Forward Stepwise Linear Regression Analysis Research Articles

Evaluation of arrow release in highly skilled archers using an acoustic measurement system

During aiming, an archer holds the stretched bow while a small piece of metal - the clicker - presses the arrow lateral against the bow. At the end of the aiming phase, the archer pulls the arrow back until the clicker slips over the arrowhead and causes a click, and then the archer shoots. To investigate the precision of the timing of this motor program, an acoustic measurement system has been developed. The system is composed of a modular microphone (AKG C 480 B comb-ULS/61), and an external FireWire Audio Interface (Focusrite Saffire LE 24Bit / 96kHz). From the audio signal, the time of the clicker's fall, the release of the shot and the hit of the target can be detected. Seven elite archers (two males, five female) performed 30 shots (ten ends of three arrows without any time limit) at 18 m indoors. Means and coefficients of variation (CV) were calculated from average speed and clicker time, i.e. the time between the click and the release of the shot. Forward stepwise multiple linear regression analysis was done to determine mean scores. CV of the clicker time accounted for 66% of the variability in scoring. A “leave-one-out” cross validation procedure revealed consistent estimate of the model (all corrected R2 were in a range of 0.66 and 0.75 with p<0.03). It has been shown that a highly precise timing in arrow release in terms of small CVs of clicker time is important for high mean scoring.

Relationship between anthropometric parameters with vertical jump in male elite volleyball players due to game’s position

The objective of this study was to examine the association between physical and anthropometric profiles and vertical jump performance in elite volleyball players. Thirty-three elite male volleyball players (21±1 y, 76.9±5.2 kg, 186.5±5 cm) were studied. Several anthropometric measurements (body mass, stature, body mass index, lower limb length and sitting height) together with jumping height anaerobic power of counter movement jump with arm swing (CMJarm) were obtained from all subjects. Forward stepwise multiple linear regression analysis was performed to determine if any of the anthropometric parameters were predictive of CMJarm. Anaerobic power was significantly higher (P≤0.05) in the tallest players relative to their shorter counterparts. A significant relationship was observed between CMJarm and lower limb length (r2=0.69; P<0.001) and between the lower limb length and anaerobic power obtained with CMJarm (r2=0.57; P<0.01). While significantly correlated (P≤0.05) with CMJarm performance, stature, lower limb length/stature and sitting height/stature ratios were not significant (P>0.05) predictors of CMJarm performance. This study demonstrates that lower limb length is correlated with CMJarm in elite male volleyball players. The players with longer lower limbs have the better vertical jump performances and their anaerobic power is higher. These results could be of importance for trained athletes in sports relying on jumping performance, such as basketball, handball or volleyball. Thus, the measurement of anthropometric characteristics, such as stature and lower limb length may assist coaches in the early phases of talent identification in volleyball.

Inverse association of serum long-acting natriuretic peptide and bone mineral density in renal transplant recipients

Our aim was to evaluate the relationship between bone mineral density (BMD) and fasting serum long-acting natriuretic peptide (LANP) concentration in renal transplant recipients. Fasting blood samples were obtained from 65 renal transplant recipients. BMD was measured using dual energy X-ray absorptiometry in lumbar vertebrae (L2-L4). Serum LANP levels were measured using a commercial enzyme immunoassay kit. Six patients (9.2%) had osteoporosis and 28 patients (43.1%) had osteopenia in renal transplant recipients. Increased serum LANP (p<0.001) was significantly correlated with low lumbar T-score cut-off points between groups (normal, osteopenia, and osteoporosis) in renal transplant recipients. Female patients had lower lumbar BMD than male renal transplant recipients (p=0.027). Univariate linear regression analysis indicated that lumbar BMD were positively correlated with height (p=0.038), body weight (p=0.003), and body mass index (BMI; p=0.019), whereas negatively correlated with LANP (p=0.004) among the renal transplant recipients. Multivariate forward stepwise linear regression analysis of the significant variables revealed that body weight (R(2) change=0.132; p=0.006) and LANP (R(2) change=0.093; p=0.008) were the independent predictors of lumbar BMD values in the renal transplant recipients. Serum LANP concentration correlates negatively with lumbar BMD values in renal transplant recipients.

