Smoking status and common carotid artery intima-medial thickness among middle-aged men and women based on ultrasound measurement: a cohort study

BACKGROUND: Cigarette smoking is an established causal factor for atherosclerosis. However, the smoking effect on different echogenic components of carotid arterial wall measured by ultrasound is not well elucidated. METHODS: Middle-aged men and women who had IMT measurement ≥ 0.7 mm at baseline and follow-up were included (N = 413, age 40–60 years at baseline in 1995). Intima-media thickness of common carotid artery (CCA-IMT) and its components (echogenic and echolucent layers) were measured at baseline and in the follow-up examination 3 years later. IMT and its components were compared across current, former and never smokers. Individual growth models were used to examine how smoking status was related to the baseline and progression of overall IMT and IMT components. RESULTS: For both men and women, current smoking was associated with thicker echogenic layer than never smokers; former smokers exhibited thinner echogenic layer than current smokers after adjustment for cigarette pack-years. Among women, current smoking was also associated with a thinned echolucent layer that resulted in a non-significant overall association of current smoking with IMT for women. CONCLUSION: Cigarette smoking is associated with carotid artery morphological changes and the association is sex-dependent. The atherogenic effect of smoking appears to be partly reversible among former smokers. IMT measurement alone may not be adequate to detect carotid atherosclerosis associated with cigarette smoking among middle-age women

The risk of lung cancer related to dietary intake of flavonoids

It has been hypothesized that flavonoids in foods and beverages may reduce cancer risk through antioxidation, inhibition of inflammation, and other antimutagenic and antiproliferative properties. We examined associations between intake of five flavonoid subclasses (anthocyanidins, flavan-3-ols, flavones, flavonols, flavanones) and lung cancer risk in a population-based case-control study in Montreal, Canada (1,061 cases and 1,425 controls). Flavonoid intake was estimated from a food frequency questionnaire that assessed diet two years prior to diagnosis (cases) or interview (controls). Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using unconditional logistic regression. Overall, total flavonoid intake was not associated with lung cancer risk, the effect being similar regardless of sex and smoking level. However, low flavonoid intake from food, but not from beverages, was associated with an increased risk. The adjusted ORs (95% CIs) comparing the highest versus the lowest quartiles of intake were 0.63 (0.47-0.85) for total flavonoids, 0.82 (0.61-1.11) for anthocyanidins, 0.67 (0.50-0.90) for flavan-3-ols, 0.68 (0.50-0.93) for flavones, 0.62 (0.45-0.84) for flavonols, and 0.70 (0.53-0.94) for flavanones. An inverse association with total flavone and flavanone intake was observed for squamous cell carcinoma but not adenocarcinoma. In conclusion, low flavonoid intake from food may increase lung cancer risk

PLoS One

Quantifying the association between lifetime exposures and the risk of developing a chronic disease is a recurrent challenge in epidemiology. Individual exposure trajectories are often heterogeneous and studying their associations with the risk of disease is not straightforward. We propose to use a latent class mixed model (LCMM) to identify profiles (latent classes) of exposure trajectories and estimate their association with the risk of disease. The methodology is applied to study the association between lifetime trajectories of smoking or occupational exposure to asbestos and the risk of lung cancer in males of the ICARE population-based case-control study. Asbestos exposure was assessed using a job exposure matrix. The classes of exposure trajectories were identified using two separate LCMM for smoking and asbestos, and the association between the identified classes and the risk of lung cancer was estimated in a second stage using weighted logistic regression and all subjects. A total of 2026/2610 cases/controls had complete information on both smoking and asbestos exposure, including 1938/1837 cases/controls ever smokers, and 1417/1520 cases/controls ever exposed to asbestos. The LCMM identified four latent classes of smoking trajectories which had different risks of lung cancer, all much stronger than never smokers. The most frequent class had moderate constant intensity over lifetime while the three others had either long-term, distant or recent high intensity. The latter had the strongest risk of lung cancer. We identified five classes of asbestos exposure trajectories which all had higher risk of lung cancer compared to men never occupationally exposed to asbestos, whatever the dose and the timing of exposure. The proposed approach opens new perspectives for the analyses of dose-time-response relationships between protracted exposures and the risk of developing a chronic disease, by providing a complete picture of exposure history in terms of intensity, duration, and timing of exposure

