Abstract 3553: Effect of Resolution of Metabolic Syndrome on Endothelial Function and Cardiovascular Events after Acute Coronary Syndromes

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Shin-ichiro Miyazaki ◽  
Yoshikazu Hiasa ◽  
Takefumi Takahashi ◽  
Riyo Ogura ◽  
Naoki Suzuki ◽  
...  

Background: Metabolic syndrome (MetS) is associated with endothelial dysfunction, and recognized as a risk factor of cardiovascular events after acute coronary syndromes (ACS). We examined whether the resolution of MetS would improve endothelial function and provide a beneficial effect on clinical outcome after ACS. Methods: We studied 60 patients with MetS who underwent a percutaneous revascularization procedure for ACS. MetS was defined using modified International Diabetes Federation criteria. Brachial artery flow-mediated dilation (FMD) and several risk parameters related to metabolic disorders were assessed at baseline and at 6 months. Each patient was given basic spoken advice on lifestyle modification and optimal medications before discharge. Patients were divided into 2 groups according to whether the criteria for MetS were fulfilled at 6 months: resolved MetS (R-MetS, n=35) and persistent MetS (P-MetS, n=25). Cardiovascular events were defined as cardiac death, stroke, myocardial infarction, unstable angina, and target vessel revascularization. Results: During the 1-year follow-up, 3 patients with R-MetS (8.6%) and 14 patients with P-MetS (56%) had cardiovascular events (p=0.0002). The extent of improvement in FMD was significantly greater in patients with R-MetS than those with P-MetS (change in FMD: 1.5 vs −1.2: p=0.007; respectively). In a multivariate logistic regression analysis, P-MetS was an independent predictor of cardiovascular events (odds ratio 18.4, 95%CI 1.67–28.5, p=0.025). Conclusion: The resolution of MetS is associated with the recovery of endothelial function and prevents cardiovascular events after ACS. Multivariate logistic regression analysis

2010 ◽  
Vol 105 (2) ◽  
pp. 256-262
Author(s):  
Lv Yangmei ◽  
Miao Yanxia ◽  
Qiao Liangmei ◽  
Zhang Jinhui ◽  
Hua Yu ◽  
...  

The present study was designed to develop a novel method of energy calculation for controlling energetic intake in patients with the metabolic syndrome. Demographics and dietary data were recorded for 2582 obese subjects. Nutritional education was applied to all the patients. One year later, the data on age, sex, activity intensity coefficient, waistline, environmental temperature and BMI in subjects who lost ≥ 5 % body weight were entered into a multivariate logistic regression analysis model. Energy requirement was calculated from the results of multivariate logistic regression. Four hundred and thirty-four metabolic syndrome patients were then randomly divided into the treated group (216) and the control group (218). The energetic intake in the experimental group was controlled based on the new energy requirement model. The traditional energy exchange method was used in the control group. The independent factors predicting metabolic syndrome prognosis, such as age, sex, activity intensity coefficient, waistline, environmental temperature and BMI, were identified by multivariate logistic regression analysis. The energy requirement model was then constructed by logistic regression analysis. After 6 months of energetic intake control based on the new model, the parameters of the experimental group were significantly different from those of the controls (all P < 0·05): waistline, 89·65 (sd 5·54) v. 91·97 (sd 4·78) cm; BMI, 24·67 (sd 3·54) v. 25·87 (sd 2·65) kg/m2; fasting blood glucose, 6·9 (sd 3·6) v. 8·7 (sd 4·6) mmol/l; 2 h PG, 8·7 (sd 5·7) v. 10·7 (sd 4·5) mmol/l; HbA1c, 7·7 (sd 1·6) v. 8·9 (sd 2·6) %; homoeostasis model insulin resistance index, 3·14 (sd 1·62) v. 4·32 (sd 2·25). The new energy requirement model can effectively improve the clinical outcomes of controlling energetic intake in metabolic syndrome patients.