C-reactive protein positively correlates with metabolic syndrome in coronary artery disease patients

Objective C-reactive protein (CRP) is an independent risk factor for coronary artery disease (CAD). Metabolic syndrome has been associated with an increased risk of CAD, as well as increased mortality from CAD. The aim of this study is to investigate the relationship between CRP and metabolic syndrome among CAD patients. Materials and Methods Fasting blood samples were obtained from 112 CAD patients. Metabolic syndrome and its components were defined using the diagnostic criteria from the International Diabetes Federation. Results Using Taiwanese individuals, a total of 56 CAD patients (50%) had metabolic syndrome. Fasting CRP levels positively correlated with metabolic syndrome ( p = 0.014). Univariate linear regression analysis showed that body weight ( p = 0.014), body mass index ( p < 0.001), and body fat mass ( p < 0.001) were positively correlated with serum CRP levels, while high-density lipoprotein cholesterol (HDL-C) ( p = 0.049) was negatively correlated with fasting serum CRP levels in CAD patients. Multivariate forward stepwise linear regression analysis of the significant variables showed that body fat mass (β = 0.530, R square = 0.289, p < 0.001) and HDL-C (β = −0.171, R square = 0.029, p = 0.034) were independent predictors of serum CRP levels in CAD patients. Conclusion CRP level positively correlated with metabolic syndrome among Taiwanese CAD patients. Body fat mass and HDL-C were independent predictors of serum CRP levels in CAD patients.

Hypoadiponectinemia Correlates With Metabolic Syndrome in Kidney Transplantation Patients

Serum adiponectin values correlate inversely with the presence of metabolic syndrome (MS). This study was undertaken to evaluate the relationship between MS and fasting serum adiponectin concentrations in 55 kidney transplantation patients. MS and its components were defined using the diagnostic criteria of the International Diabetes Federation. Thirteen subjects (23.6%) with MS showed negative correlations with adiponectin levels ( P = .035), which also negatively correlated with a number of MS criteria ( P = .015). Univariate linear regression analysis showed, serum adiponectin values to negatively correlate with waist circumference ( r = −0.367; P = .006), body mass index (r = −0.306; P = .023), and body fat mass (r = −0.373; P = .005). Multivariate forward stepwise linear regression analysis of the significant variables revealed that body fat mass ( R 2 change = 0.139; P = .035) and waist circumference ( R 2 change = 0.067; P = .041) were independent predictors of fasting serum adiponectin concentrations. Thus, serum adiponectin concentrations correlated inversely with MS. Body fat mass and waist circumference were independent predictors of serum adiponectin values in kidney transplant patients.

Hypoadiponectinemia is associated with metabolic syndrome in hemodialysis patients

Objective The serum adiponectin level decreases in patients with metabolic syndrome (MetS) and is an inverse predictor of cardiovascular outcomes in hemodialysis (HD) patients. The aim of this study was to investigate the relationship of adiponectin and MetS among HD patients. Materials and Methods Fasting blood samples were obtained from 101 HD patients. MetS and its components were defined using diagnostic criteria from the International Diabetes Federation. Results Forty-eight of the 101 HD patients (47.5%) had MetS. Adiponectin levels negatively correlated with MetS among HD patients ( p = 0.001). Univariate linear regression analysis showed that the pre-HD body weight ( p < 0.001); waist circumference ( p = 0.001); body mass index (BMI; p < 0.001); hemoglobin ( p = 0.038); triglyceride level ( p < 0.001); insulin level ( p = 0.005); and homeostasis model assessment of insulin resistance ( p = 0.001) correlated negatively with the fasting serum adiponectin levels, whereas the high-density-lipoprotein cholesterol (HDL-C; p < 0.001) level correlated positively with the fasting serum adiponectin levels in the HD patients. Multivariate forward stepwise linear regression analysis of the significant variables showed that the HDL-C level ( R 2 change = 0.142, p = 0.001) and BMI ( R 2 change = 0.078, p = 0.002) were independent predictors of fasting serum adiponectin levels in HD patients. Conclusion The serum adiponectin concentration correlates inversely with MetS in HD patients. For these patients, the HDL-C level and BMI are independent predictors of the serum adiponectin value.

