Inpatient Palliative Care Is Less Utilized in Rare, Fatal Extrahepatic Cholangiocarcinoma: A Ten-Year National Perspective.

Background-Extrahepatic cholangiocarcinoma (ECC) is a rare, morbid, fatal cancer with distressing symptoms. Maintaining a high quality of life while reducing hospital charges and length of stay (LOS) for the end-of-life period remains a major challenge for the healthcare system. Palliative care utilization has been shown to address these challenges; moreover, its use has increased in recent years among cancer patients. However, the utilization of palliative care in rare cancers, such as ECC, has not yet been explored. Objectives-To investigate palliative care utilization among ECC patients admitted to US hospitals between 2007 and 2016 and its association with patient demographics, clinical characteristics, hospital charges, and LOS. Methods-De-identified patient data of each hospitalization were retrieved from the National Inpatient Sample (NIS) database. Codes V66.7 (ICD-9-CM) or Z51.5 (ICD-10-CM) were used to find palliative care utilization. Multivariate adjusted logistic regression analyses were conducted to assess factors associated with palliative care use, LOS, hospital charges, and in-hospital death. Results-Of 4426 hospitalizations, only 6.7% received palliative care services. Palliative care utilization did not significantly increase over time (p = 0.06); it reduced hospital charges by USD 25,937 (p < 0.0001) and LOS by 1.3 days (p = 0.0004) per hospitalization. Palliative care was positively associated with female gender, severe disease, and age group ≥80 (p ≤ 0.05). The average LOS was 8.5 days for each admission. Conclusions-Hospital admissions with palliative care utilization had lower hospital charges and LOS in ECC. However, ECC patients received less palliative care compared with more common cancers sharing similar symptoms (e.g., pancreatic cancer). ECC patients also had longer LOS compared with the national average. Further research is warranted to develop interventions to increase palliative care utilization among ECC hospital patients.

How to Simplify the Diagnostic Criteria of Metabolic Syndrome in Adolescents.

BACKGROUND: This study evaluated the feasibility and accuracy of the height-corrected definition for identifying metabolic syndrome (MS). METHODS: In 2006, anthropometric and biochemical measurements were assessed in a cross-sectional population-based study of 3136 Han adolescents, aged 13-17 years. MS was defined according to the definitions of Cook et al, International Diabetes Federation, and the Society of Pediatrics, Chinese Medical Association. Waist-to-height and blood pressure-to-height ratios were alternatives to waist circumference and blood pressure in the height-corrected definition. RESULTS: According to the MS definition and the height-corrected MS definition, this agreement would be classified as "very good" (National Cholesterol Education Program kappa coefficients: 0.850 in boys and 0.816 in girls; International Diabetes Federation kappa coefficients: 0.953 in boys and 0.807 in girls; Society of Pediatrics, Chinese Medical Association kappa coefficients: 0.932 in boys; p < 0.001) and "good" (Society of Pediatrics, Chinese Medical Association kappa coefficients: 0.737 in girls; p < 0.001). CONCLUSION: The present study demonstrates that the height-corrected definition of MS is a simple, inexpensive, and accurate tool for identifying MS in Han adolescents.

A new modified blood pressure-to-height ratio simplifies the screening of hypertension in Han Chinese children.

The present study evaluated the simplicity and accuracy of a new modified blood pressure-to-height ratio (MBPHR3) in identifying hypertension among Han children aged 7-12 years. In 2011, anthropometric measurements were collected as part of a cross-sectional population-based study of 1352 Han children aged 7-12 years. Receiver operating characteristic curve analyses were performed to assess the accuracy of the modified systolic blood pressure-to-height ratio (MSBPHR3) and the modified diastolic blood pressure-to-height ratio (MDBPHR3) as diagnostic tests for the detection of elevated SBP and DBP, respectively. The accuracies of MSBPHR3 and MDBPHR3 (as assessed by the area under the curve) in identifying elevated SBP and DBP were greater than 0.85 (0.974-0.995). When the MBPHR3 was used to identify hypertensive children, the sensitivity was 100% in boys and 100% in girls. The specificity was 93.8% in boys and 97.1% in girls. In conclusion, the MBPHR3 is a simple, accurate and non-age-dependent index for the screening of hypertension in Han children.

