Objective To analyze the impact of body mass index (BMI) on surgical difficulty and surgical reaction of patients with colorectal cancer served by West China Hospital, based on the current version of Database from Colorectal Cancer (DACCA). MethodsThe data of DACCA were updated on September 22, 2021. All data items included BMI, operative duration, anatomical difficulty, pelvic stenosis, abdominal obesity, adhesion in surgical area, abnormal mesenteric status, tissue or organ hypertrophy, intestinal quality in surgical area, surgery reaction, and perioperative complications of colorectal cancer module including temperature, flatus, pain, and mental status. The patients were divided into lean (BMI <18.5 kg/m2), normal (BMI 18.5–23.9 kg/m2), overweight (BMI 24.0–27.9 kg/m2), and obesity (BMI ≥28.0 kg/m2) by Chinese four classification method. ResultsAfter scanning, 6 311 data rows were analyzed. ① The effect of BMI on surgical difficulty: BMI was weakly positively correlated with operative duration (rs=0.096, P<0.001). The overweight and obesity patients were more likely to have anatomical abnormalities (rs=0.385, P<0.001 ), pelvic stenosis (rs=0.386, P<0.001), abdominal obesity (rs=0.567, P<0.001), and adhesion in surgical area (rs=0.043, P=0.004). There was difference in tissue or organ hypertrophy among patients with different BMI (χ2=39.988, P<0.001). It was also found that the lean patients were prone to develop ‘very heavy adhesions’ when adhesions occurred in surgical area, and to ‘mesangial contracture, short, fixed’ of abnormal mesenteric status, while the obesity patients were prone to ‘mesangial thickening’ of abnormal mesenteric status. There was no difference in intestinal quality among patients with different BMI (P>0.05). ② The effect of BMI on surgical reaction: BMI was weakly positively correlated with the overall assessment of surgical reaction (rs=0.049, P=0.001), and obesity patients were more likely to have severe surgical reaction. BMI was weakly negatively correlated with pain (rs=–0.058, P<0.001）and the lean patients were more likely to have pain that needed drug control. However, there were no differences in temperature, flatus, and mental status among patients with different BMI (P>0.05). ConclusionsHigh BMI of patients will affect several indicators including operative duration, anatomical difficulty, pelvic stenosis, abdominal obesity, adhesion in surgical area, abnormal mesenteric status, tissue or organ hypertrophy, resulting in increased difficulty of surgery. Although high BMI might affect overall response state after surgery, it will not affect temperature, flatus, and mental status, reflecting a relatively weak impact on surgical reaction.
ObjectiveTo summarize the influence and mechanism of visceral fat on the treatment and prognosis of gastric cancer patients.MethodLiteratures on the correlation and mechanism between visceral fat and treatment and prognosis of gastric cancer were collected and reviewed.ResultsHigh visceral fat may promote the incidence and progress of gastric cancer, and increase the incidence of complication of radical gastrectomy, including surgical site infection, pancreatic fistula, etc., as well as prolong the length of hospital stay. Reducing patients’ visceral fat level before operation could reduce the incidence of surgical complication. However, the persistent decrease of visceral fat level after operation may indicate poor prognosis. The effect of visceral fat on gastric cancer and its treatment was mainly due to the local chronic inflammation caused by excessive visceral fat tissue, the change of adipocytokine secretion, insulin resistance, and other mechanisms.ConclusionWe need to use visceral fat and other indicators to evaluate gastric cancer patients’ weight and body composition, in order to better guide the treatment and prognosis evaluation of gastric cancer.
