Revista da Associa??o Médica Brasileira (English Edition)最新文献_第6页

Validity of the methods to assess body fat in children and adolescents using multi-compartment models as the reference method: a systematic review 使用多室模型作为参考方法评估儿童和青少年体脂的有效性:系统综述

Revista da Associa??o Médica Brasileira (English Edition)

Pub Date : 2013-01-01 DOI: 10.1016/S2255-4823(13)70507-1

Danilo R.P. Silva , Alex S. Ribeiro , Fernando H. Pavão , Enio R.V. Ronque , Ademar Avelar , Analiza M. Silva , Edilson S. Cyrino

Objective

To analyze the validity of methods to assess body fat in children and adolescents using a systematic review.

Methods

The search was performed by two independent researchers using the MEDLINE, BioMed Central, SciELO, and LILACS electronic databases. For inclusion, the articles should have been written in English or Portuguese, and must have used multi-compartment models as the criterion measure of the model, with body fat measurement of the whole body in non-athlete children and adolescents.

Results

A preliminary search resulted in 832 studies. After all selection steps were performed, 12 articles were included. The selected studies were published between 1997 and 2010, whose samples consisted of children and adolescents with levels of relative body fat ranging from 20.7% to 41.4%. The methods used were: dual energy X-ray absorptiometry (58.3%), isotope dilution (41.6%), skinfold thickness (33.3%), hydrostatic weighing (25%), bioelectrical impedance analysis (25%), air displacement plethysmography (16.6%), and total body electrical conductivity (8.3%).

Conclusions

Based on the analysis of the studies, isotope dilution and air displacement plethysmography methods were the most reliable, despite the limited number of studies. As for clinical use or for population-based studies, the equation of Slaughter et al. (1988), which uses the triceps and subscapular skinfold thickness, showed the best results for assessment of body fat in this population.

目的采用系统评价法分析儿童青少年体脂评价方法的有效性。方法由两名独立研究者使用MEDLINE、BioMed Central、SciELO和LILACS电子数据库进行检索。纳入的文章必须用英语或葡萄牙语撰写，并且必须使用多室模型作为模型的标准测量，非运动员儿童和青少年的全身体脂测量。结果初步检索得到832项研究。完成所有选择步骤后，纳入12篇文章。所选的研究发表于1997年至2010年之间，其样本包括相对体脂水平在20.7%至41.4%之间的儿童和青少年。采用双能x线吸收法(58.3%)、同位素稀释法(41.6%)、皮襞厚度法(33.3%)、静压称重法(25%)、生物电阻抗法(25%)、空气置换容积脉搏波法(16.6%)、全身电导率法(8.3%)。结论虽然研究数量有限，但同位素稀释法和空气置换法是最可靠的方法。至于临床应用或基于人群的研究，Slaughter等人(1988)使用肱三头肌和肩胛下皮褶厚度的方程显示了评估该人群体脂的最佳结果。

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引用次数: 4

Nonalcoholic fatty liver disease and its association with metabolic syndrome in the preoperative period in patients undergoing bariatric surgery 非酒精性脂肪性肝病及其与减肥手术患者术前代谢综合征的关系

Revista da Associa??o Médica Brasileira (English Edition)

Pub Date : 2013-01-01 DOI: 10.1016/S2255-4823(13)70449-1

Bruna Z. Schild, Luciano Neto Santos, Márcia Keller Alves

Objective

To investigate the association between nonalcoholic fatty liver disease (NAFLD) and metabolic syndrome (MS) in the preoperative period in patients undergoing bariatric surgery.

Methods

A total of 68 medical records of patients from a center for advanced treatment of obesity in the city of Caxias do Sul, state of Rio Grande do Sul, Brazil, were reviewed. The variables analyzed were gender, age, biochemical parameters (fasting glucose, HDL-cholesterol and triglycerides), abdominal ultrasound, blood pressure, and anthropometric data (weight, height, waist circumference, and body mass index [BMI]). The diagnosis of NAFLD was obtained by abdominal ultrasonography; the diagnosis of of MS was obtained according to the protocol described by the National Cholesterol Education Program's Adult Treatment Panel III, updated by the American Heart Association; and the National Heart, Lung, and Blood Institute.

Results

72.1% (n = 49) of the sample consisted of females, and the mean age for the sample was 37.57 ± 10.29 years. The mean weight was 123.14 ± 25.40 kg, mean height was 1.67 ± 0.09 m, and mean BMI was 56.24 ± 9.30 kg/m². A total of 60% (n = 27) of patients with MS (p = 0.008), 63.4% (n = 26) of patients with hypertension (p = 0.013), and 66.7% (n = 18) of patients with altered glucose levels (p = 0.028) were diagnosed with NAFLD.

