Aims:To compare waist circumference (WC), body mass index (BMI), waist hip ratio (WHR), and waist-to-height ratio (WHtR) and define an appropriate cut-off, which is most closely predictive of the non-adipose components of the IDF metabolic syndrome (MetS) definition.Methods and Results:A total of 3,042 adults (1,693 in rural area and 1,349 in urban area) were screened for the presence of MetS according to the IDF definition. Among 3,042 adults selected as subjects, 1,518 were male and 1,524 were female. The receiver operating curve (ROC) analysis was done to determine the optimal cut-off value and the best discriminatory value of each of these anthropometric parameters to predict two or more non-obese components of metabolic syndrome. The area under ROC (AURC) for WC was superior to that for other anthropometric variables. The optimal cut-off value of WC in urban and rural males was >89 cm, which is higher than that in urban and rural females at 83 cm and 79 cm, respectively; the optimal cut-off for WHtR was >0.51 in rural females, 0.52 in rural males, and 0.53 in both urban males and females. Both parameters were found to be better than BMI and WHR. ROC and AURC values for WC were better than those for WHtR in men and women in both urban and rural areas (P = 0.0054); however, when the entire study cohort was analyzed together, irrespective of gender and place of residence, then at a value of 0.52, WHtR scored over WC as a predictor of metabolic syndrome (P = 0.001).Conclusion:Although the predictive value of different gender-specific WC values is clearly superior to other anthropometric measures for predicting two or more non-adipose components of MetS, a single value of WHtR irrespective of gender and the area of residence can be used as a universal screening tool for the identification of individuals at high risk of development of metabolic complications.
The role of prophylactic antibiotics in mesh repair of inguinal hernia is unclear. A Cochrane meta-analysis in 2005 concluded that "antibiotic prophylaxis for elective inguinal hernia repair cannot be firmly recommended or discarded" and "further studies are needed, particularly on the use for mesh repair." So, we designed a study to define the role of prophylactic antibiotics in mesh repair of inguinal hernia. We conducted a prospective, randomized, double-blind, trial comparing wound infection rates in 450 patients (225 received intravenous Cefazolin, 225 received a placebo) undergoing primary inguinal hernia repair electively using polypropylene mesh. 334 patients who completed a followup period of one month were analyzed. Age, American Society of Anesthesiologists class, type of hernia, type of anesthesia, grade of surgeon, pre and postoperative hospital stay and duration of operation were recorded. CDC criteria was used to define wound infection. Groups were well matched for all preoperative variables studied. The overall infection rate was 8.7% (29 out of 334). The incidence of wound infection in antibiotic group was 7% and 10.5% in control group. One from each group developed deep surgical site infection. Most of the infections occurred between the 7th and 12th post-operative day after discharge from the hospital. Antibiotic prophylaxis was associated with decreased incidence of wound infection when compared to control group, but the difference was not statistically significant. Based on our results we do not recommend the routine use of antibiotic prophylaxis in elective mesh repair of inguinal hernias.
Recombinant adenoviruses (Ad) are among the most extensively used vectors for liver gene transfer. One of the major limitations for the clinical application of these vectors is the inflammatory immune response associated with systemic administration of high dose of virus. We evaluated the effect of Ad administration route on the inflammatory immune response and liver transgene expression. We compared direct intrahepatic injection (IH) with the systemic administration via tail vein (IV). IH injection of Ad resulted in a lower inflammatory response and a higher transgene expression. When a relatively low dose of virus was used, IV administration resulted in no detectable protein expression but production of proinflammatory cytokines. In contrast, IH administration induced high levels of transgene expression and no inflammation, although we detected a transient hypertransaminemia, which fully resolved within days. Furthermore, IH injection resulted in a faster protein expression being more intense at the site of injection, whereas IV administration caused slower but diffuse liver expression. IH injection also reduced the spreading of the virus to other organs. Independently of the route, depletion of Kupffer cells significantly enhanced the transduction efficiency of Ad. This effect was stronger when using IV injection, indicating that IH injection partially overcomes Kupffer cell phagocytic activity. Moreover, the antitumor efficacy of high-capacity-Ad encoding murine interleukin-12 (IL-12) was significantly greater when the vector was administered by IH injection than when given IV. In conclusion, IH injection of adenovirus represents a safe and efficient administration route for clinical applications of gene therapy targeting the liver. (HEPATOLOGY 2006;44:623-632.)
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