Healthy Reference Population Research Articles

Establishment of Community-Based Reference Intervals for Fructosamine, Glycated Albumin, and 1,5-Anhydroglucitol.

There is growing interest in fructosamine, glycated albumin, and 1,5-anhydroglucitol (1,5-AG) as alternative measures of hyperglycemia, particularly for use in settings where traditional measures (glucose and HbA1c) are problematic or where intermediate (2-4 weeks) glycemic control is of interest. However, reference intervals for these alternative biomarkers are not established. We measured fructosamine, glycated albumin, and 1,5-AG in a community-based sample of US black and white adults who participated in the Atherosclerosis Risk in Communities (ARIC) Study. We calculated reference intervals, evaluated demographic differences, and derived cutoffs aligned with current diagnostic cutpoints for HbA1c and fasting glucose. In a healthy reference population of 1799 individuals (mean age, 55 years; 51% women; 15% black), the 2.5 and 97.5 percentiles, respectively, were 194.8 and 258.0 μmol/L for fructosamine, 10.7% and 15.1% for glycated albumin, and 8.4 and 28.7 μg/mL for 1,5-AG. Distributions differed by race, sex, and body mass index. Equivalent concentrations of fructosamine and glycated albumin corresponding to an HbA1c of 6.5% (96.5 percentile) were 270.2 μmol/L and 15.6%, respectively. Equivalent concentrations of fructosamine and glycated albumin corresponding to a fasting glucose of 126 mg/dL (93.9 percentile) were 261.7 μmol/L and 15.0%, respectively. The reference intervals for these biomarkers should inform their clinical use. Diagnostic cutpoint equivalents for fructosamine and glycated albumin could be useful to identify persons with hyperglycemia in settings where fasting glucose or HbA1c are not available or where the interpretation of these traditional measures is problematic.

High-sensitivity cardiac troponin T for diagnosis of NSTEMI in the elderly emergency department patient: a clinical cohort study

Purpose: The aim of this study is to evaluate the impact of age on the diagnostic performance of high-sensitivity troponin T (hsTnT) under routine conditions.Materials and methods: Data of 4118 consecutive emergency department (ED) patients who underwent a routine TnT measurement between 11 October 2012 and 30 November 2013 were analysed. Diagnostic accuracy of hsTnT was compared in four age categories (<50, 50–64, 65–74, ≥75 years of age) for different cut-off values. Primary endpoint was a main hospital diagnosis of NSTEMI.Results: The median age of the study population (n = 4118) was 61 years (IQR: 45–75 years). NSTEMI was diagnosed in 3.3% (n = 136) of all patients. There were significant differences in hsTnT concentrations between age-groups (p < 0.001) in all patients, but not in NSTEMI patients (p = 0.297). 72.2% of all patients ≥75 years of age (583/808) without NSTEMI had hsTnT concentrations above the 99th percentile of a healthy reference population. Specificity at 14 ng/L was 93.6% (95% CI: 92.12–94.87) in patients below 50 years of age and 27.9% (95% CI: 24.78–31.08) in patients 75 years of age and older.Conclusions: Patients’ age needs to be considered at least one influencing factor on hsTnT concentrations at admission and should be included in the clinical interpretation of hsTnT concentrations for further clinical workup beneath other influencing factors like comorbidities and symptom onset time. The implementation of age-specific cut-off values could be considered for single troponin testing at admission but is associated with an increased risk of underdiagnosis of NSTEMI.

