Bezoar-induced Small Bowel Obstruction

Purpose: The aim of this study was to observe the clinical features of a bezoar-induced small bowel obstruction and to in-vestigate the role of abdominal computed tomography (CT) in establishing the diagnosis. Methods: We retrospectively reviewed 20 cases of bezoar-induced small bowel obstruction in our hospital from 1996 to 2010. Results: Thirteen patients (65%) had a history of abdominal surgery. Nine patients (45%) were diagnosed with a bezoar before surgery, seven patients were diagnosed by using abdominal CT, and two patients were diagnosed with a small bowel series. Abdominal CT was performed in 15 patients, and the diagnostic accuracy was 47 % (7/15). Surgery revealed ten bezoars in the jejunum and 11 in the ileum. Two patients had bezoars found concurrently in the stomach. Spontaneous removal took place in two patients. An enterotomy and bezoar extraction was performed in 15 patients. Fragmentation and milking, a small bowel resection, and a Meckel’s diverticulectomy were performed in one patient each. Early operative treatment was possible (P = 0.036) once the bezoar had been diagnosed by using abdominal CT. There tended to be fewer postoperative complications in patients who were diagnosed with a bezoar by using abdominal CT, but the result was not statistically significant (P = 0.712). Conclusion: A preoperative diagnosis of bezoar-induced small bowel obstruction by using clinical features was difficult. Increased use of abdominal CT led to a more accurate diagnosis and to earlier surgery for bezoar-induced small bowel obstructions, thereby reducing the rate of complications

Nutritional Status of Vitamin D and the Effect of Vitamin D Supplementation in Korean Breast-fed Infants

We investigated the vitamin D status and the effect of vitamin D supplementation in Korean breast-fed infants. The healthy term newborns were divided into 3 groups; A, formula-fed; B, breast-fed only; S, breast-fed with vitamin D supplementation. We measured serum concentrations of vitamin D (25OHD3), calcium (Ca), phosphorus (P), alkaline phosphatase (AP), intact parathyroid hormone (iPTH) and bone mineral density (BMD) at 6 and 12 months of age. Using questionnaires, average duration of sun-light exposure and dietary intake of vitamin D, Ca and P were obtained. At 6 and 12 months of age, 25OHD3 was significantly higher in group S than in group B (P<0.001). iPTH was significantly lower in group S than in group B at 6 months (P=0.001), but did not differ at 12 months. Regardless of vitamin D supplementation, BMD was lower in group B and S than in group A (P<0.05). Total intake of vitamin D differed among 3 groups (P<0.001, A>S>B), but total intake of Ca and P were higher in group A than in group B and S (P<0.001). In conclusion, breast-fed infants show lower vitamin D status and bone mineralization than formula-fed infants. Vitamin D supplementation (200 IU/day) in breast-fed infants increases serum 25-OH vitamin D3, but not bone mineral density

Effects of Once-Weekly Exenatide on Cardiovascular Outcomes in Type 2 Diabetes.

Abstract BACKGROUND: The cardiovascular effects of adding once-weekly treatment with exenatide to usual care in patients with type 2 diabetes are unknown. METHODS: We randomly assigned patients with type 2 diabetes, with or without previous cardiovascular disease, to receive subcutaneous injections of extended-release exenatide at a dose of 2 mg or matching placebo once weekly. The primary composite outcome was the first occurrence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. The coprimary hypotheses were that exenatide, administered once weekly, would be noninferior to placebo with respect to safety and superior to placebo with respect to efficacy. RESULTS: In all, 14,752 patients (of whom 10,782 [73.1%] had previous cardiovascular disease) were followed for a median of 3.2 years (interquartile range, 2.2 to 4.4). A primary composite outcome event occurred in 839 of 7356 patients (11.4%; 3.7 events per 100 person-years) in the exenatide group and in 905 of 7396 patients (12.2%; 4.0 events per 100 person-years) in the placebo group (hazard ratio, 0.91; 95% confidence interval [CI], 0.83 to 1.00), with the intention-to-treat analysis indicating that exenatide, administered once weekly, was noninferior to placebo with respect to safety (P<0.001 for noninferiority) but was not superior to placebo with respect to efficacy (P=0.06 for superiority). The rates of death from cardiovascular causes, fatal or nonfatal myocardial infarction, fatal or nonfatal stroke, hospitalization for heart failure, and hospitalization for acute coronary syndrome, and the incidence of acute pancreatitis, pancreatic cancer, medullary thyroid carcinoma, and serious adverse events did not differ significantly between the two groups. CONCLUSIONS: Among patients with type 2 diabetes with or without previous cardiovascular disease, the incidence of major adverse cardiovascular events did not differ significantly between patients who received exenatide and those who received placebo. (Funded by Amylin Pharmaceuticals; EXSCEL ClinicalTrials.gov number, NCT01144338 .)

