RESUMO
This paper argues that the Food and Drug Administration (FDA) has the authority to require a declaration of "added sugars" on the nutrition label. FDA has relied on scientific evidence from well-respected sources that concluded that "added sugars" pose a public health concern for Americans; its rule is not arbitrary or capricious. At the same time, there are certain limits on the effectiveness of the "added sugars" rule, especially consumer comprehension. Therefore, FDA should consider more effective front-of-package labeling to clearly communicate the public health risks of "added sugars".
Assuntos
Sacarose Alimentar , Rotulagem de Alimentos/métodos , Preferências Alimentares , Educação em Saúde , Obesidade/prevenção & controle , Doença Crônica/prevenção & controle , Informação de Saúde ao Consumidor , Dieta , Aditivos Alimentares/análise , Rotulagem de Alimentos/legislação & jurisprudência , Promoção da Saúde , Humanos , Política Nutricional , Estados Unidos , United States Food and Drug AdministrationAssuntos
Doença Diverticular do Colo/diagnóstico , Perfuração Intestinal/etiologia , Doenças do Colo Sigmoide/diagnóstico , Úlcera/diagnóstico , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Impacção Fecal/complicações , Impacção Fecal/cirurgia , Feminino , Humanos , Perfuração Intestinal/cirurgia , Úlcera/complicaçõesRESUMO
We studied the effects of host plant hybridization on the survival and mortality of the leaf-mining moth Phyllonorycter salicifoliella on hybrid and parental willow plants in the field and in a common garden experiment. P. salicifoliella survival differed significantly among three willow taxa in the field in 1994 but not in the field in 1995 or in the common garden. Parasitism by eulophid wasps differed significantly among taxa in 1994 and appeared to account for the variation in their survival. In the field in 1995, host feeding predation varied significant among taxa. The theory of tritrophic interactions predicts that plant genotype can affect natural enemy impact, and this study supports this prediction. Significant variation in survival and eulophid parasitism was also found among genotypes within taxa in the field in both years and in the common garden experiment. The common garden results show that genetic differences in plants affect the herbivore-parasitoid interaction. Variation among years in the patterns of survival and causes of mortality among field plants suggest that genotype by environment interactions may be important.
RESUMO
BACKGROUND: The purpose of this study was to describe the incidence and clinical/pathologic characteristics of papillary thyroid microcarcinoma (PMC) in a community hospital setting and to evaluate the frequency and characteristics of these lesions when unsuspected preoperatively. METHODS: A total of 723 patients underwent a partial or total thyroidectomy. A retrospective review was performed. RESULTS: A total of 194 of the 723 patients had a final diagnosis of papillary carcinoma. Ninety-six (49%) of these tumors were PMCs defined as being 1.0 cm or less in diameter. One third (32 of 96) of these lesions were multifocal and 16.7% (16 of 96) were found to have regional lymph node metastases. The majority (58%) of PMCs were found on final pathology and were clinically unsuspected (occult). Multifocality was found in 32.1% (18 of 56) of patients with clinically unsuspected PMC, with nodal metastases in 3.6% (2 of 56). The other 40 patients with PMC had surgeries performed for a clinical reason related to that pathologic lesion. This clinically suspected group was comparably multifocal (35%), but more likely to have cervical lymph node metastasis (35%). Sixty-six percent (37 of 56) diagnosed with a clinically unsuspected PMC underwent a partial thyroidectomy at the initial surgery. CONCLUSIONS: The prevalence of clinically unsuspected PMC in our population undergoing thyroidectomy was 7.7% (56 of 723). In our institution, this is more than half of all PMCs. The incidence of cervical lymph node metastasis in clinically unsuspected PMC was only 3.6% compared with 35% in clinically suspected disease, suggesting that the biological behavior (and possibly treatment) may be different. Long-term follow-up evaluation is needed to better evaluate the significance of these differences.
