The present study was designed to examine the effects of a short‐term diet/exercise program on markers of metabolic health and serum lipomics. 33 overweight children (15 boys, 18 girls, age 12.3±0.4 yr), were placed on an ad libitum, high‐fiber, low‐fat diet and daily exercise (2–2.5 hr) regimen in the Pritikin Longevity Center 2‐wk program. Fasting serum was taken pre‐ and post‐intervention for determination of glucose, lipids, metabolic risk markers, and lipomic analysis by gas chromatography. After 2 wks subjects lost weight (73.0±6.2 post vs. 75.7±6.5 kg pre) but remained overweight/obese (BMI: 27.2±1.7 vs. 28.2±1.8 kg/m 2 ). Despite remaining overweight, no subjects had metabolic syndrome post‐ compared with 8 pre‐intervention. RHR and BP decreased significantly, p<0.005. Serum TG, Total‐C, LDL (p<0.0001), PAI‐1, resistin, leptin (p<0.001), HDL, IL‐8, amylin and insulin (p<0.05) decreased significantly. Serum IL‐10 (p=0.14) and IL‐1ra (p=0.29) increased and VEGF (p=0.07) decreased non‐significantly. Lipomic analysis revealed decreases in total lipids (79% of baseline), saturated fatty acids (14:0, 82%, 18:0, 87% and 20:0, 33%), and increases in 20:1 (125%), 22:6 (144%) and 18:1/18:0 (114%), all p<0.05. These results indicate changes in multiple indices of metabolic health and serum lipomics with short‐term, rigorous lifestyle modification, even in the face of remaining overweight/obese. This study was supported by a grant from the L‐B Research/Education Foundation and funding from UCLA.
Hand vascularized composite allotransplantation (VCA) and myoelectric prostheses have proven their efficacy for treating hand amputation. Despite reported functional outcomes, the lack of consensus on VCA versus myoelectric prostheses brought us to report on their utilities and costs within the Canadian healthcare system.A review of utility outcomes and costs was performed for VCA and myoelectric prostheses and a comparison between unilateral versus bilateral amputations was made.The simulation model demonstrated that significant savings could be achieved with both hand transplantation ($10.04 billion) and myoelectric prostheses ($12.17 billion) in all Canadian patients sustaining hand amputation with a 30-year life expectancy., Myoelectric prosthesis had lowest total cost compared to hand VCA by generating savings of $4,458,445,840 and $1,868,121,840 when compared to bilateral and unilateral upper limb amputations respectively.Treatment of unilateral amputations with myoelectric prostheses would cost significantly less to the society, whereas the gap in cost savings becomes less significant in bilateral amputees. From the socioeconomic standpoint of the Canadian healthcare system, this simulation model demonstrates that significant savings can be achieved with both treatments.
INTRODUCTION: Infantile hemangiomas are benign vascular neoplasms that can cause numerous functional or cosmetic problems. The purpose of the present study is to review the pathogenesis of hemangioma and to compare the efficacy and complications related to therapy of infantile hemangiomas with propranolol versus corticosteroids. METHODS: A comprehensive review of literature was conducted from from 1965 to March 2012 using MEDLINE, PubMed, Ovid, Cochrane Review database, and Google Scholar. All articles were reviewed for reports of clinical cases, reported side effects, doses, duration of treatment, number of patients and response rate to treatment. RESULTS: 1,162 studies were identified. Of those only 56 articles met our inclusion criteria after review by two independent reviewers (AI and JK). For the purpose of meta-analysis, 16 studies comprising 2,629 patients, and 25 studies comprising 795 patients were included. Less than 90% of patients treated with corticosteroid responded to therapy compared to 99% of patients treated with propranolol after follow up for 12 months. Meta-analysis demonstrated the corticosteroid studies to have a pooled response rate of 69% versus propranolol response rate of 97% (p<0.001) (Table 1).Table 1: Table 1CONCLUSION: Propranolol is a relatively recent therapy of hemangiomas with fewer side effects, a different mechanism of action, and greater efficacy than current first-line corticosteroid therapy. We admit that many of these studies do not have the same patient population or duration/regimen of treatment for hemangiomas; however, based on available data in literature, it appears that propranolol could be an emerging and effective treatment for infantile hemangiomas. Further randomized control trials are recommended.
INTRODUCTION: Debilitating lower extremity lymphedema can be either congenital or acquired. Utility scores are an objective measure used in medicine to quantify degrees of impact on an individual's life. Using standardized utility outcome measures, we aimed to quantify the health state of living with severe unilateral lower extremity lymphedema. METHODS: A utility outcomes assessment using visual analogue scale (VAS), time trade-off (TTO), and standard gamble (SG) was used for lower extremity lymphedema, monocular blindness, and binocular blindness from a sample of the general population and medical students. Average utility scores were compared using a paired t-test. Linear regression was performed using age, race, and education as independent predictors. RESULTS: A total of 144 prospective participants were included. All measures (VAS, TTO, and SG) for unilateral lower extremity lymphedema (0.50 ± 0.18; 0.76 ± 0.22; 0.76 ± 0.21, respectively) were significantly different (p <0.001) from the corresponding scores for monocular blindness (0.64 ± 0.18; 0.84 ± 0.16; 0.83 ± 0.17, respectively) and binocular blindness (0.35 ± 0.17; 0.61 ± 0.28; 0.62 ± 0.26, respectively). CONCLUSION: We found that a sample of the general population and medical students, if faced with severe lymphedema, is willing to theoretically trade 8.64 life-years and undergo a procedure with a 24% risk of mortality in order to restore limb appearance and function to normal. These findings provide a frame of reference regarding the meaning of a diagnosis of severe lower extremity lymphedema to a patient and will allow objective comparison with other health states.
The presence of excess skin after massive weight loss, particularly in the thighs, not only contributes to a negative body image but can also lead to functional deficits in mobility. In the present study, we quantified the health state utility of living with excess skin in the thighs in an attempt to objectively establish the burden on the quality of life in patients living with excess thigh skin laxity.Using visual analog scale (VAS), time trade-off (TTO), and standard gamble (SG), we compared the utility outcome scores for thigh skin excess with monocular and binocular blindness from a prospective sample of medical students and the general population. Utility scores were compared using paired t test. Linear regression was performed using age, race, and education as independent predictors of each of the utility scores.One hundred thirty-four prospective participants were enrolled during a 6-month period, and 112 participants met our inclusion criteria. The utility outcome scores for thigh lift (VAS, TTO, and SG, 0.77 ± 0.15, 0.90 ± 0.11, and 0.89 ± 0.14, respectively) were statistically different from binocular blindness (VAS, TTO, and SG, 0.37 ± 0.18, 0.70 ± 0.23, and 0.70 ± 0.26; P < 0.001), but other than VAS (0.67 ± 0.15, P < 0.001), similar to monocular blindness (TTO and SG, 0.89 ± 0.13 and 0.81 ± 0.14, respectively; P > 0.05). SG (0.89 ± 0.14 vs 0.97 ± 0.02, P = 0.003) and TTO (0.89 ± 0.11 vs 0.95 ± 0.03, P = 0.038) were different between general population and medical students, respectively, corresponding to 3.96 versus 1.80 potential years willing to be traded (P < 0.05). Additionally, SG was higher in whites versus nonwhites who were willing to take a potential 8% chance of mortality compared to 15%, respectively (P = 0.001), to achieve "perfect" health.We have objectified the utility of living with thigh deformity after massive weight loss. Our sample population if faced with the condition was willing to sacrifice a potential 3.6 years of life and potentially undergo a procedure with 11% chance of mortality to address excess thigh laxity.