Mid-upper-arm circumference and arm-to-height ratio in evaluation of overweight and obesity in Han children.

BACKGROUND: The purposes of this study were: (1) to analyze whether mid-upper-arm circumference (MUAC) could be used to determine overweight and obese children and to propose the optimal cutoffs of MUAC in Han children aged 7-12 years; and (2) to evaluate the feasibility and accuracy of the arm-to-height ratio (AHtR) and propose the optimal cutoffs of AHtR for identifying overweight and obesity. MATERIALS AND METHODS: In 2011, anthropometric measurements were assessed in a cross-sectional, population-based study of 2847 Han children aged 7-12 years. Overweight and obesity were defined according to the 2004 Group of China Obesity Task Force definition. The AHtR was calculated as arm circumference/height. Receiver operating characteristic curve analyses were performed to assess the accuracy of MUAC and AHtR as diagnostic tests for elevated body mass index (BMI; defined as BMI ≥ 85(th) percentiles). RESULTS: The accuracy levels of MUAC for identifying elevated BMI [as assessed by area under the curve (AUC)] were over 0.85 (AUC: approximately 0.934-0.975) in both genders and across all age groups. The MUAC cutoff values for elevated BMI were calculated to be approximately 18.9-23.4 cm in boys and girls. The accuracy levels of AHtR for identifying elevated BMI (as assessed by AUC) were also over 0.85 (AUC: 0.956 in boys and 0.935 in girls). The AHtR cutoff values for elevated BMI were calculated to be 0.15 in boys and girls. CONCLUSION: This study demonstrates that MUAC and AHtR are simple, inexpensive, and accurate measurements that may be used to identify overweight and obese Han children. Compared with MUAC, AHtR is a nonage-dependent index with higher applicability to screen for overweight and obese children.

Blood pressure-to-height ratio as a screening measure for identifying children with hypertension.

The present study evaluated the feasibility and accuracy of the blood pressure-to-height ratio (BPHR) and proposed the optimal thresholds of BPHR for identifying hypertension in Han children aged 7-12 years. In 2011, anthropometric measurements were assessed in a cross-sectional population-based study of 1,352 Han children aged 7-12 years. Hypertension was defined according to the 2004 National High Blood Pressure Education Program Working Group definition (as gold standard). The following equations for BPHR were used: systolic blood pressure-to-height ratio (SBPHR) = SBP (mmHg)/height (cm) and diastolic blood pressure-to-height ratio (DBPHR) = DBP (mmHg)/height (cm). Receiver operating characteristic curve analyses were performed to assess the accuracy of SBPHR and DBPHR as diagnostic tests for elevated SBP and DBP, respectively. After the cutoff points were determined, hypertension was defined by SBPHR/DBPHR (new standard), and the sensitivity and specificity were calculated. The accuracy of SBPHR and DBPHR (assessed by area under the curve) for identifying elevated SBP and DBP was over 0.85 (0.946-1.000). SBPHR cutoff values for elevated SBP were calculated to be 0.76-0.88 mmHg/cm in boys and 0.78-0.90 mmHg/cm in girls. DBPHR cutoff values for elevated DBP were calculated to be 0.51-0.60 mmHg/cm in boys and 0.51-0.58 mmHg/cm in girls. When hypertension was defined by BPHR, the sensitivities were 100 % in boys and 95.0 % in girls. The specificity was 94.3 % in boys and 96.8 % in girls. BPHR is a simple, inexpensive, and accurate index for screening hypertension in Han children.

The study of soluble intercellular adhesion molecule-1 and ghrelin in adolescents with family history of type 2 diabetes.

