-regression analyses were used to estimate these two main associations with and without adjustment for other potential confounding variables, including the main effects of psychological distress and disordered eating on each other. Of the students, 45% reported eating out 3 times or more a week. Furthermore, approximately 18% screened positive for disordered eating and 33% reported high levels of psychological distress in the past 30 days. After adjustment for other variables, eating out 5 times or more a week was not significantly associated with the odds of disordered eating (OR 1.21, p = 0.32). However, eating out 5 times or more per week was significantly associated with odds of having psychological distress (OR 1.46, p = 0.03). Both psychological distress and disordered eating were strongly associated with each other (OR 2.58, p < 0.001).

Impaired renal function and abnormal level of ferritin are independent risk factors of left ventricular aneurysm after acute myocardial infarction

This study was performed to determine the prognostic value of glomerular filtration rate (GFR) and ferritin compromised in left ventricular aneurysm (LVA) patients who suffered acute myocardial infarction (AMI) beforehand.A hospital-based case–control study was conducted in the Department of Cardiology, First Affiliated Hospital, Zhejiang University in 2013 and 2014. Patients were divided into 3 groups according to kidney function and ferritin level. Observation outcomes include age, sex, C-reaction protein (CRP), medical history including major risk factors for CAD, ferritin and GFR, previous angina, time between MI and coronary angiography or time to rescue (TTR), and prior treatment.Around 60 patients were included in the case group (AMI with LVA) and 133 matched patients (AMI without LVA) in the control group. The prevalence of single-vessel disease (odd ratio [OR] = 2.490; 95% confidential interval [95% CI] = 1.376–4.506; P = .002), total LAD occlusion (OR = 1.897; 95% CI = 1.024–3.515; P = .041), absence of previous angina (OR = 1.930; 95% CI = 1.035–3.600; P = .037), time between myocardial infraction (MI) and coronary angiography more than 12 h (OR = 1.970; 95% CI = 1.044–3.719; P = .035), GFR less than 60 mL/min (OR = 2.933; 95% CI = 1.564–5.503; P = .001), and ferritin levels (P = .0003) were all higher in the aneurysm group compared with those in the control group. After adjustments for other variables, single-vessel disease (OR = 1.211; 95% CI = 1.080–1.342; P = .02), GFR lower than 60 mL/min (OR = 1.651; 95% CI = 1.250–2.172; P = .013), and high or low levels of ferritin (OR = 1.151; 95% CI = 1.050–1.252; P = .042) remained the independent determinants of LVA formation after AMI.Decreased GFR and abnormal ferritin levels are independent risk factors of LVA formation after AMI.

Evaluation of a Diabetes Self-Management Program: Claims Analysis on Comorbid Illnesses, Health Care Utilization, and Cost.

BackgroundAn estimated 30.3 million Americans have diabetes mellitus. The US Department of Health and Human Services created national objectives via its Healthy People 2020 initiative to improve the quality of life for people who either have or are at risk for diabetes mellitus, and hence, lower the personal and national economic burden of this debilitating chronic disease. Diabetes self-management education interventions are a primary focus of this initiative.ObjectiveThe aim of this study was to evaluate the impact of the Better Choices Better Health Diabetes (BCBH-D) self-management program on comorbid illness related to diabetes mellitus, health care utilization, and cost.MethodsA propensity score matched two-group, pre-post design was used for this study. Retrospective administrative medical and pharmacy claims data from the HealthCore Integrated Research Environment were used for outcome variables. The intervention cohort included diabetes mellitus patients who were recruited to a diabetes self-management program. Control cohort subjects were identified from the HealthCore Integrated Research Environment by at least two diabetes-associated claims (International Classification of Diseases-Ninth Revision, ICD-9 250.xx) within 2 years before the program launch date (October 1, 2011-September 30, 2013) but did not participate in BCBH-D. Controls were matched to cases in a 3:1 propensity score match. Outcome measures included pre- and postintervention all-cause and diabetes-related utilization and costs. Cost outcomes are reported as least squares means. Repeated measures analyses (generalized estimating equation approach) were conducted for utilization, comorbid conditions, and costs.ResultsThe program participants who were identified in HealthCore Integrated Research Environment claims (N=558) were matched to a control cohort of 1669 patients. Following the intervention, the self-management cohort experienced significant reductions for diabetes mellitus–associated comorbid conditions, with the postintervention disease burden being significantly lower (mean 1.6 [SD 1.6]) compared with the control cohort (mean 2.1 [SD 1.7]; P=.001). Postintervention all-cause utilization was decreased in the intervention cohort compared with controls with −40/1000 emergency department visits vs +70/1000; P=.004 and −5780 outpatient visits per 1000 vs −290/1000; P=.001. Unadjusted total all-cause medical cost was decreased by US $2207 in the intervention cohort compared with a US $338 decrease in the controls; P=.001. After adjustment for other variables through structural equation analysis, the direct effect of the BCBH-D was –US $815 (P=.049).ConclusionsPatients in the BCBH-D program experienced reduced all-cause health care utilization and costs. Direct cost savings were US $815. Although encouraging, given the complexity of the patient population, further study is needed to cross-validate the results.

