The micronutrient content of the diet is correlated with serum glucose biomarkers and lipid profile and is associated with the odds of being overweight/obese-a case-control study.

Background: A low micronutrient intake has been reported to contribute to the double-burden of obesity, increasing the risk for chronic diseases such as cardiovascular disease, diabetes, cancer, and mental disorders. This case-control study compared micronutrient intake profiles in overweight/obese vs. normal-weight individuals. We hypothesized that a low intake of certain micronutrients would increase the odds of being overweight/obese. Methods: The case group (n = 812 adults) consisted of individuals with a BMI of ≥25 kg/m2, and the control group (n = 793) had BMIs of 17.9-24.9 kg/m2. A validated 124-item food frequency questionnaire was used to determine micronutrient-related dietary-quality, using the index of nutritional quality (INQ), calculated as the fraction of a micronutrient consumed vs. its dietary requirement. In addition, body surface area (BSA) was calculated according to the Mosteller formula. Results: The control group had significantly higher INQ-scores of vitamin A, vitamin C, calcium, magnesium, and selenium compared to the case group. Furthermore, individuals with normal BSA (≤1.91 m2 for men; ≤1.71 m2 for women) had significantly higher INQ scores of vitamin C, calcium, magnesium, and zinc compared to participants with high BSA. In multivariable adjustment regression models, INQs of vitamin C (ORBMI = 0.79, 95%CI: 0.64-0.97; ORBSA = 0.81, 95%CI, 0.68-0.97) and magnesium (ORBMI = 0.69, 95%CI: 0.47-0.99; ORBSA = 0.71, 95%CI: 0.52-0.97) were significantly associated with the odds of obesity/overweight (in both BMI and BSA categories). Conclusion: The significant association between micronutrient levels of the diet, especially of vitamin C and magnesium, with both obesity criteria, emphasized the importance of certain micronutrients in the obesity/overweight causal network.

Prevalence and burden of atopic dermatitis involving the head, neck, face, and hand: A cross sectional study from the TARGET-DERM AD cohort.

BACKGROUND: Atopic dermatitis (AD) is severely burdensome, and there has been poor characterization of any differences in impact based on the area affected. OBJECTIVE: To estimate the prevalence and HRQoL impact of head/face/neck/hand (HFNH) involvement among patients with moderate-to-severe atopic dermatitis. METHODS: All TARGET-DERM AD registry patients with moderate/severe Investigator Global Assessment (vIGA-AD) were assessed using the Patient Oriented SCORing Atopic Dermatitis, Patient Oriented Eczema Measure (POEM) and the (Children's) Dermatology Life Quality Index ((C)DLQI). RESULTS: 541 participants met the criteria (75.0% adults) and 84% (N = 453) reported HFNH involvement. HFNH and non-HFNH involved participants had similar characteristics; 55.2% female and 46.9% White. Compared to the non-HFNH involved, the involved had severe vIGA-AD (28.5% vs 16.3%, P = .02) and higher median body surface area affected (15% vs 10%, P ≤ .01) and were twice as likely to have higher (C)DLQI and POEM scores. LIMITATIONS: This was an analysis of real-world and patient reported outcome data. CONCLUSION: Real-world HFNH involved AD patients were associated with significantly worse quality of life, POEM/(C)DLQI, and more severe disease. Detailed assessments of specific areas affected by AD are needed to personalize treatment.

Docetaxel population pharmacokinetic modelling and simulation in Chinese cancer patients.

Background: Docetaxel is a widely prescribed cytotoxic chemotherapy drug for various cancers and the main dose-limiting toxicity is dose-dependent neutropenia. In China, the current dose regimen for docetaxel frequently results in high inter-individual pharmacokinetic (PK) variability. There is a very urgent need to establish a population PK model of docetaxel for Chinese cancer patients, to predict the area under the curve (AUC) based on the PK model and avoid toxicity, providing optimal drug dose guidance to clinicians. Methods: Docetaxel was administered at a dose of 75 mg/m2 once every 3 weeks, and at the scheduled time, blood samples were collected to measure the docetaxel concentration. A nonlinear, mixed-effects modelling approach was used to fit the plasma concentration-time data. A two-compartmental model was selected to characterize the in vivo behavior of docetaxel. Using population modelling, various covariates were explored to ascertain their impact on the docetaxel PK. Monte Carlo simulations were performed to derive the optimal individualized dose regimen. Results: A total of 440 patients with 880 concentration data were collected. The covariate selection indicated that age, body mass index (BMI), and body surface area (BSA) had significant correlations with docetaxel clearance (CL). Bootstrap and visual predictive check (VPC) indicated that a robust and reliable PK model had been established. The final population model was effectively used for simulation to determine docetaxel dose regimens for Chinese cancer patients. Aiming an AUC <2.6 mg/L·h, a simple to use dose regimen was derived based on Monte Carlo simulations. Conclusions: A population PK model of docetaxel for Chinese cancer patients was developed and validated, showing that age, BMI, and BSA were significantly associated with CL. A simple to use dose regimen table was created to guide clinicians.

