Adjustment For Possible Confounders Research Articles

Postoperative supine position after primary Descemet-stripping automated endothelial keratoplasty reduces graft detachment rate

ObjectiveTo characterize the association between prolonged supine postoperative positioning of patients undergoing Descemet-stripping automated endothelial keratoplasty (DSAEK) and graft dislocation rate. MethodsIn this retrospective cohort study, medical records of patients who underwent uncomplicated DSAEK surgery at Yitzhak Shamir Medical Center between 2010 and 2019 were reviewed. Nursing documentation of patients’ adherence to supine positioning during the postoperative hospitalization period was collected. A patient was considered compliant if he or she was documented as cooperative with supine positioning throughout the first 24 hours. ResultsA total of 170 eyes of 138 patients were found eligible. Main indications for surgery were pseudophakic bullous keratopathy (50.6%), previous graft failure (25.9%), and Fuch's endothelial dystrophy (FED; 20.6%). Twelve surgeries were combined with cataract extraction. Postoperative graft detachment occurred in 26 eyes (15.3%) after an average period of 1 day (range, 0–20 days). Compliance with supine positioning was documented in 84.1% (n = 143 patients). Noncompliance rates during the first 24 hours in the detached and nondetached groups were 26.9% (n = 7) and 14.4% (n = 20), respectively; after adjustment for possible confounders, the odds ratio (OR) was 1.44 (p = 0.249). Graft dislocation was observed in 13.3% (19 of 143) and 25.9% (7 of 27) of cooperative and noncooperative patients, respectively (p = 0.17). Subanalysis of 120 eyes with either BPK or FED for which it was the first transplantation demonstrated a protective effect of supine positioning (OR 3.42, confidence interval 1.095–10.700; p = 0.034). Findings for both groups remained unchanged in multivariate analysis. ConclusionsWe found a statistically significant protective effect of 24 hours of postoperative supine positioning against graft detachment after DSAEK in eyes with no prior transplantations.

The impact of portal vein tumor thrombosis on survival in patients with hepatocellular carcinoma treated with different therapies: A cohort study.

BackgroundPortal vein tumor thrombosis (PVTT) is a frequent complication of hepatocellular carcinoma (HCC), which leads to classification as advanced stage disease (regardless of the degree of PVTT) according to the Barcelona Clinic Liver Cancer Classification. For such patients, systemic therapy is the standard of care. However, in clinical reality, many patients with PVTT undergo different treatments, such as resection, transarterial chemoembolization (TACE), selective internal radiation therapy (SIRT), or best supportive care (BSC). Here we examined whether patients benefited from such alternative therapies, according to the extent of PVTT.MethodsThis analysis included therapy-naïve patients with HCC and PVTT treated between January 2005 and December 2016. PVTT was classified according to the Liver Cancer study group of Japan as follows: Vp1 = segmental PV invasion; Vp2 = right anterior or posterior PV; Vp3 = right or left PV; Vp4 = main trunk. Overall survival (OS) was analyzed for each treatment subgroup considering the extent of PVTT. We performed Cox regression analysis with adjustment for possible confounders. To further attenuate selection bias, we applied propensity score weighting using the inverse probability of treatment weights.ResultsA total of 278 treatment-naïve patients with HCC and PVTT were included for analysis. The median observed OS in months for each treatment modality (resection, TACE/SIRT, sorafenib, BSC, respectively) was 32.4, 8.1, N/A, and 1.7 for Vp1; 10.7, 6.9, 5.5, and 1.2 for Vp2; 6.6, 7.5, 2.9, and 0.6 for Vp3; and 8.0, 3.6, 5.3, and 0.7 for Vp4. Thus, the median OS in the resection group in case of segmental PVTT (Vp1) was significantly longer compared to any other treatment group (all p values <0.01).ConclusionsTreatment strategy for HCC with PVTT should not be limited to systemic therapy in general. The extent of PVTT should be considered when deciding on treatment alternatives. In patients with segmental PVTT (Vp1), resection should be evaluated.

Excessive Orthostatic Changes in Blood Pressure Are Associated With Incident Heart Failure in Older Men: A Prospective Analysis From the BRHS.