2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Atsushi Kotera

Abstract Background Postanesthetic shivering is an unpleasant adverse event in surgical patients. A nonsteroidal anti-inflammatory drug has been reported to be useful in preventing postanesthetic shivering in several previous studies. The aim of this study was to evaluate the efficacy of flurbiprofen axetil being a prodrug of a nonsteroidal anti-inflammatory drug for preventing postanesthetic shivering in patients undergoing gynecologic laparotomy surgeries. Method This study is a retrospective observational study. I collected data from patients undergoing gynecologic laparotomy surgeries performed between October 1, 2019, and September 30, 2020, at Kumamoto City Hospital. All the patients were managed with general anesthesia with or without epidural analgesia. The administration of intravenous 50 mg flurbiprofen axetil for postoperative pain control at the end of the surgery was left to the individual anesthesiologist. The patients were divided into two groups: those who had received intravenous flurbiprofen axetil (flurbiprofen group) and those who had not received intravenous flurbiprofen axetil (non-flurbiprofen group), and I compared the frequency of postanesthetic shivering between the two groups. Additionally, the factors presumably associated with postanesthetic shivering were collected from the medical charts. Intergroup differences were assessed with the χ2 test with Yates’ correlation for continuity category variables. The Student’s t test was used to test for differences in continuous variables. Furthermore, a multivariate logistic regression analysis was performed to elucidate the relationship between the administration of flurbiprofen axetil and the incidence of PAS. Results I retrospectively examined the cases of 141 patients aged 49 ± 13 (range 21-84) years old. The overall postanesthetic shivering rate was 21.3% (30 of the 141 patients). The frequency of postanesthetic shivering in the flurbiprofen group (n = 31) was 6.5%, which was significantly lower than that in the non-flurbiprofen group (n = 110), 25.5% (p value = 0.022). A multivariate logistic regression analysis showed that administration of flurbiprofen axetil was independently associated with a reduced incidence of postanesthetic shivering (odds ratio 0.12; 95% confidence interval, 0.02-0.66, p value = 0.015). Conclusions My result suggests that intraoperative 50 mg flurbiprofen axetil administration for postoperative pain control is useful to prevent postanesthetic shivering in patients undergoing gynecologic laparotomy surgeries.


2020 ◽  
Vol 8 ◽  
Author(s):  
Chen Dong ◽  
Minhui Zhu ◽  
Luguang Huang ◽  
Wei Liu ◽  
Hengxin Liu ◽  
...  

Abstract Background Tissue expansion is used for scar reconstruction owing to its excellent clinical outcomes; however, the complications that emerge from tissue expansion hinder repair. Infection is considered a major complication of tissue expansion. This study aimed to analyze the perioperative risk factors for expander infection. Methods A large, retrospective, single-institution observational study was carried out over a 10-year period. The study enrolled consecutive patients who had undergone tissue expansion for scar reconstruction. Demographics, etiological data, expander-related characteristics and postoperative infection were assessed. Univariate and multivariate logistic regression analysis were performed to identify risk factors for expander infection. In addition, we conducted a sensitivity analysis for treatment failure caused by infection as an outcome. Results A total of 2374 expanders and 148 cases of expander infection were assessed. Treatment failure caused by infection occurred in 14 expanders. Multivariate logistic regression analysis identified that disease duration of ≤1 year (odds ratio (OR), 2.07; p &lt; 0.001), larger volume of expander (200–400 ml vs &lt;200 ml; OR, 1.74; p = 0.032; &gt;400 ml vs &lt;200 ml; OR, 1.76; p = 0.049), limb location (OR, 2.22; p = 0.023) and hematoma evacuation (OR, 2.17; p = 0.049) were associated with a high likelihood of expander infection. Disease duration of ≤1 year (OR, 3.88; p = 0.015) and hematoma evacuation (OR, 10.35; p = 0.001) were so related to high risk of treatment failure. Conclusions The rate of expander infection in patients undergoing scar reconstruction was 6.2%. Disease duration of &lt;1 year, expander volume of &gt;200 ml, limb location and postoperative hematoma evacuation were independent risk factors for expander infection.