Reduced Myocardial Flow Reserve by Positron Emission Tomography Predicts Cardiovascular Events After Cardiac Transplantation.

We evaluated the diagnostic and prognostic value of quantification of myocardial flow reserve (MFR) with positron emission tomography (PET) in orthotopic heart transplant patients. We retrospectively identified orthotopic heart transplant patients who underwent rubidium-82 cardiac PET imaging. The primary outcome was the composite of cardiovascular death, acute coronary syndrome, coronary revascularization, and heart failure hospitalization. Cox regression was used to evaluate the association of MFR with the primary outcome. The relationship of MFR and cardiac allograft vasculopathy severity in patients with angiography within 1 year of PET imaging was assessed using Spearman rank correlation and logistic regression. A total of 117 patients (median age, 60 years; 71% men) were identified. Twenty-one of 62 patients (34%) who underwent angiography before PET had cardiac allograft vasculopathy. The median time from orthotopic heart transplant to PET imaging was 6.4 years (median global MFR, 2.31). After a median of 1.4 years, 22 patients (19%) experienced the primary outcome. On an unadjusted basis, global MFR (hazard ratio, 0.22 per unit increase; 95% confidence interval, 0.09-0.50; P<0.001) and stress myocardial blood flow (hazard ratio, 0.48 per unit increase; 95% confidence interval, 0.29-0.79; P=0.004) were associated with the primary outcome. Decreased MFR independently predicted the primary outcome after adjustment for other variables. In 42 patients who underwent angiography within 12 months of PET, MFR and stress myocardial blood flow were associated with moderate-severe cardiac allograft vasculopathy (International Society of Heart and Lung Transplantation grade 2-3). MFR assessed by cardiac rubidium-82 PET imaging is a predictor of cardiovascular events after orthotopic heart transplant and is associated with cardiac allograft vasculopathy severity.

Insulin Resistance and Metabolic Syndrome: Clinical and Laboratory Associations in African Americans Without Diabetes in the Hemochromatosis and Iron Overload Screening Study.

We sought to determine associations with insulin resistance (IR) and metabolic syndrome (MetS) in African Americans. We studied African American adults without diabetes in a postscreening examination. Participants included Cases: transferrin saturation (TS) >50% and serum ferritin (SF) >300 μg/L (M), and TS >45% and SF >200 μg/L (F), regardless of HFE genotype; and Controls: TS/SF 25th to 75th percentiles and HFE wt/wt (wild type). We excluded participants with fasting <8 h; fasting glucose >126 mg/dL; hepatitis B or C; cirrhosis; pregnancy; or incomplete datasets. We analyzed age; sex; Case/Control; body mass index (BMI); systolic and diastolic blood pressures; neutrophils; lymphocytes; alanine aminotransferase; aspartate aminotransferase; elevated C-reactive protein (CRP >0.5 mg/L); TS; and SF. We computed homeostasis model assessment of insulin resistance (HOMA-IR) using fasting serum glucose and insulin, and defined IR as HOMA-IR fourth quartile (≥2.42). There were 312 Cases and 86 Controls (56.3% men). Ninety-one percent had HFE wt/wt. None had HFE p.C282Y. A significant increasing trend across HOMA-IR quartiles was observed for BMI only. Multivariable regression on HOMA-IR revealed significant positive associations: age; BMI; lymphocytes; SF; and CRP >0.5 mg/L; and significant negative associations: neutrophils and TS. Logistic regression on IR revealed BMI [odds ratio (OR) 1.3 (95% confidence interval 1.2-1.4)] and CRP >0.5 mg/L [OR 2.7 (1.2-6.3)]. Fourteen participants (3.5%) had MetS. Logistic regression on MetS revealed one association: IR [OR 7.4 (2.1-25.2)]. In African Americans without diabetes, IR was associated with BMI and CRP >0.5 mg/L, after adjustment for other variables. MetS was associated with IR alone.