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Grand multiparity associations with low bone mineral density and degraded trabecular bone pattern

IntroductionPregnancy is associated with changes in bone remodeling and calcium metabolism, which may increase the risk of fragility fracture after menopause. We hypothesized that in postmenopausal women, with history of grand multiparity, the magnitude of trabecular bone deterioration is associated with number of deliveries. Methods1217 women aged 69.2 ± 6.4 years, from the Bushehr Elderly Health (BEH) program were recruited. The areal bone mineral density (aBMD) of the lumbar spine and femoral neck and trabecular bone score (TBS) of 916 postmenopausal women, with grand multiparity defined as more than 4 deliveries, were compared with those of 301 postmenopausal women with 4 or fewer deliveries. The association of multiparity with aBMDs and TBS were evaluated after adjustment for possible confounders including age, years since menopause, body mass index, and other relevant parameters. ResultsThe aBMD of femoral neck (0.583 ± 0.110 vs. 0.603 ± 0.113 g/cm2), lumbar spine (0.805 ± 0.144 vs. 0.829 ± 0.140 g/cm2) and TBS (1.234 ± 0.086 vs. 1.260 ± 0.089) were significantly lower in women with history of grand multiparity than others. In the multiple regression analysis, after adjusting for confounders, the negative association did persist for lumbar spine aBMD (beta = −0.02, p value = 0.01), and the TBS (beta = −0.01, p value = 0.03), not for femoral neck aBMD. ConclusionWe infer that grand multiparity have deleterious effects on the aBMD and the trabecular pattern of the lumbar spine.

Health care utilization and excess costs after pelvic fractures among older people in Germany

SummaryOur study demonstrates a strong increase in utilization of inpatient health care and clear excess costs in older people in the first year after pelvic fracture, the latter even after adjustment for several confounders. Excess costs were particularly high in the first few months and mainly attributable to inpatient treatment.IntroductionWe aimed to estimate health care utilization and excess costs in patients aged minimum 60 years up to 1 year after pelvic fracture compared to a population without pelvic fracture.MethodsIn this retrospective population-based observational study, we used routine data from a large statutory health insurance (SHI) in Germany. Patients with a first pelvic fracture between 2008 and 2010 (n=5685, 82% female, mean age 80±9 years) were frequency matched with controls (n=193,159) by sex, age at index date, and index month. We estimated health care utilization and mean total direct costs (SHI perspective) with 95% confidence intervals (CIs) using BCA bootstrap procedures for 52 weeks before and after the index date. We calculated cost ratios (CRs) in 4-week intervals after the index date by fitting mixed two-part models including adjustment for possible confounders and repeated measurement. All analyses were further stratified for men/women, in-/outpatient-treated, and major/minor pelvic fractures.ResultsHealth care utilization and mean costs in the year after the index date were higher for cases than for controls, with inpatient treatment being particularly pronounced. CRs (95% CIs) decreased from 10.7 (10.2–11.1) within the first 4 weeks to 1.3 (1.2–1.4) within week 49–52. Excess costs were higher for inpatient than for outpatient-treated persons (CRs of 13.4 (12.9–13.9) and 2.3 (2.0–2.6) in week 1–4). In the first few months, high excess costs were detected for both persons with major and minor pelvic fracture.ConclusionPelvic fractures come along with high excess costs and should be considered when planning and allocating health care resources.

Higher health literacy score is associated with better healthy eating index in Iranian adults

ObjectiveAlthough there is some evidence for the importance of health literacy (HL), many health complications and nutrition knowledges such as portion size assessment, knowing the food labels, and choosing the nutrition sources affecting diet quality, data about HL and healthy eating index (HEI) are limited and controversial. The aim of this study was to evaluate the associations between HL and HEI in adults. MethodsThis cross-sectional study included 261 adults 18 to 65 y of age from five districts of Tehran, Iran. HL was estimated using the Health Literacy for Iranian Adult (HELIA) questionnaire. Dietary intake, sociodemographic data, physical activity, and anthropometric measurements were collected using validated questionnaires. Diet quality was assessed based on HEI-2015 scores using data from a food frequency questionnaire. ResultsDespite components of HEI-2015, the association between HEI-2015 and HL tertiles was significant (P of crude model = 0.007) even after adjustment for possible confounders. Multivariate regression showed a positive relationship between HL and HEI-2015 that was significant before (β = 0.12, P = 0.04) and after controlling for the confounding effect in model 1 (β = 0.14, P = 0.03). Additionally, a positive association between physical activity and HL was shown (β = 0.12, P = 0.03) and finally among the HEI components, only saturated fats were significantly related to HL (β = –0.11, P = 0.01). ConclusionFindings from the present study confirmed a considerable association between HL and HEI and shows HL levels have an important role in adherence to the Iranian Dietary Guidelines.

