Tag: nevin manimala

Zhonghua Yi Xue Za Zhi. 2024 Jun 25;104(24):2234-2241. doi: 10.3760/cma.j.cn112137-20240113-00100.

ABSTRACT

Objective: To explore the relationship between bioelectrical impedance analysis (BIA)-derived fluid status and nutritional indicators and the prognosis in patients undergoing maintenance hemodialysis (MHD). Methods: A retrospective cohort study was conducted. The clinical data of MHD patients in Jiangsu Province Hospital between January 2014 and December 2016 were analyzed. BIA data of healthy volunteers in Gulou District, Nanjing City, collected between April and October 2022, were used to determine the cut-off value of body cell mass index (BCMI). Referring to previous research, using 0.15 as the cut-off value for the ratio of overhydration and extracellular water (OH/ECW). The data were transformed into binary variables based on these cut-off values to categorize patients into different groups. Kaplan-Meier analysis was used to plot survival curves, and the Cox proportional hazards model was performed to analyze risk factors for all-cause mortality. Results: A total of 706 MHD patients (407 males and 299 females) were included, aged (54±15) years. MHD patients were classified into four groups based on whether BCMI was<5.4 kg/m² and OH/ECW was≥0.15, which included non-overhydration and non-malnutrition group, overhydration group, malnutrition group, and overhydration and malnutrition group, with 269, 186, 151, and 100 patients, respectively. During a median follow-up of [M(Q₁, Q₃)] 33 (26, 37) months, 162 patients died. Kaplan-Meier analysis showed that the median survival periods of the four groups were 52 months (95%CI: 41-54 months), 46 months (95%CI: 44-49 months), 37 months (95%CI: 34-40 months), and 34 months (95%CI: 30-38 months), respectively, with a statistically significant difference (P<0.001). The 1-year survival rates were 95.5%, 93.5%, 92.1%, and 88.0% (P<0.001), respectively, and the 2-year mortality rates were 92.6%, 87.1%, 83.4%, and 77.0% (P<0.001), respectively. Multivariate Cox regression analysis showed that compared with non-overhydration and non-malnutrition group, the risk of all-cause mortality increased by 1.18 times in the malnutrition group (HR=2.18, 95%CI: 1.29-3.71, P=0.004), and by 1.59 times in the overhydration and malnutrition group (HR=2.59, 95%CI: 1.48-4.54, P=0.001). Conclusions: BIA-derived fluid status and nutritional indicators are associated with the prognosis of MHD patients. Compared with patients without fluid overload and malnutrition, patients with malnutrition and fluid overload have an increased risk of all-cause mortality.

PMID:38901980 | DOI:10.3760/cma.j.cn112137-20240113-00100

Zhonghua Yi Xue Za Zhi. 2024 Jun 25;104(24):2229-2233. doi: 10.3760/cma.j.cn112137-20231205-01294.

ABSTRACT

Objective: To assess the efficacy and safety of flexible ureteral lithotripsy (FURL) for treating upper urinary tract calculi in patients ≥80 years. Methods: This study retrospectively analyzed the clinical data of 297 elderly patients who underwent FURL for unilateral upper urinary tract calculi at Beijing Hospital from January 2019 to September 2023. Patients were divided into elderly group (≥80 years) and low-middle aged group (≥60-<80 years). Propensity score matching (PSM) was used to match preoperative clinical data of patients. After PSM, the basic, perioperative and postoperative data of the two groups were compared. Results: After PSM, 116 patients were enrolled, including 58 patients in each group. The age [M (Q₁, Q₃)] of elderly group was 83.0 (81.0, 86.0) years, which included 29 males. The age of low-middle aged group was 69.5 (64.8, 74.0) years, which included 33 males. The duration of postoperative hospitalization [M (Q₁, Q₃)] in elderly group was longer than that in low-middle aged group [2 (1, 3) d vs 1 (1, 2) d, P=0.002]. Serious postoperative complications occurred in 3 cases in the elderly group and 1 case in the low-middle aged group, respectively, without surgical intervention. There was no significant statistical difference in stone-free rate (SFR) [79.3% (46/58) vs 84.5% (49/58)], operation time [M (Q₁, Q₃), 70.0 (48.3, 100.0) vs 65.0 (46.5, 101.2) min] and postoperative complication rate [25.9% (15/58) vs 22.4% (13/58)] between two groups (all P>0.05). Conclusions: In the treatment of upper urinary tract calculi in patients ≥80 years, the SFR, operation time and postoperative complication rate of FURL are comparable to those in low-middle aged elderly patients. FURL has good safety and effectiveness in the treatment of upper urinary tract calculi in patients ≥80 years.