Hormonal Predictors of Abnormal Luteal Phases in Normally Cycling Women.

Objective: Explore potential relationships between preovulatory, periovulatory, and luteal-phase characteristics in normally cycling women.Design: Observational study.Setting: Eight European natural family planning clinics.Patient(s): Ninety-nine women contributing 266 menstrual cycles.Intervention(s): The participants collected first morning urine samples that were analyzed for estrone-3 glucuronide (E1G), pregnanediol-3- alpha-glucuronide (PDG), follicle stimulating hormone (FSH), and luteinizing hormone (LH). The participants underwent serial ovarian ultrasound examinations.Main Outcome Measure(s): Four outcome measures were analyzed: short luteal phase, low mid-luteal phase PDG level (mPDG), normal then low luteal PDG level, low then normal luteal PDG level.Results: A long preovulatory phase was a predictor of short luteal phase, with or without adjustment for other variables. A high periovulatory PDG level was a predictor for short luteal phase as well as normal then low luteal PDG level. A low periovulatory PDG level predicted low mPDG and low then normal luteal PDG level, with or without adjustment for other variables. A small maximum follicle predicted normal then low luteal PDG level, with or without adjustment for other variables. The relationship between small maximum follicle size and short luteal phase or small maximum follicle size and low mPDG was no longer present when the regression was adjusted for certain characteristics. A younger age at menarche and a high body mass index were both predictors of low mPDG.Conclusion: Luteal phase abnormalities exist over a spectrum where some ovulation disorders may exist as deviations from the normal ovulatory process.This study confirms the negative impact of a small follicle size on the quality of the luteal phase. The occurrence of normal then low luteal PDG level is confirmed as a potential sign of luteal phase abnormality.

Role of osteopontin and its rs11730582 gene polymorphism in breast cancer

BackgroundOsteopontin (OPN) is an extracellular matrix protein of the integrin family that is involved in several biological pathways. Genetic polymorphisms in OPN gene has been found associated with many types of cancer. AimsIn this investigation, we aimed to study the possible role of OPN and its rs11730582 C/T single nucleotide polymorphism (SNP) in patients with breast cancer. MethodsOPN plasma levels were measured by ELIZA and OPN rs11730582 was genotyped by Taqman genotyping assay in 60 breast cancer patients and 60 healthy controls. ResultsObtained results revealed a significant increase in plasma OPN levels in the patients compared to the controls (mean ± SD was 194.8 ± 43 in patients versus 80.6 ± 34.7 in controls, P < 0.0001). OPN plasma level was affected by rs11730582 genotype and the hormones receptors status of the tumor (P < 0.05), while, no effect of the stage, grade or histological type of the tumor on OPN plasma level was found. The distribution of OPN rs11730582 genotypes differed significantly in the patients compared to controls, TT-genotype was significantly higher in breast cancer patients (P < 0.05) and was associated with elevated OPN levels. In addition, rs11730582 genotypes distribution was associated with tumor grade and hormones receptors status. Multivariate analysis revealed that plasma OPN levels and OPN rs11730582 C/T SNP genotypes distribution were associated with breast cancer after adjustment of other variables. ConclusionIn conclusion, OPN and its rs11730582 SNP were implicated in breast cancer in our study.

IP209. Does Preoperative Anemia Affect Outcomes After Lower Extremity Open Bypass?

