High Body Mass Index Group Research Articles

Influence of body mass index on the prevalence and progression of dysplasia in Barrett’s esophagus: a retrospective analysis

Objective: High body mass index (BMI) is a risk factor for Barrett’s esophagus (BE) and esophageal adenocarcinoma (EAC). Our aim was to determine if prevalence of dysplasia in BE varies by BMI and study the effect of BMI on progression to high-grade dysplasia (HGD) or EAC.Materials and methods: This is a retrospective review of patients with endoscopic evidence of BE confirmed by presence of intestinal metaplasia on histology from January 2000 to December 2012 at Cleveland Clinic. Patient demographics, BMI and endoscopic findings such as length of BE, dysplasia in BE and size of hiatal hernia were reviewed. Dysplasia was classified as no dysplasia (NDBE), low-grade dysplasia (LGD), HGD and EAC.Results: In this cohort of 1239 patients, average BMI was 29.8 ± 6 kg/m2. There were 228 (18.4%) in group with BMI <25, 236 (19%) in BMI group 25–27.4, 262 (21.1%) in BMI 27.5–29.9, 303 (24.5%) in BMI 30–34.9, 126 (10.2%) in BMI 35–39.9 and 86 (6.8%) in BMI ≥40. Lower BMI groups had lower prevalence of dysplasia while higher BMI groups had higher prevalence of dysplasia (p = 0.002). During mean follow up of 31.6 ± 26 months, there were 14 cases of HGD/EAC in NDBE group and 29 cases of HGD/EAC in LGD group. BMI or BMI change was not associated with progression to HGD/EAC in NDBE.Conclusions: High BMI was associated with higher prevalence of dysplasia in BE. But once in a surveillance program, higher BMI is not associated with progression of dysplasia in NDBE.

Can low BMI Chinese patients with type 2 diabetes benefit from laparoscopic Roux-en-Y gastric bypass surgery?

BackgroundThe efficacy of laparoscopic Roux-en-Y gastric bypass (LRYGB) in type 2 diabetes mellitus (T2D) is closely associated with the preoperative body mass index (BMI) of the patient. There is a lack of long-term and large sampling evidence on the efficacy of LRYGB in T2D patients with low BMI in China. ObjectivesThis retrospective study aimed to evaluate the efficacy of surgical treatment in a Chinese population with T2D (especially patients with BMI<27.5 kg/m2). SettingUniversity-affiliated hospital, China MethodsSeventy-eight patients with T2D were included in the study and evaluated before and after LRYGB surgery. No patients were lost to follow-up at any time points. ResultsThirty-eight T2D patients with BMI≥27.5 kg/m2 in group 1 (high BMI group) had significant improvements in waist circumference, blood glucose levels, homeostasis model assessment-insulin resistance index, and C-peptide levels after LRYGB (P<.05). Forty T2D patients with BMI<27.5 kg/m2 in group 2 (low BMI group, including 19 T2D patients with BMI<25 kg/m2) had significant improvements in waist circumference and waist-to-hip ratio after LRYGB (P< .05). ConclusionsLRYGB surgery may be beneficial in T2D patients with BMI<27.5 kg/m2 in China.

Differential association of body mass index on glycemic control in type 1 diabetes.

In contrast to type 2 diabetes, the association of body mass index (BMI) with glycemic control in type 1 diabetes (T1D) remains unclear. We investigated the relationship between BMI and average HbA1c levels in subjects with T1D. In this multi-centre observational study, we analysed 719 subjects with T1D aged ≥18years. Average HbA1c levels over 18months and other clinical and laboratory parameters were evaluated. The mean age and duration of diabetes at baseline were 41.5 ± 13.9 and 11.3 ± 8.7years, respectively. A U-shaped correlation between BMI and 18-month average HbA1c levels was documented by a spline curve. Based on this finding, subjects were divided into three groups according to BMI (group I, <21; group II, 21-23; and group III, ≥23kg/m2 ). In group I, the BMI negatively correlated with average HbA1c (r = -0.172, p = 0.011), while a positive relationship was observed (r = 0.162, p = 0.012) in group III. Average HbA1c levels were lower and the proportion of individuals with well-controlled glycemia (HbA1c <7%) were increased in the higher BMI tertile group among subjects with group I as well as in the lower BMI tertile group among subjects with group III BMI. After adjustment with additional covariates in the multiple regression model, these associations between BMI and HbA1c levels according to the different BMI ranges remained significant. In Korean subjects with T1D, an inverse relationship of BMI with HbA1c levels was observed in the low BMI group, while a positive correlation was shown in the high BMI group. Copyright © 2016 John Wiley & Sons, Ltd.

