ideal body weight [keywords]
- Complex relationship of obesity and obesity paradox in heart failure - higher risk of developing heart failure and better outcomes in established heart failure. [JOURNAL ARTICLE]
- Ann Med 2016 Jul 16.:1-11.
Heart failure (HF) and obesity are major public health problems. Studies have shown that obesity may increase the risk of developing new HF but after patients have developed HF, obesity may be associated with improved outcomes. This paradoxical association of obesity with HF remains poorly understood. It is believed that the obesity paradox may in part be due to the inherent limitations of body mass index (BMI) as a measure of obesity. BMI may not appropriately measure important components of body mass like body fat, fat distribution, lean body mass, and body fluid content and may not be ideal for examining the relationship of body composition with health outcomes. Differentiating between body fat and lean body mass may explain some of the paradoxical association between higher BMI and better prognosis in patients with HF. Paradoxical outcomes in HF may also be due to phenotypes of obesity. Future studies need to develop and test metrics that may better measure body composition and may serve as a better tool for the estimation of the true association of obesity and outcomes in HF and determine whether the association may vary by obesity phenotypes. KEY MESSAGES Obesity predisposes to heart failure in all age groups. But obesity in heart failure is an area of controversy, because of obesity paradox, the apparent protective effect of overweight and mild obesity on mortality after development of heart failure. Traditional markers of obesity do not measure different components of body weight like muscle mass, fat, water, and skeletal weight. Body Mass Index in heart failure subjects does not measure accurately body fat or fluid retention. So new markers of obesity like visceral adiposity index, body composition analysis, sarcopenic status assessment may be helpful in the assessment of heart failure outcomes. Different phenotypes of obesity may be responsible for the different morbidity, mortality as well as therapeutic outcomes in heart failure.
- Predictors of mortality in patients with extensively drug-resistant Acinetobacter baumannii pneumonia receiving colistin therapy. [JOURNAL ARTICLE]
- Int J Antimicrob Agents 2016 Jul 5.
The ratio of the area under the free (unbound) concentration-time curve to minimum inhibitory concentration (fAUC/MIC) was proposed to be the pharmacokinetic/pharmacodynamic index most strongly linked to the antibacterial effect of colistin against Acinetobacter baumannii. A retrospective study of patients who received colistin to treat pneumonia caused by extensively drug-resistant (XDR) A. baumannii over a 4-year period was performed to assess the impact of the colistin MIC on mortality. A total of 227 patients were included in the analysis. The 7-day and 14-day mortality rates of patients with XDR A. baumannii pneumonia receiving colistin therapy were 15.0% and 23.8%, respectively. In the multivariate analysis, Acute Physiology and Chronic Health Evaluation (APACHE) II score, days from index culture to first dose of colistin, underlying tumour and septic shock at presentation were independent predictors of mortality in patients with XDR A. baumannii pneumonia receiving colistin therapy. In the univariate analysis, the colistin dose based on ideal body weight (IBW) correlated with patient outcome. Therefore, the use of IBW appeared to be more appropriate to calculate the colistin dosage. In addition, these results highlight the clinical significance of colistin MIC in patients with XDR A. baumannii pneumonia receiving colistin therapy. Although MICs were in the 'susceptible' range, patients infected with isolates with high colistin MICs showed a poorer clinical response rate than patients infected with isolates with low colistin MICs. Further clinical studies are needed to evaluate the roles of colistin MIC for predicting mortality in XDR A. baumannii pneumonia with a high colistin MIC.
- Metabolizable energy intake of client-owned adult dogs. [JOURNAL ARTICLE]
- J Anim Physiol Anim Nutr (Berl) 2016 Jul 15.
