scholarly journals Preoperative nutritional factors and outcomes after radical cystectomy: A narrative review

2017 ◽  
Vol 11 (12) ◽  
pp. 419-24
Author(s):  
Janie Allaire ◽  
Tal Ben-Zvi ◽  
Benoît Lamarche ◽  
Karine Robitaille ◽  
Yves Fradet ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Adverse Events ◽  
Nutritional Status ◽  
Radical Cystectomy ◽  
Mortality Risk ◽  
Prospective Studies ◽  
Intervention Studies ◽  
Narrative Review ◽  
Nutritional Factors ◽  
The Impact

Only a few nutritional factors have been identified to predict the risk of developing complications after radical cystectomy (RC). This narrative review delineates the current known effects of preoperative nutritional status factors in this context. The report highlights the heterogeneity between study methods and results. We determined that low albuminemia values increase mortality risk and overall complications. In addition, obesity tends to increase the risk of developing venous thromboembolism and adverse events. Additional prospective studies, using standardized methods to both define and report complications, should be conducted to strengthen the connections between preoperative nutritional status factors and post-RC complications. Furthermore, intervention studies testing the impact of strategies to improve nutritional status on the risk of complications after RC are also needed.

Abdominal Obesity, IL-6 Levels and the Risk of Venous Thromboembolism Among Women: a Case-Control Study

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 477-477
Author(s):  
Christiane Pereira Gouveia ◽  
Dayse Maria Lourenço ◽  
Marinez Farana Matos ◽  
Cristina Mary Orikaza ◽  
Maria Aparecida Eiko Noguti ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Abdominal Obesity ◽  
Prospective Studies ◽  
Conflicts Of Interest ◽  
Continuous Variable ◽  
Geographic Region ◽  
Reactive Protein ◽  
The Metabolic Syndrome ◽  
Simultaneous Adjustment ◽  
The Impact

Abstract Abstract 477 Background: abdominal obesity is one of the components of the metabolic syndrome (MS), which is a cluster of cardiovascular risk factors. Recent prospective studies demonstrated that among the components of the MS, abdominal obesity was the only independent risk factor for venous thromboembolism (VTE). However, it remains unclear to what extent inflammation contributes to the risk of VTE from abdominal obesity. The aim of this study was to investigate the association of abdominal obesity and VTE in women and the effect of inflammation on this association. Material and methods: 94 female patients were included with a first objectively confirmed episode of VTE, with a median age of 39 years (range: 21–60). Exclusion criteria were malignancy, autoimmune diseases, chronic renal or liver diseases and arterial thrombosis. Patients were seen at least 1 month after the discontinuation of the anticoagulant treatment and > 7 months after the event of VTE. Controls were comprised of 100 healthy women, with a median age of 37 years (range: 18–63), recruited via the patients from the same geographic region and ethnic background. Controls were matched for age. Waist circumference (WC) was measured at the umbilical line. A WC ≥ 88 cm in women defined abdominal obesity according to the National Cholesterol Education Program. Plasma level of IL-6 was measured by a highly sensitive ELISA, fibrinogen by Clauss method and high-sensitive C-reactive protein (CRP) by immunoturbidimetry. High levels of IL-6 (> 2.01 pg/mL), CRP (> 6.66 mg/L) and fibrinogen (> 3.59 g/L) were dichotomized at the 90th percentile of the control values. Result: median WC was higher in patients (89 cm; range: 65–126) than in controls (84 cm; range: 62–131), P<0.01. In both groups, WC significantly correlated (P<0.01) with body mass index as expected, but also with age, fibrinogen, CRP and IL-6. Fifty-five patients and 43 controls had abdominal obesity, yielding an odds ratio (OR) of 1.87 [95% Confidence Interval (CI) 1.06 – 3.31]. The association of VTE and abdominal obesity was not affected after adjustment for potential confounders, as high levels of CRP (OR 1.86; 95% CI 1.05 – 3.30) and fibrinogen (OR 1.94; 95% CI 1.08 – 3.48), and it was of borderline significance when adjusted for age (OR 1.76; 95% CI 0.97–3.20). However, the risk was no longer significant after adjustment for high levels of IL-6 (OR 1.57; 95% CI 0.87–2.84). Simultaneous adjustment for age and high levels of CRP, fibrinogen and IL-6 yielded an OR of 1.60 (95% CI 0.85 – 3.00). The impact of abdominal obesity on the risk of VTE was more pronouncedly affected when IL-6 entered into the logistic regression model as a continuous variable (OR 1.33; 95% CI 0.72 – 2.47). Conversely, high IL-6 levels increased the risk of VTE even after adjustment for age, abdominal obesity and high levels of CRP and fibrinogen (OR 3.65; 95%CI 1.56 – 8.50). Conclusion: in this study abdominal obesity was associated with VTE in crude analysis in a relatively young population composed of women. However, the association was no longer significant after adjustment for IL-6. There is evidence that visceral adipose tissue, assessed by WC, is metabolic active, releasing cytokines. To our knowledge this is the first study that evaluated in the same population the effect of IL-6 and abdominal obesity on the risk of VTE. More data, including prospective studies, are required to elucidate the role of inflammation in the association of VTE and abdominal obesity. This study was supported by FAPESP (2005/56799-0). Disclosures: No relevant conflicts of interest to declare.