2021 ◽  
Author(s):  
Yoshihiro Nakamura ◽  
Shin Yokoya ◽  
Yuki Matsubara ◽  
Yohei Harada ◽  
Nobuo Adachi

Abstract Background The purpose of this study was to identify differences in the morphology of the scapula according to the presence or absence of a rotator cuff tear (RCT). Methods One hundred and three shoulders with and 87 shoulders without RCTs were included in this study. The critical shoulder angle (CSA) and lateral acromion angle in the frontal view and the acromial coverage angle (ACA) and coracoid and scapular spine angle (CSSA) in the lateral view were evaluated using three-dimensional computed tomography. The glenoid anterior tilt, anterior acromial projection angle (AAPA), coracoid process angle, scapular spine angle (SSA) and inferior angle angle (IAA) with respect to the scapular plane were measured in the lateral view. The morphological parameters of the scapula associated with RCT were statistically analysed using a multivariate logistic regression analysis. Results In univariate logistic regression analysis, CSA, ACA, CSSA, AAPA, SSA and IAA were significantly different between shoulders with and without RCTs. In multivariate logistic regression analysis, CSA and IAA were greater in shoulders with RCT and were significantly associated with this condition. Conclusion To the best of our knowledge, this is the first study to focus on the relationship between RCT and the scapular body. RCT cases were characterised by a greater curvature of the scapular body in addition to CSA.


2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e22524-e22524
Author(s):  
Tomohiro Kondo ◽  
Takahiro Yamada ◽  
Masahiro Yoshioka ◽  
Masakazu Nishigaki ◽  
Yoshihiro Yamamoto ◽  
...  

e22524 Background: Presumed germline pathogenic variants (PGPVs) can be detected in tumor tissues using comprehensive genomic profiling. Clinicians and patients can decide whether to conduct confirmatory germline testing or not. However, the promoting and obstructive factors for confirmatory germline testing are unclear. Methods: This single institutional retrospective study aimed to identify factors related to confirmatory germline testing in patients with PGPVs. Between April 2015 and April 2019, 270 consecutive patients with cancers of unknown primary site, rare tumors, or solid tumors refractory to standard chemotherapy, who underwent tumor-only comprehensive genomic profiling were reviewed. PGPVs were proposed to be disclosed as variants to the patients by our institutional molecular tumor board. Univariate logistic regression analysis was conducted to investigate the relationship between each patient’s characteristics and confirmatory germline testing. Factors showing a statistical relationship (p < 0.10 in univariate analyses) were included in multivariate logistic regression analysis with a backward selection of variables. Statistical significance was set at p < 0.05. Results: Of the 270 patients who underwent tumor-only comprehensive genomic profiling, 77 possessed PGPVs. The most common PGPVs were TP53 (n = 56), APC (n = 9), PTEN (n = 7), RB1 (n = 6), and BRCA2 (n = 6). Among the 77 patients, only 11 (14.3%) chose to undergo confirmatory germline testing. Multivariate logistic regression analysis revealed that the person disclosing the results (experienced oncologists with knowledge of cancer genome medicine vs. others, odds ratio [OR]: 27.7, 95% confidence interval [CI]: 4.60–167) and study period (OR: 0.110, 95% CI: 0.015–0.787) were independently and significantly associated with confirmatory germline testing. Conclusions: These findings indicate that fostering genomic competency in oncologists and collaborating with genetic experts would facilitate cancer patients and their families to receive genetic medical services in the process of cancer genomic profiling.


Author(s):  
Ting-Min Hsieh ◽  
Pao-Jen Kuo ◽  
Shiun-Yuan Hsu ◽  
Peng-Chen Chien ◽  
Hsiao-Yun Hsieh ◽  
...  