Objective To explore the relationship between the triglyceride glucose-body mass index (TyG-BMI) and hypertension, type 2 diabetes, as well as their comorbidity, aiming to provide a scientific basis for the early identification and precise prevention of these three diseases. Methods This research collected data from subjects in the China Health and Retirement Longitudinal Study (CHARLS) database. According to the quartiles of TyG-BMI, the included subjects were divided into Q1 group, Q2 group, Q3 group, and Q4 group. Logistic regression was used to analyze the association between the TyG-BMI and the three diseases separately. Further, a restricted cubic spline model was employed to investigate the potential non-linear dose-response relationship between the TyG-BMI index and the three diseases. Subgroup analysis was conducted using interaction tests to investigate whether there was an interaction between TyG-BMI and subgroup factors such as age and gender. Results A total of 4 847 participants were included. There were 1 212 cases in Q1 group, 1 212 cases in Q2 group, 1 211 cases in Q3 group, and 1 212 cases in Q4 group. The logistic regression results indicate that, after adjusting for all confounding factors, participants in the Q4 group had a higher risk of developing type 2 diabetes, hypertension, and comorbidity of hypertension and type 2 diabetes in Model 3 (P<0.05). The results from the restricted cubic spline model demonstrated a linear relationship between the TyG-BMI index and the risk of type 2 diabetes (P for non-linearity >0.05), while a non-linear relationship was observed with hypertension (P for non-linearity <0.05) and the comorbidity of hypertension and type 2 diabetes (P for non-linearity <0.05). Subgroup analysis using interaction tests showed that compared to the Q1 group, factors such as age, gender, smoking, alcohol consumption, and dyslipidemia in the Q2, Q3, and Q4 groups did not significantly alter the relationship between TyG-BMI and type 2 diabetes, hypertension, and their comorbidity. Overall, there was no significant interaction between TyG-BMI and factors like age, gender, smoking, alcohol consumption, and dyslipidemia (P for interaction >0.05). Conclusions In middle-aged and elderly populations, the higher the TyG-BMI, the greater the risk of hypertension, type 2 diabetes, and their comorbidity. The TyG-BMI could be considered an important indicator for the early identification of hypertension, type 2 diabetes, and their comorbidities.
ObjectiveTo explore the effect of body mass index (BMI) on the outcomes of laparoscopic surgery for esophageal hiatal hernia.MethodsWe divided the patients who underwent hiatal hernioraphy and fundoplication surgery in our hospital between July 2013 and June 2018 into two groups according to the BMI: a group A, BMI ≥24 kg/m2, 77 patients, 41 males, 36 females, with an average age of 42 years; a group B: BMI<24 kg/m2, 63 patients, 38 males, 25 females, with an average age of 67 years, and the age, gender, type of hiatal hernia, score of subjective feeling of symptoms, level of reflux esophagitis were analyzed with the propensity score matching method. Fifty one patients were successfully matched in each group, and the curative effect of surgery was compared between the two groups.ResultsThere was no statistical difference in the type of surgery, intraoperative complications, postoperative complications, and hospital stay between the two groups (P>0.05). The operative time of the group A was significantly longer than that of the group B (P=0.023). There was no statistical difference between the two groups in postoperative recurrence (P=0.741).ConclusionThe operative time in overweight patients is significantly longer than that in the non-overweight patients, but it has no effect on the surgical outcomes and complications.
ObjectiveTo investigate the effect of body mass index (BMI) on the short- and medium-term effectiveness of unicompartmental knee arthroplasty (UKA) in the treatment of anterior medial compartmental osteoarthritis of knee joint.MethodsThe clinical data of 55 patients (61 knees) with anterior medial compartmental osteoarthritis of knee joint treated with minimally invasive UKA between May 2014 and May 2019 were retrospectively analyzed. According to BMI, the patients were divided into 3 groups: normal body mass group [group A, BMI 18.50-24.99 kg/m2, 23 cases (25 knees)], overweight group [group B, BMI 25.00-29.99 kg/m2, 23 cases (25 knees)], obesity group [group C, BMI 30.00-39.99 kg/m2, 9 cases (11 knees)]. There was no significant difference in gender, age, sides, disease duration, and preoperative American Special Surgery Hospital (HSS) score, pain visual analogue scale (VAS) score, and knee range of motion (ROM) among 3 groups (P>0.05). The operation time, intraoperative dominant blood loss, and the postoperative decreased amount of hemoglobin at 1 week were recorded and compared among 3 groups. The HSS score, VAS score, and ROM were used to evaluate the knee function and pain improvement.ResultsThere was no significant difference in the operation time, the intraoperative dominant blood loss, and the postoperative decreased amount of hemoglobin at 1 week among 3 groups (P>0.05). All the 55 patients were followed up 5-60 months, with an average of 24 months. No complication such as infection, fat embolism, or deep venous thrombosis of lower extremity occurred after operation. The anteroposterior and lateral X-ray films of the knee joint showed that no dislocation or loosening of the prosthesis occurred and the position of the prosthesis was good. At last follow-up, the HSS score, VAS score, and ROM of the 3 groups were significantly improved when compared with preoperative ones (P<0.05); but there was no significant difference among 3 groups (P>0.05).ConclusionFor obese and overweight patients with anterior medial compartmental osteoarthritis of the knee joint, the use of minimally invasive UKA can achieve satisfactory short- and medium-term effectiveness, and the long-term effectiveness needs further follow-up.
