Medical Principles and Practice最新文献

Background: In patients with non-alcoholic fatty liver disease (NAFLD) cardiovascular diseases are more often the cause of death than the liver disease itself. However, the prevalence of atherosclerotic manifestations in individuals with NAFLD is still uncertain. This study aimed to explore the association between NAFLD and coronary artery calcification (CAC) in a Central European population.

Methods: A total of 1,743 participants from the Paracelsus 10,000 study were included. The participants underwent CAC scoring and were assessed for fatty liver index (FLI), fibrosing non-alcoholic steatohepatitis Index (FNI) and fibrosis-4 index (FIB-4 score), which are indicators for steatosis and fibrosis. Multivariable logistic regression models were calculated.

Results: Results revealed an association between liver steatosis/fibrosis and CAC. A FLI > 60 was associated with higher odds of NAFLD (OR 3.38, 95% CI: 2.61-4.39, p < 0.01) and increased prevalence of CAC-Score >300 compared to FLI <30 (9% vs. 3%, p < 0.01), even after adjusting for traditional cardiometabolic risk factors. While the crude odds ratios of the FIB-4 scores ≥ 1.3 and FNI score were significantly associated with increased odds of CAC, they became non-significant after adjusting for age, sex, and MetS.

Conclusion: This study reveals a significant association between NAFLD and CAC. The findings suggest that assessing liver fat and fibrosis could enhance assessment of cardiovascular risk, but further research is needed to determine whether hepatic fat plays an independent role in the development of atherosclerosis and whether targeting liver steatosis can mitigate vascular risk.

Objective: Bariatric surgery is currently the most effective treatment for obesity, and procedures such as Roux-en Y gastric bypass and sleeve gastrectomy (SG) also result in rapid improvements in insulin sensitivity and glucose tolerance. In addition, these procedures cause changes in the secretion of various gut-derived hormones. The role these hormones play in the mechanism of the beneficial effects of bariatric surgery is still debated, but nonetheless, their importance provides inspiration for novel obesity-targeted pharmacotherapies.

Methods: Male Sprague Dawley rats were fed either regular chow or a cafeteria diet to induce obesity. A sub-group of the obese animals then underwent either sham surgery or SG.

Results: Following a 4-week recovery period, SG rats weighed significantly less than obese or sham-operated rats. Improvements in glucose tolerance and insulin sensitivity also occurred in the SG group, but these were not always statistically significant. We measured the intracellular lipid content of liver samples and found that obese rats showed signs of non-alcoholic fatty liver disease, which were significantly ameliorated by SG. There were significantly higher glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) responses to a standard mixed meal in the SG group, as well as paradoxically higher glucagon secretion.

Conclusion: These data highlight the need for more specific anti-glucagon antibodies to characterize the changes in proglucagon-derived peptide concentrations that occur following SG. Further studies are required to determine whether these peptides contribute to the therapeutic effects of SG.

Background The relationship between overweight or obesity and low back pain (LBP) has previously been investigated. Several recent studies have focused on the relationship between other indicators of obesity, particularly indicators of fat and the risk of LBP. However, the results of body composition and LBP have been inconsistent. Methods All data for the present retrospective, cross-sectional study was extracted from the Korea National Health and Nutrition Examination Survey (KNHANES) versions V-1 and 2 conducted in 2010 and 2011 by the Korean Centers for Disease Control and Prevention. In KNHANES V-1 (2010) and V-2 (2011), those over 50 years of age completed the surveys on LBP, body weight, and body composition assessed using dual-energy X-ray absorptiometry (DXA) were included. The multivariable logistic regression analysis was used to examine the relationship between the presence of chronic LBP and body composition adjusting for confounders. Results We analyzed 3,579 persons who completed the question. In the multivariable analyses adjusting for age and sex, none of the variables, including fat mass and fat-free mass, remained positively or negatively associated with LBP. Additionally, when depression, smoking, alcohol intake, physical activity, diabetes mellitus, and fat or lean tissue mass were included in the multivariable logistic model, no significant associations were found between all measures of fat mass, fat-free mass, and LBP Conclusion This study is contrary to previous studies that concluded that there is a correlation between obesity and fat mass and LBP. LBP is not associated with increased levels of obesity and fat mass.