Multicentre cross-sectional clinical evaluation study about quality of life in adults with disorders/differences of sex development (DSD) compared to country specific reference populations (dsd-LIFE)

BackgroundPrevious studies in quality of life (QOL) in individuals with disorders/differences of sex development (DSD) have been restricted to subpopulations of the condition. We describe QOL in adult persons with DSD compared to country specific references and assess the impact of diagnosis.MethodsThe multicentre cross-sectional clinical evaluation (dsd-LIFE) took place in 14 specialized clinics in six European countries. Adolescents (≥16 years) and adults having a DSD condition were included from 02/2014 to 09/2015. The main outcome QOL was measured by the WHOQOL-BREF (domains of physical health, psychological, social relationships, and environment). QOL was compared to country specific reference populations by using unpaired t-tests. Linear regression models explained the additional variance of the diagnosis on QOL.ResultsThree hundred one individuals with Turner Syndrome, 219 with Klinefelter Syndrome (including XYY), 226 with 46,XX CAH and 294 with rare DSD conditions (gonadal dysgenesis, androgen insensitivity syndrome, severe hypospadias, and androgen synthesis errors or other diagnosis) took part. Compared to healthy European populations, QOL was similar in psychological, slightly worse in physical health, and slightly better in environment. In social relationships, QOL was significantly poorer compared to healthy and non-healthy reference populations. In linear regression models health status was the most important predictor of QOL; additional variance was explained by feelings about household’s income in all domains, and the relationship status in social relationships. Diagnosis explained nearly no additional variance.ConclusionsExcept for social relationships, most people with DSD adapt well to their life circumstances and report a good QOL. Not diagnosis, but the individual’s health status is much more important than previously thought. Therefore care for people with DSD should focus more on chronic physical or mental health problems both related and unrelated to the diagnosis itself.Trial registrationGerman Clinical Trials Register DRKS00006072.

Risk Prediction in Acute Coronary Syndrome using the US vs non-US 99th Percentile Threshold of the 5th Generation Troponin T Assay

To the Editor: Acute myocardial infarction (AMI)1 is a common reason for seeking emergency medical attention. According to the universal definition of MI (1), cardiac troponin T or I are the cornerstones in defining AMI. In addition to increasing/decreasing troponin levels, the 99th percentile concentration of a healthy reference population is recommended as a diagnostic threshold. Further, recommendations on assay total imprecision are provided. With the availability of assays fulfilling these criteria, improved AMI diagnosis has been demonstrated, especially in European cohorts. Subsequently, highly sensitive troponin assays were introduced in several international markets and have …

Advances in pediatric reference intervals: from discrete to continuous

The clinical utility of laboratory tests largely relies on availability of normative ranges (i.e., reference intervals) to enable objective interpretation and clinical decision making. Establishing accurate reference intervals is often beyond the capabilities of individual laboratories, requiring recruitment of a sufficiently large, healthy reference population, which becomes even more challenging in the pediatric population.

SOCIOECONOMIC AND NUTRITIONAL CHARACTERISTICS OF CHILDREN AND ADOLESCENTS WITH SICKLE CELL ANEMIA: A SYSTEMATIC REVIEW.

ABSTRACTObjective: To describe the socioeconomic and nutritional characteristics of children and adolescents with sickle cell anemia.Data sources: The present study is a systematic literature review based on published scientific articles. The searches were carried out using the electronic database of the National Library of Medicine, National Institutes of Health- PubMed. Two searches of articles published in the last 20years and without limitation of language were carried out. Thefirst one started from the Medical Subject Headings term “Anemia, Sickle Cell” associated with “Socioeconomic Factors”; and the second started from the term “Anemia, Sickle Cell” associated with “Anthropometry”. Thesearches were directed to research conducted on humans in the age group from 0 to 18years.Data synthesis: The final selection was composed by 11 articles on socioeconomic characteristics and 21articles on nutritional characteristics. Allstudies included children and adolescents with sickle cells disease (age range 0-18years), both genders, and most of them of black ethnicity. Families of children and adolescents with sickle cell anemia were of predominantly low socioeconomic status. Parents had lower educational levels when compared to parents of healthy children and adolescents. Body measurements (weight and height) and anthropometric indicators of children with sickle cell anemia were often lower when compared to healthy groups or reference populations.Conclusions: Children and adolescents with sickle cell anemia have socioeconomic limitations and worse nutritional conditions, when compared to reference populations. These limitations may lead to worse growth and greater occurrence of possible complications that can impair their quality of life.