Tepilamide Fumarate (PPC-06) Extended Release Tablets in Patients with Moderate-to-Severe Plaque Psoriasis: Safety and Efficacy Results from the Randomized, Double-blind, Placebo-controlled AFFIRM Study.

Objective: Safe, effective, long-term oral therapies are needed for plaque psoriasis. This study aimed to assess the safety and effectiveness of tepilamide fumarate (a fumaric acid ester) extended-release tablets. Methods: This Phase IIb, randomized, double-blind, placebo-controlled, 24-week, multicenter study treated adults with moderate-to-severe plaque psoriasis with tepilamide fumarate 400 mg once (QD) or twice daily (BID), 600 mg BID, or placebo. Coprimary endpoints were the proportion of patients achieving ≥75% reduction in the Psoriasis Area and Severity Index (PASI-75) and Investigator's Global Assessment (IGA) of clear or almost clear (≥2 points' reduction). Results: A total of 426 patients were randomized (mean age 49.6 [±13.0] years). There was a ≥75% PASI reduction in 39.7%, 47.2%, 44.3%, and 20.0% in the 400 mg QD, 400 mg BID, 600 mg BID, and placebo groups, respectively; IGA treatment success was 35.7%, 41.4%, 44.4%, and 22.0%, respectively. Between 50%-66% of tepilamide fumarate and 48% of placebo patients experienced ≥1 treatment-emergent adverse event. Gastrointestinal intolerance (20%-42%), infection (6%-18%), and decreased lymphocyte count (4%-9%) were more common with tepilamide fumarate. Limitations: High placebo response somewhat limits the utility of these findings. Conclusion: Patients with moderate-to-severe plaque psoriasis treated with oral tepilamide fumarate demonstrated positive response.

Body Surface Area (BSA) is a Better Osteoporosis Associated Anthropometric Parameter Than Other Anthropometric Parameters in Elderly Population.

Body surface area (BSA) is widely used for adjusting drug dose, while few studies have yet systematically evaluated its association with osteoporosis and compared its advantage with other anthropometric parameters in osteoporotic risk prediction. A total of 10,021 Chinese individuals aged over 65 years were enrolled in our study. Bone mineral density (BMD) was measured, and demographic information was also collected. Pearson correlation analysis, receiver operating characteristic (ROC) curves and predictive analysis were performed to assess the clinical practice of BSA for osteoporosis. BSA had the strongest correlation with BMD (0.544, p < 0.001) compared with conventional anthropometric indices. Besides, BSA had the highest power in osteoporosis prediction, with an area under the curve (AUC) reaching 0.81. After incorporating BSA into the osteoporosis risk prediction model, the AUC improved from 0.82 to 0.83 (p < 0.01). We found BSA provided additional diagnostic value beyond conventional anthropometric information with continuous and category NRIs were 30.40% (p < 0.01) and 3.29% (p < 0.01), respectively, and the IDI was 1.85% (p < 0.01). BSA was positively associated with osteoporosis and showed superior discriminative ability for osteoporosis risk prediction compared with other anthropometric parameters in the Chinese elderly population.

Psoriatic patients treated with secukinumab reach high levels of minimal disease activity: results from the SUPREME study.