Objectives: Osteoporosis patients with fragility fractures and vertebral deformities have impaired quality of life (QOL). The phase angle, an index calculated from bioelectrical impedance analysis (BIA) measurements, has been reported to be related to clinical outcomes, mortality, and QOL in various diseases. We aimed to investigate the relationship between the phase angle and QOL in patients with postmenopausal osteoporosis.

Methods: 81 female patients treated for postmenopausal osteoporosis from September 2019 to March 2020 underwent measurement of bone mineral density (BMD) by dual-energy X-ray absorptiometry, body composition by BIA, and QOL by the 36-item Short-Form Health Survey (SF-36).

Results: The phase angle showed significant positive correlations with physical functioning (r = 0.270, p = 0.015) and physical component summary (PCS) (r = 0.251, p = 0.024) of the SF-36. The phase angle showed significant positive correlations with appendicular skeletal muscle mass index (ASMI) (r = 0.456, p < 0.001), lumbar spine BMD (r = 0.241, p = 0.030), and femoral neck BMD (r = 0.26, p = 0.021) and a significant negative correlation with age (r = -0.526, p < 0.001). Multiple regression analysis of the factors potentially associated with SF-36 PCS showed that the phase angle (r = 7.506, p = 0.012) was a significant contributor to PCS (R2 = 0.184).

Conclusion: The phase angle in postmenopausal osteoporotic patients was significantly related to QOL after adjusting for age, BMI, ASMI, and BMD. As the phase angle is a parameter that can be measured easily and noninvasively, it might be a useful aid for QOL assessment in osteoporotic patients.

Background: Seizures are common in palliative care patients and its control is essential in the management of these patients as it helps to reduce suffering at the end of life. Subcutaneous levetiracetam has been used off-license for seizure control in palliative care.

Objective: The objective of the study was to describe our experience with subcutaneous levetiracetam in two hospitals in Bogota, Colombia.

Methods: We conducted a retrospective review of patients treated with subcutaneous levetiracetam in two hospitals in Colombia during 2019-2021. Data were extracted from medical records, and participants were followed up as outpatients.

Results: Twenty-one patients were included into the study. No severe adverse effects or rise in ictal frequency were documented. Twelve patients died during hospitalization and nine continued treatments as outpatients. The principal diagnosis was structural focal epilepsy. The daily dose of levetiracetam ranged from 1,000 mg to 3,000 mg, and the duration of treatment varied among subjects between 1 and 360 days.

Conclusion: Subcutaneous levetiracetam was well tolerated and effective in controlling seizures in palliative care when oral administration or intravenous access was not an option. Randomized controlled trials are needed to elucidate the efficacy and tolerability of subcutaneous levetiracetam in clinical practice.

Objective: A healthy diet is a modifiable risk factor that may impact cognition. A unique type of diet may include intermittent fasting (IF), an eating pattern in which individuals go extended periods with little or no meal intake, intervening with periods of normal food intake. IF has multiple health benefits including maintenance of blood glucose levels, reduction of insulin levels, depletion or reduction of glycogen stores, mobilization of fatty acids, and generation of ketones. IF has shown neuroprotective effects as it may lead to increased neurogenesis in the hippocampus, which may contribute to cognitive resilience. Diets including IF were examined as lifestyle modifications in the prevention and management of cognitive decline.

Methods: A systematic literature search was conducted for randomized controlled trials (RCTs) which assessed the effect of dieting on cognitive functions in adults.

Results: Dietary Approaches to Stop Hypertension (DASH), low-glycemic diets, and caloric restriction have shown improvement in cognitive function; however, there was a negative impact on problem-solving in those with comorbid cardiovascular disease. There is also contradictory evidence that caloric restriction and diet alone may not be sufficient for the improvement of cognitive functions and that exercise may have better efficacy on cognition.

Conclusion: IF is considered a safe intervention, and no adverse effects were found in the reviewed studies; however, evidence is limited as there were only 9 low-quality RCTs that assessed the impact of IF on cognition. DASH, low-glycemic diets, and exercise may have effective roles in the management and prevention of cognitive decline, although further research is needed.