Postoperative Risks for Hispanic Patients Undergoing Hysterectomy for Benign Indications.

Hispanic patients have previously been shown to have relatively lower odds of complication following hysterectomy compared with non-Hispanic white patients, but little is known about specific risks for this group. Our primary objective was to identify differences in proportions of specific complications experienced by Hispanic patients following hysterectomy for benign indications as compared with non-Hispanic white patients. Retrospective cohort study examining differences in complication rates following benign hysterectomy between Hispanic and non-Hispanic white patients in NSQIP-participating hospitals from 2012 to 2016. A total of 102,051 women were included. A total of 15.0% were Hispanic and 85.0% were non-Hispanic white. Hispanic patients were more likely to have class 1 or 2 obesity (59.7 vs 49.8%), diabetes (10.9 vs 6.7%), and anemia (hematocrit < 33: 14.1 vs 6.5%); p < 0.01 for all. Hispanic patients were more likely to undergo abdominal hysterectomy (30.0 vs 19.1%, p < 0.01) and to remain inpatient for 2-6 days (38.8 vs 24.0%, p < 0.01). After adjustment for possible confounders including anemia, an increased odds of requiring blood transfusion persisted only in the laparoscopic and vaginal groups. Hispanic patients had a decreased or equal odds for all other examined complications. Compared with non-Hispanic white patients, Hispanic women had a higher odds of requiring blood transfusion even when undergoing minimally invasive laparoscopic and vaginal approaches to hysterectomy. Despite a higher proportion of open surgery, Hispanic patients had a decreased or equal odds of postoperative complications.

Predicting the risk of type 2 diabetes through anthropometric indices in Pakistani adults- A sub-analysis of second National diabetes survey of Pakistan 2016–2017 (NDSP-07)

Background and aimExcess adiposity is associated with an increased risk of diabetes. Amongst the various measures of adiposity, the most appropriate one to predict the risk of diabetes remains debatable. Therefore, the aim of this study was to compare the ability of body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) in predicting type 2 diabetes mellitus (DM) among Pakistani adults. Subjects and methodsThis was the sub-analysis of a large population based Second National Diabetes Survey of Pakistan (NDSP) 2016–2017. With this survey, 10834 individuals were recruited and 4788 individuals fulfilled the inclusion criteria for this sub-analysis (subjects with missing anthropometric details were excluded). Participants were categorized into two groups; subjects with type 2 DM and subjects without DM. Data of participants was collected via pre-designed detailed questionnaire. Clinical and anthropometric measurements were measured using standardized techniques. ResultsOut of 4788 individuals, 3085(64.4%) were non-DM subjects and 1703(35.6%) were type 2 DM subjects with mean age of 39.78 ± 13.79 and 50.38 ± 11.33 years, respectively. Logistic regression analysis revealed a significant association of WC with type 2 diabetes after adjustment for possible confounders. Area under the curve (AUC) of WC was found higher than AUC of BMI and WHR. ConclusionThe findings from second NDSP (2016–2017) demonstrated that WC is a better marker than WHR and BMI in predicting type 2 DM for Pakistani population.

Analysis of Active and Passive Tobacco Exposures and Blood Pressure in US Children and Adolescents