PMID:38901979 | DOI:10.3760/cma.j.cn112137-20231205-01294

Zhonghua Yi Xue Za Zhi. 2024 Jun 25;104(24):2222-2228. doi: 10.3760/cma.j.cn112137-20231219-01422.

ABSTRACT

Objective: To explore the risk factors for progression to chronic kidney disease (CKD) in patients with cardiac valve replacement surgery-associated acute kidney injury (AKI). Methods: A retrospective, nested case-control study was conducted at Fuwai Central China Cardiovascular Hospital. The study subjects were patients who underwent cardiac valve replacement surgery from January 1, 2018 to December 31, 2020, with a baseline estimated glomerular filtration rate (eGFR)>60 ml·min^-1·(1.73 m²)^-1 and postoperative complication of AKI. The patients were followed up for 90 days after discharge from hospital. The endpoint event was defined as progression to CKD 90 days after the occurrence of cardiac valve replacement surgery-associated AKI. The patients were divided into CKD group and non-CKD group based on whether they experienced endpoint event. The baseline clinical data were compared between the two groups. The measurement data with non-normal distribution was represented as M (Q₁,Q₃). Logistic regression model was used to analyze the risk factors of endpoint event. The receiver-operating characteristic (ROC) curve was drawn to evaluate the performance for predicting CKD in cardiac valve replacement surgery-associated AKI patients. Results: A total of 149 cardiac valve replacement surgery-associated AKI patients (86 males and 63 females) were included in the study, aged (59.0±10.2) years. There were 27 patients (18.1%) who progressed to new-onset CKD 90 days after the occurrence of cardiac valve replacement surgery-associated AKI. Compared with non-CKD group, patients in CKD group had older age [66 (58, 70) vs 59 (53, 64) years], lower baseline eGFR [76.3 (65.8, 98.5) vs 92.7 (78.5, 101.6) ml·min^-1·(1.73 m²)^-1], higher proportion of preoperative hypertension [51.9% (14/27) vs 27.9% (34/122)] and serum creatinine at discharge [136 (101, 165) vs 86 (65, 104) μmol/L], and the differences were statistically significant (all P<0.05). The multivariate logistic regression analysis results revealed that older age (OR=1.063, 95%CI: 1.001-1.129, P=0.047), preoperative hypertension (OR=3.070, 95%CI: 1.105-8.532, P=0.031) and higher serum creatinine at discharge (OR=1.026, 95%CI:1.013-1.038, P<0.001) were risk factors for progression to CKD in patients with cardiac valve replacement surgery-associated AKI. The clinical risk model including age, preoperative hypertension, preoperative baseline eGFR, and serum creatinine at discharge produced a moderate performance for predicting progression to CKD in patients with cardiac valve replacement surgery-associated AKI [the area under the curve (AUC)=0.865, 95%CI: 0.790-0.940, P<0.001]. Conclusion: Older age, preoperative hypertension and higher serum creatinine at discharge are risk factors for progression to CKD in patients with cardiac valve replacement surgery-associated AKI.

PMID:38901978 | DOI:10.3760/cma.j.cn112137-20231219-01422

J Nucl Med Technol. 2024 Jun 20:jnmt.124.267576. doi: 10.2967/jnmt.124.267576. Online ahead of print.

ABSTRACT

Diagnostic reference levels (DRLs) are an important tool for controlling radiation exposure and ensuring safety in medical applications. In Thailand, DRL data have been gathered and established for nuclear medicine diagnostics since 2021. However, there is a lack of information on PET imaging examinations. At the National Cyclotron and PET Scan Centre, Chulabhorn Hospital, radiopharmaceuticals are produced for medical imaging and research, and a wide range of PET/CT and PET/MRI examinations are performed. Our objective was to investigate the administered activity of radiopharmaceuticals in patients undergoing PET imaging, especially the existing data on DRLs in medical diagnostic imaging. Methods: This was a retrospective study on nuclear medicine patients at the National Cyclotron and PET Scan Centre in 2023. Statistical analysis, including the mean and the 75th percentile values, was conducted to determine DRLs according to the International Commission on Radiological Protection guidelines. Results: The center performed 8,711 PET/CT and PET/MRI studies with 13 protocols in 2023. The most commonly administered activity was ¹⁸F-FDG in oncology and neurology examinations, with DRLs of 186.11 and 136.16 MBq, respectively. These values were notably almost twice lower than several reports in other countries. Conclusion: There is a lack of comprehensive data on most DRLs for PET imaging at this center because of the nonwidespread use of several radiopharmaceuticals. However, the lower DRLs for ¹⁸F-FDG can highlight the need for ongoing investigation toward the establishment of local DRLs, as well as assurance on the safety and efficiency of radiation used in nuclear medicine.

