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BACKGROUND: Dietary fiber (DF) intake may have a protective effect against type 2 diabetes (T2D); however, its relationship with diabetic kidney disease (DKD) remains unclear. AIM: To investigate the potential association between DF intake and the prevalence of DKD in individuals diagnosed with T2D. METHODS: This cross-sectional study used data from the National Health and Nutrition Examination Survey collected between 2005 and 2018. DF intake was assessed through 24-h dietary recall interviews, and DKD diagnosis in individuals with T2D was based on predefined criteria, including albuminuria, impaired glomerular filtration rate, or a combination of both. Logistic regression analysis was used to assess the association between DF intake and DKD, and comprehensive subgroup and sensitivity analyses were performed. RESULTS: Among the 6032 participants, 38.4% had DKD. With lower DF intake-T1 (≤ 6.4 g/1000 kcal/day)-as a reference, the adjusted odds ratio for DF and DKD for levels T2 (6.5-10.0 g/1000 kcal/day) and T3 (≥ 10.1 g/1000 kcal/day) were 0.97 (95%CI: 0.84-1.12, P = 0.674) and 0.79 (95%CI: 0.68-0.92, P = 0.002), respectively. The subgroup analysis yielded consistent results across various demographic and health-related subgroups, with no statistically significant interactions (all P > 0.05). CONCLUSION: In United States adults with T2D, increased DF intake may be related to reduced DKD incidence. Further research is required to confirm these findings.
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Background: Radial artery cannulation is an invasive procedure commonly performed in patients in the perioperative time, in the intensive care unit, and in other critical care settings. The current study aimed to explore the preoperative risk factors associated with difficult radial artery cannulation and develop a nomogram model for adult patients undergoing major surgery. This nomogram may optimize preoperative clinical decision-making, thereby reducing the number of puncture attempts and preventing associated complications. Methods: This was a single-center prospective cohort study. Between December 2021 and May 2022, 530 adult surgical patients were enrolled. The patients were randomized into the training and validation cohorts at a ratio of 8:2. Radial artery cannulation was performed before the induction of anesthesia. Univariate and multivariate logistic regression analyses were performed to identify variables that were significantly associated with difficult radial artery cannulation. These variables were then incorporated into the nomogram. The discrimination and calibration abilities of the nomogram were assessed. Results: One hundred and seventy-three (41.7 %) patients in the training cohort had difficult radial artery cannulation. Based on multivariate analysis, the independent risk factors were wrist circumference, anatomical abnormalities, BMI <18.5 kg/m2, grade II hypertension, hypotension, and history of chemotherapy and stroke. The concordance indices were 0.765 (95 % confidence interval [CI]: 0.719-0.812) and 0.808 (95 % CI: 0.725-0.890) in the training and validation cohorts, respectively. The calibration curve showed good agreement between the actual and predicted risks. Conclusions: A preoperative predictive model for difficult radial artery cannulation in adult patients undergoing surgery was developed and validated. This model can provide reliable data for optimizing preoperative clinical decision-making.
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Purpose: Bladder spasm (BS) and catheter-related bladder discomfort (CRBD) are complications after transurethral holmium laser enucleation of the prostate (HoLEP). The pudendal nerve (PN) innervates the perineum. Therefore, we evaluated whether PN block (PNB) can reduce the incidence of BS and CRBD in patients undergoing HoLEP. Methods: In this randomized, parallel, single-blind prospective study, we enrolled 110 patients who were scheduled to undergo HoLEP under general anesthesia. Patients were randomly allocated to the PNB group (ultrasound-guided PNB at the entrance of the pudendal [Alcock's] canal bilaterally; n = 55) or the control group (general anesthesia only; n = 55). The primary outcome was the incidence of BS and CRBD at 0.5, 1, 2, 4, 6, 12, and 24 hours postoperatively. The CRBD severity, postoperative pain, and analgesic drug use were also assessed. A P value of < 0.05 was considered statistically significant. Results: A significantly lower incidence of BS (P = 0.023) and CRBD (P < 0.001) was reported within the first 24 hours postoperatively in the PNB group. The incidence of CRBD above a moderate grade at 0.5 (P < 0.001), 1 (P < 0.001), 2 (P < 0.001), and 4 (P = 0.019) hours postoperatively was significantly lower in the PNB group. Additionally, postoperative pain scores and analgesic drug use were significantly lower in the PNB group. No PNB-related complications were observed. Conclusion: PNB at the entrance of the pudendal canal bilaterally resulted in a lower incidence of BS and CRBD, less postoperative pain, and less analgesic drug use in patients undergoing HoLEP without PNB-related side effects. Implication Statement: Bladder spasm and catheter-related bladder discomfort can occur in older individuals undergoing transurethral holmium laser enucleation of the prostate. They often result in severe pain and prolonging the hospital stay. We performed a bilateral ultrasound-guided pudendal nerve block at the entrance of the pudendal (Alcock's) canal and found that the block reduced bladder spasm, catheter-related bladder discomfort, postoperative pain, and use of anesthetics. Besides, pudendal nerve block also decreased the severity of catheter-related bladder discomfort and helped older individuals achieve rapid recovery.