A post hoc analysis of the metabolizable energy (ME) intake of privately owned pet dogs from the authors' nutrition consultation practice (Years 2007-2011) was carried out to identify if current ME recommendations are suitable for pet dogs. Data on 586 adult dogs were available (median age 5.5, median deviation from ideal weight 0.0), 55 of them were healthy; the others had various diseases. For ration calculation, a standardized questionnaire and the software diet-check Munich(™) was used. ME was predicted according to NRC (2006). Data were evaluated for the factors disease, breed, size, age, gender and type of feeding. The mean ME intake of all adult dogs amounted to 0.410 ± 0.121 MJ/kg metabolic body weight (BW(0.75) ) (n = 586). There was no effect of size and disease. Overweight dogs ate 0.360 ± 0.121 MJ/kg BW(0.75) , and underweight dogs ate 0.494 ± 0.159 MJ/kg BW(0.75) . Older dogs (>7 years, n = 149, 0.389 ± 0.105 MJ/kg BW(0.75) ) had a lower ME intake than younger ones (n = 313, 0.419 ± 0.121 MJ/kg BW(0.75) ), and intact males had a higher ME intake than the others (p < 0.001). Some breeds were above average: Jack Russell Terrier, Dalmatian, small Munsterlander and Magyar Viszla, Bearded Collies, Sight Hounds, German Boxers, English foxhounds, Rhodesian Ridgebacks and Flat-Coated Retrievers with a mean ME intake of 0.473 ± 0.121 MJ/kg BW(0.75) . The following breeds were below average: Dachshunds, Bichons, West highland White Terrier, Collies except Bearded Collies, Airedale Terriers, American Staffordshire terriers and Golden Retrievers with a mean ME intake of 0.343 ± 0.096 MJ/kg BW(0.75) . The mean maintenance energy requirements of pet dogs are similar to that of kennel dogs which do not exercise very much. These results suggest that opportunity and stimulus to exercise provided for pet dogs are lower than for kennel dogs. Lower activity in pet dogs may reduce part of potential effects of breed, medical history and age groups.
- Appropriateness of Dabigatran and Rivaroxaban Prescribing for Hospital Inpatients. [Journal Article]
- Can J Hosp Pharm 2016 May-Jun; 69(3):194-201.
Recent approval of the new oral anticoagulants dabigatran and rivaroxaban has led to rapid changes in anticoagulant prescribing practices. Postmarketing reports have highlighted safety concerns with these agents, and their use outside of evidence-based recommendations was noted at the authors' centre.To determine the incidence of and risk factors associated with inappropriate prescribing of dabigatran and rivaroxaban.This retrospective cohort study investigated randomly selected dabigatran or rivaroxaban prescriptions for patients admitted to a tertiary teaching hospital between January 2010 and December 2012. Appropriateness of prescribing was determined from the documented indication, drug dosage, patient's renal function, and presence of drug interactions, if applicable.Among a total of 321 medication orders reviewed, the incidence of inappropriate use was 31.2% (34/109) for dabigatran and 26.9% (57/212) for rivaroxaban. Of the 97 reasons for inappropriate use that were identified, the most common were prescribing for an unapproved indication (49/97 [50.5%]), concomitant prescribing of another anticoagulant (22/97 [22.7%]), and high prescribed dose (9/97 [9.3%]). The prescribing service was found to be an independent risk factor for inappropriate prescribing (p = 0.041). Corrections were made to 23.1% (21/91) of the incorrect regimens before hospital discharge. In a sensitivity analysis using calculated ideal body weight to estimate renal function, the overall incidence of inappropriate prescribing increased to 31.5% (101/321).The proportion of patients with inappropriate prescribing of dabigatran or rivaroxaban in clinical practice was higher than expected. Educational interventions and pharmacy-led initiatives with a focus on appropriate indications, concomitant anticoagulant prescribing, and review of dosage regimens are recommended to improve patient safety.
- Prospective Associations Between Binge Eating and Psychological Risk Factors in Adolescence. [JOURNAL ARTICLE]
- J Clin Child Adolesc Psychol 2016 Jul 11.:1-15.
There is evidence that intrapersonal psychological factors might contribute to the development of binge eating. However, studies considering reciprocal effects between risk factors and disordered eating are rare. The present article investigates the nature of the temporal relationships between binge eating and low self-esteem, depressive symptoms, interoceptive deficits, perfectionism, weight/shape concerns, dietary restraint, and the internalization of the societal body ideal in adolescence while taking into account the moderating effects of age and gender. A German population-based sample of 1039 boys and girls from 12 to 19 years of age answered self-report questionnaires on risk factors and eating pathology on 2 measurement points separated by 20 months. Data were analyzed using a cross-lagged panel design. Low self-esteem, interoceptive deficits, weight/shape concerns, and the internalization of the societal body ideal predicted binge eating longitudinally in bivariate analyses. Binge eating predicted later depressive symptoms, whereas perfectionism and dietary restraint were not longitudinally linked to binge eating in either direction. Low self-esteem and weight/shape concerns emerged as multivariate predictors of binge eating in girls and boys, respectively. No moderating effects of age were observed. The results suggest that depressive symptoms might rather be a consequence of binge eating than a risk factor, and this underscores that even subclinical eating pathology might be associated with negative psychological outcomes. Central risk factors that should be targeted in prevention programs might be low self-esteem for girls and weight/shape concerns for boys.