Role of Gender and Attitudes on Public Transportation Use

This study aimed to evaluate gender differences in public transportation-related attitudes and their effects on transit use. How did attitudes affect people\u27s transit use? Did public transit-related attitudes differ by gender in general and by status group (faculty, staff, and students)? This research aimed to address these questions. The analysis was based on data collected from the 2012 campus transportation survey at Ohio State University. The survey questionnaire covered individuals\u27 sociodemographic characteristics, commute mode choices, and attitudes toward driving and taking public transit, including reliability, safety, flexibility, convenience, accessibility, and comfort. After the descriptive analysis of perceptions that were segmented on the basis of gender and status (faculty, staff, undergraduates, and graduate students), binary logit models were estimated to assess the influences of individuals\u27 attitudes on transit use while controlling for other factors. First a binary logit model measuring the effects of respondents\u27 status (student, staff, or faculty), car ownership, ethnicity, proximity to bus stops, and distance to campus was estimated. Then respondents\u27 attitudes were added to the existing model. Results indicated that including attitudes significantly increased the explanatory power of the model, and the results revealed the significant connections between attitudes related to public transportation and public transit use. The findings of this study can help transportation planners understand the ways attitudes affect transit use and the differences across genders. Although the study used data from Ohio State University, the findings can help in developing plans for increasing alternative transportation use on other campuses, as well as in surrounding areas

Influences of Neighborhood Characteristics and Personal Attitudes on University Commuters’ Public Transit Use

This study examined the links between attitudes, the built environment, and travel behavior on the basis of data from the Ohio State University’s 2012 Campus Transportation Survey. The analysis results indicated that attitudes might have explained travel behavior better than the built environment. Survey respondents were asked questions about their attitudes on public transit use, and their answers were grouped into new attitudinal factors by using principal component analysis. Then, new neighborhood categories were created by K-means cluster analysis by means of built-environment and land use variables (population density, employment density, housing density, median age of structures, percentage of single-family housing, and intersection density). As a result of this analysis, discrete neighborhood categories, such as urban high-density and residential neighborhoods, and urban low-density and mixed-use neighborhoods, were created. Then, differences in attitudes toward public transit were analyzed across these new neighborhood categories. Binary logit models were estimated to determine the influence of these neighborhood categories as well as personal attitudes on public transit use after sociodemographic characteristics were controlled for. The results indicated that attitudes were more strongly associated with travel behavior than with neighborhood characteristics. The findings of this study will aid in the formation of a better understanding of public transit use by highlighting the effects of attitudes and neighborhood characteristics in transit use as well as differences in attitudes between neighborhood types

The Role of Built Environment on Health of Older Adults in Korea: Obesity and Gender Differences

This study examines the effect of the built environment on obesity in older adults, taking into consideration gender difference. In this regard, we ask two questions: (1) How does the built environment affect obesity in older adults? (2) Is there a gender difference in the effect of the built environment? To examine the research questions, this study uses the 2015 Korean National Health and Nutrition Survey and geographically weighted regression (GWR) analysis. The empirical analyses show that environmental factors have stronger effects on local obesity rates for older men than for older women, which indicates a gender difference in obesity. Based on these findings, we suggest that public health policies for obesity should consider the built environment as well as gender difference