Search

Background and Objective: To study the effects of dexmedetomidine (DEX) on perioperative blood glucose levels in adult diabetes mellitus (DM) patients undergoing cardiac surgery. Methods and Material: A prospective, observational study was conducted on 100 adult diabetic patients aged between 18 and 75 years undergoing cardiac surgery with cardiopulmonary bypass (CPB). The patients were divided into two groups (group D and group C) of 50 each. Group D patients received DEX infusion, whereas the group C patients received 0.9% normal saline infusion. Results: The blood glucose levels, heart rate, mean arterial pressure, and serum potassium levels at different time points were comparable between the two groups ( P > 0.05). The mean dose of insulin required in the combined population as well as in both controlled and uncontrolled DM patients was significantly less in group D than in group C (combined population - 36.03 ± 22.71 vs 47.82 ± 30.19 IU, P = 0.0297; uncontrolled DM - 37.36 ± 23.9 IU vs 48.16 ± 25.15 IU, P = 0.0301; controlled DM - 34.7 ± 21.5 IU vs 47.63 ± 35.25 IU, P = 0.0291). Duration of mechanical ventilation and VIS were comparable between the two groups. The incidence of arrhythmias (20% vs 46%, P = 0.0059) and delirium (6% vs 20%, P = 0.0384) was significantly less in group D than in group C. None of the patients in either group had stroke, myocardial ischemia, and mortality. Conclusion: The results suggested that DEX infusion during the intraoperative period was very effective for perioperative glycemic control and reduction of insulin requirement in DM patients undergoing cardiac surgery. [ABSTRACT FROM AUTHOR]

BACKGROUND. In women with obesity, excess gestational weight gain ([greater than or equal to] 270 g/week) occurs in 2 out of 3 pregnancies and contributes to metabolic impairments in both mother and baby. To improve obstetrical care, objectively assessed information on energy balance is urgently needed. The objective of this study was to characterize determinants of gestational weight gain in women with obesity. METHODS. This was a prospective, observational study of pregnant women with obesity. The primary outcome was energy intake calculated by the energy intake-balance method. Energy expenditure was measured by doubly labeled water and whole-room indirect calorimetry and body composition as a 3-compartment model by air displacement plethysmography and isotope dilution in early (13-16 weeks) and late (35-37 weeks) pregnancy. RESULTS. In pregnant women with obesity (n = 54), recommended weight gain (n = 8, 15%) during the second and third trimesters was achieved when energy intake was 125 [+ or -] 52 kcal/d less than energy expenditure. In contrast, women with excess weight gain (67%) consumed 186 [+ or -] 29 kcal/d more than they expended (P < 0.001). Energy balance affected maternal adiposity (recommended: -2.5 [+ or -] 0.8 kg fat mass; excess: +2.2 [+ or -] 0.5; inadequate: -4.5 [+ or -] 0.5; P < 0.001) but not fetal growth. Weight gain was not related to demographics, activity, metabolic biomarkers, or diet quality. We estimated that energy intake requirements for recommended weight gain during the second and third trimesters were not increased as compared with energy requirements early in pregnancy (34 [+ or -] 53 kcal/d, P = 0.83). CONCLUSION. We here provide what we believe are the first evidence-based recommendations for energy intake in pregnant women with obesity. Contrary to current recommendations, energy intake should not exceed energy expenditure. TRIAL REGISTRATION. ClinicalTrials.gov, NCT01954342. FUNDING. This study was funded by the National Institutes of Health (R01DK099175) and the Clinical Research Cores at Pennington Biomedical Research Center (U54GM104940 and P30DK072476)., Introduction According to the 2009 Institute of Medicine guidelines, women entering pregnancy with obesity should limit total weight gain to 5-9 kg (1). Despite these recommendations, excess gestational weight gain [...]

Background/objectives Accurately predicting energy requirements form a critical component for initializing dynamic mathematical models of metabolism. The majority of such existing estimates rely on linear regression models that predict total daily energy expenditure (TDEE) from age, gender, height, and body mass, however, there is evidence these predictors obey a power function. Subjects/methods Baseline, free-living TDEE measured by doubly labeled water (DLW) in 20 studies with no overlapping subjects were obtained from the core lab at the University of Chicago and the University of Wisconsin-Madison (N = 2501 adults, 628 males, 1873 females). Linear regression models of log-transformed equations of the form: [Formula omitted] and [Formula omitted] were developed to determine the values of the exponents of body mass (M (kg)) and height (H (cm)) along with a gender effect (Sex). A nonlinear curve fit was performed to develop a power model that also includes age [Formula omitted]. Results The power for body mass, [beta].sub.1 = 0.45 and the power for height was [beta].sub.2 = 1.52 in the database with both genders combined. Adding gender reduced these to [beta].sub.1 = 0.43 and [beta].sub.2 = 1.04. All terms were significant (p < 0.01) except for height when including gender. The powers for height in the additive gender-specific models were both closer to 1 and the power for body mass was similar across all models ranging between 0.41 and 0.57. Conclusions A nonlinear scaling relationship was found to hold for body mass and needs to be considered when adjusting TDEE for body mass or predicting human energy requirements as a function of body mass especially in individuals with obesity., Author(s): Diana M. Thomas [sup.1] , Krista Watts [sup.1] , Sara Friedman [sup.2] , Dale A. Schoeller [sup.2] Author Affiliations: (1) Department of Mathematical Sciences, United States Military Academy, West [...]