Objective To investigate the effect of body mass index (BMI) on the short-term effectiveness of high tibial osteotomy (HTO) in the treatment of varus knee arthritis. Methods The clinical data of 84 patients (84 knees) with varus knee arthritis treated with HTO between May 2016 and August 2020 were retrospectively analyzed. According to BMI, the patients were divided into normal group (32 patients in group A, BMI<25 kg/m2), overweight group (27 patients in group B, BMI>30 kg/m2), and obese group (25 patients in group C, BMI>30 kg/m2). The BMI of groups A, B, and C were (23.35±0.89), (26.65±1.03), and (32.05±1.47) kg/m2, respectively. There was no significant difference (P>0.05) in gender, age, surgical side, disease duration, and preoperative Hospital for Special Surgery (HSS) score, visual analogue scale (VAS) score, knee range of motion, and hip-knee-ankle angle (HKA) between groups. The operation time, intraoperative dominant blood loss, and the decrease of hemoglobin on the 3rd day after operation were recorded and compared between groups. The improvement of knee joint function and pain status were evaluated by knee joint HSS score, knee range of motion, and VAS score before and after operation, and measuring the HKA of patients on X-ray film. During the follow-up, the X-ray films of the knee joint were reexamined to observe the position of the internal fixator and the healing of osteotomy. Results All patients completed the operation successfully and were followed up 8-40 months (mean, 19.3 months). There was no significant difference in follow-up time, operation time, intraoperative dominant blood loss, and the decrease of hemoglobin on the 3rd day after operation between groups (P>0.05). No operative complications such as severe vascular or nerve injury occurred. After operation, deep venous thrombosis of lower extremities occurred in 1 case in groups A and B respectively, and fat liquefaction of surgical incision occurred in 2 cases in group C. There was no significant difference in the incidence of perioperative complications between groups (3.1% vs. 3.7% vs. 8.0%) (P=0.689). During the follow-up, there was no bone nonunion, plate fracture or loosening. At last follow-up, HSS score, VAS score, knee range of motion, and HKA significantly improved in the 3 groups when compared with those before operation (P<0.05), but there was no significant difference in the differences of the above indexes between groups before and after operation (P>0.05). Conclusion BMI does not affect the short-term effectiveness of HTO in the treatment of varus knee arthritis. HTO can be selected for overweight and obese patients after standard medical treatment is ineffective.
摘要:目的：研究成都地區中老年人群體重指數(BMI)與高血壓患病率及血壓水平的關系。方法:按照隨機抽樣的方法抽取樣本,對711人(平均年齡為63.28±6.25歲;男性占57.8%)進行了相關調查,調查內容中包括身高、體重、血壓及脈搏等。結果:成都地區中老年人群的超重及肥胖所占比重較大(約45%),按BMI分組(lt;18.5 kg/m2,18.5~23.9 kg/m2,24~27.9 kg/m2,≥28.0 kg/m2)的高血壓患病率分別是31.6%,54.8%,64.4%,82.8%,差異有統計學意義。采用logistic回歸分析發現在調整年齡、性別、腰圍及尿酸等后,BMI對高血壓的患病率有獨立影響。在整個人群及女性病人中,血壓隨著BMI的升高而有升高的趨勢,差異有統計學意義。結論:成都地區中老年人群超重及肥胖所占比重較大。BMI可以影響高血壓的患病率及影響女性病人的血壓水平,是高血壓的獨立危險因素。Abstract: Objective: To investigate the effects of body mass index on prevalence of hypertension and blood pressure in the elderly. MethodsA survey, including height, weight, blood pressure and pulse, was carried out in a general population of Chengdu. A total of 711 subjects (average age: 63.28±6.25 years; male: 57.8%) were recruited by random sampling method. Results：The proportion of overweight and obesity was about 45%. The hypertension prevalence rate was significantly positively correlated with BMI (Plt;0.01), and that was also seen in the level of SBP and DBP for the female (Plt;0.05). In logistic regression analysis adjusting for age, gender, waist, uric acid, the standardized OR for higher BMI (≥28.0 kg/m2) as a risk factor of hypertension was 5.140. Conclusion：The proportion of overweight and obesity was great in Chengdu area. BMI can affect the prevalence rate of hypertension and the level of blood pressure.