Hypertension is a leading cause of cardiovascular disease in adults; preclinical associations between hypertension and cardiovascular disease are seen in childhood. Nicotine is a known toxin, but its association with pediatric hypertension is unclear. To test the hypothesis that tobacco exposure is associated with the presence of elevated blood pressure in US children and adolescents and that this association is dose dependent. This cross-sectional study used data from the 2007 to 2016 National Health and Nutrition Examination Survey (NHANES), a population-based nationally representative sample of US children and adolescents. Children were eligible if they were aged 8 to 19 years at the time of participation in the main NHANES study. Exclusion criteria included those of the main NHANES study, inability to complete testing, or missing questionnaires. Of the 10 143 participants in NHANES aged 8 to 19 during the study years, 8520 were included in the analysis. Analysis was conducted from October 12, 2019, to July 9, 2020. Tobacco exposure, defined as serum cotinine levels greater than 0.05 µg/L, or reporting living with a smoker or smoking themselves. Elevated blood pressure, classified as greater than 90% for a child's age, sex, and height according to the 2017 American Academy of Pediatrics Clinical Practice Guidelines. The a priori hypothesis that there is a positive association between tobacco exposure and elevated blood pressure in the study population was tested. Analysis included logistic regression with adjustment for possible confounders. Subgroup and sensitivity analyses were conducted. A total of 8520 children were included in the analysis, representing 41 million US children. The mean (SD) age of the participants was 13.1 (0.05) years, 51% (95% CI, 49%-52%) were male, and 58% (95% CI, 54%-62%) were non-Hispanic White individuals. Participants with any tobacco smoke exposure were more likely than those without exposure to be older (mean [SD] age, 13.3 [0.07] years vs 12.8 [0.06] years), male (53% [95% CI, 51%-55%] vs 49% [95% CI, 47%-50%]), and non-Hispanic Black individuals (19% [95% CI, 16%-22%] vs 10% [95% CI, 8%-12%]). The odds of having elevated blood pressure was 1.31 (95% CI, 1.06-1.61) for any tobacco exposure after adjustment; odds were similar across subgroups and remained significant in multiple sensitivity analyses. This study suggests that tobacco exposure is associated with elevated blood pressure in US children and adolescents. This modifiable risk factor represents a target for further research into reducing hypertension in children and adolescents.

Visual acuity and risk of overall, injury-related, and cardiovascular mortality: the Kangbuk Samsung Health Study.

The associations of visual impairment (VI) with cardio-metabolic risk factors have been reported but its association with cardiovascular mortality remains uncertain. Therefore, we evaluated the association of visual acuity (VA) with overall, injury-related, and cardiovascular mortality. A cohort study was performed in 580 746 Korean adults (average age, 39.7 years) who were followed for a median of 8.1 years (maximum, 16 years). Presenting VA was measured by the Early Treatment Diabetic Retinopathy Study (ETDRS) chart. Visual acuity in the better vision eye was categorized as normal vision (≥0.8), lowered vision (0.5-0.8), mild visual impairment (VI) (0.3-0.5), or moderate to severe VI (<0.3). Vital status and cause of death were ascertained through linkage to national death records. During 4 632 892.2 person-years of follow-up, 6585 overall deaths, 974 cardiovascular deaths, and 1163 injury-related deaths were identified. After adjustment for possible confounders, the multivariable-adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for overall mortality among participants with lowered vision, minimal VI, and moderate to severe VI were 1.21 (1.13-1.29), 1.26 (1.15-1.37), and 1.54 (1.40-1.68), respectively, compared with those with normal vision. The corresponding HRs (95% CIs) for injury-related mortality were 1.12 (0.96-1.32), 0.98 (0.76-1.26), and 1.36 (1.04-1.79), respectively, and the corresponding HRs (95% CIs) for cardiovascular mortality were 1.32 (1.12-1.57), 1.43 (1.15-1.77), and 2.41 (1.94-2.99). In this large cohort of young and middle-aged individuals, VI was associated with increased risk of mortality especially due to cardiovascular disease.

Longitudinal association between leisure-time physical activity and vascular elasticity indices

AimWe investigated the association between levels of leisure-time physical activity and vascular stiffness in a longitudinal observational study from a representative Swedish population.MethodA total of 2816 randomly selected individuals were examined at visit 1 (2002–2005, Men = 1400). After a mean follow-up of 9.7 ± 1.4 years, a representative sample of 1327 of the original participants were re-examined at visit 2. After excluding subjects with hypertension at baseline, 761 participants were included in the longitudinal analyses. Leisure-time physical (LTPA) activity was self-reported and dichotomized as high or low (level 3, 4 and level 1, 2, respectively). Large Arterial Elasticity Index (LAEI) and Small Arterial Elasticity Index (SAEI) were measured using the HDI/Pulse Wave™ CR2000. Multivariable general linear models were used to investigate the differences in changes SAEI and LAEI based on LTPA levels.ResultsAt visit 1, and after adjustment for possible confounders, participants in the high LTPA group had better small artery elasticity (SAEI) (SAEI in low-level LTPA: 7.89 ± 0.11, SAEI in high-level LTPA: 8.32 ± 0.15, ΔSAEI: 0.42, CI: 0.07–0.78; p = 0.020). SAEI decreased between the two assessments (Visit 1: SAEI 8.01 ± 3.37 ml/mmHg; Δ SAEI: 1.4, CI 1.2–1.6, p < 0.001). Participants with a higher LTPA at visit 1 had significantly better SAEI at visit 2 (ΔSAEI: 0.44, CI 0.03–0.85, p = 0.037). No significant associations were observed between LAEI and LTPA after adjustments.ConclusionsHigh LTPA predicted higher small arterial compliance at visit 2 suggesting that positive effects of LTPA on arterial elasticity persists over time.