BACKGROUND: Achieving minimal disease activity (MDA) represents an ambitious and sustainable therapeutic goal in psoriasis. Clear criteria for defining MDA in psoriasis are lacking. OBJECTIVES: The primary outcome was to evaluate the effect of 300 mg secukinumab in achieving MDA in patients with psoriasis and identify the most useful criteria to define MDA in such patients. The secondary outcome was to identify clinical factors influencing MDA. MATERIALS & METHODS: In this post hoc analysis of the SUPREME study, in which 433 patients were enrolled, MDA was assessed using established criteria: ≥90% improvement in Psoriasis Area and Severity Index (PASI 90) and Dermatology Life Quality Index 0/1 (MDA-1), PASI score ≤1 or body surface area (BSA) <3% (MDA-2), or Investigator Global Assessment x BSA (MDA-1a and MDA-2a), for which cut-off values were obtained in patients achieving MDA-1 and MDA-2, respectively. RESULTS: After 16 weeks of secukinumab, 65% and 76% of the evaluable population achieved MDA-1 and MDA-2, respectively; at Week 24, this was 70% and 83%. Factors that positively influenced MDA at Week 16 were younger age, lower weight and body mass index, absence of depression and anxiety, and lower serum levels of complement C3 and high-sensitivity C-reactive protein. MDA-1a and MDA-2a were achieved by 64% and 74% of patients at Week 16 and by 70% and 81% at Week 24, respectively. CONCLUSION: Patients treated with secukinumab achieved high levels of MDA at Weeks 16 and 24, regardless of the method used to calculate MDA.

Body surface area-based equivalent dose calculation in tree shrew.

Tree shrew (Tupaia belangeri) is a promising experimental animal in biomedical research, but the equivalent doses of drugs between tree shrew and human and other animals has not been explored, which hinders its further application in a wider scope. The main objective of this article is to provide a method of equivalent dose conversion between tree shrews and other species based on body surface area (BSA). BSA of tree shrews were measured by Image J software, and then the average Km value of tree shrews was figured out based on the body weights and BSA, then the conversion coefficients of equivalent dose among tree shrew and other species of experimental animals were calculated based known data. The Km value of tree shrews was 0.105 ± 0.001. Through BSA conversion, the equivalent dose for tree shrews (D-ts) relative to rats was obtained by formula: D-ts = 1.36 × D-a (rats weighing 200g as example), and the error was less than 10% when the BW of the tree shrew was 0.09 kg-0.15 kg. The coefficients of equivalent dose transferring from tree shrews to human and other species were calculated in article. These parameters could be used to determine a suitable dosing strategy for tree shrew studies.

The impact of total body water on breath alcohol calculations.

Due to a legislative amendment in Austria to determine breath alcohol (BrAC) instead of blood alcohol (BAC) in connection with traffic offences, many results of blood alcohol calculations were simply converted using distinct conversion factors. In Austria, the transformation of BAC to BrAC was carried out by using a factor of 1:2000, which, however, is commonly known to be too low. Noticing the great demand for a calculation method that is not exclusively based on blood alcohol, a formula for calculating breath alcohol based on blood alcohol was published in 1989, but in which the body surface area (BSA) was considered the most important influencing variable. In order to refine this new method, a liquor intake experiment was conducted combined with measurements of total body water (TBW) as an additional variable, using hand to foot bioelectrical impedance assessment (BIA). The test group comprised 37 men and 40 women to evaluate the accuracy of TBW and BSA as an individual parameter for alcohol concentration. The correlation coefficient of BrAC with TBW was constantly higher than with BSA (maximum = 0.921 at 1 h and 45 min after cessation of alcohol intake). These results are valid for both men and women as well as in a gender independent calculation. Hence, for an accurate back calculation of BrAC adjusted values of eliminations rates had to be found. This study describes mean elimination rates of BrAC for both men (0.065 ± 0.011 mg/L h-1) and women (0.074 ± 0.017 mg/L h-1). As previously shown women displayed a significantly higher elimination rate than men (p = 0.006).

Treating to Target-A Realistic Goal in Psoriasis?

For many patients, the new biologic therapies for psoriasis can improve Psoriasis Area and Severity Index (PASI) scores in a relatively short time. But when results are less than optimal, patients often become frustrated. By providing effective medical treatment using a treat-to-target strategy, clinicians can relieve symptoms and halt disease progression. Although body surface area (BSA) and PASI scores are appropriate for analyzing results of clinical trials, clinicians need to use more patient-centered assessments of patients' progress such as the Dermatology Life Quality Index (DLQI) and Psoriasis Symptom Inventory (PSI), as well as other validated patientreported outcomes, which can enable them to set realistic and achievable goals for individual patients. Semin Cutan Med Surg 37(supp2):S44-S47.

Outcomes in patients with advanced heart failure and small body size undergoing continuous-flow left ventricular assist device implantation.