Conclusion

The results of this study showed that the diagnosis of MS, as well as the presence of disorders associated with this syndrome (obesity, hypertension, and high blood glucose levels) are strongly associated with the presence of NAFLD.

目的探讨减肥手术患者术前非酒精性脂肪性肝病(NAFLD)与代谢综合征(MS)的关系。方法对巴西南里奥格兰德州南卡西亚斯市肥胖症高级治疗中心的68例患者病历进行分析。分析的变量包括性别、年龄、生化参数(空腹血糖、高密度脂蛋白胆固醇和甘油三酯)、腹部超声、血压和人体测量数据(体重、身高、腰围和体重指数[BMI])。腹部超声检查诊断NAFLD;根据美国心脏协会更新的国家胆固醇教育计划成人治疗小组III所描述的方案获得MS的诊断;结果72.1% (n = 49)为女性，平均年龄为37.57±10.29岁。平均体重123.14±25.40 kg，平均身高1.67±0.09 m，平均BMI 56.24±9.30 kg/m2。共有60% (n = 27)的MS患者(p = 0.008)、63.4% (n = 26)的高血压患者(p = 0.013)和66.7% (n = 18)的血糖水平改变患者(p = 0.028)被诊断为NAFLD。结论本研究结果表明，MS的诊断以及与该综合征相关的疾病(肥胖、高血压和高血糖水平)的存在与NAFLD的存在密切相关。

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引用次数: 7

The influence of food preparation methods on atherosclerosis prevention 食物制备方法对动脉粥样硬化预防的影响

Revista da Associa??o Médica Brasileira (English Edition)

Pub Date : 2013-01-01 DOI: 10.1016/S2255-4823(13)70448-X

Carlos Scherr , Jorge Pinto Ribeiro

Objective

To analyze the influence of food preparation methods on the composition of fatty acids and cholesterol in foods.

Methods

The chemical composition of cholesterol and fatty acids was analyzed in eight different types of meat and feijoada¹ in relation to different methods of preparation.

Results

Feijoada, when prepared with the beans and meats in separate pots, has less cholesterol (12.1 vs. 16.1 mg, respectively, p = 0.005) and saturated fat (1.4 vs. 1.9 mg, p = 0.046) than when it is prepared in a single pot. Broiled chicken without the skin has less saturated fat when compared with skinless fried chicken (1,505 vs. 7,645 mg, p = 0.049). Broiled shrimp also has a lower saturated fat content than fried shrimp (532 vs. 1,262 mg, p = 0.049). Broiled ribeye steak without fat has a lower cholesterol content when compared with the fried steak (102 vs. 114 mg, p = 0.049).

Conclusion

The analysis indicates that the method of food preparation influences the fat content of foods, with potential impact on the prescription of low-fat and low-cholesterol diets.

目的分析食品制备方法对食品中脂肪酸和胆固醇组成的影响。方法对8种不同肉类和feijoad1中胆固醇和脂肪酸的化学组成与不同制备方法的关系进行分析。结果与豆角和肉馅分开锅煮时，feijoada的胆固醇含量(分别为12.1 mg对16.1 mg, p = 0.005)和饱和脂肪含量(1.4 mg对1.9 mg, p = 0.046)低于单独锅煮时。与去皮炸鸡相比，去皮烤鸡的饱和脂肪含量更低(1505 mg对7645 mg, p = 0.049)。烤虾的饱和脂肪含量也比炸虾低(532毫克对1262毫克，p = 0.049)。与油炸牛排相比，没有脂肪的烤肋眼牛排的胆固醇含量更低(102毫克vs 114毫克，p = 0.049)。结论食品制备方法影响食品脂肪含量，对低脂、低胆固醇饮食处方有潜在影响。

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引用次数: 0

Ethics for physicians and surgeons: consent 医生和外科医生的伦理:同意

Revista da Associa??o Médica Brasileira (English Edition)

Pub Date : 2013-01-01 DOI: 10.1016/S2255-4823(13)70478-8

Ivan D. Miziara

引用次数: 0

Efficacy of dexamethasone in the prophylaxis of nausea and vomiting during the postoperative period of laparoscopic cholecystectomy 地塞米松预防腹腔镜胆囊切除术术后恶心呕吐的疗效观察

Revista da Associa??o Médica Brasileira (English Edition)

Pub Date : 2013-01-01 DOI: 10.1016/S2255-4823(13)70492-2

Wanderley Marques Bernardo , Felipe Toyama Aires

Objective

To verify the efficacy of dexamethasone in the prophylaxis of nausea and vomiting in patients submitted to laparoscopic cholecystectomy.

