Association between lipid trajectories during pregnancy and risk of postpartum glucose intolerance after gestational diabetes mellitus: a cohort study

Zhuofan Yang1  · Zhuyu Li1  · Yunjiu Cheng2  · Peisong Chen3  · Dongyu Wang1  · Haitian Chen1  · Wei Chen1  · Zilian Wang1

1 Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Rd II, Guangzhou 510080, China

2 Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China

3 Department of Clinical Laboratory, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China Received: 19 February 2022 / Accepted: 12 May 2022 / Published online: 5 July 2022 © The Author(s) 2022

Abstract

Aims To assess lipid trajectories throughout pregnancy in relation to early postpartum glucose intolerance in women with gestational diabetes mellitus (GDM).

Methods This prospective cohort study included 221 Chinese women with GDM who completed plasma lipid test in each trimester of pregnancy and oral glucose tolerance test at 6–9 weeks postdelivery between January 1, 2018 and January 8, 2020. Using the group-based trajectory modeling, total cholesterol (TC), triglyceride (TG), low-density lipoprotein-cholesterol (LDL-c), and high-density lipoprotein-cholesterol(HDL-c) were identified separately as three trajectories: low, moderate, and high trajectory. The associations between lipid trajectories and early postpartum glucose intolerance were all evaluated.

Results Seventy-three participants developed postpartum glucose intolerance. For patients in low, moderate and high trajectory, the incidence of postpartum glucose intolerance was 38.4%, 34.9%, and 17.9%, respectively. GDM women with lower LDL-c trajectories presented a higher risk of postpartum glucose intolerance. The adjusted odds ratio (95% CI) for glucose intolerance was 3.14 (1.17–8.39) in low LDL-c trajectory and 2.68 (1.05–6.85) in moderate trajectory when compared with the high one. However, TC trajectory was not associated with the risk of postpartum glucose intolerance, nor were TG trajectory and HDL-c trajectory. Moreover, a significant difference of insulin sensitivity was observed in participants with different LDL-c trajectories; participants in high LDL-c trajectory had the highest insulin sensitivity, whereas the women in low LDL-c trajectory had the lowest insulin sensitivity (P=0.02).

Conclusions The high trajectory of LDL-c during pregnancy may play a protective role on postpartum glucose intolerance in women with GDM. Further studies are warranted to explore the underlying mechanism. Trial registration The study was reviewed and approved by the Institutional Review Board of The First Affiliated Hospital of Sun Yat-sen University (reference number: [2014]No. 93). All participants provided written informed consent forms, and the ethics committee approved this consent procedure.

Keywords Lipid trajectory · Glucose intolerance · Gestational diabetes mellitus · Insulin sensitivity

      This article belongs to the topical collection Pregnancyand Diabetes, managed by Antonio Secchi and Marina Scavini.

      Zhuofan Yang, Zhuyu Li, Yunjiu Cheng have contributed equally to this work. Zilian Wang 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。

Abbreviations

GDM Gestational diabetes mellitus

GBTM Group-based trajectory modeling

TC Total cholesterol

TG Triglyceride

LDL-c Low-density lipoprotein-cholesterol

HDL-c High-density lipoprotein-cholesterol

PGDM Pregestational diabetes mellitus

OGTT Oral glucose tolerance test

FBG Fasting blood glucose

HOMA-IS Homeostasis model assessment-IS

BIC Bayesian information criterion

AvePP Average posterior probability

NODM New-onset diabetes mellitus

LDLR Low-density protein receptor

The efficacy of morning versus evening exercise for weight loss: A randomized controlled trial

Paige G. Brooker1 | Sjaan R. Gomersall 1,2 | Neil A. King 3 | Michael D. Leveritt1

1 School of Human Movement and Nutrition Sciences, Faculty of Health & Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia

2 School of Health & Rehabilitation Sciences, Faculty of Health & Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia

3 School of Exercise & Nutrition Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia Correspondence Paige G. Brooker, School of Human Movement and Nutrition Sciences, Faculty of Health & Behavioural Sciences, The University of Queensland, Brisbane, Queensland,