Hyperleptinaemia positively correlated with metabolic syndrome in hemodialysis patients

Objective To evaluate the relationship between metabolic syndrome (MetS) and the fasting serum leptin concentration in hemodialysis (HD) patients. Patients and methods Fasting blood samples were obtained from 101 HD patients. MetS and its components were defined using the diagnostic criteria of the International Diabetes Federation. Results Forty-eight patients (47.5%) had MetS. Serum leptin concentrations were positively correlated with MetS (p < 0.001). Serum leptin levels correlated with increasing numbers of MetS criteria in HD patients (p = 0.001). Univariate linear regression analysis showed that the pre-HD body weight (p < 0.001), waist circumference (p < 0.001), body mass index (p = 0.001), triglycerides (p = 0.003), insulin level (p = 0.043), and homeostasis model assessment of insulin resistance (p = 0.003) positively correlated with serum leptin levels in HD patients and high-density lipoprotein-cholesterol (p = 0.016) negatively correlated with serum leptin levels in HD patients. Multivariate forward stepwise linear regression analysis of the significant variables revealed that pre-HD body weight (R 2 = 0.175; p < 0.001) was the independent predictor of the fasting serum leptin concentration. Conclusion Fasting serum leptin levels positively correlated with MetS and the pre-HD body weight could influence serum leptin in HD patients.

Prognostic factors for visual outcomes 2-years after intravitreal bevacizumab for myopic choroidal neovascularization

To determine the pre-treatment ocular factors significantly associated with the visual outcome 24 months after intravitreal bevacizumab (IVB) for myopic choroidal neovascularization (mCNV). A total of 23 eyes of 23 patients with mCNV were treated with IVB followed by as needed therapy. The efficacy of IVB was evaluated by the best-corrected visual acuity (BCVA) at 24 months after the initial treatment. Forward stepwise multiple linear regression analyses were performed to evaluate the influence of pre-treatment factors on the BCVA and the improvement of the BCVA at 24 months. The mean pre-IVB BCVA was 0.74 ± 0.30 logarithm of the minimum angle of resolution (logMAR) units, and it improved to 0.43 ± 0.31 logMAR units after 1 month (P < 0.001, paired t-test). The improvement was maintained at 24 months (0.46 ± 0.40, P < 0.005). The mean number of IVB performed during the 24 months was 1.35 ± 0.71. Forward stepwise regression analysis showed that the pre-IVB CNV size (standardized β = 0.52, P < 0.01) and BCVA (standardized β = -0.44, P < 0.05) significantly affected the visual acuity change after 24 months. The CNV size was the only factor that significantly affected the BCVA after 24 months (standardized β=0.56, P < 0.01). IVB with as needed therapy for mCNV led to a rapid and sustained visual improvement. Smaller CNV size was a significant prognostic factor that predicts better visual acuity. Patients with lower pre-treatment BCVA had better visual recovery than those with better pre-treatment BCVA, however, this may be due to a ceiling/floor effect.

