Primary Outcome Variable Of Interest Research Articles

Parathyroidectomy in dialysis patients

BackgroundThe optimal surgical treatment for secondary hyperparathyroidism is not well defined. Subtotal parathyroidectomy and total parathyroidectomy (tPTX) with autotransplant are accepted options; treatment method is left to surgeon preference. We sought to describe different characteristics of patients with secondary hyperparathyroidism receiving surgical treatment and to compare outcomes between the two treatment strategies. MethodsWe conducted a retrospective cohort study of patients aged >18 y and on dialysis who received a parathyroidectomy (Current Procedural Terminology code = 60500) using the American College of Surgeons National Surgical Quality Improvement Program Participant Use File (2008–2011). Procedures were classified as subtotal if no autotransplant was performed and total if autotransplant was performed. Descriptive statistics were performed. The primary outcome variable of interest was 30-day morbidity. Secondary outcome variables studied were operative time, postoperative length of stay (LOS), 30-day mortality, and 30-day readmission. Univariate analyses were performed. ResultsA total of 898 patients studied; of which, 236 patients (26.4%) received a tPTX and 662 (73.7%) received a subtotal parathyroidectomy. The median age was 49 y (interquartile range [IQR]: 38, 59), and majority of patients were American Society of Anesthesiologists class III (629, 70%). Nearly half of the patients were black (447, 49.8%); blacks were more likely to receive a tPTX than whites (30.2% versus 19.9%, P = 0.01). Median operative time (133 min, IQR: 92, 160 versus 120 min, IQR: 103, 181; P < 0.01) and median LOS (4 d, IQR: 3, 7 versus 4 d, IQR: 2, 6; P < 0.01) were longer after a tPTX. There was no difference in the 30-day morbidity, mortality, or readmission rates between the two treatments. ConclusionsWe used a national multi-institutional data set to show that despite the high-risk patient cohort and difference in operative duration, there is no difference in the more general postoperative complication rates.

Association between cord blood 25-hydroxyvitamin D concentrations and respiratory tract infections in the first 6 months of age in a Korean population: a birth cohort study (COCOA)

PurposePrevious studies suggest that the concentration of 25-hydroxyvitamin D [25(OH)D] in cord blood may show an inverse association with respiratory tract infections (RTI) during childhood. The aim of the present study was to examine the influence of 25(OH)D concentrations in cord blood on infant RTI in a Korean birth cohort.MethodsThe levels of 25(OH)D in cord blood obtained from 525 Korean newborns in the prospective COhort for Childhood Origin of Asthma and allergic diseases were examined. The primary outcome variable of interest was the prevalence of RTI at 6-month follow-up, as diagnosed by pediatricians and pediatric allergy and pulmonology specialists. RTI included acute nasopharyngitis, rhinosinusitis, otitis media, croup, tracheobronchitis, bronchiolitis, and pneumonia.ResultsThe median concentration of 25(OH)D in cord blood was 32.0 nmol/L (interquartile range, 21.4 to 53.2). One hundred and eighty neonates (34.3%) showed 25(OH)D concentrations less than 25.0 nmol/L, 292 (55.6%) showed 25(OH)D concentrations of 25.0-74.9 nmol/L, and 53 (10.1%) showed concentrations of ≥75.0 nmol/L. Adjusting for the season of birth, multivitamin intake during pregnancy, and exposure to passive smoking during pregnancy, 25(OH)D concentrations showed an inverse association with the risk of acquiring acute nasopharyngitis by 6 months of age (P for trend=0.0004).ConclusionThe results show that 89.9% of healthy newborns in Korea are born with vitamin D insufficiency or deficiency (55.6% and 34.3%, respectively). Cord blood vitamin D insufficiency or deficiency in healthy neonates is associated with an increased risk of acute nasopharyngitis by 6 months of age. More time spent outdoors and more intensified vitamin D supplementation for pregnant women may be needed to prevent the onset of acute nasopharyngitis in infants.

Prior Heat Stress

The impact of prior heat stress on subsequent aerobic exercise-heat performance has not been studied. To determine whether prior heat stress degrades subsequent aerobic exercise performance in the heat. Eighteen nonheat acclimated males were trained (four practice trials) on an aerobic exercise performance test in 22 degrees C and then divided into two (n = 8) groups. One group (EUHPH; (.)VO2peak = 44 +/- 7 mL x kg x min(-1)) was tested after 90 min of recovery (in 22 degrees C) from 3 h of intermittent light-intensity (<30% (.)VO2peak) exercise-heat (50 degrees C) stress, where sweat losses were matched with fluid intake (3.5 +/- 0.5 L) to maintain euhydration. The other group (EUH; (.)VO2peak = 45 +/- 5 mL x kg x min(-1)) was tested while euhydrated without prior exercise-heat stress. Aerobic performance was determined from a 30-min cycling preload (50% (.)VO2peak) followed by a 15-min time trial in 40 degrees C. Total work during the 15-min performance time trial in EUH and EUHPH was compared, as were the percent changes from the best practice trials. Volunteers were euhydrated (plasma osmolality < 290 mOsm x kg(-1)) and normothermic before each exercise-heat trial. Heart rate and core temperature were not different (P > 0.05) between groups at any time point during exercise. Total work was not different (P > 0.05) at baseline or between EUH (150.5 +/- 28.3 kJ; 2.0 +/- 0.3 kJ x kg(-1)) and EUHPH (160.3 +/- 24.0 kJ; 1.8 +/- 0.2 kJ x kg(-1)). The percent change in total work relative to baseline was not different (P > 0.05) between EUH (-18.7% +/- 9.2%) and EUHPH (-15.0% +/- 7.8%). If hydration and body temperatures recover, prior exercise-heat stress does not result in a greater degradation in aerobic time trial performance in the heat compared with heat exposure alone.