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Abstract

Objective: The aim of this study was to investigate the influence of morning versus evening exercise on weight loss, cardiometabolic health, and components of energy

Methods: A total of 100 inactive adults with overweight or obesity were randomized to morning exercise (AMEx; 06:00–09:00), evening exercise (PMEx; 16:00–19:00), or wait-list control (CON). AMEx and PMEx were prescribed 250 min
wk 1 of selfpaced aerobic exercise for 12 weeks. Anthropometry and body composition, physical activity, and dietary intake were assessed at baseline, 6 weeks, and 12 weeks. Cardiorespiratory fitness (V̇  O2peak), resting metabolic rate, and blood markers were assessed at baseline and 12 weeks. Body composition and V̇  O2peak were also measured at 3- and 6-month follow-up.

Results: AMEx and PMEx lost weight during the intervention (mean [SD], AMEx, - 2.7 [2.5] kg, p < 0.001; PMEx, -3.1 [3.4] kg, p < 0.001). V̇ O2peak significantly increased in both intervention groups, and these changes were different from CON (AMEx, +4.7 mL . kg- 1 . min- 1 , p = 0.034; PMEx, +4.2 mL. kg- 1 . min- 1 , p = 0.045). There were no between-group differences for resting metabolic rate or physical activity. At 12 weeks, total energy intake was significantly reduced in both AMEx and PMEx versus CON (AMEx, - 3974 kJ, p < 0.001; PMEx, - 3165 kJ, p = 0.001).

Conclusions: Adults with overweight and obesity experience modest weight loss in response to an exercise program, but there does not appear to be an optimal time to exercise.

皮肤牵拉闭合器联合富氧可调节负压辅助疗法 治疗难治性创面的疗效

张鑫锋 1,2,3），张小丽 1,2,3），李孟丽 1,2,3），罗华友 1,2,3），舒　若 1,2,3），雷　毅 1,2,3）（1）昆明医科大学第一附属医院国家卫健委毒品依赖和戒治重点实验室；2）胃肠与疝外科；3）科研实验中心，云南 昆明　650032）

[摘要]  目的　探讨 Top Closure 皮肤牵拉闭合器联合富氧可调节负压辅助疗法治疗难治性创面的临床疗效。

方法　选取 2018 年 8 月至 2020 年 7 月昆明医科大学第一附属医院胃肠与疝外科收治的不同部位难治性创面患者 36 例，回顾性分析 Top Closure 皮肤牵拉闭合器与富氧可调节负压辅助疗法的治疗效果。结果　35 例患者经Top Closure 皮肤牵拉闭合器与富氧可调节负压辅助疗法治疗后，创面均愈合良好，无愈合不良或不愈合。1 例患者因为术后严重的心肺功能衰竭死亡。结论　Top Closure 皮肤持续牵张技术联合富氧可调节负压辅助疗法相对简单，大大降低了手术难度，术后伤口愈合良好，可应用于治疗难治性创面。

[关键词]

Top Closure 皮肤持续牵张技术； 富氧可调节负压辅助疗法； 难治性创面； 褥疮； 糖尿病足

[中图分类号]   R64   [文献标志码]   A [文章编号]  2095 − 610X（2021）07 − 0043 − 06

Top Closure Tension-relief System with Regulated Oxygenenriched Negative Pressure-assisted Wound Therapy for the Treatment of Refractory Wounds

ZHANG Xin-feng 1,2,3），ZHANG Xiao-li 1,2,3），LI Meng-li 1,2,3），LUO Hua-you 1,2,3），SHU Ruo 1,2,3），LEI Yi 1,2,3）（1） The NHC Key Laboratory of Drug Addiction Medicine; 2） Dept. of Gastrointestinal and Hernia Surgery; 3） The Scientific Research Laboratory Center，The 1st Affiliated Hospital of Kunming Medical University，Kunming Yunnan 650032，China）