Fasting Serum Leptin Level Correlates With Mid‐Arm Fat Area in Peritoneal Dialysis Patients

Leptin correlates with body fat content and plays a pivotal role in inflammatory response. This study aimed to investigate the relationships of fasting serum leptin levels and the anthropometric fat components among peritoneal dialysis (PD) patients. Fasting blood samples were obtained from 40 PD patients. Leptin levels were measured using a commercial enzyme-linked immunosorbent assay kit. Body weight (r=0.424; P=0.006), waist circumference (r=0.352; P=0.026), body mass index (BMI; r=0.483; P=0.002), body fat mass (r=0.352; P=0.026), high sensitivity C-reactive protein (hs-CRP; r=0.494; P=0.001), triceps skinfold thickness (TSF; r=0.505; P=0.001), mid-arm circumference (MAC; r=0.471; P=0.002), and mid-arm fat area (MAFA; r=0.564; P<0.001) were positively correlated, while high density lipoprotein (HDL)-cholesterol (r=-0.345; P=0.028) was negatively correlated with fasting serum leptin levels among the PD patients. Multivariate forward stepwise linear regression analysis showed that MAFA (R(2)=0.318, P=0.011) was the independent predictor of fasting serum leptin levels among the PD patients. In conclusion, fasting leptin level was positively associated with body fat composition (body weight, waist circumference, BMI, body fat mass, TSF, MAC, and MAFA) and hs-CRP among PD patients, and MAFA was the independent predictor of fasting serum leptin levels among the PD patients.

C-reactive Protein Positively Correlates With Metabolic Syndrome in Kidney Transplantation Patients

Objective C-reactive protein (CRP) is an independent risk factor for renal allograft loss and predicts all-cause mortality in kidney transplantation patients. Metabolic syndrome has also been associated with increased mortality in kidney transplantation patients. The aim of this study was to investigate the relationship between CRP and metabolic syndrome in kidney transplantation patients. Materials and Methods Fasting blood samples were obtained from 55 kidney transplantation patients. Metabolic syndrome and its components were defined using diagnostic criteria from the International Diabetes Federation. Results In total, 13 kidney transplantation patients (23.6%) had metabolic syndrome. Fasting CRP levels positively correlated with metabolic syndrome ( p = 0.001). Univariate linear regression analysis indicated that fasting serum CRP values were positively correlated with body weight ( p = 0.001), waist circumference ( p = 0.008), body mass index ( p p = 0.042). Multivariate forward stepwise linear regression analysis of the significant variables showed that body mass index (β = 0.455, R 2 = 0.207, p Conclusion CRP level positively correlated with metabolic syndrome in kidney transplantation patients. Body mass index was an independent predictor of serum CRP levels in kidney transplantation patients .

The proportion and metabolic effects of adiponectin multimeric isoforms in patients with chronic kidney disease on maintenance hemodialysis

Adiponectin circulates at least in three major forms of oligomeric complexes in plasma: a low-molecular-weight (LMW) trimer, a middle-molecular-weight (MMW) hexamer, and high-molecular-weight (HMW) adiponectin. Although it has been reported that adiponectin has the favorable metabolic properties for humans, the roles of these multimers in the patients with the end-stage renal disease (ESRD) were unidentified. We determined the level of total and multimeric adiponectin in 71 patients with nondiabetic ESRD treated with hemodialysis (HD) using a commercially available kit of enzyme-linked immunosorbent assay (ELISA). Correlations between metabolic variables and total and multimeric adiponectin were examined by Spearman's correlations analysis. Forward stepwise multiple linear regression analysis was also performed to determine the factors independently associated with them. Female patients had significantly higher total, HMW, and MMW levels than male patients did. According to homeostasis model of assessment of insulin resistance (HOMA-IR), value was associated not only with HMW but also with MMW and LMW. In multivariate analyses, HMW showed independently and positively associated with high-density lipoprotein cholesterol (HDL-C), body mass index (BMI), and sex as total adiponectin did. Unexpectedly, LMW adiponectin was independently and negatively correlated with TG and high-sensitive C-reactive protein (hs-CRP). Not only HMW adiponectin but also LMW adiponectin track with favorable metabolic effects in the patient with the ESRD.

