Citations

Objectives To determine the prevalence range for sarcopenic obesity and its relationship with sex, age, and ethnicity. Design Cross‐sectional analysis of a population‐based sample. Setting Noninstitutionalized persons in the U nited S tates participating in the N ational H ealth and N utrition E xamination S urveys 1999–2004. Participants Subsample of 4,984 subjects aged 60 and older with dual‐energy X‐ray absorptiometry body composition data. Measurements Eight definitions of sarcopenic obesity identified from six studies found using a systematic literature review ( B aumgartner, B ouchard, D avison, Z oico, L evine, K im‐1,2,3) were applied to the sample. Results were stratified according to sex, age, and ethnicity. Results Prevalence of sarcopenic obesity ranged from 4.4% to 84.0% in men and from 3.6% to 94.0% in women. Prevalence was higher in men using definitions from Baumgartner (17.9% vs 13.3%, P < .001), Levine (14.2% vs 6.6%, P < .001), and Kim‐1 (30.0% vs 9.3%, P < .001); lower for men using the Davison (4.4% vs 11.1%, P < .001) and Kim‐2 (83.7% vs 94.0%) definitions; and the same for men and women using the Bouchard (45.3% vs 44.3%, P = .32) and Kim‐3 (75.6% vs 77.0%, P = .51) definitions. For all but one definition, sarcopenic obesity increased with each decade and was lower in non‐ H ispanic blacks than whites. Conclusion Prevalence of sarcopenic obesity in older adults varies up to 26‐fold depending on current research definitions. Such a high degree of variability suggests the need to establish consensus criteria that can be reliably applied across clinical and research settings.

AbstractWe previously reported an increased risk of monoclonal gammopathy of undetermined significance (MGUS) in first‐degree relatives of MGUS and multiple myeloma patients. Here, we examine whether primary cytogenetic categories of myeloma differ between patients with and without a family history of MGUS or myeloma. We studied 201 myeloma patients with available data on family history and molecular cytogenetic classification. Myeloma with trisomies was more common in probands who had an affected first‐degree relative with MGUS or myeloma compared with those without a family history (46.9% vs. 33.5%, P = 0.125); however, the difference was not statistically significant. Additional studies on the cytogenetic types of myeloma associated with familial tendency are needed.

This study is a retrospective analysis of the influence of previous cardiac surgery on the outcome of heart transplantation in 118 consecutive recipients from January 1988 to December 1996. Group 1 consisted of 67 patients who had no previous sternotomy, group 2 was 33 patients who had one previous sternotomy, and group 3 was 18 patients who had two or more previous sternotomies. The three groups were demographically similar apart from the indication for transplantation and the sex distribution. Preoperative hemodynamic data, except systolic pulmonary artery pressure, were similar among the three groups. There was no significant difference in hospital mortality, 1-year and 5-year actuarial survival rates, incidence of renal dysfunction requiring dialysis, prolonged respiratory support, elevated total bilirubin, re-exploration for bleeding, incidence of mediastinitis, or postoperative hospital stay between the groups. The rejection-free and infection-free survival rates were similar in the three groups. However, previous sternotomy resulted in significantly longer cardiopulmonary bypass times and increased requirement for blood and blood products. The use of a cell saver limited the need for stored red blood cells. This study demonstrated no survival disadvantage of previous sternotomy in patients undergoing heart transplantation.

Tight blood glucose control has become a therapeutic goal for anesthetic management of patients undergoing cardiovascular surgery. We discuss the evidence for a link between blood glucose levels and rates of morbidity and mortality in cardiac surgical patients in the intensive care unit. Hyperglycemia per se has been associated with higher rates of deep wound infection, neurologic, renal, and cardiac complications following surgery, as well as longer intensive care unit stay. We review the specifics of glucose management in patients undergoing cardiac surgery and hypothermic cardiopulmonary bypass, including the role that insulin may play in regulating blood glucose levels intraoperatively and the relationship between insulin and outcome.

ABSTRACTVenous thromboembolism (VTE) is a common, heritable disease resulting in high rates of hospitalization and mortality. Yet few associations between VTE and genetic variants, all in the coagulation pathway, have been established. To identify additional genetic determinants of VTE, we conducted a two‐stage genome‐wide association study (GWAS) among individuals of European ancestry in the extended cohorts for heart and aging research in genomic epidemiology (CHARGE) VTE consortium. The discovery GWAS comprised 1,618 incident VTE cases out of 44,499 participants from six community‐based studies. Genotypes for genome‐wide single‐nucleotide polymorphisms (SNPs) were imputed to approximately 2.5 million SNPs in HapMap and association with VTE assessed using study‐design appropriate regression methods. Meta‐analysis of these results identified two known loci, in F5 and ABO. Top 1,047 tag SNPs (P ≤ 0.0016) from the discovery GWAS were tested for association in an additional 3,231 cases and 3,536 controls from three case‐control studies. In the combined data from these two stages, additional genome‐wide significant associations were observed on 4q35 at F11 (top SNP rs4253399, intronic to F11) and on 4q28 at FGG (rs6536024, 9.7 kb from FGG; P < 5.0 × 10−13 for both). The associations at the FGG locus were not completely explained by previously reported variants. Loci at or near SUSD1 and OTUD7A showed borderline yet novel associations (P < 5.0 × 10−6) and constitute new candidate genes. In conclusion, this large GWAS replicated key genetic associations in F5 and ABO, and confirmed the importance of F11 and FGG loci for VTE. Future studies are warranted to better characterize the associations with F11 and FGG and to replicate the new candidate associations.

ABSTRACTSearching for rare genetic variants associated with complex diseases can be facilitated by enriching for diseased carriers of rare variants by sampling cases from pedigrees enriched for disease, possibly with related or unrelated controls. This strategy, however, complicates analyses because of shared genetic ancestry, as well as linkage disequilibrium among genetic markers. To overcome these problems, we developed broad classes of “burden” statistics and kernel statistics, extending commonly used methods for unrelated case‐control data to allow for known pedigree relationships, for autosomes and the X chromosome. Furthermore, by replacing pedigree‐based genetic correlation matrices with estimates of genetic relationships based on large‐scale genomic data, our methods can be used to account for population‐structured data. By simulations, we show that the type I error rates of our developed methods are near the asymptotic nominal levels, allowing rapid computation of P‐values. Our simulations also show that a linear weighted kernel statistic is generally more powerful than a weighted “burden” statistic. Because the proposed statistics are rapid to compute, they can be readily used for large‐scale screening of the association of genomic sequence data with disease status.