Advances in Therapy and the Management of Antithrombotic Drugs for Venous Thromboembolism

Hematology ◽  
2000 ◽  
Vol 2000 (1) ◽  
pp. 266-284
Author(s):  
Jack E. Ansell ◽  
Jeffrey I. Weitz ◽  
Anthony J. Comerota
Keyword(s):  
Venous Thromboembolism ◽  
Adverse Events ◽  
Venous Thrombosis ◽  
Tissue Factor ◽  
Oral Anticoagulants ◽  
Diverse Range ◽  
Anticoagulant Drugs ◽  
Wide Range ◽  
The Impact ◽  
Block Factor

This review focuses on antithrombotic therapy for venous thromboembolism and covers a diverse range of topics including a discussion of emerging anticoagulant drugs, a renewed focus on thrombolytic agents for selected patients, and an analysis of the factors leading to adverse events in patients on warfarin, and how to optimize therapy. In Section I Dr. Weitz discusses new anticoagulant drugs focusing on those that are in the advanced stages of development. These will include drugs that (a) target factor VIIa/tissue factor, including tissue factor pathway inhibitor and NAPc2; (b) block factor Xa, including the synthetic pentasaccharide and DX9065a; (c) inhibit factors Va and VIIIa, i.e., activated protein C; and (d) block thrombin, including hirudin, argatroban, bivalirudin and H376/95. Oral formulations of heparin will also be reviewed.In Section II, Dr. Comerota will discuss the use of thrombolysis for selected patients with venous thromboembolism. Fibrinolytic therapy, which has suffered from a high risk/benefit ratio for routine deep venous thrombosis, may have an important role to play in patients with iliofemoral venous thrombosis. Dr. Comerota presents his own results with catheter-directed thrombolytic therapy and the results from a large national registry showing long-term outcomes and the impact on quality of life.In Section III, Dr. Ansell presents a critical analysis of the factors responsible for adverse events with oral anticoagulants and the optimum means of improving outcomes. The poor status of present day anticoagulant management is reviewed and the importance of achieving a high rate of “time in therapeutic range,” is emphasized. Models of care to optimize outcomes are described, with an emphasis on models that utilize patient self-testing and patient self-management of oral anticoagulation which are considered to be the ultimate in anticoagulation care. The treatment of venous and arterial thromboembolism is undergoing rapid change with respect to the development of new antithrombotic agents, an expanding list of new indications, and new methods of drug delivery and management. In spite of these changes, many of the traditional therapeutics are still with us and continue to play a vital role in the treatment of thromboembolic disease. The following discussion touches on a wide range of therapeutic interventions, from old to new, exploring the status of anticoagulant drug development, describing a new intervention for iliofemoral venous thrombosis, and analyzing the critical factors for safe and effective therapy with oral anticoagulants.

scholarly journals Human Milk Oligosaccharide Profiles and Associations with Maternal Nutritional Factors: A Scoping Review