Methods

This was a systematic review of the literature through the MEDLINE, Embase, and LILACS databases. Only controlled and randomized clinical trials comparing dexamethasone to placebo in the prophylaxis of nausea and vomiting in patients submitted to laparoscopic cholecystectomy were included.

Results

The results of this review were based on data from 12 controlled and randomized clinical trials, totaling 947 patients. The group of patients who received preoperative dexamethasone showed lower incidence of nausea (number needed to treat [NNT] = 7), vomiting (NNT = 7), and need for smaller doses of rescue antiemetics (NNT = 6).

Conclusion

The preoperative infusion of 8 mg of dexamethasone decreases the risk of complications in the postoperative period for patients submitted to laparoscopic cholecystectomy.

目的探讨地塞米松预防腹腔镜胆囊切除术患者恶心、呕吐的疗效。方法通过MEDLINE、Embase和LILACS数据库对相关文献进行系统综述。仅纳入比较地塞米松和安慰剂预防腹腔镜胆囊切除术患者恶心和呕吐的对照和随机临床试验。结果本综述的结果基于12项对照和随机临床试验的数据，共947例患者。术前应用地塞米松组患者恶心发生率(需要治疗人数[NNT] = 7)、呕吐发生率(NNT = 7)较低，且需要较少剂量的救急止吐药(NNT = 6)。结论术前输注地塞米松8mg可降低腹腔镜胆囊切除术患者术后并发症的发生风险。

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引用次数: 0

Cystatin C, kidney function, and cardiovascular risk factors in primary hypertension 原发性高血压的胱抑素C、肾功能和心血管危险因素

Revista da Associa??o Médica Brasileira (English Edition)

Pub Date : 2013-01-01 DOI: 10.1016/S2255-4823(13)70425-9

João Victor Salgado , Ana Karina França , Nayra Anielly Cabral , Joyce Lages , Valdinar Sousa Ribeiro , Alcione Miranda Santos , Bernardete Jorge Salgado

Objective

To investigate the clinical usefulness of serum cystatin C (Scys) and cystatin C-based equations for the screening of chronic kidney disease in primary hypertensive patients, and correlate these markers with risk factors for cardiovascular disease.

Methods

A cross-sectional study was performed in 199 middle-aged adults at a basic health unit. Kidney function assessment included measurements of serum creatinine (Scr) and Scys levels, 24-hour microalbuminuria (MA), as well as glomerular filtration rate (GFR) through Larsson and Modification of Diet in Renal Disease (MDRD) study equations. Bland-Altman plot analysis was used to calculate the agreement between equations.

Results

High levels of Scys were found in 22% of the patients, even with normal values of GFR estimated by MDRD study equation. Systolic blood pressure and MA correlated better with Scys than Scr, but there was no correlation between Scys and diastolic blood pressure. Gender, age ≥ 60 years, MA, and uric acid were significantly associated with high Scys levels. After multivariate analysis, only age ≥ 60 yrs (RR = 6.4; p < 0.001) and male gender (RR = 3.0; p = 0.006) remained associated with high Scys levels.

Conclusion

Cystatin C can be used as a screening marker both for detecting mild declines of renal function and for preventing the risk of cardiovascular events in hypertensive subjects with presumably normal renal function.

目的探讨血清胱抑素C (cystatin C, Scys)和基于胱抑素C的方程在原发性高血压患者慢性肾脏疾病筛查中的临床应用价值，并探讨这些指标与心血管疾病危险因素的相关性。方法采用横断面研究方法对199名基层卫生单位的中年人进行调查。肾功能评估包括测量血清肌酐(Scr)和Scys水平，24小时微量白蛋白尿(MA)，以及肾小球滤过率(GFR)通过Larsson和肾脏疾病饮食改变(MDRD)研究方程。采用Bland-Altman图分析计算方程间的一致性。结果在22%的患者中发现高水平的Scys，即使根据MDRD研究方程估计GFR值正常。收缩压和MA与Scys的相关性优于Scr，而Scys与舒张压无相关性。性别、年龄≥60岁、MA和尿酸与高Scys水平显著相关。经多因素分析，只有年龄≥60岁(RR = 6.4;p & lt;0.001)和男性(RR = 3.0;p = 0.006)仍然与高Scys水平相关。结论对于肾功能正常的高血压患者，胱抑素C可作为检测肾功能轻度下降和预防心血管事件发生的筛查标志物。