PMID:38901963 | DOI:10.2967/jnmt.124.267576

Clin Nutr ESPEN. 2024 Aug;62:95-101. doi: 10.1016/j.clnesp.2024.04.023. Epub 2024 May 18.

ABSTRACT

OBJECTIVE: We aimed to evaluate the association of temporal patterns of food consumption with cardiovascular disease (CVD) risk.

METHODS: This cross-sectional study included male rotating shift workers in an iron ore extraction company. Data on food consumption was collected using a 24 h recall, applied by trained interviewers. The variables for temporal patterns of food consumption were: eating window, eating at night, number of meals and omission of breakfast. CVD-risk was measured by calculating the Framingham coronary heart disease risk score (FCRS), and classified as low risk or intermediate to high risk. Descriptive, univariate and multivariate logistic regression analyses examined the association between variables related to temporal patterns of food consumption and CVD-risk.

RESULTS: The study assessed 208 workers, the majority with 20-34 years (45.1%), non-white (77.2%), and 5 years or more in shift work (76.0%). Most participants had a feeding window exceeding 12 h (63.9%), consumed meals until 10 p.m. (68.1%), had five or more meals per day (54.8%), and did not skip breakfast (86.5%). Regarding CVD-risk, 43.8% of the participants were classified with intermediate to high risk for CVD. In the multivariate model, a feeding window (OR: 2.32; 95%CI: 1.01-5.35), eating after 10 p.m. (OR: 3.31; 95%CI: 1.01-11.0), and skipping breakfast (OR: 2.58; 95%CI: 1.07-6.19) increased the likelihood of intermediate to high CVD-risk. Conversely, having five or more meals per day decreased the odds (OR: 0.27; 95%CI: 0.08-0.92).

CONCLUSION: Eating window longer than 12 h, eating after 10 p.m., less than four meals a day and omission of breakfast, are associated with cardiovascular risk in shift workers.

PMID:38901954 | DOI:10.1016/j.clnesp.2024.04.023

Clin Nutr ESPEN. 2024 Aug;62:128-136. doi: 10.1016/j.clnesp.2024.04.019. Epub 2024 May 23.

ABSTRACT

BACKGROUND: Previous studies have shown a strong correlation between gut microbiota and diabetes and its associated complications. We aimed to evaluate the causal relationships between the gut microbiota, gut metabolites, and diabetic neuropathy.

METHODS: Summary statistics of 211 gut microbiota and 12 gut-related metabolites (β-hydroxybutyric acid, betaine, trimethylamine-N-oxide, carnitine, choline, glutamate, kynurenine, phenylalanine, propionic acid, serotonin, tryptophan, and tyrosine) were obtained from previous genome-wide association studies (GWAS). A two-sample Mendelian randomization (MR) design was used to estimate the effects of gut microbiota and gut metabolites on the risk of diabetic neuropathy based on FinnGen GWAS.

RESULTS: Higher levels of Acidaminococcaceae (OR = 0.62; 95%CI = 0.46 to 0.84; P = 0.002), Peptococcaceae (OR = 0.70; 95%CI = 0.54 to 0.90; P = 0.006), and Eubacterium coprostanoligenes group (OR = 0.68; 95%CI = 0.50 to 0.93; P = 0.016) are genetically determined to provide protection against diabetic neuropathy. Conversely, the presence of Alistipes (OR = 1.65; 95%CI = 1.18 to 2.31; P = 0.003), ChristensenellaceaeR7 group (OR = 1.52; 95%CI = 1.03 to 2.23; P = 0.033), Eggerthella (OR = 1.28; 95%CI = 1.05 to 1.55; P = 0.014), RuminococcaceaeUCG013 (OR = 1.35; 95%CI = 1.01 to 1.82; P = 0.046), and Firmicutes (OR = 1.42; 95%CI = 1.05 to 1.93; P = 0.023) increases the risk of diabetic neuropathy. Moreover, a correlation has been identified between diabetic neuropathy and two gut metabolites: betaine (OR = 0.95; 95%CI = 0.90 to 1.00; P = 0.033) and tyrosine (OR = 1.03; 95%CI = 1.01 to 1.06; P = 0.019). Sensitivity analysis indicated robust results with no sign of heterogeneity or pleiotropy.