Objective To explore relationship between body mass index and all-cause mortality or cancer-specific mortality of colorectal cancer. Methods The published articles relevant body mass index and colorectal cancer mortality were retrieved according to the inclusion and exclusion criteria from PubMed, Elsevier-Science Direct, and Web of Science databases. The meta-analysis was performed with RevMan 5.3 software. Results A total of 14 articles were eligible for the meta-analysis, involved 53 804 patients (colorectal cancer patients with underweight 1 853 cases, colorectal cancer patients with overweight 9 088 cases, colorectal cancer patients with obesity 4 463 cases). The results of meta-analysis showed that the colorectal cancer patients with obesity and underweight had the higher all-cause mortalities 〔RR=1.11, 95% CI (1.06, 1.16), P<0.000 01; RR=1.34, 95% CI (1.11, 1.61), P=0.002〕 and colorectal cancer-specific mortalities 〔RR=1.15, 95% CI (1.05, 1.24), P=0.001; RR=1.33, 95% CI (1.09, 1.62), P=0.005〕 as compared with the colorectal cancer patients with normal weight. The all-cause mortality and colorectal cancer-specific mortality had no significant differences between the colorectal cancer patients with overweight and the colorectal cancer patients with normal weight 〔RR=0.96, 95% CI (0.89, 1.04), P=0.31; RR=1.00, 95% CI (0.90, 1.12), P=0.98〕 . Conclusion Colorectal cancer patients with obesity and underweight might have a higher mortality rate.
ObjectiveTo study the correlation of lymph node metastasis and recurrence with body mass index (BMI) and estrogen receptor (ER) in papillary thyroid carcinoma (PTC).MethodThe relevant literatures were retrieved in the past six years through the CNKI, VIP, Wanfang, CBM, PubMed, Medline, Embase, Cochrane Library, etc. databases for meta-analysis of relationship of lymph node metastasis and recurrence of PTC with BMI or ER and its subtypes.ResultsThe meta-analysis showed that the lymph node metastasis of PTC was associated with the BMI and ERα [OR=1.27, 95% CI (1.12, 1.42), P<0.000 1; OR=2.68, 95% CI (1.86, 3.86), P<0.000 01, respectively ], and which not associated with the ER and ERβ [OR=0.87, 95% CI (0.56, 1.35), P=0.53; OR=1.22, 95% CI (0.78,1.89), P=0.39, respectively ]. The ERα was associated with the PTC recurrence [OR=1.87, 95% CI (1.04, 3.35), P=0.04 ], but the BMI was not the risk factor for the recurrence of PTC [OR=1.187 1, 95% CI (0.930 0, 1.515 3), P=0.17 ].ConclusionsAlthough BMI was not found to be associated with PTC recurrence, high BMI promotes PTC metastasis, so lymph node dissection in obese patients should be more careful and comprehensive. Positive ERα increases risk of lymph node metastasis and recurrence of PTC, which can be used as a negative factor in evaluating prognosis of PTC and provide a new idea for endocrine therapy of PTC.
ObjectiveTo analyze the effect of releasing the lower pulmonary ligament on right residual lung expansion after right upper lobe resection under different body mass index (BMI) levels. MethodsThe clinical data of patients who underwent thoracoscopic right upper lobe resection in the First Affiliated Hospital with Nanjing Medical University from 2021 to 2022 were retrospectively analyzed. Patients were divided into a group A (17 kg/m2＜BMI≤23 kg/m2), a group B (23 kg/m2＜BMI≤29 kg/m2) and a group C (BMI＞29 kg/m2) according to BMI. The presence of residual cavity was judged by chest X-ray at 7-10 days after operation, the degree of compensation change of the right main bronchus angle was measured, and the changes in lung volume were determined by CT three-dimensional reconstruction. ResultsA total of 157 patients who underwent thoracoscopic right upper lobe resection were included, including 71 males and 86 females, with an average age of 59.7±11.2 years. There were 50 patients in the group A, 75 patients in the group B, and 32 patients in the group C. In the group A, compared with those without releasing the lower pulmonary ligament, patients with releasing had a lower incidence of postoperative residual cavity (P=0.016), greater changes in bronchus angle (P<0.001), and smaller changes in lung volume (P<0.001). In the group B and C, there was no significant effect of releasing the lower pulmonary ligament on postoperative residual cavity, bronchus angle, and lung volume changes (P>0.05). ConclusionFor patients with thin and long body shape and low BMI, releasing the lower pulmonary ligament is helpful to promote the expansion of the residual lung after right upper lobe resection and reduce the occurrence of postoperative residual cavity in patients.