［Abstract］   Objective　To investigate the clinical efficacy of Top Closure tension-relief system combined with regulated oxygen-enriched negative pressure-assisted wound therapy in the treatment of refractory wounds. Methods　From August 2018 to July 2020，36 patients with refractory wounds at different sites were selected from the Department of Gastroenterology and hernia surgery，the First Affiliated Hospital of Kunming Medical University. We retrospectively analyzed the therapeutic effects of Top Closure tension-relief system combined with regulated oxygen-enriched negative pressure-assisted wound therapy. Results　After 35 patients were treated with Top Closure skin traction occluder and oxygen-enriched adjustable negative pressure therapy，the wounds healed well and there was no malunion or nonunion. One patient died of severe cardiopulmonary failure after operation. Conclusion　Top Closure tension-relief system combined with regulated oxygen-enriched negative pressureassisted wound therapy in the treatment of refractory wounds is relatively simple，it can greatly reduce the difficulty of operation，and make the wound heal well after operation，so it can be used to treat refractory wounds.

［Key words］ Top Closure tension-relief system； Regulated oxygen-enriched negative pressure-assisted wound therapy；Refractory wounds；Pressure ulcer；Diabetic foot

[收稿日期]   2021 − 05 − 19

[基金项目]   国 家 自 然 科 学 基 金 资 助 项 目（ 82060516）；云 南 省 消 化 疾 病 防 治 工 程 技 术 研 究 中 心 基 金 资 助 项 目（2018DH006）；云南省医疗卫生单位内设研究机构科研基金资助项目（2017NS001）

[作者简介]   张鑫锋（1996～），男，河北涿州人，医学硕士，住院医师，主要从事普通外科研究工作。

[通信作者]   雷毅，E-mail：该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。

A systematic description of continent ileostomy revision techniques

Nils Karl Josef Ecker1  · Mathias Tönsmann2  · Karl‑Wilhelm Ecker3,4,5

Accepted: 8 November 2022 / Published online: 21 November 2022

© The Author(s) 2022

Abstract

Purpose Comprehensive description of surgical techniques for revision of complications of continent ileostomy (CI).

Methods By analyzing 133 revision procedures performed over 30 years, a systematically classified approach to the appropriate techniques for CI revision surgery has been derived. Based on the anatomic site and severity of the respective complication, four classes of revision surgeries have been defined: class 1 refers to the nipple valve, class 2 to the pouch, class 3 to the stoma, and class 4 to the afferent loop. The severity of the complication or the complexity of the revision procedure is indicated by a subdivision from a to d.

Results The surgical variants (class 1a–d, class 2a–c, class 3a–b, and class 4a–b) are shown in schematic illustrations with accompanying descriptions of technical details, the respective fields of application, and the special indications.

Conclusion Based on these classes of revision surgeries, the specialized surgeon may find differentiated techniques at their disposal to save the CI and avoid unnecessary sacrifice of the artificial continence organ.

Keywords Nipple valve · Pouch fistula · Stoma complication · Crohn’s disease · Surgical repair · Technical details

Determination of medical device-related pressure injury in COVID-19 patients: A prospective descriptive study

Eylem Togluk Yi˘gito˘glu a,* , Semine Aydo˘gan b a Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty Hospital, Ostomy and Wound Care Unit, Istanbul, Turkey b Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty Hospital, Sadı Sun

˙In tensive Care Unit, Istanbul, Turkey

ARTICLE INFO

Keywords: COVID-19  ICU  Medical device-related injury  Pressure injury

ABSTRACT

Background: COVID-19 patients are at risk for the development of pressure injuries (PI).

Aim: The aim of this study was to determine the incidence of medical device-related pressure injury (MDRPI) in patients treated in the COVID-19 Intensive Care Unit (ICU)s.

Methods: The sample of the study consisted of 132 patients, and each with a maximum follow-up of 7 days. Data were collected in the COVID-19 ICU of a university hospital between January and May 2021 by using a Patient Characteristics Form, the MDRPI Follow-up Form, the Braden Pressure Ulcer Risk Assessment Scale, and the Pressure Ulcer Staging Form.