The purpose of this study was to observe both the changes of soluble intercellular adhesion molecule-1 (sICAM-1) and ghrelin in adolescents with family history of type 2 diabetes (FHD) and the relationship between sICAM-1 and ghrelin. This case-control study included 63 adolescents (boys/girls 29/34, age 14.1 ± 0.7 years) without FHD (FHD-) and 67 adolescents (boys/girls 33/34, age 14.0 ± 0.8 years) with FHD (FHD+). Anthropometric measurements, including height, weight, waist circumference (WC), and blood pressure, were obtained. Blood samples were collected, and fasting plasma glucose (FPG), serum lipids, true insulin, sICAM-1, and ghrelin were assayed. The results showed that the age and gender were similar in two groups (P > 0.05). Body mass index (BMI), WC, FPG, fasting insulin, HOMA-IR, and sICAM-1 were all significantly higher in the FHD+ group than in the FHD- group (P < 0.05). Ghrelin was significantly lower in the FHD+ group than in the FHD- group (P < 0.05). sICAM-1 was positively correlated with WC (r = 0.178, P = 0.043), fasting insulin (r = 0.195, P = 0.026), HOMA-IR (r = 0.197, P = 0.024), and ghrelin (r = 0.290, P = 0.001). After multivariate analysis, the ghrelin (ß = 0.788, 95 % CI: 0.416-1.159, P = 0.000) and HOMA-IR (ß = 0.106, 95 % CI: 0.045-0.167, P = 0.001) maintained an independent association with sICAM-1. These findings led to the conclusion that endothelial dysfunction and decline of ghrelin were found in adolescents with family history of diabetes. The decline of ghrelin maybe a protection mechanism for endothelial function in adolescents with family history of diabetes and should be examined in future studies.

Neck circumference is an accurate and simple index for evaluating overweight and obesity in Han children.

BACKGROUND: The prevalence of obesity has reached alarming levels in recent years. Neck circumference (NC) has been shown to be an indicator of central adiposity. AIM: The purpose of this study was to analyse whether NC can be used to determine overweight and obesity in Han Chinese children. SUBJECTS AND METHODS: In 2011, anthropometric measurements were gathered in a cross-sectional, population-based study of 2847 Han children aged 7-12 years. Overweight and obesity were defined according to the 2004 Chinese obesity task force definition. Receiver operating characteristic curve analyses were conducted to assess the accuracy of NC as a diagnostic test for elevated body mass index (BMI) (overweight and obesity). RESULTS: The prevalence of overweight and obesity in boys was 18.0% and 26.0%, respectively, and 11.7% and 15.7%, respectively, for girls. The mean NC in boys was significantly greater than in girls (29.2 ± 3.1 cm vs 28.1 ± 2.8 cm, p < 0.001). NC was significantly correlated with age, BMI and waist circumference in both boys and girls (p < 0.001 for all comparisons). NC cut-off values for elevated BMI were between 27.4~31.3 cm in boys and 26.3~31.4 cm in girls. The sensitivities were 75.5~86.7% in boys and 80.0~92.5% in girls. The specificities were 73.9~91.7% in boys and 74.7~93.3% in girls. CONCLUSION: The present study demonstrates that NC is a simple, inexpensive and accurate measurement that may be used to identify overweight and obesity in Han children.

Value of dual-energy X-ray absorptiometry derived parameters vs anthropometric obesity indices in the assessment of early atherosclerosis in abdominally obese men.

OBJECTIVE: The purpose of this study was to evaluate the value of dual-energy X-ray absorptiometry (DEXA) derived parameters vs anthropometric obesity indices in the assessment of early atherosclerosis in abdominally obese men. METHODS: This case-control study included 44 abdominally obese men (waist circumference ≥ 90 cm) and 30 non-abdominally obese men (waist circumference < 90 cm) who were between 20 and 50 years of age. All subjects were of the Han ethnicity. The carotid intima-media thickness (CIMT) was used as a surrogate marker of early atherosclerosis. In the first multiple linear regression model, body fat distribution was assessed by anthropometric obesity indices, while in the second one it was quantified by DEXA-derived parameters. RESULTS: CIMT (0.74 ± 0.11 vs 0.67 ± 0.04 mm) were significantly higher in the abdominally obese men than in the non-abdominally obese men (P < 0.01). CIMT was positively correlated with anthropometric obesity indices (r: 0.352-0.488, P < 0.01) and the indices from DEXA(r: 0.244-0.482, P < 0.05). The correlation coefficients of anthropometric obesity indices and the indices from DEXA were highest for waist to height ratio and trunk fat mass, respectively. In model 1, 23.8% of the total variance of CIMT was due to waist to height ratio. In model 2, trunk fat mass explained 23.2% of the total variance of CIMT. CONCLUSIONS: The present study demonstrates the importance of characterizing body fat distribution in identifying early atherosclerosis. Body fat distribution evaluated by dualenergy X-ray absorptiometry was associated with CIMT, but was not superior to anthropometric measurements.

