1 year

  • 文章类型: Journal Article
    目的:确定有妊娠糖尿病(GDM)和糖尿病前期病史的妇女产后1年体重滞留(PPWR)和葡萄糖耐受不良(糖尿病前期+糖尿病)的危险因素。
    方法:在对MELINDA随机对照试验的探索性分析中,我们报告了167名糖尿病前期女性在近期GDM病史后进行的6~16周(早期)产后口服葡萄糖耐量试验的数据.
    结果:在所有参与者中,45%(75)的PPWR>0kg在产后1年。与没有PPWR的女性相比,PPWR妇女的妊娠期体重增加较高[10.5±6.4vs.6.5±4.5kg,p<0.001],较高的BMI(p<0.01)和较差的代谢特征(较高的腰围,在产后早期和晚期,血脂状况恶化和胰岛素抵抗增加)(所有p<0.05)。在所有患有PPWR的女性中,40.0%发展为代谢综合征,相比之下,没有晚期PPWR的女性为18.9%(p=0.003)。晚期PPWR的唯一独立预测因素是产后早期体重滞留(p<0.001)。在所有参与者中,55.1%(92)有葡萄糖不耐受(84例糖尿病前期,8例糖尿病)产后1年。产后晚期葡萄糖不耐受的独立预测因素是在怀孕和剖宫产分娩时开始胰岛素治疗时孕龄较低(分别p=0.044和0.014)。
    结论:在产后早期有GDM和糖尿病前期病史的女性中,产后早期PPWR是晚期PPWR的强独立预测因子,而妊娠期间较早开始胰岛素治疗和剖宫产分娩是产后晚期葡萄糖耐受不良的独立预测因素。
    OBJECTIVE: To determine risk factors for 1-year postpartum weight retention (PPWR) and glucose intolerance (prediabetes + diabetes) in women with a previous history of gestational diabetes (GDM) and prediabetes in early postpartum.
    METHODS: In this exploratory analysis of the MELINDA randomized controlled trial, we report data of 167 women with prediabetes at the 6-16 weeks (early) postpartum oral glucose tolerance test after a recent history of GDM.
    RESULTS: Of all participants, 45% (75) had PPWR >0 kg at 1-year postpartum. Compared to women without PPWR, women with PPWR had higher gestational weight gain [10.5 ± 6.4 vs. 6.5 ± 4.5 kg, p < 0.001], higher BMI (p < 0.01) and a worse metabolic profile (higher waist circumference, worse lipid profile and more insulin resistance) (all p < 0.05) both in early and late postpartum. Of all women with PPWR, 40.0% developed metabolic syndrome, compared to 18.9% of women without late PPWR (p = 0.003). The only independent predictor for late PPWR was weight retention in early postpartum (p < 0.001). Of all participants, 55.1% (92) had glucose intolerance (84 prediabetes, 8 diabetes) 1-year postpartum. Independent predictors for late postpartum glucose intolerance were lower gestational age at start insulin therapy in pregnancy and delivery by caesarean section (resp. p = 0.044 and 0.014).
    CONCLUSIONS: In women with a previous history of GDM and prediabetes in early postpartum, PPWR in early postpartum was a strong independent predictor for late PPWR, while earlier start of insulin therapy during pregnancy and delivery by caesarean section were independent predictors of glucose intolerance in late postpartum.
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  • 文章类型: Journal Article
    OBJECTIVE: Postintensive care syndrome has a strong impact on coronavirus disease 2019 survivors.
    OBJECTIVE: Assess the 1-year prevalence of postintensive care syndrome after coronavirus disease 2019.
    METHODS: This was a single-center prospective cohort using questionnaires and telephone calls from 4 months to 1 year after ICU discharge. Patients who were treated for coronavirus disease 2019-related acute respiratory distress between March 19, 2020, and April 30, 2020, participated.
    METHODS: Postintensive care syndrome was evaluated according to physical, mental, and cognitive domains. We surveyed the 8-item standardized Short Form questionnaire for assessing physical postintensive care syndrome; the Impact of Event Scale-Revised and the Hospital Anxiety and Depression Scale for assessing mental postintensive care syndrome; and Short-Memory Questionnaire for assessing cognitive postintensive care syndrome. The primary outcome was postintensive care syndrome occurrence of any domain at 1 year. Furthermore, the co-occurrence of the three postintensive care syndrome domains was assessed.
    RESULTS: Eighteen patients consented to the study and completed the survey. The median age was 57.5 years, and 78% of the patients were male. Median Acute Physiology and Chronic Health Evaluation-II score was 18. During ICU stay, 78% received invasive mechanical ventilation, and 83% received systemic steroid administration. Early mobilization was implemented in 61%. Delirium occurred in 44%. The median days of ICU and hospital stay were 6 and 23.5, respectively. Overall postintensive care syndrome occurrence was 67%. Physical, mental, and cognitive postintensive care syndrome occurred in 56%, 50%, and 33% of patients, respectively. The co-occurrence of all three domains of postintensive care syndrome was 28%. Age and Acute Physiology and Chronic Health Evaluation-II scores were higher, and systemic steroids were more commonly used in the postintensive care syndrome groups compared with the nonpostintensive care syndrome groups. Chronic symptoms were more common in the postintensive care syndrome groups than the nonpostintensive care syndrome groups.
    CONCLUSIONS: Patients who suffered critical illness from coronavirus disease 2019 had a high frequency of postintensive care syndrome after 1 year. Long-term follow-up and care should be continuously offered.
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  • 文章类型: Journal Article
    UNASSIGNED: Femoral nerve blocks (FNBs) for fragility hip fractures have benefits in improving pain relief and early mobilization while decreasing opioid use and rates of pneumonia. However, no study has looked at 1-year mortality outcomes for this intervention. This study aims to provide insight into 1-year outcomes.