Hyperleptinemia positively correlated with metabolic syndrome in renal transplant recipients

Our aim was to evaluate the relationship between metabolic syndrome and fasting serum leptin concentration in renal transplant recipients. Fasting blood samples were obtained from 55 renal transplant recipients. Metabolic syndrome and its components were defined using the diagnostic criteria of the International Diabetes Federation. Thirteen patients (23.6%) had metabolic syndrome. Fasting leptin concentrations were positively correlated with metabolic syndrome (p=0.003). Univariate linear regression analysis indicated fasting serum leptin values were positively correlated with waist circumference (r=0.284; p=0.036), body mass index (r=0.358; p=0.007), body fat mass (r=0.610; p<0.001), triglycerides (r=0.268; p=0.048), high-sensitivity C-reactive protein (hs-CRP) (r=0.377; p=0.005), triceps skinfold (r=0.335; p=0.012), and mid-arm fat area (r=0.351; p=0.009). Multivariate forward stepwise linear regression analysis of the significant variables revealed that body fat mass (R2 change=0.373; p<0.001) and hs-CRP (R2 change=0.045; p=0.049) were the independent predictors of fasting serum leptin concentration. Serum leptin concentration correlates positively with metabolic syndrome in renal transplant recipients.

Fasting Serum Adiponectin Level Inversely Correlates with Metabolic Syndrome in Peritoneal Dialysis Patients

Background:Metabolic syndrome is a significant risk factor for cardiovascular disease and predicts hospitalization in peritoneal dialysis (PD) patients. An inverse association between circulating adiponectin and metabolic syndrome has been observed in humans. However, no data are available on the relationship between metabolic syndrome and serum adiponectin levels in PD patients. Method: Fasting blood samples were obtained from 47 PD patients and 47 subjects in an outpatient department were enrolled as a control group. Metabolic syndrome and its components were defined using diagnostic criteria from the International Diabetes Federation. Adiponectin levels were measured using a commercial enzyme immunoassay kit. Results: Twenty-seven of 47 PD patients (57.5%) had metabolic syndrome. PD patients had lower serum albumin (p < 0.001) and higher serum adiponectin levels (p = 0.016), high-sensitivity C-reactive protein (p = 0.008), creatinine (p < 0.001) and metabolic syndrome (p < 0.001) than controls. The fasting adiponectin level inversely correlated with the metabolic syndrome in these PD patients (p = 0.006). Univariate linear regression analysis showed that the waist circumference (r = –0.304; p = 0.038), body mass index (r = –0.347; p = 0.017), body fat mass (r = –0.305; p = 0.037), white blood count (r = –0.631; p < 0.001), triglyceride (TG; r = –0.526; p < 0.001), and fasting glucose (r = –0.394; p = 0.006) were negatively correlated with the fasting serum adiponectin levels, while high-density lipoprotein-cholesterol (r = 0.443; p = 0.002) was positively correlated with the fasting serum adiponectin levels among the PD patients. Multivariate forward stepwise linear regression analysis of the significant variables showed that white blood count (R² change = 0.398, p < 0.001), and TG (R² change = 0.118, p = 0.002) were the independent predictors of fasting serum adiponectin levels and explained 51.6% of variance. Conclusions: We observed that PD patients had higher metabolic syndrome than the general population and an inverse association was found between the circulating fasting adiponectin level and metabolic syndrome in PD patients. White blood count and TG were independent predictors of the serum adiponectin level among PD patients.

The Association of Serum Osteoprotegerin and Osteoporosis in Postmenopausal Hemodialysis Patients: A Pilot Study