Nutrients ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 965
Author(s):  
Caren Biddulph ◽  
Mark Holmes ◽  
Anna Kuballa ◽  
Peter S. W. Davies ◽  
Pieter Koorts ◽  
...  
Keyword(s):  
Body Composition ◽  
Nutritional Status ◽  
Human Milk ◽  
Dietary Intake ◽  
Milk Sample ◽  
Sample Collection ◽  
Body Composition Assessment ◽  
Nutritional Factors ◽  
The Impact ◽  
Maternal Dietary Intake

Human milk oligosaccharides (HMOs) are complex unconjugated glycans associated with positive infant health outcomes. This study has examined current knowledge of the effect of maternal diet and nutritional status on the composition of HMOs in breast milk. Using the PRISMA-ScR guidelines, a comprehensive, systematic literature search was conducted using Scopus, Web of Science, Global Health (CABI), and MEDLINE. Titles and abstracts were screened independently by two reviewers against predefined inclusion and exclusion criteria. Fourteen studies met the inclusion criteria and reported on maternal dietary intake (n = 3), maternal body composition indices (n = 9), and dietary supplementation interventions (n = 2). In total, data from 1388 lactating mothers (4011 milk samples) were included. Design methodologies varied substantially across studies, particularly for milk sample collection, HMO analysis, dietary and body composition assessment. Overall, this review has identified potential associations between maternal dietary intake and nutritional status and the HMO composition of human milk, though an abundance and sufficiency of evidence is lacking. Standardised procedures for human milk sample collection and HMO analysis, along with robust and validated nutrition assessment techniques, should be employed to further investigate the impact of maternal nutritional factors on HMO composition.

scholarly journals Optimal Nutritional Factors Influencing the Duration of Mechanical Ventilation Among Adult Patients with Critical Illnesses in an Intensive Care Unit

2021 ◽  
Author(s):  
Apinya Koontalay ◽  
Wanich Suksatan ◽  
Jonaid M Sadang ◽  
Kantapong Prabsangob
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Nutritional Status ◽  
Nutritional Factors ◽  
Factors Influencing ◽  
Ventilation Duration ◽  
Mechanical Ventilation Duration ◽  
Critical Patients ◽  
The Impact

Objective: This study aims to identify the impact of nutritional factors on mechanical ventilation duration for critical patients. Patients and Methods: The current study was a single-center, prospective observational design which enrolled one-hundred critically ill patients who were admitted to an intensive care unit (ICU). It demonstrates purposive sampling and also performs the descriptive nutritional factors influencing the mechanical ventilation duration. Daily calories target requirement scale (DCRS), subjective global assessment form (SGA), dyspnea assessment form, and APACHE II have been used as methods in the study along with time to initial enteral nutrition (EN) after 24-hour admission and daily calories target requirement over 7 days to assess patients. Data is analyzed using the multiple regressions. Results: As a result, nutritional status monitoring, time to initial EN, calories and target requirements are statistically positive significance associated with the mechanical ventilation duration respectively (R = 0.54, R = 0.30, R= 0.40, p &lt; 0.05). However, age, illness severity, and dyspnea scales are not associated with the mechanical ventilation duration (p&gt; 0.05). Therefore, the nutritional status, malnutrition scores and calorie target requirements can be used to significantly predict the mechanical ventilation duration. The predictive power is 58 and 28.0% of variance. The most proper influencer to predict the mechanical ventilation duration is nutritional status or malnutrition scores. Conclusion: The research findings show that the nutritional status, time to initial EN, and calorie target requirement within 7 days of admission are associated with the mechanical ventilation duration in the critical patients. Therefore, it can be used to develop guidelines reducing the mechanical ventilation duration and to promote the ventilator halting for critical patients.