Assessment of the ability of the CHA2DS2-VASc scoring system to grade left atrial function by 2D speckle-tracking echocardiography

BackgroundThe CHA2DS2-VASc scoring system is correlated with left atrial (LA) reservoir function in patients with atrial fibrillation (AF) rhythm or paroxysmal AF. We assessed the ability of CHA2DS2-VASc to grade LA function in patients with sinus rhythm who were candidates for coronary artery bypass grafting (CABG).MethodsThis cross-sectional study recruited 340 consecutive candidates for CABG and categorized them according to their CHA2DS2-VASc scores as mild-, moderate-, and high-risk score groups with 34 (10%), 83 (24%), and 223 (66%) patients, respectively. LA function was evaluated via 2D speckle-tracking echocardiography in terms of global longitudinal strain and strain rate during the reservoir, conduit, and contraction phases. In-hospital mortality, postoperative AF, prolonged intensive care unit (ICU) stay, and prolonged mechanical ventilation were assessed.ResultsLA strain and strain rate during the reservoir phase was statistically significantly lower in the high-risk score group than the low- and moderate-risk score groups (27.8 ± 6.9% vs 31.0 ± 5.0% vs 29.8 ± 6.1%, respectively; P = 0.004 and 2.6 ± 0.7 s−1 vs 2.9 ± 0.6 s−1 vs 2.9 ± 0.6 s−1, correspondingly; P = 0.009) and regarding LA strain and strain rate during the conduit phase (9.7 [7.1–12.5]% vs 12.9 [9.4–15.1]% vs 11.5 [9.1–13.8]%, correspondingly; P < 0.001 and 2.1 [1.6–2.7] s−1 vs 2.8 [2.4–3.6] s−1 vs 2.6 [2.2–3.0] s−1, respectively; P < 0.001). In addition, LA strain rate during the conduit phase was lower in the moderate-risk score group than the low-risk score group. After adjustments for possible confounders, these differences remained statistically significant. The risk of postoperative AF and prolonged ICU stay was highest in the high-risk score group (relative risk = 9.67 (1.31–71.43) and 8.05 (1.08–60.16), respectively; P = 0.026 and P = 0.042, respectively).ConclusionsLA reservoir and conduit functions decreased in the high-risk score group, which was accompanied by an increased risk of postoperative AF and prolonged ICU stay.

Application of leukocyte subsets and sperm DNA fragment rate in infertile men with asymptomatic infection of genital tract.