This study aimed to assess whether hypothermia is an independent predictor of mortality in trauma patients in the condition of defining hypothermia as body temperatures of <36 °C. Data of all hospitalized adult trauma patients recorded in the Trauma Registry System at a level I trauma center between 1 January 2009 and 12 December 2015 were retrospectively reviewed. A multivariate logistic regression analysis was performed in order to identify factors related to mortality. In addition, hypothermia and normothermia were defined as temperatures <36 °C and from 36 °C to 38 °C, respectively. Propensity score-matched study groups of hypothermia and normothermia patients in a 1:1 ratio were grouped for mortality assessment after adjusting for potential confounders such as age, sex, preexisting comorbidities, and injury severity score (ISS). Of 23,705 enrolled patients, a total of 401 hypothermic patients and 13,368 normothermic patients were included in this study. Only 3.0% of patients had hypothermia upon arrival at the emergency department (ED). Compared to normothermic patients, hypothermic patients had a significantly higher rate of abbreviated injury scale (AIS) scores of ≥3 in the head/neck, thorax, and abdomen and higher ISS. The mortality rate in hypothermic patients was significantly higher than that in normothermic patients (13.5% vs. 2.3%, odds ratio (OR): 6.6, 95% confidence interval (CI): 4.86–9.01, p < 0.001). Of the 399 well-balanced propensity score-matched pairs, there was no significant difference in mortality (13.0% vs. 9.3%, OR: 1.5, 95% CI: 0.94–2.29, p = 0.115). However, multivariate logistic regression analysis revealed that patients with low body temperature were significantly associated with the mortality outcome. This study revealed that low body temperature is associated with the mortality outcome in the multivariate logistic regression analysis but not in the propensity score matching (PSM) model that compared patients with hypothermia defined as body temperatures of <36 °C to those who had normothermia. These contradicting observations indicated the limitation of the traditional definition of body temperature for the diagnosis of hypothermia. Prospective randomized control trials are needed to determine the relationship between hypothermia following trauma and the clinical outcome.


2018 ◽  
Vol 75 (9) ◽  
pp. 926-934
Author(s):  
Svetlana Radevic ◽  
Snezana Radovanovic ◽  
Nela Djonovic ◽  
Ivana Simic-Vukomanovic ◽  
Natasa Mihailovic ◽  
...  

Background/Aim. Non-communicable diseases (NCDs) are a major public health challenge worldwide. Although they are preventable, NCDs are the major global causes of morbidity and mortality, absenteeism, disability and premature death. The aim of this study was to examine socioeconomic inequalities in the prevalence of non-communicable diseases in Serbia. Methods. Data from the 2013 National Health Survey of the population of Serbia was used in this study. There were 13,765 adults interviewed, aged ? 20 years. We used multivariate logistic regression analyses with demographic and socioeconomic determinants of health as independent variables and prevalence of non-communicable diseases as a dependent variable. The minimum level of significance was p < 0.05. Results. Hypertension was the most prevalent NCDs (36.1%). The prevalence of multimorbidity was 47.1%. Multivariate logistic regression analysis showed that gender, age, place of residence, employment status and education were associated with the presence of NCDs. The odds ratio (OR) for age was 1.074 [95% confidence interval (CI) : 1.070?1.077). Women were at a higher risk of NCDs by 58.9% when compared to men (OR = 1.589; 95% 95% CI : 1.467?1.726). Respondents who lived in the rural areas were at a higher risk for NCDs by 14.1% compared to those who lived in urban areas (OR = 1.141; 95% CI : 1.047? 1.244). Odds ratio for unemployment was 1.227 (95% CI: 1.118?1.346). Respondents with primary education were at a higher risk for chronic diseases by 47.1% (OR = 1.471; 95% CI : 1.281?1.687) while those with secondary school were at a higher risk by 27.7% (OR = 1.277; 95% CI : 1.142?1.428) compared to respondents who had higher education. When it comes to Wealth Index, univariate logistic regression analysis showed that respondents who belonged to the poor and middle classes were at a higher risk for NCDs (OR = 2.031; 95% CI : 1.819?2.267; OR = 1.473; 95% CI : 1.343? 1.615) compared to respondents who belonged to the rich class. Multivariate logistic regression analysis did not show statistically significant correlations between the Wealth index and NCDs. Conclusion. Socioeconomic inequalities in health status are the major challenge and should be a target of national health policy in Serbia, not only because they represent social injustice but also because solving the health problems of underprivileged groups of the population can influence improvement of health status of the population as a whole.


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