Left ventricular assist devices (LVADs) have become a preferred treatment option for patients with end-stage heart failure when used as a bridge to transplant or as a destination therapy. However, the association between small body size and postoperative outcomes for continuous-flow (CF) LVAD recipients is still being studied. We sought to determine whether body surface area (BSA) is associated with patient outcomes after CF-LVAD implantation. The study cohort of our single-center, retrospective review consisted of all patients (n = 526) who underwent CF-LVAD implantation (n = 403 HeartMate II, n = 123 HeartWare) between November 2003 and March 2016 regardless of indication. Patients were stratified into 2 cohorts according to their BSA measurements: small BSA (<1.5 m2, n = 13) and non-small BSA (≥1.5 m2, n = 513). We compared the survival of the small-BSA cohort with that of the non-small-BSA cohort. Patients with a small BSA had lower survival rates at 1, 6, 12, and 24 months (76.9, 61.5, 53.8, and 38.5%, respectively) than did patients with a non-small BSA (90.4, 80.9, 74.7, and 67.6% respectively; overall, p = 0.004). Cox proportional hazard analysis showed that a small BSA was an independent predictor of postoperative mortality (hazard ratio = 0.22, 95% confidence interval = 0.05-0.97, p < 0.04). These findings highlight the adverse impact of a small BSA on outcomes after CF-LVAD implantation.

Body surface area: a novel predictor for conversion to thoracotomy in patients undergoing video-assisted thoracoscopic lung cancer lobectomy.

BACKGROUND: The purpose of our study was to explore the value of body surface area (BSA) for predicting conversion to thoracotomy in patients undergoing video-assisted thoracoscopic (VATS) lobectomy for non-small cell lung cancer (NSCLC). METHODS: We performed a monocentric retrospective analysis based on a prospectively-maintained dataset of consecutive patients between March 2014 and August 2015 at our unit. The median value of BSA was used as the cut-off. Patients with BSA > median value were classified as the "large" group, while those with BSA ≤ median value were classified as the "non-large" group. The conversion rate and post-VATS morbidity between these two groups were evaluated. Finally, a multivariate logistic-regression analysis was performed to identify the predictors for conversion to thoracotomy. RESULTS: A total of 475 patients with a median BSA of 1.73 m2 were enrolled. There were 16 patients converted to thoracotomy (ratio =3.4%). The overall morbidity rate was 28.4%. The "large" group (BSA >1.73 m2) included 236 patients, while the "non-large" group (BSA ≤1.72 m2) included the remaining 239 patients. The conversion (5.5% vs. 1.3%; P=0.010) in the "large" patients was significantly higher than that in the "non-large" patients. No difference was found in the overall morbidity rate between these two groups (32.2% vs. 24.7%; P=0.069). The multivariate logistic-regression analysis demonstrated that BSA >1.73 m2 could be a strongly independent predictor for conversion to thoracotomy [odds ratio (OR): 7.17; P=0.028]. CONCLUSIONS: BSA is an excellent categorical predictor for conversion to thoracotomy in NSCLC patients undergoing VATS lobectomy. It may be considered when informing patients about intraoperative risks and selecting cases in the early learning curve of VATS techniques.

Ultrafiltration Rate and Mortality in Maintenance Hemodialysis Patients.

BACKGROUND: Observational data have demonstrated an association between higher ultrafiltration rates and greater mortality among hemodialysis patients. Prior studies were small and did not consider potential differences in the association across body sizes and other related subgroups. No study has investigated ultrafiltration rates normalized to anthropometric measures beyond body weight. Also, potential methodological shortcomings in prior studies have led to questions about the veracity of the ultrafiltration rate-mortality association. STUDY DESIGN: Retrospective cohort. SETTING & PARTICIPANTS: 118,394 hemodialysis patients dialyzing in a large dialysis organization, 2008 to 2012. PREDICTORS: Mean 30-day ultrafiltration rates were dichotomized at 13 and 10mL/h/kg, separately and categorized using various cutoff points. Ultrafiltration rates normalized to body weight, body mass index, and body surface area were investigated. OUTCOMES: All-cause mortality. MEASUREMENTS: Multivariable survival models were used to estimate the association between ultrafiltration rate and all-cause mortality. RESULTS: At baseline, 21,735 (18.4%) individuals had ultrafiltration rates > 13mL/h/kg and 48,529 (41.0%) had ultrafiltration rates > 10mL/h/kg. Median follow-up was 2.3 years, and the mortality rate was 15.3 deaths/100 patient-years. Compared with ultrafiltration rates ≤ 13mL/h/kg, ultrafiltration rates > 13mL/h/kg were associated with greater mortality (adjusted HR, 1.31; 95% CI, 1.28-1.34). Compared with ultrafiltration rates ≤ 10mL/h/kg, ultrafiltration rates > 10mL/h/kg were associated with greater mortality (adjusted HR, 1.22; 95% CI, 1.20-1.24). Findings were consistent across subgroups of sex, race, dialysis vintage, session duration, and body size. Higher ultrafiltration rates were associated with greater mortality when normalized to body weight, body mass index, and body surface area. LIMITATIONS: Residual confounding cannot be excluded given the observational study design. CONCLUSIONS: Regardless of the threshold implemented, higher ultrafiltration rate was associated with greater mortality in the overall study population and across key subgroups. Randomized controlled trials are needed to investigate whether ultrafiltration rate reduction improves clinical outcomes.