Preoperative anemia has been shown in several surgical disciplines to increase adverse events, overall hospital costs, and 30-day mortality. The association between postoperative complications and preoperative anemia has not been fully established in vascular surgery. By using the Michigan State Vascular Quality Initiative (VQI) data for patients who underwent open bypasses for peripheral arterial disease, we sought to determine whether preoperative anemia is a risk factor for postoperative complications in patients undergoing open bypasses for peripheral arterial disease. A retrospective analysis of a prospectively collected database was performed using VQI data from the Michigan region for all open suprainguinal and infrainguinal bypasses performed between April 2011 and March 2017. Anemia was defined by the World Health Organization definition, hemoglobin concentration <13 g/dL for men and <12 g/dL for women, and classified into three groups based on its severity: mild, 10 to 13 g/dL for men and 10 to 12 g/dL for women; moderate, 8 to 10 g/dL; and severe, <8 g/dL. Association between preoperative anemia and postoperative complications was analyzed using univariate and then multivariate analysis, specifically looking at cardiac complications (composite of myocardial infarction, dysrhythmia, and congestive heart failure), acute kidney injury (AKI), and 30-day mortality. During the study period, 1755 bypass procedures, 1288 infrainguinal and 467 suprainguinal, were recorded in the regional VQI registry. Average age was 65 years, and men composed 68% of the cohort. Seventy-nine percent were white. Forty-seven percent (827) were anemic: 70% (n = 584) with mild anemia, 26% (n = 213) with moderate anemia, and 4% (n = 30) with severe anemia. After adjustment for other variables using multivariate regression, mild and moderate preoperative anemia was not associated with cardiac complications, AKI, or 30-day mortality. The incidence of severe preoperative anemia was very low, and the study was not powered enough to detect any association with outcomes for the severe anemia group. However, postoperative blood transfusion was associated with cardiac complications, AKI, and 30-day mortality. Preoperative anemia, at least in its mild and moderate forms, was not associated with postoperative complications or mortality after open bypass for arterial occlusive disease.

A raised serum lactate level is an independent predictor of in-hospital mortality in patients with isolated cerebral gunshot wounds.

Cerebral gunshot wounds (CGSWs) represent a highly lethal form of traumatic brain injury, and triaging these patients is difficult. The prognostic significance of the serum lactate level in the setting of CGSWs is largely unknown. To examine the relationship between elevated serum lactate levels and mortality in patients with isolated CGSWs. A retrospective review of the regional trauma registry was undertaken at the Pietermaritzburg Metropolitan Trauma Service, South Africa, over a 5-year period from 1 January 2010 to 31 December 2014. All patients with an isolated CGSW were included. A total of 102 patients with isolated CGSWs were identified. Of these, 92.2% (94/102) were male. The mean age (standard deviation) was 29 (8) years, and the in-hospital mortality rate was 21.6% (22/102). The mean serum lactate level was significantly higher among non-survivors than among survivors (6.1 mmol/L v. 1.3 mmol/L; p&lt;0.001). Lactate levels among non-survivors were &lt;2 mmol/L in 4.5%, 2 - 3.99 mmol/L in 9.1%, 4 - 5.99 mmol/L in 36.4% and ≥6 mmol/L in 50.0%. The odds ratio for mortality with a lactate level of 4 - 5.99mmol/L was 67 (95% confidence interval (CI) 1.7 - 2 674.2), while for a lactate level of ≥6 mmol/L it was 1 787 (95% CI 9.0 - 354116.1). The serum lactate level accurately predicted mortality even after adjustment for other variables. Based on a receiver operating curve analysis, an optimal cut-off of 3.3 mmol/L for serum lactate as a predictor for mortality was identified (area under the curve = 0.957). CGSWs are associated with significant mortality, and a raised serum lactate level appears to be an independent predictor of in-hospital mortality. It is a potentially useful adjunct in the resuscitation room for identifying patients with a very poor prognosis.

Changes in Bone Mineral Density After Kidney Transplantation

BackgroundNumerous studies have shown that osteoporosis is common in kidney transplant recipients. However, the change in bone mineral density after kidney transplantation (KT) is not fully understood. MethodsThirty-nine kidney transplant recipients with bone densitometry at pretransplant and 24 months after KT were reviewed. ResultsThe recipients' median age (44.5 ± 10.7 years) and dialysis duration before KT (4.2 ± 3.4 years) were recorded. The T-scores of the lumbar spine and femur neck at 24 months after KT were positively associated with the respective pretransplant T-score (P < .001 in the lumbar spine and P < .001 in the femur neck). However, the T-score after KT did not show significant change (P = .680 in lumbar spine, P = .093 in femur neck). Changes in the T-scores of the lumbar spine and femur neck over 24 months (delta T-score) were negatively associated with the respective pretransplant T-scores (P = .001 in lumbar spine, P = .026 in femur neck). Changes in the T-scores of the lumbar spine and femur neck over 24 months (delta T-score) were also associated with the pretransplant T-scores after the adjustment of other variables. ConclusionThe change of bone mineral density was related with pretransplant bone mineral density. Careful follow-up of bone densitometry for KT recipients was needed.

A standardized antenatal class reduces the rate of cesarean section in southern Italy: A retrospective cohort study.