A long-standing question in nutrition and obesity research involves quantifying the relationship between body fat and anthropometry. To date, the mathematical formulation of these relationships has relied on pairing easily obtained anthropometric measurements such as the body mass index (BMI), waist circumference, or hip circumference to body fat. Recent advances in 3D body shape imaging technology provides a new opportunity for quickly and accurately obtaining hundreds of anthropometric measurements within seconds, however, there does not yet exist a large diverse database that pairs these measurements to body fat. Herein, we leverage 3D scanned anthropometry obtained from a population of United States Army basic training recruits to derive four subpopulations of homogenous body shape archetypes using a combined principal components and cluster analysis. While the Army database was large and diverse, it did not have body composition measurements. Therefore, these body shape archetypes were paired to an alternate smaller sample of participants from the Pennington Biomedical Research Center in Baton Rouge, LA that were not only similarly imaged by the same 3D scanning machine, but also had concomitant measures of body composition by dual-energy X-ray absorptiometry body composition. With this enhanced ability to obtain anthropometry through 3D scanning quickly of large populations, our machine learning approach for pairing body shapes from large datasets to smaller datasets that also contain state-of-the-art body composition measurements can be extended to pair other health outcomes to 3D body shape anthropometry., Author(s): James D. Pleuss [sup.1] , Kevin Talty [sup.1] , Steven Morse [sup.1] , Patrick Kuiper [sup.1] , Michael Scioletti [sup.1] , Steven B. Heymsfield [sup.2] , Diana M. Thomas [...]

Context: Exercise can decrease central adiposity, but the effect of exercise dose and the relationship between central adiposity and exercise-induced compensation is unclear. Objective: Test the effect of exercise dose on central adiposity change and the association between central adiposity and exercise-induced weight compensation. Methods: In this ancillary analysis of a 6-month randomized controlled trial, 170 participants with overweight or obesity (mean ± SD body mass index: 31.5 ± 4.7 kg/m²) were randomized to a control group or exercise groups that reflected exercise recommendations for health (8 kcal/kg/week [KKW]) or weight loss and weight maintenance (20 KKW). Waist circumference was measured, and dual-energy X-ray absorptiometry assessed central adiposity. Predicted weight change was estimated and weight compensation (weight change – predicted weight change) was calculated. Results: Between-group change in waist circumference (control: .0 cm [95% CI, −1.0 to 1.0], 8 KKW: −.7 cm [95% CI, −1.7 to .4], 20 KKW: −1.3 cm [95% CI, −2.4 to −.2]) and visceral adipose tissue (VAT; control: −.02 kg [95% CI, −.07 to .04], 8 KKW: −.01 kg [95% CI, −.07 to .04], 20 KKW: −.04 kg [95% CI, −.10 to .02]) was similar (P ≥ .23). Most exercisers (82.6%) compensated (weight loss less than expected). Exercisers who compensated exhibited a 2.5-cm (95% CI, .8 to 4.2) and .23-kg (95% CI, .14 to .31) increase in waist circumference and VAT, respectively, vs those who did not (P < .01). Desire to eat predicted VAT change during exercise (β = .21; P = .03). Conclusion: In the presence of significant weight compensation, exercise at doses recommended for health and weight loss and weight maintenance leads to negligible changes in central adiposity. [ABSTRACT FROM AUTHOR]

The pH-sensitive exfoliated clay-alginate composite was investigated for the controlled oral delivery of bovine serum albumin (BSA). The X-ray diffraction analysis and transmission electron microscopy analysis revealed the exfoliated structure of clay in the composite. The degree of exfoliation was increased with sonication and it was optimised that the maximum exfoliation of clay in the aqueous medium occurred for 150 min of sonication. The maximum adsorption of BSA in the clay-alginate was detected at a pH of 4.5. The in-vitro release study of BSA from the exfoliated clay and the clay-alginate composite was analysed at simulated gastric and simulated intestinal pH conditions which suggested that the adsorption and release of BSA could be controlled simply by adjusting the solution pH condition. In the in-vitro release study, it was noted that there was no release of BSA from the clay-alginate composite up to 30 min in gastric pH conditions. But, there was a slow release rate of BSA within 10 h from the clay-alginate composite in the intestinal pH condition. The release profile from the clay–alginate composite was more fitted to the Peppas kinetic model. [ABSTRACT FROM AUTHOR]

* Context.--Pathology practices have begun integrating digital pathology tools into their routine workflow. During 2020, the coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged as a pandemic, causing a global health crisis that significantly affected the world population in several areas, including medical practice, and pathology was no exception. Objective.--To summarize our experience in implementing digital pathology for remote primary diagnosis, education, and research during this pandemic. Design.--We surveyed our pathologists (all subspecialized) and trainees to gather information about their use of digital pathology tools before and during the pandemic. Quality assurance and slide distribution data were also examined. Results.--During the pandemic, the widespread use of digital tools in our institution allowed a smooth transition of most clinical and academic activities into remote with no major disruptions. The number of pathologists using whole slide imaging (WSI) for primary diagnosis increased from 20 (62.5%) to 29 (90.6%) of a total of 32 pathologists, excluding renal pathology and hematopathology, during the pandemic. Furthermore, the number of pathologists exclusively using whole slide imaging for primary diagnosis also increased from 2 (6.3%) to 5 (15.6%) during the pandemic. In 35 (100%) survey responses from attending pathologists, 21 (60%) reported using whole slide imaging for remote primary diagnosis following the Centers for Medicare and Medicaid Services waiver. Of these 21 pathologists, 18 (86%) responded that if allowed, they will continue using whole slide imaging for remote primary diagnosis after the pandemic. Conclusions.--The pandemic served as a catalyst to pathologists adopting a digital workflow into their daily practice and realizing the logistic and technical advantages of such tools. (Arch Pathol Lab Med. 2021;145:1051-1061; doi: 10.5858/arpa.2020-0715-SA, In the last 20 years, substantial advances have occurred in the field of digital pathology (DP). In particular, whole slide imaging (WSI) can now produce high-resolution digital replicas of glass [...]