Osteoprotegerin (OPG) is a potent inhibitor of osteoclasts and plays an important role in bone metabolism. Relatively high serum levels of OPG have been observed in postmenopausal women with osteoporosis compared with age-matched controls. No data, however, are available on the relationship between low bone density and serum OPG levels in postmenopausal hemodialysis (HD) patients. The enrolled subjects included 28 postmenopausal HD patients and 28 age-matched postmenopausal women with normal renal function as controls. Bone mineral density (BMD) was measured by dual energy x-ray absorptiometry (DEXA) in both hips. Low BMD was defined as femoral neck T-score <-2.5. Serum OPG levels were measured using a commercial enzyme-linked immunosorbent assay (ELISA) kit. Eight of the age-matched postmenopausal controls (28.6%) and 12 of the postmenopausal HD patients (42.9%) had low BMD. There was no statistically significant difference in low BMD between postmenopausal HD patients and age-matched postmenopausal patients (p = 0.263). The serum OPG level was significantly higher in the postmenopausal HD group (p < 0.001). Increased serum OPG (p = 0.017) and decreased serum albumin (p = 0.021) were significantly correlated with low BMD in postmenopausal HD patients. Univariate linear regression analysis showed that serum albumin (r = -0.455, p = 0.015) was negatively correlated, whereas age (r = 0.423, p = 0.025) and the length of time since menopause (r = 0.397, p = 0.036) were positively correlated with the serum OPG level in postmenopausal HD patients. Multivariate forward stepwise linear regression analysis showed that serum OPG (adjusted R(2) = 0.262, p = 0.003) was an independent predictor of low BMD in postmenopausal HD patients and explained 26.2% of the variance. Serum OPG is associated with low BMD in postmenopausal HD patients.

Dietary Vitamin K2 Supplement Improves Bone Status After Lung and Heart Transplantation

Osteoporosis is a problem after transplantation. Studies since the last year indicate that vitamin K plays a role in optimal bone health. The aim of this randomized, double blind, prospective longitudinal study was to investigate the effect of a dietary supplement with vitamin K2 (180 microg menakinon-7) on bone mass, the first year after lung and heart transplantation. After preoperative baseline investigation of bone mass and bone-related biochemistry, 35 lung and 59 heart recipients were postoperatively randomized to vitamin K2 or placebo and reinvestigated the following year. In all recipients, 1 year after solid organ transplantation, the difference between vitamin K2 and placebo for the lumbar spine (L2-L4) bone mineral density (BMD) was 0.028 (SE 0.014) g/cm(2), P=0.055 and for L2 to L4 bone mineral content was 1.33 (SE 1.91) g/cm(2) (P=0.5). In lung recipients separately, the difference for bone mineral content was 3.39 g (SE 1.65), P=0.048 and in heart recipients 0.45 (SE 0.02) g, P=0.9 after controlling for baseline measures. In a forward stepwise linear regression analysis fitted to model differences in the L2 to L4 BMD, controlled for possible confounding variables (including use of bisphosphonate), and the only significant predictors were organ (B=-0.065 g/cm(2), P<0.001) and vitamin K2 (B=0.034 g/cm(2), P=0.019). Insufficient vitamin D status was common, and the parathyroid hormone was highest in the K2 group indicating a higher need for vitamin D. One year of vitamin K2 supplement suggest a favorable effect on lumbar spine BMD with different response in lung and heart recipients. Vitamin D status should receive more attention.

Fasting Adiponectin is Inversely Correlated with Metabolic Syndrome in Patients with Coronary Artery Disease

Hypoadiponectemia was observed to correlate with the prevalence or extent of coronary artery disease (CAD), the relationship between metabolic syndrome and fasting serum adiponectin concentration in CAD patients are not well elucidated. Fasting blood samples were obtained from 98 CAD patients. Metabolic syndrome and its components were defined using the diagnostic criteria of the International Diabetes Federation. Adiponectin concentrations were measured using a commercial enzyme immunoassay kit. Fifty patients with CAD (51.0%) had metabolic syndrome. For this group of patients, fasting adiponectin concentrations were found to correlate inversely with metabolic syndrome (p=0.009). Fasting adiponectin values for these subjects also tended to decrease as the number of diagnostic criteria for metabolic syndrome increased (p=0.024). CAD patients with hyperlipidemia (p=0.002), obesity (p=0.030) or receiving statin therapy (p=0.005) had lower serum adiponectin values. By univariate linear regression analysis, fasting serum adiponectin values were positively correlated with age (r=0.242; p=0.017) and high density lipoprotein-cholesterol concentration (HDL-cholesterol; r=0.267; p=0.008) but were negatively correlated with triglyceride concentration (TG; r=-0.251; p=0.013). Multivariate forward stepwise linear regression analysis of the significant variables revealed that HDL-cholesterol concentration (R square=0.071, p=0.008) and age (R square=0.039, p=0.044) are the independent predictors of fasting serum adiponectin concentration for patients with CAD. Serum adiponectin concentration is inversely correlated with metabolic syndrome and the number of metabolic syndrome criteria in patients with CAD. For these patients HDL-cholesterol concentration and age are independent predictors of the serum adiponectin value.