Effect of small body habitus on peri-operative outcomes after robotic-assisted pulmonary lobectomy: retrospective analysis of 208 consecutive cases.

BACKGROUND: Patients with smaller body surface area (BSA) have smaller pleural cavities, which limit visualization and instrument mobility during video-assisted thoracoscopic surgery (VATS). We investigated the effects of BSA on outcomes with robotic-assisted VATS lobectomy. METHODS: We analyzed 208 consecutive patients who underwent robotic-assisted lobectomy over 34 months. Patients were separated into group A (BSA ≤1.65 m(2)) and group B (BSA >1.65 m(2)). Operative times, estimated blood loss (EBL), conversions to thoracotomy, complications, hospital length of stay (LOS), and in-hospital mortality were compared. RESULTS: Group A had 40 patients (BSA 1.25-1.65 m(2)), and group B had 168 patients (BSA 1.66-2.86 m(2)). Median skin-to-skin operative times [± standard error of the mean (SEM)] were 169±16 min for group A and 176±6 min for group B (P=0.34). Group A had median EBL of 150±96 mL compared to 200±24 mL for group B (P=0.37). Overall conversion rate to thoracotomy was 8/40 (20.0%) in group A versus 12/168 (7.1%) in group B (P=0.03); while emergent conversion for bleeding was 2/40 (5.0%) in group A versus 5/168 (3.0%) in group B (P=0.62). Postoperative complications occurred in 12/40 (30.0%) in group A, compared to 66/168 (39.3%) in group B (P=0.28). Patients from both groups had median hospital LOS of 5 days (P=0.68) and had similar in-hospital mortality. CONCLUSIONS: Patients with BSA ≤1.65 m(2) have similar perioperative outcomes and complication risks as patients with larger BSA. Patients with BSA ≤1.65 m(2) have a higher overall conversion rate to thoracotomy, but similar conversion rate for bleeding as patients with larger BSA. Robotic-assisted pulmonary lobectomy is feasible and safe in patients with small body habitus.

Supraceliac and Infrarenal Aortic Flow in Patients with Abdominal Aortic Aneurysms: Mean Flows, Waveforms, and Allometric Scaling Relationships.

PURPOSE: Hemodynamic forces are thought to play a critical role in abdominal aortic aneurysm (AAA) growth. In silico and in vitro simulations can be used to study these forces, but require accurate aortic geometries and boundary conditions. Many AAA simulations use patient-specific geometries, but utilize inlet boundary conditions taken from a single, unrelated, healthy young adult. METHODS: In this study, we imaged 43 AAA patients using a 1.5 T MR scanner. A 24-frame cardiac-gated one-component phase-contrast magnetic resonance imaging sequence was used to measure volumetric flow at the supraceliac (SC) and infrarenal (IR) aorta, where flow information is typically needed for simulation. For the first 36 patients, individual waveforms were interpolated to a 12-mode Fourier curve, peak-aligned, and averaged. Allometric scaling equations were derived from log-log plots of mean SC and IR flow vs. body mass, height, body surface area (BSA), and fat-free body mass. The data from the last seven patients were used to validate our model. RESULTS: Both the SC and IR averaged waveforms had the biphasic shapes characteristic of older adults, and mean SC and IR flows over the cardiac cycle were 51.2 ± 10.3 and 17.5 ± 5.44 mL/s, respectively. Linear regression of the log-log plots revealed that BSA was most strongly predictive of mean SC (R2 = 0.29) and IR flow (R2 = 0.19), with the highest combined R2. When averaged, the measured and predicted waveforms for the last seven patients agreed well. CONCLUSIONS: We present a method to estimate SC and IR mean flows and waveforms for AAA simulation.