Italy, along with Poland and Hungary, has the highest cesarean section rate (35.7%) in Europe. Among Italian regions, Campania has the highest rate of cesarean section (58.4%).We developed a standardized antenatal class to evaluate whether women who attend this class during pregnancy have a lower cesarean section rate. This antenatal class was developed according to the indication of the Italian Ministry of Health and the World Health Organization. We selected a cohort of women who participated in this antenatal class and a cohort of women who did not participate. We collected information on the mode of delivery, and other characteristics, of these women from certificate of birth assistance form available in 2 hospitals where the women gave birth.Among women who participated in the antenatal class, there were more Italians, the women were more educated, more women were employed and there were more primiparas compared with those who did not participate. Non-participants of antenatal class showed a higher rate of cesarean section than those who participated (56.2% vs 23.1%; relative risk [RR] = 2.43; 95% confidence interval [CI] 1.95–3.03; P < .0001), as well as after adjustment for other variables. This difference was stronger in 1 hospital (RR = 2.88; 95% CI 2.13–3.89; P < .0001) than in the other hospital (RR = 1.86; 95% CI 1.36–2.55; P < .0001).Our standardized antenatal class, which was performed in an area with a high rate of cesarean section, significantly reduced this rate, and this was still significant after adjustment for potential confounders.

Left ventricular global longitudinal strain across the spectrum of heart failure stages and its prevalence, correlates and prognostic relevance in heart failure with preserved ejection fraction

LV global longitudinal strain (GLS) is significantly altered in HFpEF and is a powerful predictor of outcome according to a recent meta-analysis. We sought to determine the evolution of GLS across the spectrum of AHA HF stages and to analyze the correlation of GLS with other clinical, biological and imaging variables and its prognostic value in HFpEF. GLS was assessed by 2D speckle-tracking echocardiography in 172 patients with HFpEF stage C (78 ± 10 yrs, 38%men), 22 stage B (73 ± 10 yrs, 32%men), 56 stage A (63 ± 16 yrs, 52% men) and 20 healthy volunteers (38 ± 12 yrs, 55% men). Impaired GLS was defined as −16.6%, corresponding to 2 SD below the mean value of age and sex matched controls. All patients underwent 2D echo and cMR. Patients were followed up for a composite outcome of mortality and first HF hospitalization. Mean GLS was −20.1 ± 1.0%, −19.8 ± 1.6%, −19.1 ± 2.6% and −16.6 ± 3.0% in volunteers, stage A, stage B and stage C respectively ( P for trend < 0.001), showing the worsening of GLS across the stages ( Fig. 1 ). In HFpEF stage C, 86 patients (50%) had an impaired GLS. They had higher NTproBNP ( P = 0.002), higher sST2 ( P = 0.023), higher incidence of AF (55% vs. 36%, P = 0.014), lower LVEF ( P < 0.001), higher indexed RA volume ( P = 0.041) and impaired RV systolic function (lower FAC, P = 0.002; lower TAPSE, P < 0.001 and lower cMR RVEF, P < 0.001). In multivariate logistic analysis, only RVEF (OR 0.94 [0.89–0.98], P = 0.005) and NTproBNP (OR 1.91 [1.26–2.88], P = 0.003) were associated with impaired GLS in HFpEF stage C, even after adjustment for other variables. During a mean follow up of 19 ± 9months, 85 patients (49%) reached the combined endpoint. In univariate Cox analysis, GLS was not associated with outcome. There is a continuum in GLS impairment across the spectrum of AHA HF stages confirming the role of a subclinical myocardial dysfunction in HFpEF. Impaired GLS was associated with RV dysfunction and NTproBNP but not with clinical outcomes in HFpEF.

Morphine Analgesia Pre-PPCI Is Associated with Prothrombotic State, Reduced Spontaneous Reperfusion and Greater Infarct Size.

URL: http://www.clinicaltrials.gov. Unique identifier: NCT02562690.

Social and contextual factors and their relationship with the use of palliative chemotherapy in patients with metastatic colorectal cancer (mCRC): A retrospective cohort study.

