Background and Purpose: Although obesity is an established risk factor for the occurrence of a primary stroke, the association between obesity with post-stroke mortality remains unclear. We evaluated the association of dynamic obesity status with mortality among first-ever stroke survivors in China. Methods: Data from 775 patients with first-ever ischaemic stroke from a longitudinal study, 754 patients were categorized 4 categories of BMI (underweight, normal weight, overweight and obese) and 2 categories of WC (normal WC and abdominal obesity) according to Chinese-specific criteria. Mortality information and obesity status were obtained through every 3 months via telephone follow-up, beginning in 2010 and continuing through 2016. Chi-square tests were used to compare different obesity status at admission and personal characteristics. Time-dependent Cox proportional hazards models were used to estimate the unadjusted and adjusted hazard ratios (HRs) for relationship between all-cause mortality and dynamic obesity status. Results: Of 754 analyzed patients, 60.87% were males, with a mean age of 61.45 years. After adjusting for possible confounders, there were significant inverse associations between BMI and WC with all-cause mortality: compared with normal BMI or WC counterparts, overweight and abdominal obesity patients significantly decrease risk of all-cause mortality (HR and 95% confidence interval (CI):0.521(0.303,0.897),0.545(0.352,0.845),respectively), whereas under-weight patients have the highest risk and obese have decreased risk of mortality, though significance was not obtained (1.241(0.691,2.226),0.486(0.192,1.231), respectively). Conclusions: Overweight and abdominal obesity was paradoxically associated with reduced risk of mortality among first-ever ischaemic stroke survivors in China. Body weight management recommendations ought to not be based on mere projection from primary prevention of stroke.
BackgroundPressure dressings have been used after open hemorrhoidectomy to protect surgical wounds and manage postoperative bleeding for many years. However, pressure dressings may increase the incidence of postoperative complications, such as urinary retention, medical adhesive-related skin injury, and pain. A previous controlled trial included 67 patients who underwent Milligan-Morgan hemorrhoidectomy. The data indicated that the use of a nonpressure dressing after hemorrhoidectomy reduces the incidence of urinary retention and catheterization. However, the incidence of severe postoperative bleeding and other postoperative complications was not assessed. There is no consensus on whether it is necessary and beneficial to use a nonpressure dressing after hemorrhoidectomy. The results of this randomized clinical study will help answer this question.MethodsIn this study, we plan to include 186 patients who have undergone Milligan-Morgan hemorrhoidectomy. The purpose is to determine whether the use of nonpressure dressings after open hemorrhoidectomy is inferior to the use of pressure dressings in terms of severe postoperative bleeding and postoperative complications. The primary endpoints of the trial are the incidence of urinary retention within 24 hours after surgery and the incidence of severe postoperative bleeding one hour after dressing removal, which requires revision surgery within 24 hours after the surgery. The secondary endpoints of the study are the pain score, anal distension score, postoperative use of analgesics, and incidence of medical adhesive-related skin injury, all of which will be assessed before removing the dressings. The length of hospitalization in days and hospitalization expenses will be recorded. Safety will be assessed with consideration of all adverse and severe adverse events related to the study treatment.DiscussionThe study received full ethics committee approval. The first patient was enrolled on 27 November 2020. The results of this trial will finally answer the question of whether a nonpressure dressing after open hemorrhoidectomy is necessary and beneficial.Trial registrationChinese Clinical Trial Registry (registration ID: ChiCTR2000040283). Registered on 28 November. 2020. {2} http://www.chictr.org.cn/edit.aspx?pid=58894&htm=4 {2b}
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