About 15% of male infertility is due to genital tract infection and inflammation, some of them have no clinical symptoms, but manifested as leukocytospermia (LCS). Leukopenia will lead to functional impairment of male sperm and integrity damage of sperm morphology. A large amount of reactive oxygen species (ROS) produced by leukocytes can damage sperm nuclear DNA. The aim of this study was to investigate the correlation between leukocyte subsets and sperm DNA fragmentation rate in semen of infertile men with asymptomatic infection of genital tract. One hundred and eight cases of infertile men were enrolled, who were admitted to our hospital from May 2016 to September 2018, and all had genital tract infections. After routine sperm analysis, realtime PCR was performed for detecting the infection of chlamydia trachoma (CT) and Ureaplasma urealyticum (UU). Furthermore, total leukocyte count in semen was evaluated by detection of CD45 molecules using immunocytochemistry. Flow cytometry was used for subset analysis, monocyte/macrophages were evaluated by CD14, and activated macrophages were evaluated by HLA-DR antigen. Sperm DNA fragmentation index (DFI) were evaluated by SCD method and 8-hydroxydeoxyguanosine (8-OHdG) expression were evaluated by chromatin diffusion method and TUNEL method; the correlation analysis was conducted between semen leukocyte subsets, sperm DNA fragment rate and conventional semen parameters. There was a significant correlation among the concentrations of cells expressing HLA-DR antigen and those expressing CD14 (P<0.01), but the concentrations of differential leukocyte subsets all had no significant correlation with sperm DFI, the percentage of 8-OHdG-expressing cells and routine semen parameters. The percentage of 8-OHdG-expressing sperm was positively correlated with the percentage of sperm fragments (r=0.42, P<0.01), and negatively correlated with sperm concentration (r=-0.32, P<0.01). After adjustment for possible confounders including age, abstinence time and smoking, the percentage of 8-OHdG-expressing sperms independently associated with sperm concentration (β=-0.30; P=0.006) and DFI (β=0.180, P=0.06). Among infertile men with genital tract infection, the sperm DFI is associated with decreased semen quality and not the concentration of differential leukocyte subsets.

Sex modification of the association of the radial augmentation index and incident hypertension in a Chinese community-based population.

BACKGROUNDArterial stiffness, as assessed by aortic ultrasound and pulse wave velocity, is associated with incident hypertension. However, there is still no consensus on whether the augmentation index (AI) affects new onset of hypertension. This study investigated the relationship of radial AI (rAI) and incident hypertension in a Chinese community-based population without hypertension at baseline.METHODA total of 1,615 Chinese non-hypertensive participants from an atherosclerosis cohort in Beijing, China were included in our analysis. Baseline rAI normalized to heart rate of 75 beats/min (rAIp75) was obtained using HEM-9000AI. New-onset hypertension was defined as blood pressure ≥ 140/90 mmHg or self-reported hypertension or taking anti-hypertensive medications at the follow up survey. Multivariate regression models were used to evaluate the impact of rAIp75 on the risk of new-onset hypertension.RESULTSAfter a mean 2.35-year follow-up, 213 (13.19%) participants developed incident hypertension. No significant relation between rAIp75 and incident hypertension was observed in the whole population after adjustment for possible confounders (adjusted odds ratio (OR) and 95% confidence interval (CI): 1.09 [0.95−1.27];P = 0.2260). However, rAIp75 was significantly associated with incident hypertension in women, but not in men (adjusted OR and 95% CI: 1.29 [1.06−1.56],P = 0.0113 for women; 0.91 [0.72−1.15],P = 0.4244 for men; P for interaction = 0.0133). CONCLUSIONSSex modified the effect of the rAI on incident hypertension in a Chinese, community-based, non-hypertensive population. Screening of the rAI could be considered in women with a high risk of hypertension for the purpose of primary intervention.

Association between quantitative lower limb arterial calcification and bilateral severe knee osteoarthritis

Objectives To investigate whether lower limb arterial calcification (LLAC) quantified using computed tomography (CT) was a risk factor for bilateral severe knee osteoarthritis (OA). Methods This cross-sectional study included patients who were scheduled for surgical treatment of primary varus knee OA. Knee OA was evaluated using the Kellgren-Lawrence (KL) classification, KL grades 3 and 4 were defined as severe OA. The LLAC score in the bilateral whole leg CT was quantitatively measured and categorized into low or high groups based on the median value. A modified Poisson regression model was used to examine the relationship between the categorized LLAC score and the presence of bilateral severe knee OA with adjustment for possible confounders. Results Of a total of 252 patients examined, multivariable modified Poisson regression analysis showed a significant association between higher LLAC score and the presence of bilateral severe knee OA (adjusted risk ratio = 1.28; 95% confidence interval [CI], 1.12–1.48; p < .001). A substantial interaction was observed between male sex and high LLAC (p for interaction = .03). Conclusion LLAC was associated with bilateral severe knee OA, and the LLAC score may be a useful measurement to identify patients at risk of bilateral severe knee OA.

Association between levator ani avulsion and urinary incontinence in women: A systematic review and meta-analysis.