Catch-up growth in stunted children: Definitions and predictors.

This paper examines the incidence and correlates of linear growth catch up in early childhood among stunted children, using a range of definitions of catch up. Catch-up growth between two and five years of age is defined in both absolute terms (i.e. the centimetre height deficit from the healthy reference population mean is reduced) and relative terms (the height-for-age z-score improved or passed the -2SD or -1SD cut-off points). Data from a cohort study from urban South Africa are used to estimate the percentage of children who caught up and the predictors of catch-up growth according to these varying definitions. The results show that our sample of stunted children exhibits catch-up growth regardless of the definition used, however prevalence of catch up is highly sensitive to the way catch up is classified, ranging from 19%-93%. Of the biological, early growth, socioeconomic status and maternal reproductive variables included in the multivariate probit regressions, only a few were found to be consistent predictors of the incidence of catch-up growth. Mother’s height was positively correlated with the incidence of catch-up growth and early stunting at one year was associated with a lower likelihood of subsequent catch up.

Patient-related outcome of unstable pelvic ring fractures stabilized with a minimal invasive screw-rod system

BackgroundClinical and radiological outcomes of operatively treated unstable pelvic ring fractures are well documented, whereas little is known about the patient’s related outcome. The purpose of this study is to evaluate the patient-reported outcome after minimal invasive treatment of pelvic ring fractures using the SF-36 and EQ-5D medical outcome scores.MethodsPatients with unstable pelvic ring fractures treated in our trauma department with a minimal invasive screw-rod system between 01/2004 and 12/2014 were included. Next to patient data (sex, age), injury related details (fracture type, additional injuries, Injury Severity Score (ISS)) as well as operation details (method, time to operation, general complications, adverse events associated with the surgical procedure, revision surgery, fracture reduction) were assessed. The patient related outcome was evaluated using the SF-36 and the EQ-5D score.ResultsA total of 105 patients (57 men; 48 women; mean age 56 ± 21 years) were identified as candidates for the study. 60 patients completed the SF-36 and EQ-5D score after a mean follow-up of five years (60.5 months (14-142 months)). Of these patients 77% were multiply injured with a mean ISS of 26 ± 19. Within the respondent group 22% showed type B and 78% type C pelvic ring fractures. In 82% the dorsal pelvic ring fracture was stabilized using a minimally invasive transiliac internal fixator, in 18% an iliolumbar fixation was performed respectively. The mean physical component score of the SF-36 was 37.9 ± 12.0, the mean mental component score was 49.8 ± 12.5. The mean EQ-5D VAS reached 70.5 ± 24.4.ConclusionPatients being multiply injured and treated with minimal invasive treated dorsal pelvic ring fractures were suffering more especially concerning physical domains compared to the healthy reference population. Nevertheless, the overall patient-related outcome is comparable to pelvic ring fractures in general.Trial Registration NumberClinical Trial Registry University of Regensburg Z-2017-0878-3. Registered 22. July 2017. Retrospectively registered.

The impact of sarcopenia on health-related quality of life in elderly people: Korean National Health and Nutrition Examination Survey.

Background/AimsThe purpose of the study is to investigate the associations between sarcopenia and health-related quality of life in elderly men and women in Korea.MethodsIn a cross-sectional study using data from 2008 to 2011 Korean National Health and Nutrition Examination Survey, 4,937 adults aged 60 years and older who underwent a dual-energy X-ray absorptiometry scan were included in the study. Sarcopenia is defined as an appendicular skeletal muscle index of two standard deviations or more below the mean for young, healthy reference populations. The health-related quality of life was measured using the EuroQol-5 dimension questionnaire.ResultsThe overall prevalence of sarcopenia was 6.6% in these Korean people over the age of 60 years: 11.1% for men and 3.2% for women. Sarcopenic men tended to have lower income, lower physical activity, lower body mass index, and smaller waist circumference compared with nonsarcopenic men. Sarcopenic women tended to have higher body mass index and larger waist circumference compared with nonsarcopenic women. Sarcopenic men showed higher impairments in mobility, self-care, usual activities, and pain/discomfort compared with nonsarcopenic men. Women with sarcopenia also showed higher impairments in mobility, self-care, usual activities, and anxiety/depression compared with nonsarcopenic women. Sarcopenia showed an association with impairments in selfcare for men, and with impairments in self-care, usual activities, and anxiety/depression for women, after adjusting for other confounding factors.ConclusionsThere is a significant association between sarcopenia and impaired health-related quality of life in this elderly Korean population, and these results differ between men and women.