- [Does intraoperative lung-protective ventilation reduce postoperative pulmonary complications?] [JOURNAL ARTICLE, ENGLISH ABSTRACT]
- Anaesthesist 2016 Jul 8.
Recent studies show that intraoperative protective ventilation is able to reduce postoperative pulmonary complications (PPC).This article provides an overview of the definition and ways to predict PPC. We present different factors that lead to ventilator-induced lung injury and explain the concepts of stress and strain as well as driving pressure. Different strategies of mechanical ventilation to avoid PPC are discussed in light of clinical evidence.The Medline database was used to selectively search for randomized controlled trials dealing with intraoperative mechanical ventilation and outcomes.Low tidal volumes (VT) and high levels of positive end-expiratory pressure (PEEP), combined with recruitment maneuvers, are able to prevent PPC. Non-obese patients undergoing open abdominal surgery show better lung function with the use of higher PEEP levels and recruitment maneuvers, however such strategy can lead to hemodynamic impairment, while not reducing the incidence of PPC, hospital length of stay and mortality. An increase in the level of PEEP that results in an increase in driving pressure is associated with a greater risk of PPC.The use of intraoperative VT ranging from 6 to 8 ml/kg based on ideal body weight is strongly recommended. Currently, a recommendation regarding the level of PEEP during surgery is not possible. However, a PEEP increase that leads to a rise in driving pressure should be avoided.
- A new oridonin analog suppresses triple-negative breast cancer cells and tumor growth via the induction of death receptor 5. [JOURNAL ARTICLE]
- Cancer Lett 2016 Jul 4; 380(2):393-402.
Triple-negative breast cancer (TNBC) remains the leading cause of death among women with breast cancer worldwide. Oridonin is a natural anti-cancer compound that is isolated from the traditional Chinese herb Rabdosia rubescens. However, the antitumor efficacies of oridonin in the treatments of TNBC and other cancers are far from ideal. In this study, we investigated a series of newly designed oridonin analogs in terms of their actions against HCC1806 and HCC1937 TNBC cell lines and identified CYD-6-28, which significantly inhibits cancer cell proliferation and induces G2/M-phase cell cycle arrest and apoptosis. CYD-6-28 induces the expression of p21 and the cleavage of caspase-3, -7, -8 and PARP and inhibits the expression levels of Cyclin D1, FLIPL and XIAP. CYD-6-28 also inhibits the activations of STAT3 and AKT and induces the activation of ERK. We demonstrated that CYD-6-28 induces apoptosis at least partially by inducing the expression of death receptor 5 (DR5). Finally, CYD-6-28 significantly suppresses HCC1806 xenograft tumor growth in nude mice at 5 mg/kg without affecting body weight. Taken together, these results indicate that CYD-6-28 has the potential to be developed as a therapeutic agent to treat TNBC.
- Establishment of a mouse model of 70% lethal dose by total-body irradiation. [Journal Article]
- Lab Anim Res 2016 Jun; 32(2):116-21.
Whereas increasing concerns about radiation exposure to nuclear disasters or side effects of anticancer radiotherapy, relatively little research for radiation damages or remedy has been done. The purpose of this study was to establish level of LD70/30 (a lethal dose for 70% of mice within 30 days) by total-body γ irradiation (TBI) in a mouse model. For this purpose, at first, 8-week-old male ICR and C57BL/6N mice from A and B companies were received high dose (10, 11, 12 Gy) TBI. After irradiation, the body weight and survival rate were monitored for 30 days consecutively. In next experiment, 5-week-old male ICR and C57BL/6N mice from B company were received same dose irradiation. Results showed that survival rate and body weight change rate in inbred C57BL/6N mice were similar between A and B company. In ICR mice, however, survival rate and body weight change rate were completely different among the companies. Significant difference of survival rate both ICR and C57BL6N mice was not observed in between 5-week-old and 8-week-old groups receiving 10 or 12 Gy TBI. Our results indicate that the strain and age of mice, and even purchasing company (especially outbred), should be matched over experimental groups in TBI experiment. Based on our results, 8-week-old male ICR mice from B company subjected to 12 Gy of TBI showed LD70/30 and suitable as a mouse model for further development of new drug using the ideal total-body irradiation model.
- Prospective cohort study evaluating risk factors for the development of pasture-associated laminitis in the UK. [JOURNAL ARTICLE]
- Equine Vet J 2016 Jul 1.