Glycemic variability in abdominally obese men with normal glucose tolerance as assessed by continuous glucose monitoring system.

The purpose of this study was to observe both the glycemic variability in abdominally obese men with normal glucose tolerance (NGT) and the relationship between glycemic variability and early atherosclerosis. This case-control study included 23 abdominally obese men (waist circumference (WC) ≥90 cm) and 23 nonabdominally obese men (WC <90 cm) with NGT who were between 20 and 50 years of age. All subjects were of the Han ethnicity. The cases and controls were age-matched. A continuous glucose monitoring system (CGMS) was used in this study. With the CGMS, the standard deviation of blood glucose (SDBG) and the mean amplitude of glucose excursion (MAGE) were calculated to estimate glycemic variability. The carotid intima-media thickness (CIMT) was used as a surrogate marker of early atherosclerosis. Mean blood glucose (MBG) (6.13 ± 0.94 vs. 5.55 ± 0.87 mmol/l), SDBG (0.89 ± 0.34 vs. 0.64 ± 0.24 mmol/l), MAGE (2.05 ± 0.83 vs. 1.57 ± 0.52 mmol/l), and CIMT (0.73 ± 0.12 vs. 0.67 ± 0.05 mm) were significantly higher in the abdominally obese men than in the nonabdominally obese men (P < 0.05). WC positively correlated with MBG (r = 0.302, P = 0.041), SDBG (r = 0.362, P = 0.013), MAGE (r = 0.302, P = 0.041), and CIMT (r = 0.487, P = 0.001). CIMT did not correlate with MBG (r = 0.206, P = 0.169), SDBG (r = 0.114, P = 0.450), and MAGE (r = 0.085, P = 0.574). After multivariate analysis, WC was still significantly associated with MBG (ß = 0.025, P = 0.041), SDBG (ß = 0.010, P = 0.013), MAGE (ß = 0.019, P = 0.042), and CIMT (ß = 0.008, P = 0.022). This study demonstrates that glycemic variability is increased in abdominally obese men with NGT. A relationship between glycemic variability and atherosclerosis was not observed in this study and requires further investigation.

The relationship between the waist-to-height ratio and glucose and lipid metabolism in Han adolescents.

OBJECTIVE: To evaluate the relationship between waist-to-height ratio (WHtR) and glucose and lipid metabolism in Han adolescents aged 13-15 years. METHODS: A study was conducted on 1665 Han adolescents aged 13-15 years. Measurements included height, weight, waist circumference, fasting plasma glucose(FPG), triglyceride and high-density lipoprotein cholesterol. The subjects were divided into two groups according to WHtR. RESULTS: Compared with the control group (n=1340,WHtR<0.46), the abdominal obesity group(n=325,WHtRe"0.46) had significantly higher levels of body mass index (BMI) (26.3+/-3.6 vs 18.9+/-2.3), WHtR (0.51+/-0.04 vs 0.40+/-0.03), FPG (4.99+/-0.48 vs 4.86+/-0.46), and triglyceride (1.21+/-0.62 vs 0.87+/-0.41), and a lower level of high-density lipoprotein cholesterol (1.26+/-0.27 vs 1.46+/-0.30) (P<0.01). Logistic regression analysis showed that after controlling for age, sex and BMI, the elevated FPG and dyslipidemia risk odds ratios of the abdominal obesity group were 1.954 (95% CI:1.250 approximately 3.054) and 2.012 (95% CI:1.204 approximately 3.362) (P<0.01) respectively. When clustered, the odds ratio of elevated FPG and dyslipidemia was 6.659 (95% CI: 1.337 approximately 33.159) (P<0.01). CONCLUSION: The waist-to-height ratio is an appropriate measure to assess dyslipidemic-diabetic adolescents and should be used to guide early intervention with the aim of future prevention of these linked diseases.

Prevalence of impaired fasting glucose and analysis of risk factors in Han adolescents.