The Effect of BMI on Outcomes Following Complex Abdominal Wall Reconstructions.

The management of complex abdominal wall defects continues to be a challenging process secondary to the high potential for wound healing issues and ventral hernia recurrences. Body mass index (BMI) is a well-known risk factor when it comes to complications. We hypothesize that higher BMIs result in higher rates of postoperative complications in complex abdominal wall reconstructions (CAWRs). We retrospectively reviewed all patients who underwent CAWR at Emory University Hospital over a 12-year period. Patients were divided into 4 cohorts based on BMI (15-24.9, 25-29.9, 30-34.9, and ≥35 kg/m). Complication rates among the 4 groups were evaluated as the primary outcome using Pearson χ analysis. Further analysis was done on specific complications including mesh exposure, skin necrosis, delayed healing, rate of fistula formation, seroma, hematoma, infection, rate of recurrence, and rate of reoperation. We included 313 patients with a mean follow-up of 15.6 months. The rate of overall complications demonstrated a nonsignificant increase with BMI of 15 to 24.9, 25 to 29.9, 30 to 34.9, and 35 kg/m or greater (31.7%, 35.0%, 47.6%, and 48.3%; P = 0.079, respectively). The rate of skin necrosis was significantly increased in the higher BMI groups (1.7%, 1.3%, 9.5%, and 13.5%; P = 0.004). The rate of ventral hernia recurrence was significantly increased in the higher BMI groups (8.3%, 12.5%, 29.8%, and 27.0%; P = 0.002). Rates of reoperation were also statistically increased in the higher BMI groups (25.0%, 22.5%, 41.7%, and 34.8%; P = 0.035). Rates of mesh exposure, delayed healing, fistula formation, seroma, hematoma, and infection were not statistically significant among the 4 BMI groups. Patients undergoing CAWR with BMIs greater than 30 kg/m have significantly higher rates of skin necrosis, hernia recurrence, and reoperation compared with subgroups of lower BMI. Rates of overall complications among all BMI groups are similar, although trended up with BMI. Surgeons should weight the risks and benefits of CAWR in patients with higher BMIs to reduce specific postoperative complications.

Novel measures of inflammation and insulin resistance are related to obesity and fitness in a diverse sample of 11-14 year olds: The HEALTHY Study.

BackgroundGlycA is a novel serum marker of systemic inflammation. There is no information on GlycA in pediatric populations, how it differs by gender or its association with body mass index (BMI) or fitness. LP-IR is a serum measure of insulin resistance which is related to changes in BMI group in adolescents, but its relationship with fitness is unknown. The current study examined the independent associations between fitness and BMI with GlycA and LP-IR among US adolescents.MethodsParticipants were 1664 US adolescents from the HEALTHY study with complete 6th and 8th grade BMI, fitness and blood data. GlycA and LP-IR were measured by NMR spectroscopy. Three BMI groups and three fitness groups were created. Linear mixed models examined associations between GlycA, LP-IR, fitness and BMI.ResultsLP-IR decreased between 6th and 8th grade. GlycA increased among girls but decreased among boys. At 8th grade, median GlycA values were 27 (7.6%) μmol/L higher (381 versus 354) for girls than boys. Median GlycA 6th grade values were 9% higher in obese girls than healthy weight girls. Overall there was strong evidence (p<0.001) that GlycA was higher in higher BMI groups. Fitness was negatively associated with GlycA (r = −0.37 and −0.35) and LP-IR (r = −0.34 and − 0.18) at the 6th and 8th grade assessments. As BMI category increased and fitness category decreased, GlycA and LP-IR levels increased. Lowest GlycA was found in the low BMI/high fitness group.ConclusionsGlycA was associated with BMI and fitness among in US adolescents. These findings suggest that there are independent effects for BMI and fitness group with both GlycA and LP-IR. Future studies should validate the role of GlycA and LP-IR to evaluate the effects of interventions to modify obesity and fitness in order to improve systemic inflammation and insulin resistance.