Certain individuals appear predisposed to recurrent pasture-associated laminitis. Previous studies have predominantly investigated risk factors only after disease occurrence.To investigate pasture-associated laminitis risk factors prior to disease occurrence.Prospective cohort study.Non-laminitic ponies >7 years old were recruited. Body condition score (BCS), height, weight, crest height and thickness were measured and an overnight dexamethasone suppression test performed. Plasma/serum adiponectin, leptin, triglyceride, basal insulin, insulin post dexamethasone, insulin-like growth factor (IGF)-1, IGF binding protein (IGFBP)-1, IGFBP-3, C-reactive protein, von Willebrand's factor (vWF), soluble (s) E-selectin and p-selectin concentrations were assayed. Follow-up was obtained from owners annually for 3 years to ascertain occurrence of veterinary-diagnosed pasture-associated laminitis. Data were analysed by multivariate logistic regression. ROC curves analysis was performed for significant risk factors and cut off values determined.446 animals were recruited; the median (interquartile range) age was 15 (10, 20) years; 50.4% were mares and 49.6% geldings; the most common breeds were Welsh (36%), Shetland (17%) and cob (9%); 72.2% were overweight/obese (BCS 7-9/9), 27.3% ideal weight (BCS 4-6/9) and 0.5% underweight (BCS 1-3/9). After 1, 2 and 3 years, 18 (4%), 30 (7%) and 44/446 (10%) animals had had laminitis. Plasma/serum [adiponectin], basal [insulin] and [insulin] post dexamethasone were significantly (p<0.05) associated with laminitis occurrence cumulatively after 1, 2 and 3 years. The accuracy to separate animals that did or did not develop laminitis determined using the area under the ROC curves was good (basal [insulin] after 1 year), fair (all others) or poor ([insulin] post dexamethasone).Animals were evaluated at a single time point and biomarkers were assayed using single assays.Risk factors for future laminitis prior to disease occurrence include low plasma adiponectin and high serum basal insulin or insulin post dexamethasone concentrations. This article is protected by copyright. All rights reserved.
- The Geriatric Nutritional Risk Index is Independently Associated with Prognosis in Patients with Critical Limb Ischemia Following Endovascular Therapy. [JOURNAL ARTICLE]
- Eur J Vasc Endovasc Surg 2016 Jun 26.
Patients with critical limb ischemia (CLI) have poor overall and limb prognosis. Although nutritional status influences overall prognosis, and the Geriatric Nutritional Risk Index (GNRI) is a widely used, simple and well established nutritional status screening method, the association between the GNRI and the overall and limb prognosis of patients with CLI following endovascular therapy (EVT) has not been explored.Clinical outcomes were retrospectively evaluated in 473 consecutive patients (74 ± 10 years; 59% male) with CLI who underwent EVT. The GNRI on admission was calculated as follows: [14.89 × albumin (g/dL)] + [41.7 × (body weight/ideal body weight)]. Cox proportional hazard analysis was performed to explore the independent association between the GNRI and mortality and major amputation.Patients (53% ambulatory, 38% wheelchair bound, and 9% bedridden) were divided into two groups based on the median GNRI: the higher group (GNRI ≥ 91.2, n = 237) and the lower group (GNRI < 91.2, n = 236). Median follow up duration after EVT was 11.3 months. Three years after EVT, the survival rate (74% in the higher GNRI, and 48% in the lower GNRI, respectively), and limb salvage rate (92% in the higher GNRI, and 84% in the lower GNRI) were significantly lower in the lower GNRI group. GNRI (hazard ratio [HR], 1.03; 95% confidence interval [CI], 1.01-1.05), along with being wheelchair bound (HR, 1.87; 95% CI 1.17-2.97; vs. ambulatory status), being bedridden (HR, 3.10; 95% CI, 1.63-2.97; vs. ambulatory status), being on hemodialysis (HR, 2.33; 95% CI, 1.49-3.64), and having chronic heart failure (HR, 2.22; 95% CI, 1.44-3.43) were the independent predictors of mortality. The GNRI (HR, 1.04; 95% CI, 1.01-1.07), being bedridden (HR, 4.15; 95% CI, 1.67-10.3; vs. ambulatory status), isolated below knee disease (HR, 2.49; 95% CI, 1.30-4.77), and hemodialysis (HR, 2.44; 95% CI, 1.23-4.85) were independently associated with major amputation.The GNRI on admission was independently associated with mortality and major amputation after EVT in patients with CLI.