CONCLUSION: The present study elucidated the impact of specific gut microbiota and gut metabolites on the susceptibility to diabetic neuropathy. Interventions targeting the improvement of the gut microbiota diversity and composition hold considerable promise as a potential strategy.

PMID:38901934 | DOI:10.1016/j.clnesp.2024.04.019

Clin Nutr ESPEN. 2024 Aug;62:120-127. doi: 10.1016/j.clnesp.2024.05.010. Epub 2024 May 18.

ABSTRACT

BACKGROUND: Malnutrition is present in 20-50% of hospital patients but its recognition is often neither timely nor complete. The Global Leadership Initiative on Malnutrition (GLIM) aims to improve this, but its successful implementation may be compromised by its dependence on (a choice of) prior screening tools and difficulties in consistent assessment of muscle mass.

AIMS: To explore different approaches to screening and muscle assessment in GLIM and to offer simpler choices for its more widespread application.

METHODS: (1) Data from 300 consenting in-patients provided Nutritional Risk Screening (NRS-2002), Malnutrition Universal Screening Tool (MUST), and Subjective Global Assessment (SGA) scores. GLIM scoring was preceded by NRS-2002 or MUST (using threshold scores of 1 or 2 for MUST), or no prior screening. The results of GLIM scoring preceded by different screening approaches were compared with those of SGA. (2) The literature on mid-upper arm circumference (MUAC) and calf circumference (CC) as simple, non-invasive, objective methods of muscle assessment methods was reviewed (3) The cumulative times taken to obtain GLIM scores were measured and corrected for the different screening strategies.

RESULTS: (1) Participants’ mean age was 60 years, 157 (52%) were female and mean BMI was 27.8 kg/m². In comparison with SGA, GLIM with no prior screening had the highest sensitivity (65%) and negative predictive value (NPV) (76%), but the lowest specificity (90%) and positive predictive value (PPV) (84%). The equivalent figures for GLIM with prior MUST “1” were 62%, 75%, 93% and 88%; with prior NRS-2002, 55%∗, 73%, 98%∗ and 95%∗; and with prior MUST “2”, 44%∗, 69%∗, 98%∗, 95%∗. The area under an ROC curve was the highest (0.78) when GLIM was performed without screening or with prior MUST “1”. (2) Being less affected by oedema and gender differences than calf circumference, MUAC could serve as a standard globally accessible muscle mass assessment method which can be supplemented by technical approaches if available and deemed necessary. (3) The overall per-capita time requirement of GLIM was 240-245 s without prior screening, and was increased by 2-3% with prior MUST “1”, by 27-29% with prior NRS-2002 and decreased by 8-9% with prior MUST “2”.

CONCLUSIONS: Preceding GLIM by screening can decrease its sensitivity and increase overall time utilisation; “gold standard” muscle assessment is not globally accessible. Our results therefore support considering using GLIM as a combined screening and assessment tool, with MUAC as the method of muscle assessment which can be supplemented by technical approaches if available and deemed necessary. This could potentially both simplify the use of GLIM and improve the early detection of malnutrition. ∗Indicates statistically significant difference from use of GLIM without prior screening.

PMID:38901933 | DOI:10.1016/j.clnesp.2024.05.010

Clin Nutr ESPEN. 2024 Aug;62:108-114. doi: 10.1016/j.clnesp.2024.04.022. Epub 2024 May 22.

ABSTRACT

Diet and inflammation may contribute to the development of multiple sclerosis (MS). The aim of this systematic review and meta-analysis was to assess the association between proinflammatory diet, as estimated by the Dietary Inflammatory Index (DII®), and the likelihood of developing MS or other demyelinating autoimmune diseases. A systematic search was performed of search engines and databases (PubMed, ISI Web of Sciences, Scopus, and Embase) to identify relevant studies before 10th June 2023. The search identified 182 potential studies, from which 39 full-text articles were screened for relevance. Five articles with case-control design (n = 4,322, intervention group: 1714; control group: 2608) met the study inclusion criteria. The exposure variable was DII, with studies using two distinct models: quartile-based comparisons of DII and assessment of continuous DII. The meta-analysis of high versus low quartiles of DII with four effect sizes showed a significant association with MS/demyelinating autoimmune disease likelihood, with an odds ratio (OR) of 3.26 (95% confidence interval (CI) 1.16, 9.10). The meta-analysis of four studies with DII fit as a continuous variable showed a 31% increased likelihood of MS per unit increment; which was not statistically significant at the nominal alpha equals 0.05 (OR 1.31; 95% CI 0.95, 1.81). In conclusion, this systematic review and meta-analysis provides evidence of a positive association between higher DII scores with the likelihood of developing MS, highlighting that diet-induced inflammation could play a role in MS or other demyelinating autoimmune diseases risk.