Exercise tolerance can explain the obesity paradox in patients with systolic heart failure: data from the MECKI Score Research Group

Obesity has been found to be protective in heart failure (HF), a finding leading to the concept of an obesity paradox. We hypothesized that a preserved cardiorespiratory fitness in obese HF patients may affect the relationship between survival and body mass index (BMI) and explain the obesity paradox in HF. A total of 4623 systolic HF patients (LVEF 31.5 ± 9.5%, BMI 26.2 ± 3.6 kg/m(2) ) were recruited and prospectively followed in 24 Italian HF centres belonging to the MECKI Score Research Group. Besides full clinical examination, patients underwent maximal cardiopulmonary exercise test at study enrolment. Median follow-up was 1113 (553-1803) days. The study population was divided according to BMI (<25, 25-30, >30 to ≤35 kg/m(2) ) and predicted peak oxygen consumption (peak VO2 , <50%, 50-80%, >80%). Study endpoints were all-cause and cardiovascular deaths including urgent cardiac transplant. All-cause and cardiovascular deaths occurred in 951 (28.6%, 57.4 per person-years) and 802 cases (17.4%, 48.4 per 1000 person-years), respectively. In the high BMI groups, several prognostic parameters presented better values [LVEF, peak VO2 , ventilation/carbon dioxide slope, renal function, and haemoglobin (P < 0.01)] compared with the lower BMI groups. Both BMI and peak VO2 were significant positive predictors of longer survival: both higher BMI and peak VO2 groups showed lower mortality (P < 0.001). At multivariable analysis and using a matching procedure (age, gender, LVEF, and peak VO2 ), the protective role of BMI disappeared. Exercise tolerance affects the relationship between BMI and survival. Cardiorespiratory fitness mitigates the obesity paradox observed in HF patients.

Obstructive sleep apnea in postmenopausal women: a comparative study using drug induced sleep endoscopy

IntroductionThe key to successful treatment of OSAS is to individually tailor such treatment. Thus, it is very important to determine the severity of OSAS, its pattern, and the extent of collapse, by gender, age, and BMI. ObjectiveThe objective of the study was to understand the characteristics of obstructive sleep apnea in postmenopausal women by comparing postmenopausal and premenopausal subjects, and men, using DISE. We hope that our work will help the medical community to consult on, diagnose, and treat OSAS more effectively. MethodsA total of 273 patients (195 males and 78 females) diagnosed with OSAS were enrolled. Female patients were divided into pre-menopausal (n=41) and post-menopausal patients (n=37). The group of post-menopausal female patients was matched with a group of male patients with similar age and body mass index (BMI). DISE findings were compared between pre-menopausal female patients and post-menopausal female patients, and also between post-menopausal female patients and male patients matched for age and BMI. ResultsUpon PSG examination, post-menopausal patients (who had a significantly higher BMI than did pre-menopausal patients; 25.6kg/m2 vs. 23.5kg/m2; p=0.019) tended to have a higher AHI and a lower lowest SaO2, but the differences did not attain statistical significance. With DISE analysis, post-menopausal female patients showed higher values in all obstruction sites, with significantly higher value in lateral diameter of retropalatal (1.49 vs. 0.90; p=0.001) and retrolingual levels (1.14 vs. 0.61; p=0.003) compared to pre-menopausal females patients. Post-menopausal female patients showed significantly more retrolingual collapse (antero-posterior, AP, p≤0.0001, and lateral diameter, p=0.042) in the lower BMI group (BMI<25) and more concentric retropalatal collapse (lateral diameter, p=0.017 and tonsillar obstruction, p=0.003) in higher BMI group (BMI≥25) than BMI and age matched male patients. ConclusionPost-menopausal female patients showed a different pattern of airway obstruction compared to pre-menopausal female patients and male patients matched for age and BMI based on DISE findings.