Advances in Therapy and the Management of Antithrombotic Drugs for Venous Thromboembolism

Hematology ◽  
2000 ◽  
Vol 2000 (1) ◽  
pp. 266-284
Author(s):  
Jack E. Ansell ◽  
Jeffrey I. Weitz ◽  
Anthony J. Comerota
Keyword(s):  
Venous Thromboembolism ◽  
Adverse Events ◽  
Venous Thrombosis ◽  
Tissue Factor ◽  
Oral Anticoagulants ◽  
Diverse Range ◽  
Anticoagulant Drugs ◽  
Wide Range ◽  
The Impact ◽  
Block Factor

Abstract This review focuses on antithrombotic therapy for venous thromboembolism and covers a diverse range of topics including a discussion of emerging anticoagulant drugs, a renewed focus on thrombolytic agents for selected patients, and an analysis of the factors leading to adverse events in patients on warfarin, and how to optimize therapy. In Section I Dr. Weitz discusses new anticoagulant drugs focusing on those that are in the advanced stages of development. These will include drugs that (a) target factor VIIa/tissue factor, including tissue factor pathway inhibitor and NAPc2; (b) block factor Xa, including the synthetic pentasaccharide and DX9065a; (c) inhibit factors Va and VIIIa, i.e., activated protein C; and (d) block thrombin, including hirudin, argatroban, bivalirudin and H376/95. Oral formulations of heparin will also be reviewed. In Section II, Dr. Comerota will discuss the use of thrombolysis for selected patients with venous thromboembolism. Fibrinolytic therapy, which has suffered from a high risk/benefit ratio for routine deep venous thrombosis, may have an important role to play in patients with iliofemoral venous thrombosis. Dr. Comerota presents his own results with catheter-directed thrombolytic therapy and the results from a large national registry showing long-term outcomes and the impact on quality of life. In Section III, Dr. Ansell presents a critical analysis of the factors responsible for adverse events with oral anticoagulants and the optimum means of improving outcomes. The poor status of present day anticoagulant management is reviewed and the importance of achieving a high rate of “time in therapeutic range,” is emphasized. Models of care to optimize outcomes are described, with an emphasis on models that utilize patient self-testing and patient self-management of oral anticoagulation which are considered to be the ultimate in anticoagulation care. The treatment of venous and arterial thromboembolism is undergoing rapid change with respect to the development of new antithrombotic agents, an expanding list of new indications, and new methods of drug delivery and management. In spite of these changes, many of the traditional therapeutics are still with us and continue to play a vital role in the treatment of thromboembolic disease. The following discussion touches on a wide range of therapeutic interventions, from old to new, exploring the status of anticoagulant drug development, describing a new intervention for iliofemoral venous thrombosis, and analyzing the critical factors for safe and effective therapy with oral anticoagulants.

Elevated Levels of IL-6 and IL-8 Are Associated with An Increased Risk of Venous Thromboembolism – a Case Control Study.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2975-2975
Author(s):  
Marinez F Matos ◽  
Dayse M Lourenço ◽  
Cristina M Orikaza ◽  
Maria A E Noguti ◽  
Vânia M Morelli
Keyword(s):  
Venous Thromboembolism ◽  
Prospective Studies ◽  
Plasma Levels ◽  
Conflicts Of Interest ◽  
Limit Of Detection ◽  
Case Control ◽  
Control Group ◽  
Case Control Studies ◽  
Increased Risk ◽  
The Impact