Prog Urol

Objectifs: La prévalence de l'obésité n'a cessé d'augmenter ces 20 dernières années dans la population générale et parmi les patients receveurs de transplants rénaux. Dans l'esprit chirurgical, l'obésité est associée à une augmentation des difficultés chirurgicales. L'objectif de cette étude était d’évaluer l'impact de l'IMC sur les complications périopératoires. Méthodes: Toutes les transplantations rénales réalisées chez l'adulte dans notre centre de 2006 à 2011 ont été analysées. Les données concernant les caractéristiques des patients, la procédure chirurgicale, les complications per- et postopératoires ainsi que la fonction rénale ont été collectées. Les patients on été repartis en 4 groupes: sous-poids (BMI < 18,5 kg/m2), poids normal (18,5 kg/m2 ≤ BMI < 25 kg/m2), surpoids (25 kg/m2 ≤ BMI < 30 kg/m2) et obésité (BMI ≥ 30 kg/m2). Nous avons également étudié l'impact de l'IMC sur les complications en tant que variable continue afin d'identifier de potentielles valeurs seuils. Résultats: Parmi 694 patients inclus, 52 % avait un IMC normal, 7 %, 31 % et 9 % étaient respectivement en sous-poids, surpoids et obèses. En analyse multivariée, le surpoids était associé à une augmentation de la durée opératoire comparé au patients de poids normal (différence moyenne estimée à 10,4 min, 95 % intervalle de confiance (IC) [4,0; 16,9]) et l'obésité était associée à une augmentation du risque d’éventration (odds ratio 3,1, 95 %CI [1,3; 7,3] comparé aux patients de poids normal). En considérant l'IMC en tant que variable continue le risque d’éventration augmentait significativement au-delà d'un IMC à 26 kg/m2, de pertes sanguines et de sténose urétérale au-delà d'un IMC à 32 kg/m2 et d'hématome de paroi au-delà d'un IMC à 34 kg/m2. Conclusions: Nous avons trouvé des seuils d'IMC au-delà desquels les pertes sanguines, le risque d’éventration, de sténose urétérale et d'hématome de paroi augmentent significativement. Niveau de preuve: 3. © 2020 Elsevier Masson SASObjectives: Obesity prevalence has increased over the past 20 years in the general population and among kidney transplant recipients. General surgical belief is that obesity increases surgical difficulty. The aim of this study was to assess the impact of Body Mass Index (BMI) on perioperative complications. Methods: All kidney transplantations performed in adults in our centre from 2006 to 2011 were analysed. Data on patients’ characteristics, surgical protocol, intra and postoperative complications and renal function were collected. Patients were divided into 4 groups as follows: underweight (BMI < 18.5 kg/m2), normal weight (18.5 kg/m2 ≤ BMI < 25 kg/m2), overweight (25 kg/m2 ≤ BMI < 30 kg/m2) and obese (BMI ≥ 30 kg/m2). We also studied the impact of BMI on complications using it as a continuous variable to identify potential threshold values. Results: Among 694 patients included, 52% had normal BMI, 7%, 31% and 9% were underweight, overweight and obese, respectively. In multivariate analysis, overweight was significantly associated with longer operative time compared to normal-weight patients (estimated mean difference of 10,4 min, 95% confidence interval (CI) [4.0; 16.9]) and obesity was associated with an increased risk of wound dehiscence (odds ratio 3.1, 95% CI [1.3; 7.3] compared with normal-weight patients). Considering BMI as a continuous variable, the risk of parietal dehiscence significantly increased beyond a BMI of 26 kg/m2, intraoperative blood loss and the risk of ureteral stenosis beyond 32 kg/m2 and the risk of abdominal wall hematoma beyond a BMI of 34 kg/m2. Conclusions: We found BMI thresholds above which intraoperative blood loss and the risk of parietal dehiscence, ureteral stenosis, and parietal hematoma significantly increased. Level of evidence: 3. © 2020 Elsevier Masson SA

Risk Factors of Early Kidney Graft Transplantectomy

BACKGROUND: Kidney allograft explant in the first month after transplant is a major concern for medicosurgical teams specialized in kidney transplantation and unacceptable graft loss in the current shortage. The aim of our study was to evaluate the risk factors of early kidney graft explant. METHODS: We retrospectively analyzed all adult kidney transplantations performed at our center from January 2006 to December 2011. Recipient, donor, and transplant characteristics were collected, as well as operating data and early postoperative complications. Univariate and multivariate logistic regression models were used to determine risk factors of early renal allograft explant. RESULTS: From a total of 707 kidney transplantations, 28 transplantectomies were performed in the first month following transplantation (3.96%). The average delay in days +/- SD was 7.6 +/- 10. Eighty-six percent of transplantectomies were due to vascular complications. In multivariate analysis, obesity (odds ratio [OR] = 9.6; 95% confidence interval [CI], 1.63-56.5; P = .0007), range of transplantation (OR = 36.89; 95%CI, 5.5-245; P = .0006), intraoperative complications (OR = 3.99; 95%CI, 1.22-13; P = .026), and early postoperative vascular complications (OR = 85.15; 95%CI, 23.6-306; P < .0001) were independent risk factors. Neither donors nor graft characteristics were significant. CONCLUSIONS: Early renal graft transplantectomies are rare but account for 50% of renal graft loss in the first year. Because obesity, perioperative complications, and early vascular complications are independent factors associated with early transplantectomies, their prevention should be based on meticulous surgery during organ procurement, implantation of the kidney, and on the rehabilitation of future recipients