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引用次数: 0

Does impact factor influence the ethics of the instructions provided to journal authors?* 影响因子是否影响向期刊作者提供指导的伦理?*

Revista da Associa??o Médica Brasileira (English Edition)

Pub Date : 2013-01-01 DOI: 10.1016/S2255-4823(13)70470-3

Renan Kleber Costa Teixeira , Vitor Nagai Yamaki , Thiago Barbosa Gonçalves , Nara Macedo Botelho , José Antonio Cordero da Silva

Objective

Verify whether a journal's impact factor is a mechanism that modifies the ethical requirements described in the instructions provided to authors of articles published in Brazilian medical journals.

Methods

48 selected journals were divided into two groups: impact-factor (n = 24), and no-impact-factor (n = 24). The number of ethical requirements was compared between both groups based on a specific research protocol, ranging from zero to six points, analyzing the presence of an approval by a research ethics committee; reference to the fact that the research follows the precepts of the Declaration of Helsinki and the rules of Resolution 196/96; use of an informed consent; information about the authors’ conflicts of interest; and a request for registration of clinical trials in the Brazilian Clinical Trials Registry.

Results

The average score of the impact-factor group was significantly higher than that of the no-impact-factor group (3.12 ± 1.03 vs. 2.08 ± 1.64, p = 0.0121). When each ethical requirement was compared between the groups, there was significant difference only between the requirement of an informed consent and the disclosure of conflicts of interest (p < 0.05).

Conclusion

The impact factor is a determinant factor on the ethics included in the instructions to authors of articles in scientific journals, showing that higher-quality journals seek better-designed articles that are conscientious at the beginning of the research.

目的验证期刊的影响因子是否是一种机制，该机制修改了向巴西医学期刊上发表的文章的作者提供的说明中所描述的伦理要求。方法将48份入选期刊分为影响因子组(n = 24)和非影响因子组(n = 24)。根据特定的研究方案，比较两组之间的伦理要求数，从0到6分，分析是否存在研究伦理委员会的批准;提到这项研究遵循《赫尔辛基宣言》的规定和第196/96号决议的规则;使用知情同意书;有关作者利益冲突的信息;以及在巴西临床试验注册中心注册临床试验的请求。结果有影响因素组的平均评分显著高于无影响因素组(3.12±1.03∶2.08±1.64,p = 0.0121)。当在两组之间比较每个伦理要求时，只有在知情同意的要求和利益冲突的披露之间存在显著差异(p <0.05)。结论影响因子是影响科学期刊文章作者伦理的决定性因素，表明高质量的期刊在研究之初就寻求设计更好、有责任心的文章。

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引用次数: 1

Trends in prostate cancer incidence and mortality in a mid-sized Northeastern Brazilian city 巴西东北部一个中等城市前列腺癌发病率和死亡率的趋势

Revista da Associa??o Médica Brasileira (English Edition)

Pub Date : 2013-01-01 DOI: 10.1016/S2255-4823(13)70424-7

Carlos Anselmo Lima , Angela Maria da Silva , André Yoichi Kuwano , Margareth Rose Uchôa Rangel , Matheus Macedo-Lima

Objective

International data have reported prostate cancer as the most frequent among men, and the third highest in mortality. A rise in incidence has been observed in the course of recent decades, probably influenced by early detection, mainly in asymptomatic men, through regular screening with prostate-specific antigen (PSA) testing. The purpose of this study was to contribute to information on trends in prostate cancer incidence and mortality using population-based data.

Methods

This was an exploratory ecological study of time trends, aiming at describing changes in prostate cancer incidence and mortality in Aracaju, Sergipe, Brazil, from 1996 to 2006. Rates were calculated from data of the Registro de Câncer de Base Populacional de Aracaju. Trends were calculated using the Joinpoint Regression Program.

Results

For the study period, 1,490 incident cases and 334 deaths were included. Incident cases were more common after 50 years of age, and deaths after 55 years. Age-standardized incidence rates of 46.6 and 50.0/100,000 were observed in the early years of the series, and then progressively increased, with rates higher than 100.0/100,000 in later years. For mortality, age-standardized rates varied from 21.6 and 16.6/100,000 to 24.1 and 28.9/100,000 in later years. Joinpoint analysis identified one joinpoint for the incidence series, resulting in two trends, the first with annual percent change of 34% and the second with 5.8%; for the mortality series no joinpoint was identified, and the annual percent change was 2.1%.