BackgroundUrinary incontinence is a bothersome symptom. Although the relationship between stress urinary incontinence (SUI) and vaginal delivery is established, the pathology underlying SUI after vaginal birth remains to be elucidated.ObjectivesTo determine whether levator ani muscle avulsion predisposes for SUI in women.Search strategyPubmed and Embase were searched for terms and their variations “levator ani muscle avulsion” and “urinary incontinence”, from inception until 5 November 2019.Selection criteriaInclusion criterion: studies describing the relationship between urinary incontinence and levator ani muscle avulsion in women at least 1 year after delivery. Exclusion criterion: studies only analyzing the urethral sphincter or hiatus dimensions.Data collection and analysisOdds ratios were used and if not available, were calculated as means of data synthesis, adjusted odds ratios if presented by the study, random‐effects model to compute a pooled estimate.ResultsSeven studies were included, accounting for 2388 women. Comparing women with and without levator ani muscle avulsion, the overall odds ratio for SUI is 0.87 (95% confidence interval 0.56–1.34), and after adjustment for possible confounders was 0.72 (95% confidence interval 0.40–1.30).ConclusionThere is no relationship between levator ani muscle avulsion and SUI in women.

Sex modulates the association of radial artery augmentation index with renal function decline in individuals without chronic kidney disease

PurposeAn increase in arterial stiffness is associated with rapid renal function decline (RFD) in patients with chronic kidney disease (CKD). The aim of this study was to investigate whether the radial augmentation index (rAI), a surrogate marker of arterial stiffness, affects RFD in individuals without CKD.MethodsA total of 3165 Chinese participants from an atherosclerosis cohort with estimated glomerular filtration rates (eGFR) of ≥ 60 mL/min/1.73 m2 were included in this study. The baseline rAI normalized to a heart rate of 75 beats/min (rAIp75) was obtained using an arterial applanation tonometry probe. The eGFRs at both baseline and follow-up were calculated using the equation derived from the Chronic Kidney Disease Epidemiology Collaboration. The association of the rAIp75 with RFD (defined as a drop in the eGFR category accompanied by a ≥ 25% drop in eGFR from baseline or a sustained decline in eGFR of > 5 mL/min/1.73 m2/year) was evaluated using the multivariate regression model.ResultsDuring the 2.35-year follow-up, the incidence of RFD was 7.30%. The rAIp75 had no statistically independent association with RFD after adjustment for possible confounders (adjusted odds ratio = 1.12, 95% confidence interval: 0.99–1.27, p = 0.074). When stratified according to sex, the rAIp75 was significantly associated with RFD in women, but not in men (adjusted odds ratio and 95% confidence interval: 1.23[1.06–1.43], p = 0.007 for women, 0.94[0.76–1.16], p = 0.542 for men; p for interaction = 0.038).ConclusionThe rAI might help screen for those at high risk of early rapid RFD in women without CKD.

Association of sleep disturbances with sarcopenia and its defining components: the ELSA-Brasil study.

Sarcopenia and sleep problems share common physiopathology. We aimed to investigate the association of sleep disturbances with sarcopenia and its defining components in Brazilian middle-aged and older adults. In this cross-sectional analysis of the second wave of the ELSA-Brasil study, we included data from 7948 participants aged 50 years and older. Muscle mass was evaluated by bioelectrical impedance analysis and muscle strength by hand-grip strength. Sarcopenia was defined according to the Foundation for the National Institutes of Health criteria. Sleep duration and insomnia complaint were self-reported. Short sleep duration was considered as ≤6 h/night and long sleep duration as >8 h/night. High risk of obstructive sleep apnea (OSA) was assessed using the STOP-Bang questionnaire. Possible confounders included socio-demographic characteristics, lifestyle, clinical comorbidities, and use of sedatives and hypnotics. The frequencies of sarcopenia, low muscle mass, and low muscle strength were 1.6, 21.1, and 4.1%, respectively. After adjustment for possible confounders, high risk of OSA was associated with low muscle mass (OR=2.17, 95%CI: 1.92-2.45). Among obese participants, high risk of OSA was associated with low muscle strength (OR=1.68, 95%CI: 1.07-2.64). However, neither short nor long sleep duration or frequent insomnia complaint were associated with sarcopenia or its defining components. In conclusion, high risk of OSA was associated with low muscle mass in the whole sample and with low muscle strength among obese participants. Future studies are needed to clarify the temporal relationship between both conditions.