Research on the relationship between the body mass index and rewarming in the hypothermia patients with primary liver cancer after surgery

Objective To evaluate the rewarming and?anesthetic recovery regularity in different body mass index(BMI) patients with primary liver cancer by the same rewarming measures. Methods The data of 67 primary liver cancer patients with hypothermia after surgery were analyzed retrospectively and divided into three groups (low BMI group:BMI <18.50 kg/m2,normal BMI group: BMI 18.50-22.99 kg/m2, and high BMI group: BMI ≥23.00 kg/m2) according to the standard of Asian BMI. Rewarming time and speed, spontaneous breathing recovery time,waking time and shivers in the three groups were observed and compared. Results Rewarming time, spontaneous breathing recovery time,waking time were (114.75 ± 21.91), (62.60±23.47), (94.65±20.54) min in low BMI group, (93.46±30.39), (41.19±21.47), (66.11±24.78) min in normal BMI group and (61.43±16.37), (25.81±8.90), (50.57±10.41) min in high BMI group,there were significant differences among three groups (F=25.300, 18.962, 25.647, all P <0.05). Rewarming speed was (0.85±0.13) ℃/h in high BMI group, (0.44±0.10) ℃/h in normal BMI group, (0.47±0.16) ℃/h in low BMI group,there were significant differences among three groups(F=65.810, P<0.05). Conclusions Rewarming for a long time in the primary liver cancer patients with low BMI and hypothermia after surgery by the same measures.More attentions should be paid to management of low BMI patients in the rewarming process, and aggressive measures should be taken to restore body temperature to normal. Key words: Body mass index; Liver neoplasms; Anesthesia recovery period; Rewarming; Hypothermia

Hand Grip Strength in Low, Medium, and High Body Mass Index Males and Females

Background: Hand grip strength (HGS) is a predictor of upper extremity function and changes in muscle strength, physical movement and ability to undertake activities of daily living. Body mass index (BMI) is a critical indicator of physical health; however, the relationship between HGS and BMI has not yet been thoroughly examined. Objectives: The current study aims to compare HGS in low, medium, and high BMI males and females in both hands, and also investigates the correlation between HGS and anthropometric characteristics among the three BMI groups. Patients and Methods: The study included 200 participants who were divided into three groups based on their BMI (60 low, 58 medium, and 82 high). HGS was assessed using a hand-held Jamar dynamometer. BMI was assessed by an electric body-weight height analysis machine. Data was analyzed using descriptive and inferential statistics at P 0.05). Weight and height strongly correlated with HGS for hands (correlation (r) ranged from 0.000 - 0.775). Regression analysis showed that when using sex and BMI as independent variables for predicting the dependent variable HGS, the coefficient of the determinant R 2 was 0.753 (P < 0.001). Conclusions: The current study revealed that a significant difference existed in HGS among the low, medium, and high BMI groups. A positive correlation existed between HGS and weight and height, while sex was the most significant factor affecting HGS. These findings can serve as a reference to assess HGS prediction, whereby the sex effect should be considered.

A szérumkoleszterin-szint és a verbális memória kapcsolatának vizsgálata a testtömegindex tükrében

The objective of this study was to examine the relationship between verbal memory and total cholesterol (TC) levels related to body mass index (BMI) in healthy young women. Verbal memory was assessed using the Rey Auditory-Verbal Learning Test (RAVLT) while total serum cholesterol was measured by enzymatic colorimetric test. In order to analyze the potential significance of BMI subjects were divided into three groups according to their calculated BMI percentile values. No significant correlation was found when assessing the group as a whole. However a remarkable pattern of correlation emerged when assessing the BMI groups separately: a close-to-significant positive correlation was found for total learning score and TC in the low BMI group, no correlation emerged in the medium BMI group while a strong inverse correlation was found in the high BMI group. These findings indicate that the relationship between verbal memory and serum TC level is also influenced by BMI.

Association of blood pressure with body mass index and waist circumference in adolescents

Background: Hypertension in children is increasing along with the childhood obesity epidemic. Body mass index (BMI) and waist circumference (WC) are commonly used indices to assess obesity. WC as a visceral fat indicator can be suggested to be a better predictor of CVD risk such as high BP than BMI, which reflects both lean and fat mass. There are few studies investigating the relationship between WC and elevated blood pressure in school age children. Hence this study was undertaken to study the effect of body mass index and waist circumference on blood pressure. Methods: A total of 610 children aged 10-18 years who completed both anthropometric and BP measurements were studied. Height, weight, body mass index, waist circumference and blood pressure were recorded. Results: SBP and DBP was found to be higher in children with high BMI (>85th percentile) and high WC (>90th percentile) groups. Waist circumference and BMI are strongly associated with both SBP and DBP (p< 0.001). Conclusions: This study showed that increased BMI and WC are good predictors of rise in SBP and DBP. WC is easier to measure than blood pressure in terms of training and access to equipment, especially in low income settings. Therefore we suggest measurement of WC as a screening tool for childhood hypertension.