849 Background: Although there is evidence that social and contextual factors such as living alone are associated with outcomes in cancer patients, little is known about their influence on the use of palliative chemotherapy in mCRC. We previously reported various patient-and tumor-related factors that correlate with the use of palliative chemotherapy in mCRC (Oncology. 2015;88:289). In this study we examine social and contextual factors including marital status, having children and distance to cancer center for their association with the use of chemotherapy in patients with mCRC. Methods: A cohort of 569 patients with mCRC diagnosed from 2006-2010 in Saskatchewan was evaluated. Logistic regression analyses were performed to assess relationship between the use of chemotherapy and various variables. Results: Median age was 69 yrs (IQR 59-77) and M:F was 59:41. 326 (57%) patients received chemotherapy. Significant differences were noted between the chemotherapy vs. no chemotherapy groups with respect to median age (62 vs. 76 year, p &lt; 0.001), WHO performance status (PS) &gt; 1 (18 vs. 58%, p &lt; 0.001), comorbid illness (24 vs 63%, p &lt; 0.001), low albumin (61 vs. 89%, p &lt; 0.001), anemia (61 vs. 87%, p &lt; 0.001), elevated alkaline phosphatase (53 vs. 84% &lt; 0.001), elevated creatinine (6 vs. 11%, p = 0.025), hyponatremia (20 vs. 14%, p = 0.03), primary tumor resection (61 vs 47%, p = 0.001), metastasectomy (21 vs. 9%, p &lt; 0.001), mean distance to cancer center (98.7±113.6 vs. 127.8±124.6 km, p &lt; 0.001), married/partnered (67 vs 33%, p &lt; 0.001), and having children (64 vs. 36%, p &lt; 0.001), respectively. On multivariate logistic regression analysis after adjustment of other variables, WHO PS &gt; 1 (HR 5.1; 95%CI: 3.1-81.), not having children (3.3, 1.78-6.2, &lt; 0.001), elevated alkaline phosphatase (HR 2.9; 95%CI: 1.8-4.8), and low albumin (HR 2.2; 95%CI: 1.2-3.8), were correlated with low rates of chemotherapy. Marital status or travel distance did not correlate with use of chemotherapy. Conclusions: Our results show that use of chemotherapy in patients with mCRC significantly varies in those with and without children. Future study are required to explore this difference.

Abstract WP144: Variables Associated With Recovery of Communication After Stroke

Background: Communication deficits are common and disabling after both left hemisphere (LH) and right hemisphere (RH) stroke, and can be quantified by the number of Content Units (CU; concepts mentioned by healthy speakers) in describing the cookie theft picture from the NIHSS. In LH and RH stroke, CU correlates with lesion volume. Hypothesis: Communication recovery in LH and RH stroke is influenced by % damage to specific areas or vascular territories, independently of lesion volume and initial severity. Methods: 25 acute ischemic RH (n=9) and LH (n=16) stroke patients were evaluated with DWI and described the NIHSS picture &lt;24 from onset and again at 6 months. Communication recovery was measured by change in CU divided by baseline CU. A radiologist identified % damage to each cortical lobe, thalamus, basal ganglia, and each vascular territory on DWI, after co-registration to an atlas. We identified variables (age, infarct volume, initial CU, % damage to each region and vascular territory) associated with achieving the highest quartile of recovery (“best recovery”) using logistic regression. Results: Together, age, lesion volume, initial CU, and % damage to each cortical/subcortical area were strongly associated with best recovery (F(9, 15) = 12.55; p&lt; 0.00001; r 2 = 0.88), but only initial severity (CU; t=-4.95; p&lt;0.001) and % damage to basal ganglia (BG) (t=4.77; p&lt;0.0001) independently predicted best recovery after adjustment for other variables. Likewise, age, lesion volume, initial CU, and % damage to each vascular territory were strongly associated with best recovery (F(10, 14) = 10.13; p = 0.0001; r 2 = 0.88), but only initial CU (t=-4.56; p&lt;0.00001) and % damage to lenticulostriate territory (t=6.44; p&lt;0.00001) independently predicted best recovery. To explore why higher % damage to BG predicted best recovery, we examined Day 1 PWI scans. Patients with BG strokes who showed best recovery had &gt;50% damage to BG and had cortical hypoperfusion at Day 1. We speculate that good recovery was due to cortical reperfusion, but repeat PWI scans were not obtained. Conclusions: Patients who had the most room to improve on our measure of communication showed the most recovery. Independently of initial severity, more damage to left or right BG was associated with best recovery.