10 patients, 10 years – Long term follow-up of cardiovascular risk factors in Glut1 deficiency treated with ketogenic diet therapies: A prospective, multicenter case series

Glut1 Deficiency (Glut1D) is caused by impaired glucose transport into brain. The resulting epileptic encephalopathy and movement disorders can be treated effectively by high-fat carbohydrate-restricted ketogenic diet therapies (KDT) mimicking fasting and providing ketones as an alternative cerebral fuel. Recently 6-24 months follow-ups of epileptic patients reported elevated blood lipids and intima thickening of the carotid artery raising concerns about potential cardiovascular risks by KDT. To clarify potential cardiovascular risks we performed a prospective 10 year follow up of 10 Glut1D patients. Between August 2001 and January 2016 we enrolled Glut1D patients on KDT at two hospitals in Germany in this prospective, multicenter case series. The minimal follow up was 10 years. Standard deviation scores (SDS) of body mass index (BMI), total cholesterol (TC), HDL-/LDL cholesterol, and triglycerides (TG) before initiation of KDT were compared with respective values at 6 months, 2, 5 years, and 10 years after initiation. After 10 years on KDT cardiovascular risk, assessed by BMI, carotid intima-media thickness (CIMT) measurement, and blood pressure, was compared to a healthy reference population (n=550). Baseline and 10 year follow-up investigations were available for 10 individuals with Glut1D on KDT. After two years on KDT BMI increased significantly, while total cholesterol, HDL-cholesterol, and LDL-cholesterol decreased. Within 3-5 years on KDT these differences disappeared, and after 10 years blood lipid parameters reflected the situation at initiation of KDT. Prior to KDT one child had dyslipidaemia, but no child after 10 years on KDT. No significant differences were observed with respect to BMI SDS (p=0.26), CIMT (p=0.63) or systolic and diastolic blood pressure (SDS p=0.11 and p=0.37, respectively) in Glut1D children treated with KDT forat least10 years compared to healthy controls. In contrast to previous short-term reports on adverse effects of KDT, 10-year follow-up did not identify cardiovascular risks of dietary treatment for Glut1D.

Are we using the appropriate reference samples to develop juvenile age estimation methods based on bone size? An exploration of growth differences between average children and those who become victims of homicide

The population on which forensic juvenile skeletal age estimation methods are applied has not been critically considered. Previous research suggests that child victims of homicide tend to be from socioeconomically disadvantaged contexts, and that these contexts impair linear growth. This study investigates whether juvenile skeletal remains examined by forensic anthropologists are short for age compared to their normal healthy peers. Cadaver lengths were obtained from records of autopsies of 1256 individuals, aged birth to eighteen years at death, conducted between 2000 and 2015 in Australia, New Zealand, and the U.S. Growth status of the forensic population, represented by homicide victims, and general population, represented by accident victims, were compared using height for age Z-scores and independent sample t-tests. Cadaver lengths of the accident victims were compared to growth references using one sample t-tests to evaluate whether accident victims reflect the general population. Homicide victims are shorter for age than accident victims in samples from the U.S., but not in Australia and New Zealand. Accident victims are more representative of the general population in Australia and New Zealand. Different results in Australia and New Zealand as opposed to the U.S. may be linked to socioeconomic inequality. These results suggest that physical anthropologists should critically select reference samples when devising forensic juvenile skeletal age estimation methods. Children examined in forensic investigations may be short for age, and thus methods developed on normal healthy children may yield inaccurate results. A healthy reference population may not necessarily constitute an appropriate growth comparison for the forensic anthropology population.