Objectives: Nuclear factor κB (NF-κB) is a superfamily of transcription factors that plays a key role in cancer genesis and progression. The present study aimed to examine the expression of NF-κB/p65 in breast cancer and its relationship with prognostic markers such as tumour grade, tumour size, hormone receptors, and HER-2.

Methods: Ninety-nine unselected formalin-fixed paraffin-embedded invasive ductal and lobular tissue sections were evaluated by immunohistochemistry methods to measure the expression of NF-κB/p65, oestrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor-2 (HER-2), and Ki-67. We assessed the correlation between NF-κB/p65 and clinicopathological parameters.

Results: NF-κB/p65 was found only in the cytoplasm and positively correlated with large tumours (≥2 cm) and high-grade tumours (p < 0.001 and p = 0.018, respectively). Other breast cancer markers, such as histological type (p = 0.766), HER-2 (p = 0.416), PR (p = 0.356), and ER (p = 0.606), had no significant link with the expression of NF-κB/p65. Furthermore, no significant relation with the Ki-67 marker was detected (p = 0.117).

Conclusions: The current study is indicative of a link between overexpression of NF-κB/p65 and both large tumour size and higher grade. This suggests that the expression of NF-κB/p65 is associated with aggressive biological activity in breast cancer; elucidating the mechanisms that lead to NF-κB/p65 cytoplasmic accumulation could lead to the development of novel therapeutic methods.

Objectives: Helicobacter pylori (H. pylori) and colorectal neoplasia (CRN) are frequent entities. Epidemiological data suggest an association between H. pylori positivity (H. pylori +) and CRN, whereas pathophysiologic considerations substantiate a possible causal relationship. However, the relationship between CRN and H. pylori + may also be mediated by shared risk factors. Therefore, the aim of this cross-sectional study was to evaluate a possible independent relationship between H. pylori and CRN in a Central European cohort.

Methods: We included 5,707 asymptomatic patients. All patients underwent screening colonoscopy and upper gastrointestinal endoscopy. We assessed the association between any CRN and advanced CRN with H. pylori + using multilevel logistic regression. We adjusted for age, sex, a positive family history of colorectal cancer, and cardiovascular risk.

Results: 1,082 patients (19%) were H. pylori + and 4,625 (81%) H. pylori -. Patients with both CRN and H. pylori had more cardiometabolic risk factors. In univariate (aOR 1.20; 1.10-1.31) and multivariable analysis (aOR 1.20; 1.08-1.32), H. pylori + was associated with the diagnosis of any CRN. However, H. pylori + was associated with the presence of advanced CRN (aOR 1.26; 0.96-1.64) only in trend.

Conclusions: We found a clustered co-occurrence of CRN and H. pylori. This association persisted after correction for shared cardiometabolic risk factors. We suggest that our analysis emphasizes the clinical value of H. pylori eradication. Whether "test and treat" H. pylori is warranted to prevent CRN remains unclear but is at least a possibility given the simplicity of "test and treat."

Objectives: The present study aims to investigate whether the dimple of Venus affects the anatomy of spinopelvic junction.

Subjects and methods: Inclusion criteria were having a lumbar MRI examination in the last 1 year, being older than 18 years of age and being able to radiologically evaluate the whole vertebral colon and pelvic girdle. Exclusion criteria were having congenital diseases of the pelvic girdle/hip/vertebral column and history of fracture or previous surgery in the same anatomic regions. The patients' demographic data and low back pain were noted. At radiological examination, the pelvic incidence angle was measured by lateral lumbar X-ray. The facet joint angle, tropism, facet joint degeneration, intervertebral disc degeneration, and intervertebral disc herniation at the level of L5-S1 were examined on lumbar MRIs.

Results: We included 134 male and 236 female patients with a mean age of 47.86 ± 14.50 years and 48.49 ± 13.49 years, respectively. We found that the patients with the dimple of Venus had higher pelvic incidence angle (p < 0.001) and more sagittally oriented facet joint (right facet joint p = 0.017, left facet joint p = 0.001) compared to those without the dimple of Venus. There was no statistically significant relationship between low back pain and the presence of the dimple of Venus.

Conclusions: The dimple of Venus affects the anatomy of the spinopelvic junction and is associated with an increased pelvic incidence angle and a more sagittally oriented facet joint angle.