Survival impact of postoperative body mass index in gastric cancer patients undergoing gastrectomy

BackgroundThe relationship between preoperative body mass index (BMI) and the survival of postoperative gastric cancer patients is not clear. Furthermore, the survival impact with postoperative BMI is not known, even though weight loss is inevitable after gastrectomy. MethodsPatients who underwent gastrectomy for gastric cancer between 2000 and 2008 were included in the study (n = 1909). Patients were divided into three groups based on their BMIs: low (<18.5 kg/m2), normal (18.5–24.9 kg/m2), and high BMI (≥25.0 kg/m2). Patient survival was compared according to BMI at two time points: baseline and 1 year after surgery. ResultsRegarding BMI 1 year after surgery, overall survival, disease-specific survival, and recurrence-free survival were longer in the high BMI group than the low and normal BMI groups. In a Cox proportional hazards model, adjusting for the patient's age, sex, type of surgery, tumour stage, histology, curative resection, and BMI at baseline, a high BMI 1 year after surgery was associated with lower overall mortality compared to normal BMI (hazard ratio 0.51; 95% confidence interval, 0.26–0.98). However, BMI at baseline was not an independent prognostic factor. ConclusionBMI 1 year after surgery significantly predicted the long-term survival of patients with gastric cancer compared with the preoperative BMI.

Association of cancer mortality with postdiagnosis overweight and obesity using body mass index.

Although overweight and obesity increase cancer risk, it is still controversial with respect to cancer mortality. In the current study, we enrolled 2670 patients of 14 tumor types from the Cancer Genome Atlas (TCGA) project, to identify the prognostic role of overweight and obesity in cancer patients. After dividing the patients into different groups by the body mass index (BMI), we found significant lower mortality in the obesity group. In addition, we also treat BMI value as a binary categorical variable or continuous variable, respectively. We found significant lower mortality in the higher BMI group. Furthermore, when focusing on each tumor type, cervical cancer and bladder cancer showed lower mortality in the patients with higher BMI values. Taken together, our results demonstrate that postdiagnosis obesity might indicate a better prognosis in cancer patients. However, these findings should be interpreted cautiously because of small sample size.

Bariatric surgery does not improve outcomes in patients undergoing primary total knee arthroplasty

Bariatric surgery has been advocated as a means of reducing body mass index (BMI) and the risks associated with total knee arthroplasty (TKA). However, this has not been proved clinically. In order to determine the impact of bariatric surgery on the outcome of TKA, we identified a cohort of 91 TKAs that were performed in patients who had undergone bariatric surgery (bariatric cohort). These were matched with two separate cohorts of patients who had not undergone bariatric surgery. One was matched 1:1 with those with a higher pre-bariatric BMI (high BMI group), and the other was matched 1:2 based on those with a lower pre-TKA BMI (low BMI group). In the bariatric group, the mean BMI before bariatric surgery was 51.1 kg/m(2) (37 to 72), which improved to 37.3 kg/m(2) (24 to 59) at the time of TKA. Patients in the bariatric group had a higher risk of, and worse survival free of, re-operation (hazard ratio (HR) 2.6; 95% confidence interval (CI) 1.2 to 6.2; p = 0.02) compared with the high BMI group. Furthermore, the bariatric group had a higher risk of, and worse survival free of re-operation (HR 2.4; 95% CI 1.2 to 3.3; p = 0.2) and revision (HR 2.2; 95% CI 1.1 to 6.5; p = 0.04) compared with the low BMI group. While bariatric surgery reduced the BMI in our patients, more analysis is needed before recommending bariatric surgery before TKA in obese patients.

Novel dehydroepiandrosterone troche supplementation improves the serum androgen profile of women undergoing in vitro fertilization.

