BODY MASS INDEX (BMI) CAN HELP PREDICT IMMUNE STATUS AND SHORT-TERM SURVIVAL IN PATIENTS WITH SEPSIS ADMITTED TO ICU

Abstract Aims Cardiogenic shock (CS) is associated with poor outcomes in older patients, but it remains unclear if this is due to higher shock severity. We sought to determine the associations between age and shock severity on mortality among patients with CS. Methods and results Patients with a diagnosis of CS from Mayo Clinic (2007–15) and University Clinic Hamburg (2009–17) were subdivided by age. Shock severity was graded using the Society for Cardiovascular Angiography and Intervention (SCAI) shock stages. Predictors of 30-day survival were determined using Cox proportional-hazards analysis. We included 1749 patients (934 from Mayo Clinic and 815 from University Clinic Hamburg), with a mean age of 67.6 ± 14.6 years, including 33.6% females. Acute coronary syndrome was the cause of CS in 54.0%. The distribution of SCAI shock stages was 24.1%; C, 28.0%; D, 33.2%; and E, 14.8%. Older patients had similar overall shock severity, more co-morbidities, worse kidney function, and decreased use of mechanical circulatory support compared to younger patients. Overall 30-day survival was 53.3% and progressively decreased as age or SCAI shock stage increased, with a clear gradient towards lower 30-day survival as a function of increasing age and SCAI shock stage. Progressively older age groups had incrementally lower adjusted 30-day survival than patients aged <50 years. Conclusion Older patients with CS have lower short-term survival, despite similar shock severity, with a high risk of death in older patients with more severe shock. Further research is needed to determine the optimal treatment strategies for older CS patients.

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The Relationship between Body Mass Index and Mammographic Density during a Premenopausal Weight Loss Intervention Study

Cancers ◽

10.3390/cancers13133245 ◽

2021 ◽

Vol 13 (13) ◽

pp. 3245

Author(s):

Emma C. Atakpa ◽

Adam R. Brentnall ◽

Susan Astley ◽

Jack Cuzick ◽

D. Gareth Evans ◽

...

Keyword(s):

Body Mass Index ◽

Weight Loss ◽

Body Mass ◽

Breast Density ◽

Small Sample ◽

Weight Loss Intervention ◽

Short Term ◽

Dense Area ◽

Short Term Change ◽

Term Change

We evaluated the association between short-term change in body mass index (BMI) and breast density during a 1 year weight-loss intervention (Manchester, UK). We included 65 premenopausal women (35–45 years, ≥7 kg adult weight gain, family history of breast cancer). BMI and breast density (semi-automated area-based, automated volume-based) were measured at baseline, 1 year, and 2 years after study entry (1 year post intervention). Cross-sectional (between-women) and short-term change (within-women) associations between BMI and breast density were measured using repeated-measures correlation coefficients and multivariable linear mixed models. BMI was positively correlated with dense volume between-women (r = 0.41, 95%CI: 0.17, 0.61), but less so within-women (r = 0.08, 95%CI: −0.16, 0.28). There was little association with dense area (between-women r = −0.12, 95%CI: −0.38, 0.16; within-women r = 0.01, 95%CI: −0.24, 0.25). BMI and breast fat were positively correlated (volume: between r = 0.77, 95%CI: 0.69, 0.84, within r = 0.58, 95%CI: 0.36, 0.75; area: between r = 0.74, 95%CI: 0.63, 0.82, within r = 0.45, 95%CI: 0.23, 0.63). Multivariable models reported similar associations. Exploratory analysis suggested associations between BMI gain from 20 years and density measures (standard deviation change per +5 kg/m2 BMI: dense area: +0.61 (95%CI: 0.12, 1.09); fat volume: −0.31 (95%CI: −0.62, 0.00)). Short-term BMI change is likely to be positively associated with breast fat, but we found little association with dense tissue, although power was limited by small sample size.

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Parenteral Nutrition and Oxidant Load in Neonates

Nutrients ◽

10.3390/nu13082631 ◽

2021 ◽

Vol 13 (8) ◽

pp. 2631

Author(s):

Kandeepan Karthigesu ◽

Robert F. Bertolo ◽

Robert J. Brown

Keyword(s):

Parenteral Nutrition ◽

Storage Temperature ◽

Oral Feeding ◽

Published Data ◽

Short Term ◽

Antioxidant Defences ◽

Term Survival ◽

Nutrient Sources ◽

Short Term Survival

Neonates with preterm, gastrointestinal dysfunction and very low birth weights are often intolerant to oral feeding. In such infants, the provision of nutrients via parenteral nutrition (PN) becomes necessary for short-term survival, as well as long-term health. However, the elemental nutrients in PN can be a major source of oxidants due to interactions between nutrients, imbalances of anti- and pro-oxidants, and environmental conditions. Moreover, neonates fed PN are at greater risk of oxidative stress, not only from dietary sources, but also because of immature antioxidant defences. Various interventions can lower the oxidant load in PN, including the supplementation of PN with antioxidant vitamins, glutathione, additional arginine and additional cysteine; reduced levels of pro-oxidant nutrients such as iron; protection from light and oxygen; and proper storage temperature. This narrative review of published data provides insight to oxidant molecules generated in PN, nutrient sources of oxidants, and measures to minimize oxidant levels.