Prevalence and Prognostic Association of Circulating Troponin in the Acute Respiratory Distress Syndrome.

Circulating cardiac troponin has been associated with adverse prognosis in the acute respiratory distress syndrome in small and single-center studies; however, comprehensive studies of myocardial injury in acute respiratory distress syndrome using modern high-sensitivity troponin assays, which can detect troponin at much lower circulating concentrations, have not been performed. We performed a prospective cohort study. We included patients enrolled in previously completed trials of acute respiratory distress syndrome. One thousand fifty-seven acute respiratory distress syndrome patients were included. To determine the association of circulating high-sensitivity troponin I (Abbott ARCHITECT), with acute respiratory distress syndrome outcomes, we measured high-sensitivity troponin I within 24 hours of intubation. The primary outcome was 60-day mortality. Detectable high-sensitivity troponin I was present in 94% of patients; 38% of patients had detectable levels below the 99th percentile of a healthy reference population (26 ng/L), whereas 56% of patients had levels above the 99th percentile cut point. After multivariable adjustment, age, cause of acute respiratory distress syndrome, temperature, heart rate, vasopressor use, Sequential Organ Failure Assessment score, creatinine, and PCO2 were associated with higher high-sensitivity troponin I concentration. After adjustment for age, sex, and randomized trial assignment, the hazard ratio for 60-day mortality comparing the fifth to the first quintiles of high-sensitivity troponin I was 1.61 (95% CI, 1.11-2.32; p trend = 0.003). Adjusting for Sequential Organ Failure Assessment score suggested that this association was not independent of disease severity (hazard ratio, 0.95; 95% CI, 0.64-1.39; p = 0.93). Circulating troponin is detectable in over 90% of patients with acute respiratory distress syndrome and is associated with degree of critical illness. The magnitude of myocardial injury correlated with mortality.

Análisis de la calidad de vida del paciente en la etapa prediálisis

Objetivos: El objetivo del presente estudio fue analizar la Calidad de Vida Relacionada con la Salud de los pacientes con Enfermedad Renal Crónica Avanzada en estadio 5. Pacientes y Método: Se estudiaron a 32 pacientes (41% mujeres), con una edad media de 67.3±12.2 años, con Enfermedad Renal Crónica Avanzada en estadio 5 y un filtrado glomerular &lt; 15mil/min. Se realizó un estudio observacional descriptivo y transversal, en el Servicio de Nefrología del Hospital Reina Sofía de Córdoba. Para valorar la Calidad de Vida Relacionada con la Salud se utilizó el cuestionario KDQOL-SF. Otra variable estudiada fue la comorbilidad asociada. Resultados: Las dimensiones más afectadas fueron: la situación laboral, la función sexual, el rol físico, la salud general y la función física. Por el contrario, las mejor conservadas fueron: la función cognitiva, la calidad de las relaciones sociales, el apoyo social, la función social y el bienestar emocional. No se encontraron diferencias significativas en ninguna de las dimensiones respecto al sexo. Se encontró una asociación entre mayor edad y peor función sexual, función física, rol físico y vitalidad. También se correlacionó estadísticamente la comorbilidad con función física y vitalidad; y con la edad. Conclusión: Los pacientes con Enfermedad Renal Crónica Avanzada en estadio 5 tienen disminuida su Calidad de Vida Relacionada con la Salud en comparación con la población sana de referencia; siendo la situación laboral, la función sexual, función física y salud general, las dimensiones más afectadas. La edad y la comorbilidad se asociaron a peor calidad de vida.