    UNASSIGNED: A single-site retrospective case-control study from 2007 to 2016 in primary fragility hip fractures compared 665 patients who received an emergency department FNB to 326 patients who did not receive an FNB. The primary outcome was 1-year mortality. Secondary outcomes included mortality, mobility, and residence at discharge, 6 months, and 1-year intervals.
    UNASSIGNED: There were no significant differences in preoperative characteristics. Although there was no statistically significant difference in 1-year mortality, patients who did not receive an FNB were more likely to be nonambulant at 1 year (odds ratio 1.71, 95% confidence interval, 1.14-2.57, P = .005). There were no other significant differences in mobility, residence, or mortality.
    UNASSIGNED: There was no statistically significant difference in 1-year mortality, although individuals who did not receive an FNB were more likely to be nonambulant at 1 year.
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  • 文章类型: Journal Article
    Increasing obesity rates have driven research into dietary support for body weight control, but previous studies have only assessed changes in body weight of ±3 kg. We investigated the relationships between white or brown/multi-grain rice consumption and 1-year body weight gain ≥3 kg in Japanese factory workers (n = 437). Routine medical check-up data from a 1-year nutrition and lifestyle cohort study were analysed. Participants were divided into white rice and brown/multi-grain rice consumption groups and further classified by tertile of rice consumption. Multiple logistic regression analyses were performed by tertile. At 1 year, high white rice consumption was significantly associated with increased risk of body weight gain ≥3 kg compared with low white rice consumption, maintained after adjustment for age, sex, and consumption of other obesogenic foods (p = 0.034). In the brown/multi-grain rice consumption group, however, there was no significant difference in risk between high and low consumption, even after multi-variate adjustment (p = 0.387). The consumption of white rice, but not brown rice/multi-grain rice, was positively correlated with the risk of a 1-year body weight gain of 3 kg or more. This suggests that brown rice/multi-grain rice consumption is useful for body weight control among Japanese workers.
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  • 文章类型: Clinical Trial, Phase II
    BACKGROUND: Patients with moderate to severe plaque psoriasis demonstrated positive responses to ixekizumab, an anti-interleukin-17A monoclonal antibody, in a phase-II, randomized, placebo-controlled trial.
    OBJECTIVE: We sought to evaluate long-term efficacy and safety of ixekizumab.
    METHODS: After receiving 10, 25, 75, or 150 mg of ixekizumab or placebo during randomized, placebo-controlled trial, patients with less than 75% improvement from baseline on the Psoriasis Area and Severity Index (PASI) score (PASI75) entered open-label extension (OLE); patients with PASI75 or higher entered a treatment-free period (weeks 20-32), then entered OLE after meeting response criteria. During OLE, patients received 120 mg of subcutaneous ixekizumab every 4 weeks.
    RESULTS: In all, 120 patients entered OLE; 103 completed 52 weeks or more of treatment. Overall, 77% of patients achieved PASI75 at week 52 (nonresponder imputation). Patients who responded to treatment in the randomized, placebo-controlled trial maintained a high-level response by week 52 of OLE (PASI75 = 95%; 90% improvement from baseline on the PASI score = 94%; 100% improvement from baseline on the PASI score = 82%). Irrespective of dose in the randomized, placebo-controlled trial, each group had similar response rates at week 52 of OLE. The exposure-adjusted incidence rate for adverse events was 0.47 and for serious adverse events was 0.06 per patient-year during OLE.
    CONCLUSIONS: No control group, small sample sizes, and bias toward retention of patients with positive responses limit interpretation.
    CONCLUSIONS: A high proportion of patients responded to ixekizumab therapy and maintained clinical responses over 1 year of treatment with no unexpected safety signals.
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  • 文章类型: Journal Article
    OBJECTIVE: The purpose of this study was to evaluate the 1-year clinical outcomes of more complex XIENCE V USA real-world patients with small versus nonsmall vessel lesions.
    BACKGROUND: Patients with small vessel lesions undergoing coronary stent placement are at higher risk of major adverse cardiac events. Improved safety and efficacy of XIENCE V everolimus eluting stents (EES) have been previously demonstrated in selected low-risk small vessel populations in randomized clinical trials.
    METHODS: The XIENCE V USA study was a condition of approval, single-arm study in unselected real-world patients. Baseline and 1-year clinical outcomes were compared between XIENCE V USA patients who received a single 2.5 mm stent (small vessel group, N = 838) and patients implanted with a single >2.5 mm stent (non-small vessel group, N = 2,015). Mean reference vessel diameter was 2.55 ± 0.36 and 3.25 ± 0.46 mm in the small and non-small vessel groups, respectively (P < 0.001).
    RESULTS: Small vessel group had more females, presented with a higher rate of diabetes, and had more complex lesion characteristics. The definite or probable ST rates analyzed using Kaplan-Meier method were low and not significantly different between the groups at 0.37 and 0.40% for the small and nonsmall vessel group (P = 0.88), respectively. The composite rate of cardiac death or MI was comparable at 4.5% for the small and 5.1% for the non-small vessel 1 groups (P = 0.57). The 1-year target lesion revascularization rate was also comparable in the small vessel group (3.8% vs. 3.0%, P = 0.35).
    CONCLUSIONS: Despite gender difference, higher prevalence of diabetes and more complex lesions in the small vessel groups, the 1-year clinical outcomes were similar in both small and nonsmall vessel groups. These results demonstrate the therapeutic benefit of XIENCE V EES in a real-world all inclusive patient population with small vessel disease.
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