Fasting Serum Level of Fatty-Acid-Binding Protein 4 Positively Correlates With Metabolic Syndrome in Patients With Coronary Artery Disease

The serum level of fatty-acid-binding protein 4 (FABP4) increases in patients with metabolic syndrome (MetS), so the relationship between FABP4 and MetS among patients with coronary artery disease (CAD) was investigated in the present study. Fasting blood samples were obtained from 98 CAD patients. MetS and its components were defined using the diagnostic criteria of the International Diabetes Federation; 50 CAD patients (51.0%) had MetS. The fasting level of FABP4 positively correlated with MetS (P=0.037) and serum levels of FABP4 correlated with a number of MetS criteria (P=0.035). Univariate linear regression analysis showed that body fat mass (R=0.234; P=0.020) and the levels of triglycerides (R=0.348; P<0.001), and low-density lipoprotein-cholesterol (R=0.217; P=0.032) positively correlated with the serum level of FABP4, whereas the level of high-density lipoprotein-cholesterol (R=-0.243; P=0.016) negatively correlated with it. Multivariate forward stepwise linear regression analysis of the significant variables showed that the level of triglycerides (beta=0.348, R(2)=0.121, P<0.001) was the independent predictor of fasting serum level of FABP4. Among CAD patients in the present study, the fasting level of FABP4 positively correlated with MetS and serum levels of FABP4 correlated with a number of MetS criteria.

A Clinical Study of Prognosis and Glucocorticoid Pulse Treatment in Patients with Acute Paraquat Intoxication

Objective Paraquat is a highly toxic herbicide that binds strongly to tissue and causes high mortality rates due to pesticide intoxication in Taiwan. In this study, we evaluated the usefulness of methylprednisolone pulse therapy and calculation of the severity index of paraquat poisoning (SIPP) to predict the prognosis in patients with oral paraquat intoxication Materials and Methods Thirty-two patients with paraquat poisoning from January 2003 to April 2005 were enrolled into this study at a medical center in eastern Taiwan. All 32 patients had history of oral intake of paraquat and urine paraquat was positive at the emergency department. Time of oral intake of paraquat and serum paraquat levels were assayed at the emergency department for calculating SIPP (hour × mg/L) level. Sixteen patients with oral paraquat poisoning were treated with intravenous methylprednisolone 1 g/day and charcoal hemoperfusion for 3 days (MP group), and 16 patients with oral paraquat poisoning were treated with charcoal hemoperfusion only for 3 days (control group). Results The mortality rate of the patients with oral paraquat poisoning was high (87.5%). There were no statistically significant differences in death ( p = 1.000), age ( p = 0.706), sex ( p = 0.069), serum blood urea nitrogen ( p= 0.104), creatinine ( p= 0.174), aspartate aminotransferase ( p= 0.083), alanine aminotransferase ( p = 0.365), plasma level of paraquat ( p = 0.880) and SIPP level ( p = 0.734) between the MP group and control group. Young age ( p = 0.030), lower initial plasma paraquat level ( p = 0.002), lower serum creatinine ( p = 0.009), female sex ( p = 0.033), lower elapsed time from ingestion of paraquat to arrival at hospital ( p = 0.035) and SIPP level less than 10 ( p < 0.001) were associated with survival in patients with oral paraquat poisoning. Multivariate forward stepwise linear regression analysis of deaths showed that SIPP > 10 (hour × mg/L) ( p < 0.001) was an independent predictor of death in patients with oral paraquat poisoning and explained 77.1% of the variance ( R 2 = 0.771). Conclusion Treatment with methylprednisolone pulse therapy did not show better results in patients with acute oral paraquat poisoning. SIPP was an independent predictor of death in patients with oral paraquat poisoning.