Dehydroepiandrosterone (DHEA) is the most abundant steroid hormone in the circulation and has potent multifunctional activity. Epidemiological evidence suggests that levels of serum DHEA decrease with advancing age, and this has been associated with onset or progression of various age-related ailments, including cognitive decline and dementia, cardiovascular disease, and obesity. Consequently, these findings have sparked intense research interest in DHEA supplementation as an “antiaging” therapy. Currently, DHEA is being used by 25% of in vitro fertilization (IVF) clinicians as an adjuvant in assisted reproductive programs, yet the therapeutic benefit of DHEA is unclear. Here, we examined the use of novel DHEA-containing oral troches in patients undertaking IVF and investigated the impact of these troches on their serum androgen profile. This retrospective study determined the androgen profile of 31 IVF patients before (baseline) and after DHEA supplementation (with DHEA). Baseline serum measurements of testosterone (total and free), DHEA sulfate (DHEAS), sex hormone-binding globulin (SHBG), and androstenedione were made before and after supplementation. Each patient received DHEA troches containing 25 mg of micronized DHEA, and troches were administered sublingually twice daily for a period of no greater than 4 months. Adjuvant treatment with DHEA boosted the serum concentration of a number of androgen-related analytes, including total and free testosterone, androstenedione, and DHEAS, while serum SHBG remained unchanged. Supplementation also significantly increased the free-androgen index in IVF patients. Interestingly, the increase in serum analyte concentration following DHEA supplementation was found to be dependent on body mass index (BMI), but not individual age. Patients with the lowest BMI (<20.0 kg/m2) tended to have lower testosterone and DHEAS, but higher SHBG and androstenedione levels in comparison with other BMI groups postsupplementation. However, patients in the highest BMI group (>30.0 kg/m2) tended to have lower androgen responses following DHEA supplementation, but these were not statistically different from the corresponding baseline level. This method of DHEA administration results in a similar enhancement of testosterone, DHEAS, and androstenedione levels in comparison with other methods of administration. Furthermore, we showed that BMI significantly influences DHEA uptake and metabolism, and that BMI should be carefully considered during dosage calculation to ensure a significant and robust androgen-profile boost.

Body mass index modulates the relationship of sugar-sweetened beverage intake with serum urate concentrations and gout.

IntroductionBoth sugar-sweetened beverage (SSB) intake and body mass index (BMI) are associated with elevated serum urate concentrations and gout risk. The aim of this study was to determine whether the associations of SSB intake with serum urate and gout are moderated by BMI.MethodThe effects of chronic SSB intake on serum urate and gout status were analysed in a large cross-sectional population study. The effects of an acute fructose load on serum urate and fractional excretion of uric acid (FEUA) were examined over 180 minutes in a short-term intervention study. In all analyses, the responses were compared in those with BMI <25 mg/kg2 (low BMI) and ≥25 mg/kg2 (high BMI).ResultsIn the serum urate analysis (n = 12,870), chronic SSB intake was associated with increased serum urate in the high BMI group, but not in the low BMI group (Pdifference = 3.6 × 10−3). In the gout analysis (n = 2578), chronic high SSB intake was associated with gout in the high BMI group, but not in the low BMI group (Pdifference = 0.012). In the acute fructose loading study (n = 76), serum urate was increased in the high BMI group at baseline and throughout the observation period (PBMI group <0.0001), but there were similar acute serum urate increases in both BMI groups in response to the fructose load (Pinteraction = 0.99). The baseline FEUA was similar between the two BMI groups. However, following the fructose load, FEUA responses in the BMI groups differed (Pinteraction <0.0001), with increased FEUA at 120 minutes and 180 minutes in the low BMI group and reduced FEUA at 60 minutes in the high BMI group.ConclusionsThese data suggest that BMI influences serum urate and gout risk in response to chronic SSB intake, and renal tubular uric acid handling in response to an acute fructose load. In addition to many other health benefits, avoidance of SSBs may be particularly important in those with overweight/obesity to prevent hyperuricaemia and reduce gout risk.Trials registrationAustralian Clinical Trials Registry ACTRN12610001036000. Registered 24 November 2010.

Treatment Response in Patients with Stones, and Low Urinary pH and Hypocitraturia Stratified by Body Mass Index