Metabolic Syndrome Is Associated with Health-Related Quality of Life in Suspected Patients with Nonalcoholic Steatohepatitis

Objective: This study was designed to examine the effect of metabolic syndrome (MetS) on health-related quality of life (HRQOL) in patients with suspected nonalcoholic steatohepatitis (NASH). Subjects and Methods: Three hundred thirty-two patients (236 males and 96 females) with suspected NASH from the Amol cohort study were included in this study. MetS was diagnosed based on Adult Treatment Panel III criteria and HRQOL was measured using the 12-Item Short-Form Health Survey (SF-12) questionnaire (with 8 subscales and 2 summary components). A multivariable linear regression model was used to assess the independent effect of MetS on HRQOL. Results: The mean age of the study population was 42 ± 13 years (range 18–82). The prevalence of MetS was 43.4% (n = 144) and the mean scores on the Physical Component Summary (PCS) and the Mental Component Summary were 72.4 ± 20.86 and 42.7 ± 12.42, respectively. The multivariable linear regression model showed that MetS was negatively associated with 4 subscales of HRQOL that included: role limitations due to physical problems (RP) (B = –14.05, p = 0.004), bodily pain (BP) (B = –7.37, p = 0.02), vitality (VT) (B = –7.72, p = 0.022), and role limitations due to emotional problems (RE) (B = –12.67, p = 0.005) after adjustment for other variables. Also, MetS had a borderline association with the general health and mental health subscales and the PCS (p < 0.1). Conclusion: In this study, there was a strong association between MetS and 4 subscales (RP, BP, VT, and RE) of HRQOL in patients with suspected NASH; this could be considered as a part of health policy to improve general health.

The impact of obesity in the cardiac lipidome and its consequences in the cardiac damage observed in obese rats

AimsTo explore the impact of obesity on the cardiac lipid profile in rats with diet-induced obesity, as well as to evaluate whether or not the specific changes in lipid species are associated with cardiac fibrosis. MethodsMale Wistar rats were fed either a high-fat diet (HFD, 35% fat) or standard diet (3.5% fat) for 6 weeks. Cardiac lipids were analyzed using by liquid chromatography-tandem mass spectrometry. ResultsHFD rats showed cardiac fibrosis and enhanced levels of cardiac superoxide anion (O2), HOMA index, adiposity, and plasma leptin, as well as a reduction in those of cardiac glucose transporter (GLUT 4), compared with control animals. Cardiac lipid profile analysis showed a significant increase in triglycerides, especially those enriched with palmitic, stearic, and arachidonic acid. An increase in levels of diacylglycerol (DAG) was also observed. No changes in cardiac levels of diacyl phosphatidylcholine, or even a reduction in total levels of diacyl phosphatidylethanolamine, diacyl phosphatidylinositol, and sphingomyelins (SM) was observed in HFD, as compared with control animals. After adjustment for other variables (oxidative stress, HOMA, cardiac hypertrophy), total levels of DAG were independent predictors of cardiac fibrosis while the levels of total SM were independent predictors of the cardiac levels of GLUT 4. ConclusionsThese data suggest that obesity has a significant impact on cardiac lipid composition, although it does not modulate the different species in a similar manner. Nonetheless, these changes are likely to participate in the cardiac damage in the context of obesity, since total DAG levels can facilitate the development of cardiac fibrosis, and SM levels predict GLUT4 levels.

The Association between Blood Pressure Status and Colorectal Polyps in a Taiwanese Population

Aim : Colorectal cancer is the third most common cancer worldwide, especially in more developed countries. Colorectal adenomas can progress to malignant carcinoma based on the pathogenesis of adenoma-carcinoma sequence. This study was conducted to investigate the association with colorectal polyps of blood pressure status after excluding the confounding effect of anti-hypertensive agents. MATERIALS AND METHODS : A total of 8,700 eligible subjects with age ≥ 18 years were enrolled from the Health Examination Center of National Cheng Kung University Hospital (NCKUH) between June 2001 and August 2009. We categorized colonoscopic findings into four subgroups: polyp-free, non-neoplastic polyps, non-advanced adenomatous polyps, and advanced adenomatous polyps. Subjects were divided into normal blood pressure, prehypertension and hypertension. RESULTS : The subjects were divided into polyp-free (n = 6,773), non-neoplastic polyps (n = 806), non-advanced adenomatous polyps (n = 876), and advanced adenomatous polyps (n = 245). With adjustments for other variables, hypertension was positively related to non-advanced adenomatous polyps (OR: 1.40, 95% CI: 1.14–1.73) and advanced adenomatous polyps (OR: 1.93, 95% CI: 1.37–2.72). Prehypertension was associated with a higher risk of non-neoplastic polyps (OR: 1.20, 95% CI: 1.01–1.43) and non-advanced adenomatous polyps (OR: 1.42, 95% CI: 1.21–1.68), but not associated with advanced adenomatous polyps. CONCLUSION : Hypertension was positively related to an increased risk of non-advanced and advanced adenomatous polyps, but not non-neoplastic polyps. In contrast, prehypertension was associated with a less advanced stage of colon polyps, including non-neoplastic polyps and non-advanced adenomatous polyps, but not associated with advanced adenomatous polyps.