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Short-Term Outcomes Following Removal of Infected Hernia Mesh

The American Surgeon ◽

10.1177/00031348211024189 ◽

2021 ◽

pp. 000313482110241

Author(s):

Christine Tung ◽

Junko Ozao-Choy ◽

Dennis Y. Kim ◽

Christian de Virgilio ◽

Ashkan Moazzez

Keyword(s):

Risk Factors ◽

Body Mass Index ◽

Logistic Regression ◽

Body Mass ◽

Smoking History ◽

Multivariate Logistic Regression ◽

Short Term ◽

Mesh Removal ◽

Mesh Placement ◽

Infected Mesh

There are limited studies regarding outcomes of replacing an infected mesh with another mesh. We reviewed short-term outcomes following infected mesh removal and whether placement of new mesh is associated with worse outcomes. Patients who underwent hernia repair with infected mesh removal were identified from 2005 to 2018 American College of Surgeons-National Surgical Quality Improvement Program database. They were divided into new mesh (Mesh+) or no mesh (Mesh-) groups. Bivariate and multivariate logistic regression analyses were used to compare morbidity between the two groups and to identify associated risk factors. Of 1660 patients, 49.3% received new mesh, with higher morbidity in the Mesh+ (35.9% vs. 30.3%; P = .016), but without higher rates of surgical site infection (SSI) (21.3% vs. 19.7%; P = .465). Mesh+ had higher rates of acute kidney injury (1.3% vs. .4%; P = .028), UTI (3.1% vs. 1.3%, P = .014), ventilator dependence (4.9% vs. 2.4%; P = .006), and longer LOS (8.6 vs. 7 days, P < .001). Multivariate logistic regression showed new mesh placement (OR: 1.41; 95% CI: 1.07-1.85; P = .014), body mass index (OR: 1.02; 95% CI: 1.00-1.03; P = .022), and smoking (OR: 1.43; 95% CI: 1.05-1.95; P = .025) as risk factors independently associated with increased morbidity. New mesh placement at time of infected mesh removal is associated with increased morbidity but not with SSI. Body mass index and smoking history continue to contribute to postoperative morbidity during subsequent operations for complications.

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LACK OF ASSOCIATION BETWEEN 99MTC-PYP HEART TO CONTRALATERAL RATIO AND SHORT-TERM SURVIVAL IN PATIENTS REFERRED FOR TRANSTHYRETIN CARDIAC AMYLOIDOSIS EVALUATION

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(21)02762-5 ◽

2021 ◽

Vol 77 (18) ◽

pp. 1404

Author(s):

Trejeeve Martyn ◽

Joshua Saef ◽

Muzna Hussain ◽

Ossama Abou Hassan ◽

Eoin Donnellan ◽

...

Keyword(s):

Cardiac Amyloidosis ◽

Short Term ◽

Term Survival ◽

Short Term Survival

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A registry study on radial head arthroplasties in the Netherlands: Indications, types and short-term survival

Shoulder & Elbow ◽

10.1177/1758573220987843 ◽

2021 ◽

pp. 175857322098784

Author(s):

Arno A Macken ◽

Ante Prkić ◽

Koen LM Koenraadt ◽

Iris van Oost ◽

Anneke Spekenbrink-Spooren ◽

...

Keyword(s):

Radial Head ◽

Register Data ◽

Implant Survival ◽

Short Term ◽

Term Survival ◽

Arthroplasty Register ◽

Common Indication ◽

Radial Head Arthroplasty ◽

Kaplan Meier ◽

Short Term Survival

Background This study aims to use the Dutch Arthroplasty Register data to report an overview of the contemporary indications and implant designs, and report the short-term survival of radial head arthroplasty. Methods From the Dutch Arthroplasty Register, data on patient demographics, surgery and revision were extracted for radial head arthroplasties performed from January 2014 to December 2019. Implant survival was calculated using the Kaplan–Meier method. Results Two hundred fifty-eight arthroplasties were included with a median follow-up of 2.2 years. The most common indication was a fracture of the radial head (178, 69%). One hundred thirty-nine (68%) of the prostheses were of bipolar design, and the most commonly used implant type was the Radial Head System (Tornier; 134, 51%). Of the 258 included radial head arthroplasties, 16 were revised at a median of six months after surgery. Reason for revision was predominantly aseptic loosening (9). The overall implant survival was 95.8% after one year, 90.5% after three years and 89.5% after five years. Discussion For radial head arthroplasties, acute trauma is the most common indication and Radial Head System the most commonly used implant. The implant survival is 89.5% after five years.

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