P 44 Brisk jerk reflexes in a CMT case – novel heterozygous variant c.785T>C; p.Leu262Pro in KIF5A explaining the mixed phenotype

Introduction Charcot-Marie-Tooth (CMT) disease is a progressively disabling syndrome phenotypically comprising distal muscle weakness and atrophy, foot deformities, sensory loss, and reduced or absent tendon reflexes. In spastic paraplegia (SPG), a hereditary disorder affecting the upper motor neuron only, pareses are spastic, and deep tendon reflexes increased. Mixed forms between both diseases have been previously described ( Liu et al., 2014 ). By multiple gene panel based analysis using next-generation-sequencing (NGS), we herein identified the novel variant c.785T>C; p.Leu262Pro in KIF5A as the putative cause of a mixed CMT and SPG phenotype. Methods The patient’s examination took place in the neuromuscular outpatient clinic of the RWTH Aachen University hospital. After obtaining the patient’s informed consent, the molecular genetic analysis of an NGS-based panel comprising 84 genes in total was performed following the commercialized standard procedures established by CeGaT GmbH. The pathogenicity of each variant was evaluated according to the international ACMG criteria ( Richards et al., 2015 ). Case report At the age of 44 years, the now 48-year-old male patient with a negative family history noticed the first signs of gait unsteadiness. In the course, he developed profound symmetric calf atrophies, high arched feet, claw toes, and steppage gait. Except for the absent ankle jerk reflex, the deep tendon reflexes where surprisingly brisk. Sensory loss turned out comparably mild. Nerve conduction studies showed an axonal motor neuropathy in the legs, but were normal in the arms. The molecular genetic analysis revealed the heterozygous variant c.785T>C; p.Leu262Pro in the KIF5A gene, which has been described in association to SPG10 and/or an axonal CMT subtype following an autosomal dominant inheritance. The variant c.785T>C; p.Leu262Pro affects a highly conserved amino acid position within a functionally relevant domain. A change of secondary protein structure is conceivable as the linear leucine is replaced by proline, a cyclic amino acid. Several other missense mutations are described in the very close vicinity. The variant is predicted to be pathogenic by all available prediction programs. Its allele frequency in the healthy reference population is unknown. Unfortunately, co-segregation analyses could be performed since further family members were not available. For further evaluation, functional tests would be required. Discussion On the current state of knowledge, the novel variant c.785T>C; p.Leu262Pro in KIF5A is evaluated as being a variant of uncertain significance. Due to the well matching phenotype ( Liu et al., 2014 ), however, we consider it to be putatively pathogenic. This example underlines the necessity of precise phenotyping in the context of NGS-based multigene panels.

Penetrance and the Healthy Elderly.

The variable penetrance of pathogenic variants (PVs) represents a major challenge to the field of human genetics, often complicating clinical decision-making and risk management. Nonpenetrance, the detection of PVs in the absence of disease manifestation, is a common phenomenon, yet, we know very little about the underlying factors, which may protect some individuals and not others. Placing a new focus on the genomic study of the healthy elderly may be pivotal for advancing our understanding of penetrance. Studying those who remain unaffected late into life, despite harboring known genetic risk variants, could provide important insights into disease mechanisms and ultimately inform clinical care, yet, it has received relatively little attention as a research strategy. The ever increasing use of sequencing technology is further driving the requirement to understand the penetrance of ascertained variants. The ASPREE Biobank of Healthy Ageing provides a unique opportunity to address this area of need. DNA has been collected from a cohort of over 14,000 healthy elderly individuals aged 70 years or older enrolled in an aspirin clinical trial. The ASPREE cohort represents a healthy reference population ascertained without the typical biases of a genetic study. The cohort is depleted of expressed monogenetic disease, yet will contain hundreds of elderly individuals with known PVs in clinically actionable genes. Investigating this population along with other cohorts of the healthy elderly will provide critical new knowledge into the penetrance of actionable variants as a foundation for informing clinical care.