Short-term outcome after cystectomy: comparison of early oral feeding in an enhanced recovery protocol and feeding using Bengmark nasojejunal tube

PurposeCystectomy for bladder cancer is associated with a high risk of postoperative complications. Standardized perioperative protocols, such as enhanced recovery after surgery (ERAS) protocols, aim to improve postoperative outcome. Postoperative feeding strategies are an important part of these protocols. In this two-centre study, we compared complications and length of hospital stay (LOS) between an ERAS protocol with early oral nutrition and a protocol with early enteral feeding with a Bengmark nasojejunal tube.MethodsWe retrospectively reviewed 154 consecutive patients who underwent cystectomy for bladder cancer in two hospitals (Hospital A and B) between 2014 and 2016. Hospital A uses an ERAS protocol (n = 45), which encourages early introduction of an oral diet. Hospital B uses a fast-track protocol comprising feeding with a Bengmark nasojejunal tube (Bengmark-protocol, n = 109). LOS and complications according to Clavien classification were compared between protocols.ResultsOverall 30-day complication rates in the ERAS and Bengmark protocol were similar (64.4 and 67.0%, respectively; p = 0.463). The rate of postoperative ileus (POI) was significantly lower in the Bengmark protocol (11.9% vs. 34.4% in the ERAS protocol, p = 0.009). This association remained significant after adjustment for other variables (odds ratio 0.32, 95% confidence interval 0.11–0.96; p = 0.042). Median LOS did not differ significantly between protocols (10 days vs. 11 days in the ERAS and Bengmark protocols, respectively; p = 0.861).ConclusionsEarly oral nutrition in Hospital A was well tolerated. However, the Bengmark protocol was superior with respect to occurrence of POI. A prospective study may clarify whether the lower rate of POI was due to the use of early nasojejunal tube feeding or other reasons.

Sustained virological response halts fibrosis progression: A long-term follow-up study of people with chronic hepatitis C infection.

Background/AimsLong-term follow-up studies validating the clinical benefit of sustained virological response (SVR) in people with chronic hepatitis C (CHC) infection are lacking. Our aim was to identify rates and predictors of liver fibrosis progression in a large, well characterized cohort of CHC patients in whom paired liver fibrosis assessments were performed more than 10 years apart.MethodsCHC patients who had undergone a baseline liver biopsy pre-2004 and a follow up liver fibrosis assessment more than 10 years later (biopsy or liver stiffness measurement (LSM) using transient elastography [FibroScan]) were identified. Subjects who had undergone a baseline liver biopsy but had no follow up fibrosis assessment were recalled for LSM. Fibrosis was categorised as mild-moderate (METAVIR F0-2 / LSM result of ≤ 9.5 kPa) or advanced (METAVIR F3-4/ LSM >9.5 kPa). The primary objective was to assess the association between SVR and the rate of liver fibrosis progression over at least 10 years, defined as an increase from mild-moderate fibrosis at baseline liver biopsy (METAVIR F0-2) to advanced fibrosis at follow-up liver fibrosis assessment.Results131 subjects were included in this analysis: 69% male, 82% Caucasian, 60% G1 HCV, 25% G3 HCV. The median age at F/U fibrosis staging was 57 (IQR 54–62) years with median estimated duration of infection 33-years (IQR 29–38). At F/U, liver fibrosis assessment was performed by LSM in 86% and liver biopsy in 14%. The median period between fibrosis assessments was 14-years (IQR 12–17). 109 (83%) participants had received interferon-based antiviral therapy. 40% attained SVR. At F/U, there was a significant increase in the proportion of subjects with advanced liver fibrosis: 27% at baseline vs. 46% at F/U (p = 0.002). The prevalence of advanced fibrosis did not change among subjects who attained SVR, 30% at B/L vs 25% at F/U (p = 0.343). However, advanced fibrosis became more common at F/U among subjects with persistent viremia: 10% at B/L vs 31% at F/U (p = 0.0001). SVR was independently associated with protection from liver fibrosis progression after adjustment for other variables including baseline ALT (p = 0.011), duration of HCV infection and mode of acquisition.ConclusionHCV eradication is associated with lower rates of liver fibrosis progression. The data support early treatment to prevent long-term liver complications of HCV infection.