Assuntos
Achados Incidentais , Neoplasias da Glândula Tireoide/diagnóstico , Adulto , Carcinoma , Carcinoma Papilar , Feminino , Humanos , Incidência , Excisão de Linfonodo , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Pescoço , Prevalência , Prognóstico , Estudos Retrospectivos , Câncer Papilífero da Tireoide , Neoplasias da Glândula Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , TireoidectomiaRESUMO
Obesity is a severe health issue that is a global epidemic. Bariatric surgery is an accepted, popular, and effective therapy for weight loss. Ghrelin, a peptide secreted primarily by the fundus cells of the stomach, has been found to impact body weight by its influence on appetite. Although numerous studies have investigated serum ghrelin levels following bariatric surgery, there is no solid agreement yet as to the direction or magnitude of its change, or even its impact on weight loss. Some studies have found an increase in ghrelin, some have found a decrease, and others have found no change in ghrelin following bariatric surgery. The purpose of this review was to establish the impact of ghrelin changes following bariatric surgery.
Assuntos
Cirurgia Bariátrica , Grelina/sangue , Obesidade Mórbida/cirurgia , Humanos , Obesidade Mórbida/sangue , Redução de PesoRESUMO
Follicular neoplasms of the thyroid are a frequent indication for surgery of the thyroid gland. We evaluated the use of frozen sections on intraoperative decision-making, possible avoidance of reoperative surgery, and histologic findings in a retrospective cohort. A database was created of all thyroid operations from 2001 to 2007. Data collected included age, gender, preoperative cytology, indication for surgery, surgeon, intraoperative decision-making, and histologic findings. Of the 723 thyroidectomies, 203 were performed for follicular neoplasms diagnosed by fine needle aspiration. Of these, 135 had cytology reports available within our electronic medical record; 44 per cent (59 of 135) of these patients had an intraoperative frozen section. Only two of 59 (3.4%) were positive for carcinoma, both of which were papillary carcinomas. One was interpreted as "suspicious" for carcinoma by the pathologist. In these three cases, the surgeon proceeded with total thyroidectomy at the time of initial surgery. The results of frozen section altered the operation in only three of 59 cases (5.1%). Intraoperative frozen section rarely impacts the conduct of thyroidectomy for follicular neoplasms.
Assuntos
Adenocarcinoma Folicular/patologia , Adenocarcinoma Folicular/cirurgia , Secções Congeladas , Seleção de Pacientes , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia , Adenoma/patologia , Diagnóstico Diferencial , Humanos , Cuidados Intraoperatórios , Meio-Oeste dos Estados Unidos , Estudos Retrospectivos , Sensibilidade e Especificidade , Resultado do TratamentoRESUMO
BACKGROUND: Patient quality outcomes are a major focus of the health care industry. It is unknown what effect involvement in graduate medical education (GME) has on patient outcomes. The purpose of this study is to begin to examine whether GME involvement in postoperative care impacts patient quality outcomes. METHODS: The retrospective cohort included all patients who underwent a nonemergent colectomy from January 1, 2007 to January 1, 2008 at a 2-hospital system. Data collected included patient demographics, patient quality outcomes, complications, and GME involvement. Patient quality outcomes were based on compliance with the Surgical Care Improvement Project (SCIP) guidelines. RESULTS: A total of 159 nonemergent colectomies were analyzed. The GME group accounted for 116 (73%) patients. A significant difference was found in several SCIP process-based measures of quality when comparing the GME group with the non-GME group. Postoperative antibiotics were more likely to be stopped within 24 hours (p = 0.010), and preoperative heparin and postoperative deep vein thrombosis (DVT) prophylaxis were more likely to be administered (p < 0.001). Additionally, patients in the GME group showed improved quality outcomes as there were significantly fewer postoperative complications (p < 0.001) and a shorter duration of stay (p = 0.008). The use of gastrointestinal prophylaxis was more common in the non-GME group (p = 0.002). No significant differences were observed between the 2 groups in respect to age, sex, diabetes, preoperative antibiotics, antibiotics, 1 hour before surgery, postoperative antibiotics, and continuation of home beta blockade. CONCLUSIONS: GME at teaching institutions has a positive impact on patient quality outcomes. At our institution, many of the SCIP measurable outcomes had improved compliance if an attending physician participated in the GME program.