Fasting Serum Total Ghrelin Level Inversely Correlates with Metabolic Syndrome in Hemodialysis Patients

Metabolic syndrome (MS) is a significant risk factor for cardiovascular disease and predicts hospitalization in patients undergoing hemodialysis. An inverse association between circulating ghrelin and MS has been observed in adults. However, no data are available on the relationship between MS and serum total ghrelin levels in hemodialysis patients. Fasting blood samples were obtained from 52 hemodialysis patients. MS and its components were defined using diagnostic criteria from the International Diabetes Federation. Total ghrelin levels were measured using a commercial enzyme-linked immunosorbent assay kit. Of the 52 hemodialysis patients, 30 (58%) had MS. Fasting total ghrelin level inversely correlated with MS among these hemodialysis patients (p<0.001). There was a tendency for the fasting total ghrelin level to decrease as the number of diagnostic criteria for MS in patients increased. Univariate linear regression analysis showed that the pre-hemodialysis body weight (r=-0.401; p=0.007), waist circumference (r=-0.554; p<0.001), triglyceride level (r=-0.317; p=0.022), and insulin level (r=-0.353; p=0.015) were negatively correlated with total ghrelin levels, whereas high-density lipoprotein (HDL) (r=0.506; p<0.001) and growth hormone (r=0.305; p<0.040) levels were positively correlated with the total ghrelin level. Multivariate forward stepwise linear regression analysis of the significant variables showed that waist circumference (R(2) change=0.297, p<0.001) was an independent predictor of the total ghrelin among the hemodialysis patients and explained 29.7% of the variance. We observed an inverse association between the circulating fasting total ghrelin level and MS among hemodialysis patients. There was a tendency for the total ghrelin level to decrease as the number of diagnostic criteria for MS in patients increased. Waist circumference was an independent predictor of the total ghrelin level among hemodialysis patients.

Fasting Serum Ghrelin Level is Associated with Metabolic Syndrome in Peritoneal Dialysis Patients

Serum ghrelin levels are elevated in uremic patients. However, no data are available on the relationship between metabolic syndrome and serum ghrelin levels in peritoneal dialysis (PD) patients. Metabolic syndrome and its components were defined using diagnostic criteria recommended by the International Diabetes Federation. Fasting serum samples were taken from 30 PD patients. Serum ghrelin levels were measured by using a commercial enzyme-linked immunosorbent assay kit. Of the 30 PD patients, 53.3% (16/30) had metabolic syndrome. Fasting serum ghrelin corrected inversely with metabolic syndrome among these PDs patients (p = 0.002). By odds ratio (OR) analysis of metabolic syndrome and metabolic syndrome diagnostic criteria, the predictors for metabolic syndrome are fasting glucose [OR: 39.00; 95% confidence interval (CI): 3.80 to 399.85; p < 0.001], triglycerides (OR: 37.50; 95% CI: 3.64 to 386.51; p < 0.001), and waist circumference (OR: 4.20; 95% CI: 1.95 to 9.03; p < 0.001). Univariate linear regression analysis showed that body weight (r = -0.461, p = 0.010), waist circumference (r = -0.390, p = 0.033), and body mass index (r = -0.438, p = 0.016) were negatively correlated with serum ghrelin, and serum high density lipoprotein [HDL (r = 0.626, p < 0.001)] was positively correlated with serum ghrelin. Multivariate forward stepwise linear regression analysis of the significant variables showed that HDL (R(2) change = 0.392; p < 0.001) was the independent predictor of serum ghrelin in PD patients and explained 39.2% of the variance. These results indicate an inverse association between circulating fasting ghrelin and metabolic syndrome in PD patients. Serum HDL was associated with serum ghrelin among PD patients.