OBJECTIVE: To evaluate the prevalence of impaired fasting glucose (IFG) and its relationship with cardiovascular risk factors in Han adolescents aged 13 to 18 years. METHODS: Step 1: A cross-sectional study was conducted on 3937 Han adolescents. IFG was defined as a fasting glucose of 5.6 to 7.0 mmol/l. Measurements included anthropometric measurements, fasting plasma glucose (FPG), and serum lipids. Step 2: We identified 60 adolescents with IFG from the IFG group using a random number table, and 60 adolescents with normal fasting glucose (NFG) were matched for age and gender with the random IFG sample. Serum true insulin (TI) was further measured. RESULTS: (1) The prevalence of IFG was 3.5% and was similar in boys and girls (3.9% vs. 3.1%, P=.177). The prevalence of IFG in adolescents with a family history of type 2 diabetes (FHD) was higher than in adolescents without FHD (6.3% vs. 2.5%, P=.000). (2) In logistic regression, the clustering of cardiovascular risk factors among adolescents with IFG was 1.889 (95% CI: 1.125-3.171, P=.016) times compared with adolescents with NFG adjusted by age and gender. (3) Multiple linear regression analysis using FPG as the dependent variable showed that waist circumference (beta=0.003, P=.000) was a significant independent predictor. (4) In Step 2, the IFG group showed significantly higher levels of lnTI and lnHOMA-IR than the NFG group (P<.01). FPG was a significant independent predictor for lnTI (beta=0.478, P=.000) and lnHOMA-IR (beta=0.671, P=.000). CONCLUSION: We found a high prevalence of IFG in Han adolescents. Genetic susceptibility and abdominal obesity were the main factors causing adolescent IFG. Adolescents with IFG increased the clustering of cardiovascular risk factors.

Factors associated with insulin resistance and fasting plasma ghrelin levels in adolescents with obesity and family history of type 2 diabetes.

OBJECTIVE: To investigate the changes of insulin resistance and fasting plasma ghrelin levels in adolescents with obesity and family history of type 2 diabetes mellitus (FHD) and analyze its related factors. METHODS: The study included 159 adolescents aged 13-15 years. Anthropometric- measurements, including height, weight and waist. Blood samples were collected and fasting plasma glucose (FPG), serum lipids, true insulin (TI) and fasting plasma ghrelin were assayed. They were divided into four groups according to body mass index (BMI) and FHD: 40 non-obese adolescents without FHD in group A; 40 overweight and obese adolescents without FHD in group B; 40 non-obese adolescents with FHD in group C; 39 overweight and obese adolescents with FHD in group D. RESULTS: Group B, C and D had significantly higher levels of HOMA-IR and HOMA-beta index than group A, especially Group D (p<0.01). Group C and D had significantly higher levels of FPG and lower levels of ghrelin than group A (p<0.01). HOMA-IR showed positive correlation with BMI (r=0.445), waist (r=0.435), waist-to-height ratio (WHtR)(r=0.471) (p<0.01). Ghrelin showed negative correlation with FPG (r=-0.339), TI (r=-0.237) and HOMA-IR (r=-0.269) (p<0.01). In multiple linear regression analysis, WHtR (beta=4.925, p=0.000) and FHD (beta=0.492, p=0.000) were significant independent predictors for HOMA-IR. FHD (beta=-289.856, p=0.000) and FPG (beta=-228.203, p=0.001) were significant independent predictors for ghrelin. CONCLUSION: This study showed that the subjects with FHD and obesity who are predisposed to diabetes have insulin resistance in adolescent stage. The lower ghrelin levels in subjects with FHD may be the result of elevated FPG.

[The best waist circumference cut-point for identifying cardiovascular risk factors among adolescents: a preliminary study].

OBJECTIVE: To explore the best waist circumference (WC) cut-point for identifying cardiovascular risk factors among adolescents. METHODS: Human basic parameters were measured among 3986 adolescents aged 14 - 18 in Qinhuangdao. Receiver operator characteristic curve (ROC) analysis was employed to determine the optimal WC cut-point for detecting cardiovascular risk factors. RESULTS: The prevalence of the clustering of cardiovascular risk factors significantly increased after the WC was >or= 80th percentiles (77.0 - 79.0 cm for the boys and 70.0 - 72.5 cm for the girls). The age standardization detection rate was 24.9% in boys and 9.9% in girls. ROC analysis showed that the optimal WC cut-point was 80th percentiles, with the sensitivity of 84.3% and specificity of 85.9% in boys, and with sensitivity of 90.7% and specificity of 83.2% in girls. CONCLUSION: There is a significant correlation between WC and cardiovascular risk factors. The optimal WC cut-point for predicting the clustering of cardiovascular risk factors is the 80th percentile.