Conclusion

There was a sharp increase in incidence rates during the study period, probably due to screening. Mortality rates had a small upward trend, and did not show major changes during the study period.

目的国际数据显示，前列腺癌是男性中最常见的疾病，也是死亡率第三高的疾病。近几十年来，发病率有所上升，可能是受到早期发现的影响，主要是在无症状的男性中，通过前列腺特异性抗原(PSA)检测进行定期筛查。本研究的目的是利用基于人群的数据提供前列腺癌发病率和死亡率趋势的信息。方法本研究是一项时间趋势的探索性生态学研究，旨在描述1996年至2006年巴西Sergipe Aracaju地区前列腺癌发病率和死亡率的变化。比率是根据阿拉卡朱人口基地登记中心的数据计算的。使用关节点回归程序计算趋势。结果在研究期间，包括1490例事件和334例死亡。50岁以后的偶发病例和55岁以后的死亡更为常见。研究早期的年龄标准化发病率分别为46.6 /10万和50.0/10万，随后逐渐增加，后期高于100.0/10万。在死亡率方面，年龄标准化比率从21.6和16.6/10万到24.1和28.9/10万不等。联合点分析确定了发病率序列的一个联合点，得出了两个趋势，第一个趋势的年变化百分比为34%，第二个趋势的年变化百分比为5.8%;对于死亡率系列，没有确定连接点，年变化百分比为2.1%。结论研究期间发病率急剧上升，可能与筛查有关。死亡率有小幅上升的趋势，在研究期间没有显示出大的变化。

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引用次数: 0

Update on cervical herniated disc 颈椎间盘突出症的最新进展

Revista da Associa??o Médica Brasileira (English Edition)

Pub Date : 2013-01-01 DOI: 10.1016/S2255-4823(13)70423-5

Wanderley M. Bernardo, Carlos Fernando Pereira da Silva Herrero, Fabiano Ricardo de Tavares Canto, Fernando Antonio Façanha Filho, Helton Delfino, Marcelo Luis Mudo, Mario Augusto Taricco, Osmar J.S. Moraes, Ricardo dos Santos Simões, Ricardo Vieira Botelho, Robert Neves, Sérgio Zylbersztein

引用次数: 2

Lung age in women with morbid obesity 病态肥胖女性的肺年龄

Revista da Associa??o Médica Brasileira (English Edition)

Pub Date : 2013-01-01 DOI: 10.1016/S2255-4823(13)70467-3

Fabiana Sobral Peixoto-Souza , Camila Piconi-Mendes , Letícia Baltieri , Irineu Rasera-Junior , Marcela Cangussu Barbalho-Moulim , Maria Imaculada de Lima Montebelo , Dirceu Costa , Eli Maria Pazzianotto-Forti

Objective

To investigate the influence of morbid obesity on the lung age in women and to correlate with body mass, body mass index (BMI), and ventilatory variables.

Methods

This was a cross-sectional study with 72 morbidly obese women and a control group consistingof 37 normal weightwomen. The subjects performed apulmonary function test to determine lung age, and the results were correlated to anthropometric variables and lung volumes.

Results

The morbidly obese group had significantly higher lung age (50.1 ± 6.8 years) than the control group (38.8 ± 11.4 years). There was no difference in chronological age between groups. There was a significant positive correlation among chronological age, body mass, BMI, and lung age (r = 0.3647, 0.4182, and 0.3743, respectively). There was a negative correlation among forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC ratio, expiratory reserve volume (ERV), and lungage (r = -0.7565, -0.8769, —0.2723, and —0.2417, respectively).

Conclusion

Lung age is increased in morbidly obese women and is associated with increased body mass and BMI.

目的探讨病态肥胖对女性肺年龄的影响及其与体重、体重指数(BMI)和通气指标的相关性。方法对72名病态肥胖女性和37名正常体重女性作为对照组进行横断面研究。受试者进行肺功能测试以确定肺年龄，结果与人体测量变量和肺容量相关。结果病态肥胖组肺年龄(50.1±6.8岁)明显高于对照组(38.8±11.4岁)。两组之间的实际年龄没有差异。实足年龄、体重、BMI、肺年龄呈显著正相关(r分别为0.3647、0.4182、0.3743)。用力肺活量(FVC)、每秒用力呼气量(FEV1)、FEV1/FVC比值、呼气储备量(ERV)与肺活量呈负相关(r分别为-0.7565、-0.8769、-0.2723、-0.2417)。结论病态肥胖女性肺年龄增加，且与体重和BMI增加有关。

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引用次数: 0