Abstract Abstract 2975 Poster Board II-953 Background: high levels of some cytokines have been associated with an increased risk of venous thromboembolism (VTE) in some case-control studies, but not in prospective studies. However, data regarding the impact of cytokines levels on the risk of VTE are still limited. The aim of this study was to investigate the association between the risk of VTE and plasma levels of interleukin (IL)-1β, IL-6, IL-8, IL-10, tumor necrosis factor (TNF)-αa and monocyte chemotactic protein (MCP)-1. Materials and Methods: we studied 122 patients (96 women, 79%), with a first objectively confirmed episode of VTE and with a median age of 39.5 years (range: 21-60). Exclusion criteria were malignancy, autoimmune diseases, antiphospholipid syndrome, chronic renal or liver disease and arterial thrombosis. Patients were seen at least 1 month after the discontinuation of the anticoagulant treatment and > 7 months after the event of VTE. Control group was comprised of 131 healthy subjects (105 women, 80%), with median age of 38 years (range: 18-66), recruited via the patients from the same geographic region and ethnic background. Controls were matched for age and sex. Plasma levels of cytokines were measured by commercial ELISA and a highly sensitive assay was used to measure IL-1β, IL-6 and IL-10 levels. Since a high percentage of samples of IL-1β (73%), IL-10 (62%) and TNF-αa (97%) was below the lower limit of detection (LLD) of the assay, levels of these cytokines were categorized as detectable (> LLD) and not detectable (< LLD). Elevated levels of IL-6 (> 2.15pg/mL), IL-8 (> 10.11pg/mL) and MCP-1 (> 84.11pg/mL) were defined by plasma concentration of these cytokines exceeding the 90th percentile of the distribution of the control population. Results: elevated levels of IL-6 were detected in 27% of the patients with VTE in comparison with 10% (by definition) of the controls [odds ratios (OR) = 3.4, 95% Confidence Interval (CI) 1.6 - 7.6]. Elevated levels of IL-8 were detected in 21% of the patients in comparison with 10% of the controls (OR = 2.5, 95%CI 1.1 - 5.6). The risk remained significant for IL-6 (OR = 2.8, 95%CI 1.2 - 6.5) and IL-8 (OR = 2.6, 95%CI 1.1 - 6.7) after adjustment for putative confounders (sex, age, body mass index, smoking and high levels of homocysteine and C-reactive protein). On the other hand, we found no significant association between VTE and elevated levels of MCP-1 (OR = 0.8, 95%CI 0.3 - 1.9) as well as detectable levels of IL-1β (OR = 0.9, 95%CI 0.5-1.6), IL-10 (OR = 1.3, 95%CI 0.8 - 2.2) and TNF-αa (OR = 6.7, 95%CI 0.8 - 56.7). In our study, patients were included at different time intervals after the VTE episode [median: 36 months (range: 7-87)]. No correlation was found between the time since the event of VTE and levels of IL-6 (rs = 0.06, P = 0.54) and IL-8 (rs= 0.07; P = 0.48). Conclusion: this study shows a significant impact of elevated levels of IL-6 and IL-8 on the risk of VTE in a relatively young population of patients. Interestingly, no association was found between the time since the event and the level of these cytokines. Taking into account the importance of the relationship between inflammation and VTE, more epidemiological data including prospective studies are required to elucidate the role of inflammation on the risk of VTE. This study was supported by FAPESP (2005/56799-0). Disclosures: No relevant conflicts of interest to declare.

scholarly journals The Impact of Circulating Tumor Cells on Venous Thromboembolism and Cardiovascular Events in Bladder Cancer Patients Treated with Radical Cystectomy

2020 ◽  
Vol 9 (11) ◽  
pp. 3478
Author(s):  
Michael Rink ◽  
Sabine Riethdorf ◽  
Hang Yu ◽  
Mara Kölker ◽  
Malte W. Vetterlein ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Tumor Cells ◽  
Radical Cystectomy ◽  
Circulating Tumor Cells ◽  
Cardiovascular Events ◽  
Comprehensive Complication Index ◽  
Increased Risk ◽  
Relevant Risk Factor ◽  
Carcinoma Of The Bladder ◽  
The Impact

Background: Cancer is a relevant risk factor for venous thromboembolism (VTE). Circulating tumor cells (CTC) are associated with an increased risk of VTE in breast cancer. In addition, circulating cell-free nucleic acids have been associated with cardiovascular events (CVE). Objective: To investigate the association of CTC status and the risk of VTE as well as CVE in urothelial carcinoma of the bladder (UCB) patients treated with radical cystectomy (RC). Methods: We collected data of 189 UCB patients treated with RC at our institution. Blood samples were acquired preoperatively and analyzed for CTC using the CellSearch® system. Thirty-day postoperative complications were extracted from digital charts and graded according to the Clavien–Dindo classification (CDC). Moreover, each patient’s individual Comprehensive Complication Index® (CCI®) was calculated. Results: CTC were present in 43 patients (22.8%). Overall, six patients experienced VTE (3.2%) and eight patients (4.2%) experienced CVE. There was no association of VTE or CVE according to CTC status. In total, 168 patients (89%) experienced a total of 801 complications, of which the majority was classified as “minor” (CDC grade ≤ IIIa; 79%). There was no association between CTC status and any grade of a complication or CCI®. Presence of CTC was associated with more aggressive clinicopathological UCB features. Conclusions: The overall rate of VTE and CVE was low in our study. Presence of CTC was neither associated with an increased risk of VTE nor CVE in UCB patients treated with RC. According to this study, CTC are not a qualified biomarker for individualized thromboprophylaxis management in these patients.