Obesity has been shown to be a risk factor for kidney stone formation. Obesity leads to insulin resistance which subsequently leads to low urinary pH. Low urinary pH is typically treated with potassium citrate. We determined if the response to potassium citrate for the treatment of low urinary pH and hypocitraturia varied when patients were stratified by body mass index. We retrospectively reviewed the records of patients with urolithiasis and concomitant hypocitraturia and low urinary pH as unique abnormalities upon metabolic evaluation treated exclusively with potassium citrate. Based on body mass index the cohort was divided into the 4 groups of normal weight, overweight, obese and morbidly obese. Metabolic data were compared among the 4 groups at baseline and subsequent followup visits up to 2 years. We compared urinary pH and citrate in absolute values and the relative changes in these parameters from baseline. Similarly, we compared the rates of potassium citrate treatment failure. A total of 125 patients with hypocitraturia and low urinary pH were included in this study. Median patient age was 61 years, 80 patients were male and median body mass index was 30.4 kg/m(2). Patients with a higher body mass index tended to be younger (p=0.010), and had a lower urinary citrate but higher sodium, oxalate and uric acid levels. Urinary pH was similar across body mass index groups. pH values and their absolute changes from baseline were lower as body mass index increased (p ≤0.001). Similarly, we noted an association between increasing body mass index category and lower urinary citrate levels accompanied by a statistically significant trend indicating lower absolute changes in citrate with increasing body mass index (p ≤0.001). Potassium citrate dose was increased more frequently among the higher body mass index groups. Patients with a higher body mass index presented with a lower increase in citrate excretion and urinary pH levels after they were started on potassium citrate, and they needed more frequent adjustments to their therapy.

Radiation dose differences between thoracic radiotherapy planning CT and thoracic diagnostic CT scans

PurposeTo compare the absorbed dose from computed tomography (CT) in radiotherapy planning (RP-CT) against those from diagnostic CT (DG-CT) examinations and to explore the possible reasons for any dose differences. MethodTwo groups of patients underwent CT-scans of the thorax with either DG-CT (n = 55) or RP-CT (n = 55). Patients from each group had similar weight and body mass index (BMI) and were divided into low (<25) and high BMI (>25). Parameters including CTDIvol, DLP and scan-length were compared. ResultsThe mean CTDIvol and DLP values from RP-CT (38.1 mGy, 1472 mGy cm) are approximately four times higher than for DG-CT (9.63 mGy, 376.5 mGy cm). For low BMI group, the CTDIvol in the RP-CT scans (36.4 mGy) is 6.3 times higher than the one in the DG-CT scans (5.8 mGy). For the high BMI group, the CTDIvol in the RP-CT (39.6 mGy) is 2.5 times higher than the one in the DG-CT scans (15.8 mGy). In the DG-CT scans a strong negative linear correlation between noise index (NI) and mean CTDIvol was observed (r = −0.954, p = 0.004); the higher NI, the lower CTDIvol. This was not the case in the RP-CT scans. ConclusionThe absorbed radiation dose is significantly higher and less BMI dependent for RP-CT scans compared to DG-CT. Image quality requirements of the examinations should be researched to ensure that radiation doses are not unnecessarily high.

Effect of body mass index on postoperative short-term outcomes of laparoscopy radical gastrectomy: a meta-analysis

To evaluate the effect of body mass index (BMI) on postoperative short-term outcomes of laparoscopy radical gastrectomy by meta-analysis. A literature search was performed in PubMed, EMBASE, Cochrane Library databases, CNKI, and CBM, Wanfang database to screen clinical trials published before October 2014 that compared short-term outcomes between high BMI and low BMI patients undergoing laparoscopy radical gastrectomy. RevMan 5.2 was used to perform the meta-analysis. Begg's and Egger's tests were carried out with Stata 12.0 software to evaluate the publication bias of enrolled literatures. Twelve studies involved a total of 4798 gastric cancer patients after laparoscopy radical gastrectomy. There were 1215 patients in high BMI group(BMI≥25 kg/m2) and 3583 patients in the low BMI group (BMI<25 kg/m2). Compared with the low BMI group, the high BMI group were associated with longer operation time (SMD=0.64, 95%CI:0.35-0.93, P=0.000), more intraoperative blood loss(SMD=0.63, 95%CI:0.24-1.03, P=0.002), less retrieved lymph nodes(SMD=-0.44, 95%CI:-0.72--0.17, P=0.002), and more postoperative complications(OR=1.44, 95%CI:1.19-1.74, P=0.000). There were no significant differences in postoperative hospital stay, the time to first flatus and initial complication(P>0.05). The higher BMI may result in a longer operation time, more intraoperative blood loss and a higher rate of postoperative complication after laparoscopy radical gastrectomy.

Relationship between tissue stress during gait in healthy volunteers and patterns of urate deposition and bone erosion in gout: a biomechanical computational modelling study

ObjectivesTo determine whether patterns of high internal tissue stress during gait are associated with patterns of monosodium urate crystal deposition and bone erosion in gout.MethodsWe compared patterns of foot von...