Assuntos
Educação de Pós-Graduação em Medicina , Corpo Clínico Hospitalar/normas , Avaliação de Resultados em Cuidados de Saúde , Qualidade da Assistência à Saúde , Adulto , Idoso , Idoso de 80 Anos ou mais , Competência Clínica , Colectomia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Estudos RetrospectivosRESUMO
BACKGROUND: More than one third of adults in the United States are obese. Coronary artery bypass graft surgery (CABG) has become necessary for many obese persons. We evaluated the effect of this procedure on in-hospital mortality and morbidity of patients based on their body mass index (BMI). METHODS: Data in a cardiac surgery database were examined retrospectively. Data selected from the database included CABG surgery from January 2003 to December 2007. The resulting cohort included a total of 10,590 patients. The BMI was grouped into four categories: underweight (BMI < or = 19), normal weight (BMI 20 to 29), obese (BMI 30 to 39), and morbidly obese (BMI > or = 40). Regression analysis was conducted to determine whether BMI was an independent predictor of morbidity and mortality after CABG. RESULTS: Our results indicate that patients with an obese BMI are not at greater risk for morbidity or mortality after CABG. Logistic regression analysis found that CABG patients in the underweight body mass index group had the greatest risk of mortality, prolonged ventilation, reoperation for bleeding, and renal failure. Linear regression indicated length of hospital stay and intensive care unit stay after surgery were the longest for patients with an underweight BMI. CONCLUSIONS: Despite the comorbidities that are often present with obesity, an obese BMI was not found to be an independent predictor of morbidity or mortality after CABG. On the contrary, the underweight patients are at greater risk for mortality and complications after CABG surgery.
Assuntos
Índice de Massa Corporal , Ponte de Artéria Coronária/métodos , Doença da Artéria Coronariana/complicações , Mortalidade Hospitalar/tendências , Tempo de Internação/tendências , Obesidade/complicações , Idoso , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade , Obesidade/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Estados UnidosRESUMO
OBJECTIVE: The objective of this study was to assess outcome differences in aortic valve replacement based on gender. METHODS: A study from a ten-year hospitalization cohort with prospective data collection was conducted. Included in the study were patients undergoing aortic valve replacement surgery between March 1997 and July 2003 (N=406). There were 223 males and 183 females included in the study. The study examined 41 potential confounding risk factors and 16 outcome variables. RESULTS: Univariate analysis on potential confounding risk factors revealed a significant difference between males and females on 12 factors. Co-morbid disease, hypertension, current vascular disease, aortic insufficiency, body surface area, blood added on pump, and annulus size significantly correlated with age. The correlation resulted in five confounding risk factors: age, tobacco history, obesity, left ventricular hypertrophy, and creatinine level. Logistic regression analysis found that after controlling for age, tobacco history, obesity, left ventricular hypertrophy, and creatinine level, there is no difference between males and females on outcomes following aortic valve replacement. Additionally, choice of vascular prosthesis had no impact on post-operative outcomes. CONCLUSION: After controlling for confounding variables, similar outcomes were observed for males and females undergoing aortic valve replacement.
Assuntos
Estenose da Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca , Idoso , Distribuição de Qui-Quadrado , Comorbidade , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Fatores Sexuais , Análise de Sobrevida , Resultado do TratamentoRESUMO
PURPOSE: Our aim was to assess the feasibility of totally endoscopic robotic mitral valve surgery using a novel atrial retractor manipulated by a fourth arm da Vinci surgical system (Intuitive Surgical Inc, Sunnyvale, CA). DESCRIPTION: Eighteen patients with mitral valve disease underwent totally endoscopic mitral valve surgery using the retractor. It was inserted in the second or third intercostal space just lateral to the sternum, and it was manipulated at the robotic console for dynamic exposure of the valve structures. EVALUATION: Mitral valve repair procedures were feasible in all patients with the robotic-controlled atrial retractor providing superior exposure of the mitral valve anatomy. The time until satisfactory exposure of the mitral valve was noticeably decreased with the robotic retractor. All patients were discharged home in sinus rhythm and transesophageal echocardiography revealed competent mitral valves. CONCLUSIONS: The EndoWrist atrial retractor (Intuitive Surgical Inc) facilitated complex totally endoscopic mitral valve surgery, including concomitant procedures, regardless of pathology with excellent clinical outcomes.