Results: Of the patients, 59.1% (n = 78) developed at least one MDRPI. MRDPI was observed in those with a mean age of 65.45 ± 2.462 years who were invasively ventilated (51.3%), enterally fed (46.2%), placed in the prone position (78.2%), and had a Braden score ≤12 (50%). The most common medical devices that caused MDRPIs included endotracheal tube (ET) (31.2% n = 44), non-invasive mechanical ventilation (NIVM) (23.4% n = 33), nasal high-flow (11.3% n = 16), nasogastric tube (10.6% n = 15), the ET connection (8.5% n = 12), respectively. The most common sites for pressure injuries were the nose (28.8% n = 34), mouth (25.8% n = 34), ear (12.9% n = 17), lip (9.1% n = 12), and cheek (8.3% n = 11). The most common gradings of MDRPIs were stage 2 (28.8% n = 38), stage 1 (19.7% n = 26), stage 3 (9.1% n = 12) mucous membrane injuries (12.9% n = 17) and suspected deep tissue injuries (9.1% n = 12), respectively. The time to PI was 3 days (25.7% n = 36).

Conclusions: MDRPI was common among COVID-19 patients. It was found that the most common cause of pressure injury was ventilators, and PI developed in the mouth and lip sites most frequently in patients in prone position, stage 2 and suspected deep tissue damage was the most common grade. It is important to evaluate the skin in contact with medical devices in COVID-19 patients and to take the necessary interventions to prevent PI.

Development of a home health care service platform for ostomy patient management

Seongwoo Yang1,*, Ji Won Park2,*, Hyuk Hur3,5, Min Jung Kim2 , Seung-Yong Jeong2 , Kyounghoon Park1 , Ik Yong Kim4,5

1 HERINGS, The Institute of Advanced Clinical & Biomedical Research, Seoul; 2 Department of Surgery, Seoul National University College of Medicine, Seoul; 3 Department of Surgery, Yonsei University College of Medicine, Seoul; 4 Division of Colorectal Surgery, Department of Surgery, Yonsei University Wonju College of Medicine, Wonju; 5 Korean Wound and Ostomy Study Group of The Korean Society of Coloproctology, Seoul, Korea

Purpose: The use of an ostomy for urination and defecation leads to reduced quality of life. Although many ostomy management strategies are needed, such strategies are often implemented by patients. Thus, there is a need for a home health

care service platform that can be used in ostomy patient management.

Methods: We developed an ostomy patient management platform by identifying the needs of patients and medical staff through the Chronic Care Ostomy Self-Management Training Program in the United States and from studies conducted in Korea.

Results: The platform encompassed physical management, psychological management, maintenance of social function, spiritual stability, and home medical care. These components were implemented through monitoring, self-care guidance, and a community platform. For the monitoring function, a patient entered their health status in a mobile application (app); the medical staff at the affiliated hospital then monitored the stoma status through a web interface.

Conclusion: Our platform allows medical staff to monitor ostomy patients through a web interface and help such patients to fully manage their ostomy at home using an app. We expect that the continued development of patient-oriented functions in our app will allow ostomy patients to experience quality of life improvements.

Keywords: Ostomy; Home care services; Telehealth; Digital health platform; Telemedicine

Received: May 23, 2022 • Revised: Jul 12, 2022 • Accepted: Jul 18, 2022 Correspondence to: Kyounghoon Park, M.D., Ph.D. HERINGS, The Institute of Advanced Clinical & Biomedical Research, 560 Eonju-ro, Gangnam-gu, Seoul 06144, Korea

Tel: +82-2-6949-3516, Fax: +82-2-6949-3517

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ORCID: https://orcid.org/0000-0001-5800-917X Co-Correspondence to: Ik Yong Kim, M.D., Ph.D. Department of Surgery, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju 26426, Korea

Tel: +82-33-741-0573, Fax: +82-33-741-0574

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ORCID: https://orcid.org/0000-0001-6375-2216

* Seongwoo Yang and Ji Won Park contributed equally to this work as co-first authors.

This study was presented at The Korean Society of Coloproctology the 55th Annual Meeting, held in Busan, Korea from April 8 to 10, 2022.

© 2022 The Korean Society of Coloproctology

This is an open-access article distributed under the terms of the Creative Commons Attribution NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.