Concentrations of Trace Elements in Hemodialysis Patients: A Prospective Cohort Study

Low concentrations and excessive concentrations of trace elements have been commonly reported in hemodialysis patients, but available studies have several important limitations. Random sample of patients drawn from a prospective cohort. 198 incident hemodialysis patients treated in 3 Canadian centers. We used mass spectrometry to measure plasma concentrations of the 25 elements at baseline, 6 months, 1 year, and 2 years following enrollment in the cohort. We focused on low concentrations of zinc, selenium, and manganese and excessive concentrations of lead, arsenic, and mercury; low and excessive concentrations of the other 19 trace elements were treated as exploratory analyses. Low and excessive concentrations were based on the 5th and 95th percentile plasma concentrations from healthy reference populations. At all 4 occasions, low zinc, selenium, and manganese concentrations were uncommon in study participants (≤5.1%,≤1.8%, and≤0.9% for zinc, selenium, and manganese, respectively) and a substantial proportion of participants had concentrations that exceeded the 95th percentile (≥65.2%,≥74.2%, and≥19.7%, respectively). Almost all participants had plasma lead concentrations above the 95th percentile at all time points. The proportion of participants with plasma arsenic concentrations exceeding the 95th percentile was relatively constant over time (9.1%-9.8%); the proportion with plasma mercury concentrations that exceeded the 95th percentile varied between 15.2% and 29.3%. Low arsenic, platinum, tungsten, and beryllium concentrations were common (>50%), as were excessive cobalt, manganese, zinc, vanadium, cadmium, selenium, barium, antimony, nickel, molybdenum, lead, and chromium concentrations. There was no evidence that low zinc, selenium, or manganese concentrations exist in most contemporary Canadian hemodialysis patients. Some patients have excessive plasma arsenic and mercury concentrations, and excessive lead concentrations were common. These findings require further investigation.

Using hyperpolarized 129Xe MRI to quantify regional gas transfer in idiopathic pulmonary fibrosis

BackgroundAssessing functional impairment, therapeutic response and disease progression in patients with idiopathic pulmonary fibrosis (IPF) continues to be challenging. Hyperpolarized 129Xe MRI can address this gap through its unique capability...

The Influencing Factors on Sarcopenic Obesity among Male and Female Aged in Korea: Based on the Korean National Health and Nutrition Examination Survey 2010-2011

본 연구의 목적은 한국 남녀 노인의 근감소성 비만의 유병률과 근감소성 비만 영향 요인을 파악하기 위함이다. 본 연구는 2010-2011년 제 5기 국민건강영양조사 원시 자료를 사용하여 복합표본분석 모듈을 이용하여 분석하였다. 본 연구에는 65세 이상 남자 노인 816명, 여자 노인 1064명이 분석에 이용되었다. 근감소성 비만을 정의하기 위해 근감소증의 정의는 사지 근육량(appendicular skeletal muscle, ASM)을 체중으로 나눈뒤 100을 곱한 값이 건강한 젊은 성별 기준집단의 평균값보다 2SD 미만으로 감소된 상태로 하였고, 비만의 정의는 허리둘레를 기준으로 정의하였다. 연구결과 근감소성 비만의 유병률은 65세이상 남녀 노인 각각 4.8%, 7.8%로 나타났고, 전체 노인의 근감소성 비만의 유병률은 6.6%였다. 일변량 로지스틱 회귀분석에서 유의한 변수들을 독립변수로 투입하여 다변량 로지스틱 회귀분석을 실시한 결과 남자 노인은 연령, 학력, 평생 음주경험, 중성지방이, 여자 노인은 골관절염, 공복혈당, 중성지방이 근감소성 비만에 대한 영향요인으로 규명되었다. 본 연구결과에 따라 한국 노인의 근감소성 비만의 예방과 관리를 위해서 본 연구결과에 기반한 근감소성 비만 관리 프로그램의 개발 및 적용을 권장한다.This study was conducted to investigate the prevalence of sarcopenic obesity and its influencing factors of aged in Korea. Data for 816 male aged and 1064 female aged (age≥65) from the fifth national health and nutrition examination survey 2010-2011 were included. Sarcopenic obesity was defined as the mixed status of sarcopenia and obesity. Appendicular skeletal muscle mass/weight*100(%) less than 2 standard deviations below the mean for gender specific young, healthy reference population was used to define sarcopenia and waist circumference was used to define obesity. Sarcopenic obesity prevalence rates were 4.8% in male aged and 7.8% in female aged. Also, sarcopenic obesity prevalence rates were 6.6% in all. Mutivariate logistic regression analysis showed that age, education, alcohol history and triglyceride were influencing factors of sarcopenic obesity in male age and osteoarthritis, fasting glucose and triglyceride were influencing factors of sarcopenic obesity in female aged. These results indicate that these factors of sarcopenic obesity could help to develop programs for preventing and controlling the sarcopenic obesity.

