Purpose
Conformal sphincter preservation operation (CSPO) is a sphincter preservation operation for very low rectal cancers. Compared to intersphincteric resection (ISR), CSPO retains more dentate ...line and distal rectal wall, and also avoids damaging the nerves in the intersphincteric space. This study aimed to compare the postoperative anal function and quality of life between the CSPO and ISR.
Method
Patients with low rectal cancer undergoing CSPO (
n
= 117) and ISR (
n
= 66) were included from Changhai and Huashan Hospital, respectively, between 2011 and 2020. A visual analog scale (range 0–10) was utilized to evaluate satisfaction with anal function and quality of life. The anal function was evaluated with Wexner scores and low anterior resection syndrome (LARS) score. Quality of life was evaluated with the EORTC QLQ-C30 and QLQ-CR38.
Results
The CSPO group had more male patients (65.8% vs. 50%,
p
= 0.042), more preoperative chemoradiotherapy (33.3% vs. 10.6%,
p
< 0.001), lower tumor position (3.45 ± 1.13 vs. 4.24 ± 0.86 cm,
p
< 0.001), and more postoperative chemotherapy (65% vs. 13.6%,
p
< 0.001) compared to the ISR group. In addition, CSPO patients had shorter postoperative stay (6.63 ± 2.53 vs. 7.85 ± 4.73 days,
p
= 0.003) and comparable stoma reversal rates within 1 year after surgery (92.16% vs. 96.97%,
p
= 0.318). Multivariable analysis showed that CSPO significantly contributed to higher satisfaction with anal function (beta = 1.752, 95% CI 0.776–2.728) and with quality of life (beta = 1.219, 95% CI 0.374–2.064), but not to Wexner, LARS score, or EORTC QLQ-C30 and QLQ-CR38.
Conclusion
CSPO improved the satisfaction with anal function and quality of life but utilized more preoperative chemoradiotherapy. CSPO may be an alternative choice for patients with very low rectal cancers in better physical health and with higher requirements for anal function and quality of life.
Abstract
Muscle mass heavily influences creatinine-based renal function estimation: a 12-year longitudinal general population-based cohort study
Background
Current guidelines suggest the use of ...estimated glomerular filtration rate (eGFR) based on creatinine as measurement of renal function. However, the influence of muscle mass as key determinant of creatinine after renal function may render those estimates imprecise.
Purpose
To investigate the effects of 24-hour height-indexed creatinine excretion rate (CER index) – deemed an excellent marker of total muscle mass – on creatinine-based eGFR and to compare this with effects of CER index on muscle mass-independent cystatin C-based eGFR.
Methods
We included community-dwelling individuals aged 28–75 years enrolled in the prospective Prevention of REnal and Vascular ENd-stage Disease study. CER was assessed in paired 24-h urine specimens collected during five consecutive screening rounds, each round comprising two outpatient visits separated by three weeks. Cross-sectional and longitudinal associations were respectively quantified using linear regression and linear mixed-effects models, both of which were adjusted for sociodemographic and cardiovascular risk factors.
Results
Of the 7,698 individuals aged 49.8 (12.6) years, of whom 3,839 (49.9%) were male, baseline mean (SD) CER index was 7.0 (1.8) mmol/(24 h·m). Lower CER index was curvilinearly associated with higher creatinine-based eGFR and lower cystatin C-based eGFR (Figure 1). In a hypothetical 70-year-old male, assumed to have a CER index of 4 mmol/(24 h·m) (indicating low muscle mass), predicted creatinine-based eGFR and cystatin C-based eGFR were 79.8 and 64.1 (difference: 15.7) ml/min per 1.73 m2, respectively (Figure 1). If the CER index is held constant at 4 mmol/(24 h·m), the predicted ages at which the threshold of 60 ml/min per 1.73 m2 for the detection of chronic kidney disease would have been exceeded, were 84.7 years for creatinine-based eGFR and 72.7 years for cystatin C-based eGFR (difference: 12.0 years) (Figure 1). During 12.5 years of follow-up, CER index decreased with 0.21 (0.23) mmol/(24 h·m) per 10 years. For every 0.1 mmol/(24 h·m) annual decrease in CER index, creatinine-based eGFR increased with 0.16 (0.07 to 0.25; P=0.0004) ml/min per 1.73 m2 per year, whereas cystatin C-based eGFR decreased with 0.25 (0.15 to 0.34; P<0.0001) ml/min per 1.73 m2 after full adjustment.
Conclusions
Low muscle mass may cause considerable overestimation of single measurements of creatinine-based eGFR compared with cystatin C-based eGFR. Moreover, loss of muscle mass may cause spurious increases in repeatedly measured creatinine-based eGFR. Implementing muscle mass-independent markers for estimating renal function, like cystatin C, could provide a better alternative to accurately assess renal function in all settings wherein low muscle mass or muscle wasting may be encountered.
Figure 1. Sex-specific 3D representation.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Dutch Kidney Foundation
The current study examined the relations between the three Dark Triad (DT) traits and three types of jealousy, among both heterosexual and homosexual men and women involved in a romantic relationship ...(n=439). It was hypothesized that the three DT traits would be related positively to those types of jealousy that have the potential to become delusional, that is anxious and preventive jealousy, but not to the relatively ‘healthy’ type of jealousy, that is reactive jealousy. In addition, differences were examined between men and women, and between homosexuals and heterosexuals with regard to the DT traits, the three types of jealousy, and the relationships between these variables. Results largely confirmed the hypothesis. In addition, moderation analyses showed that the relationships between the three DT traits and the three types of jealousy were not moderated by participant sex or sexual orientation. The current study's findings may deepen our understanding of the role of the DT in the mating psychology of both heterosexuals and homosexuals.