PMID:38901931 | DOI:10.1016/j.clnesp.2024.04.022

Clin Nutr ESPEN. 2024 Aug;62:1-9. doi: 10.1016/j.clnesp.2024.04.021. Epub 2024 May 10.

ABSTRACT

BACKGROUND & AIMS: Resistant starch (RS) is a prebiotic fiber that has been scientifically shown to control the development of obesity. Prebiotic role of RS has also seen to be very important as it helps gut bacteria to regulate fermentation and fatty acid production. This study aimed to check the different levels of RS on glycemic index, oxidative stress and mineral absorption rate in healthy rat models. To evaluate these objectives, the trial was conducted for 40 days of follow up; 10 days were the adjustment period and the collection period over 30 days.

METHODS: Thirty-six healthy female Wistar rats were divided into 4 groups of (9 animals each) NC (Normal Control: without resistant starch), RS_0.20 (resistant starch: 0.20 g/kg body weight), RS_0.30 (resistant starch: 0.30 g/kg body weight), RS_0.40 (resistant starch: 0.40 g/kg body weight). All the diets were isocaloric and isonitroginous.

RESULTS: The impact of different levels of RS on the dry-matter intake (DMI) presented statistically significant results (p ≤ 0.05): DMI was reduced in RS _(0.02) fed rats as compared to NC rats in first 3 weeks; and after 4th and 5th weeks, there was a DMI reduction of 28% in RS _(0.04) fed rats. Moreover, there was no significant increase in the nutrient intake in all RS diets. The dry-matter (DM) digestibility was statistically significantly (P ≤ 0·05), which increased in all rats fed with different level of RS. The weight loss showed statistically significant results: RS _(0.04) exhibited 19 g reduction in weight as compared with NC rats. Significant increase was observed in total oxidant status (TOS), in all the RS fed rats when compared with NC rats. The levels of Mg, Ca, Fe and Zn were shown to be decrease in feces analysis, which proves their better absorbance in gut. Statistically significant increase was observed in antioxidant capacity, whereas significant decrease was observed in the total weight of the animals, showing the role of RS in controlling obesity.

CONCLUSIONS: Overall, significant results were found in all dosage level of RS but long term administration of the higher dosage level (RS_0.40) may need to be studied for enhanced results. RS can help improve insulin sensitivity in overweight adults.

PMID:38901928 | DOI:10.1016/j.clnesp.2024.04.021

Neurologia (Engl Ed). 2024 Jul-Aug;39(6):496-504. doi: 10.1016/j.nrleng.2021.09.016.

ABSTRACT

BACKGROUND: Despite comprehensive study, the aetiology of stroke is not identified in 35% of cases.

AIMS: We conducted a study to assess the diagnostic capacity of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in the identification of ischaemic stroke of cardioembolic origin. The secondary purpose of the study was to evaluate the prognostic value of NT-proBNP for predicting 90-day all-cause mortality.

METHODS: We designed a prospective observational study including patients hospitalised due to stroke between March 2019 and March 2020. Blood samples were collected on admission to the emergency department and serum NT-proBNP levels were determined. Statistical analysis was performed using a bivariate logistic regression model and receiver operating characteristic (ROC) and Kaplan-Meier curves. Statistical significance was established at p<.05.

RESULTS: The study included 207 patients with first ischaemic stroke. Plasma NT-proBNP levels were significantly higher (p<.001) in the cardioembolic stroke group (2069pg/mL±488.5). ROC curves showed that NT-proBNP>499pg/mL was the optimum value for diagnosing cardioembolic ischaemic stroke (sensitivity, 82%; specificity, 80%). Moreover, plasma NT-proBNP levels>499pg/mL were independently associated with cardioembolic stroke (OR: 9.881; p=.001). Finally, NT-proBNP>1500pg/mL was useful for predicting 90-day mortality (sensitivity, 70%; specificity, 93%).

CONCLUSIONS: NT-proBNP was independently associated with cardioembolic stroke and should be quantified in blood tests within 24h of stroke onset. High plasma levels (>499pg/mL) may indicate an underlying cardioembolic cause, which should be further studied, while NT-proBNP >1500pg/mL was associated with increased 90-day mortality.

PMID:38901926 | DOI:10.1016/j.nrleng.2021.09.016