Asymmetry in gait pattern following bicondylar tibial plateau fractures—A prospective one-year cohort study

IntroductionDespite the high number of studies evaluating outcomes following tibial plateau fractures, the literature lacks studies including the objective assessment of gait pattern. The purpose of the present study was to evaluate asymmetry in gait patterns at 12 months after frame removal following ring fixation of a tibial plateau fracture. Patients and methodsThe study design was a prospective cohort study. The primary outcome measurement was the gait patterns 12 months after frame removal measured with a pressure-sensitive mat. The mat registers footprints and present gait speed, cadence, as well as temporal and spatial parameters of the gait cycle. Gait patterns were compared to a healthy reference population. ResultsTwenty-three patients were included with a mean age of 54.4 years (32–78 years). Patients presented with a shorter step-length of the injured leg compared to the non-injured leg (asymmetry of 11.3%). Analysis of single-support showed shorter support time of the injured leg compared to the non-injured leg (asymmetry of 8.7%). Moreover, analysis of swing-time showed increased swing-time of the injured leg (asymmetry of 8.9%). Compared to a healthy reference population, increased asymmetry in all gait patterns was observed. The association between asymmetry and health-related quality of life (HRQOL) showed moderate associations (single-support: R=0.50, P=0.03; step-length: R=0.43, P=0.07; swing-time: R=0.46, P=0.05). ConclusionCompared to a healthy reference population, gait asymmetry is common 12 months after frame removal in patients treated with external ring fixation following a tibial plateau fracture of the tibia.

Stroke in right dorsal anterior insular cortex Is related to myocardial injury.

Elevated levels of cardiac troponin, and especially their relative changes over time, indicate acute myocardial injury. They are also frequently observed after acute ischemic stroke (AIS), indicating poor functional outcome and increased mortality. However, recent evidence showed that, in most AIS patients, myocardial injury is not caused by coronary ischemia. Instead, stroke lesion location has been suggested to precipitate myocardial injury. Voxel-based lesion-symptom mapping (VLSM) was used in 299 patients who had a magnetic resonance imaging-confirmed acute ischemic stroke within the anterior circulation and a high-sensitivity cardiac troponin T (hs-cTnT) acquired on the day of admission. Of these, 228 had a second troponin measurement during the acute phase. The absolute hs-cTnT levels above the 99th percentile of a healthy reference population (≥14ng/l) as well as their relative temporal changes were used as continuous variables of interest in the VLSM model, including a multiple regression analysis adjusted for confounding variables. The anterior insular cortex of the right hemisphere, in particular its dorsal subregion, was significantly associated with the relative temporal changes of hs-cTnT (p < 0.01, corrected for multiple comparisons). In contrast, the baseline hs-cTnT levels on admission were not related to lesion location anywhere within the anterior circulation. Our results amplify recent evidence from functional neuroimaging, which suggests a prominent role of dorsal anterior insular cortex in the parasympathetic control of cardiac and autonomic function. Acute vascular damage of this insular subregion might lead to autonomic dysbalance and an upregulation of sympathetic function, thereby resulting in myocardial injury. Ann Neurol 2017;81:502-511.