•The Dark Triad traits are related positively to anxious and preventive jealousy.•These relations are not moderated by participant sex and sexual orientation.•Heterosexual men showed relatively high levels of psychopathy.
The potential role of branched-chain amino acids (BCAAs) in the pathogenesis of cardiometabolic diseases is increasingly recognized, but the association of BCAAs with incident hypertension remains ...unknown. The aim of the present study was to explore the association of BCAAs with incident hypertension in a prospective population-based cohort study. We measured plasma concentrations of BCAAs by means of nuclear magnetic resonance spectroscopy in 4169 participants from the PREVEND (Prevention of Renal and Vascular End-stage Disease) study. We estimated the risk of incident hypertension using multivariable-adjusted Cox regression models. After a median follow-up of 8.6 years, incident hypertension was ascertained in 924 subjects. Cox regression analyses revealed a significant association between BCAAs and incident hypertension. The hazard ratio per one SD of BCAAs was 1.11 (95% CI, 1.02-1.20;
=0.01) after full adjustment for multiple clinical variables. Likewise, the fully adjusted association remained significant when evaluated as categorical variable (hazard ratio for upper quartile with lowest quartile as reference category, 1.36; 95% CI, 1.11-1.68;
=0.003). Furthermore, the net reclassification improvement assessment improved after addition of BCAAs to a traditional risk model (
<0.001). This prospective study revealed that high plasma concentrations of BCAAs are associated with an increased risk of newly developed hypertension. The association remained after adjusting for age, sex, body mass index, and lipid profile.
To study the prospective association between dietary protein intake and renal function deterioration in patients with type 2 diabetes (T2D).
Prospective analyses were performed in data of 382 ...patients of the Diabetes and Lifestyle Cohort Twente (DIALECT) study. Dietary protein intake was determined by the Maroni equation from 24-h urinary urea excretion. Renal function deterioration was defined as need for renal replacement therapy or a persistent increase of ≥50% in serum creatinine. Cox proportional hazards models were used to calculate hazard ratios (HRs) for the association between dietary protein intake and renal function deterioration. Threshold levels represent the dietary protein intake at which there was a significantly increased and reduced hazard of renal function deterioration.
Renal function deterioration occurred in 53 patients (14%), with a median follow-up duration of 6 (interquartile range 5-9) years. Mean dietary protein intake was 91 ± 27 g/day (1.22 ± 0.33 g/kg ideal body weight/day). Dietary protein intake was inversely associated with renal function deterioration (HR 0.62 95% CI 0.44-0.90). Patients with an intake <92 g/day had an increased hazard for renal function deterioration (HR 1.44 95% CI 1.00-2.06), while patients with an intake >163 g/day had a decreased hazard for renal function deterioration (HR 0.42 95% CI 0.18-1.00). Regarding dietary protein intake per kilogram body weight, patients with an intake <1.08 g/kg/day had an increased hazard for renal function deterioration (HR 1.63 95% CI 1.00-2.65).
In patients with T2D, unrestricted dietary protein intake was not associated with an increased hazard of renal function deterioration. Therefore, substituting carbohydrates with dietary protein is not contraindicated as a part of T2D management, although it may have a positive effect on body weight while minimizing loss of muscle mass.
Background
In the failing heart, energy metabolism is shifted towards increased ketone body oxidation. Nevertheless, the association of beta‐hydroxybutyrate (β‐OHB) with development of heart failure ...(HF) remains unclear. We investigated the association between plasma β‐OHB and the risk of HF in a prospective population‐based cohort.
Design
Plasma β‐OHB concentrations were measured in 6134 participants of the PREVEND study. Risk of incident HF with reduced (HFrEF) or preserved (HFpEF) ejection fraction was estimated using multivariable‐adjusted Cox regression models.
Results
During median follow‐up for 8.2 years, 227 subjects were diagnosed with HF (137 with HFrEF; 90 with HFpEF). Cox regression analyses revealed a significant association of higher β‐OHB concentrations with incident HF (HR per 1 standard deviation increase, 1.40 (95% CI: 1.21‐1.63; P < .001), which was largely attributable to HFrEF. In women, the hazard ratio (HR) for HFrEF per 1 standard deviation increase in β‐OHB was 1.73 (95% confidence interval (CI): 1.17‐2.56, P = .005) in age, BMI, type 2 diabetes, hypertension, myocardial infarction, smoking, alcohol consumption, total cholesterol, HDL‐C, triglycerides, glucose, eGFR and UAE adjusted analysis. In men, in the same fully adjusted analysis, the HR was 1.14 (CI: 0.86‐1.53, P = .36) (P < .01 for sex interaction). In N‐terminal pro‐brain natriuretic peptide (NT‐proBNP)‐stratified analysis, the age‐adjusted association with HF was significant in women with higher NT‐proBNP levels (P = .008).
Conclusions
This prospective study suggests that high plasma concentrations of β‐OHB are associated with an increased risk of HFrEF, particularly in women. The mechanisms responsible for the sex differences of this association warrant further study.
PDF