Czynniki ryzyka depresji. O nowych przesłankach na temat znaczenia niedoborów selenu

Cel pracyCelem artykułu jest weryfikacja hipotezy o związku niedoborów selenu z zaburzeniami depresyjnymi przy kontroli zmiennych ubocznych i zakłócających. Na podstawie danych empirycznych porównane zostanie znaczenie niedoborów selenu z innymi czynnikami ryzyka, przy czym nie tylko tymi związanymi z żywieniem.MetodaModel równań strukturalnych oszacowano przy zastosowaniu estymatora diagonalnie ważonych najmniejszych kwadratów ze skorygowaną statystyką testową chi-kwadrat (WLSMV). Obliczono wielkość dziennego spożycia selenu i innych składników odżywczych w celu oceny ich ew. związku z subiektywną oceną występowania zaburzeń depresyjnych. Oddziaływanie wzorów żywieniowych oszacowano przy uwzględnieniu w modelu: chorób chronicznych, problemów życiowych, poziomu bólu, aktywności fizycznej oraz dochodów. Analiza została przeprowadzona na próbie 9 354 mężczyzn i kobiet w wieku 45–65 z badania PONS.WynikiWedług zaproponowanego modelu istotne jest oddziaływanie na zaburzenia depresyjne niskiego spożycia selenu (standaryzowane oddziaływanie całkowite: 0,133), wysokiego spożycia lipidów (0,102) oraz niskiego spożycia żelaza (0,065). Innych czynników żywieniowych nie cechuje istotny statystycznie związek z występowaniem zaburzeń depresyjnych w modelu (p&gt;0,05). Pośród pozostałych czynników ryzyka problemy w życiu prywatnym (0,181), ból (0,179) oraz niskie dochody (0,178) wykazują najsilniejszy związek z występowaniem depresji. Ból pośredniczy mniejszości całkowitego oddziaływania chorobowości na depresję (0,140). Zaburzenia depresyjne wykazują również związek z trudnościami w pracy zawodowej (0,123) oraz niską aktywnością fizycznej (0,024).WnioskiWielkość spożycia selenu wykazuje najsilniejszy związek z występowaniem depresji pośród analizowanych czynników żywieniowych. Znaczenie zmiennych żywieniowych jest zarazem umiarkowane w porównaniu do pozostałych czynników ryzyka uwzględnionych w modelu. Przewlekły ból, niskie dochody i chorobowość są najważniejszymi korelatami występowania zaburzeń depresyjnych.

Association of Lumbar Spinal Stenosis with Severe Disability and Mortality Among Community-Dwelling Older Adults: The Locomotive Syndrome and Health Outcomes in the Aizu Cohort Study.

This prospective cohort study analyzed data from the Locomotive Syndrome and Health Outcomes in the Aizu Cohort Study. To investigate the association between lumbar spinal stenosis (LSS) and severe disability and mortality among community-dwelling older adults. Only a few studies have investigated LSS longitudinally, and the study participants were limited to selected patients diagnosed with LSS during a hospital visit. Additionally, the prognosis of LSS remains unclear. We enrolled independent community-dwelling older adults aged 65 years or older at the time of a baseline health checkup in 2008. LSS was diagnosed using a validated diagnostic support tool for LSS. The primary endpoint was a composite of severe disability (long-term care insurance certification grade 4 or 5) and mortality. We used 1 minus Kaplan-Meier failure estimates and the log-rank test to compare the interval between baseline and the predetermined endpoint as well as a Cox proportional hazards model to estimate hazard ratios (HRs) for the LSS group with adjustment for possible confounders. Multiple imputation by chained equations was performed for sensitivity analysis. Of 2058 subjects enrolled, 1560 did not have missing covariates; 269 (17%) were diagnosed with LSS. After a median follow-up of 5.8 years, the rates of severe disability and mortality were 0.022 per year in subjects with LSS and 0.012 per year in those without (P = 0.006). The adjusted HR for the composite endpoint in the LSS group was 1.55 (95% confidence interval [CI], 1.01-2.38). A similar association was observed after multiple imputation of missing covariates (adjusted HR, 1.51 [95% CI, 1.06-2.16]). LSS was associated with severe disability and mortality in community-dwelling older adults. Detection of adults with LSS in the community may contribute to local health promotion.Level of Evidence: 2.