scholarly journals Nutritional Status Impairment Due to Neoadjuvant Chemotherapy Predicts Post-Radical Cystectomy Complications

Nutrients ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 4471
Author(s):  
Sharon Cohen ◽  
Jonathan Gal ◽  
Yuval Freifeld ◽  
Sobhi Khoury ◽  
Yoram Dekel ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Nutritional Status ◽  
Radical Cystectomy ◽  
Psoas Muscle ◽  
Nutritional Intervention ◽  
Status Change ◽  
Muscle Area ◽  
Cross Sectional ◽  
Increased Risk ◽  
The Impact

Background: Radical cystectomy (RC) is the standard treatment for muscle invasive bladder cancer (MIBC). Neoadjuvant chemotherapy (NAC) is associated with improved patient survival. The impact of NAC on nutritional status is understudied, while the association between malnutrition and poor surgical outcomes is well known. This study aims to examine the association between NAC, nutritional status impairment, and post-operative morbidity. Materials and Methods: We included MIBC patients who underwent RC and received NAC from multiple academic centers in Israel. Cross-sectional imaging was used to measure the psoas muscle area and normalized it by height (smooth muscle index, SMI). Pre- and post-NAC SMI difference was calculated (represents nutritional status change). The primary outcomes were post-RC ileus, infection, and a composite outcome of any complication. Logistic regression models were fit to identify independent predictors of the outcomes. Results: Ninety-one patients were included in the study. The median SMI change was −0.71 (−1.58, −0.06) cm2/m2. SMI decline was significantly higher in patients with post-RC complications (−18 vs. −203, p < 0.001). SMI change was an independent predictor of all complications, ileus, infection, and other complications. The accuracy of SMI change for predicting all complications, ileus, infection, and other complications was 0.85, 0.87, 0.75, and 0.86, respectively. Conclusions: NAC-related nutritional deterioration is associated with increased risk of complications after RC. Our results hint towards the need for nutritional intervention during NAC prior to RC.

scholarly journals Correlation between neuropsychomotor development and nutritional status of children from 13 to 30 months of age: a preliminar study

2021 ◽  
Author(s):  
Everton Horiquini Barbosa ◽  
Isadora Ferreira ◽  
Thamires Máximo Neves Felice
Keyword(s):  
At Risk ◽  
Nutritional Status ◽  
Motor Development ◽  
Pearson Correlation ◽  
Strong Association ◽  
Nutritional Factors ◽  
Pearson Correlation Test ◽  
Final Interpretation ◽  
Nutritional Status Of Children ◽  
The Impact

Introduction: The knowledge about the impact of biological and socio- environmental factors on motor development is essential to generate subsidies to planning strategies to promote and prevent neuropsychomotor delays. The aim of this study was to assess the influence of nutritional factors on the neuropsychomotor development of children aged 13 to 30 months, through the correlation between neuropsychomotor development assessed by the Denver II test and the nutritional status calculated by the z score of BMI-for-age (z-BMI/A) and weight-for-height (z-W/H). Methods: This study was carried out with nine children regularly enrolled in the Braziliand public education system. Results: Based on the final interpretation of the Denver II test, a prevalence of 33% of children with atypical performance (2 male and 1 female) was found. Regarding to z-BMI/A, one child was characterized as overweight (1 male) and three children were at risk of being overweight (1 male and 2 female), based on z-W/H three children were at risk of being overweight (2 male and 1 female). The Pearson correlation test showed that there was a strong association between changes in the Denver II and the nutritional status. Conclusion: The findings of the present study show that children classified as overweight and at risk of being overweight are more likely to be at risk for development, based on Denver test. Therefore, taking together the above findings, the present study reinforces the importance of evaluating and monitoring longitudinally both nutritional and motor development, highlighting the importance of multiprofessional performance and early approach.

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