[What is an effect modifier?]

Scapulothoracic dissociation and blunt vertebral vascular injury: case report

Case Description:

A 24-year-old male suffers from a motor vehicle accident with penetrating neck trauma and concomitant closed left cervicothoracic trauma.

Clinical Findings:

High impact trauma causing hypovolemic shock, left zone I penetrating neck trauma, ischemia due to blunt trauma to the axillary vessels, and brachial plexus injury. Transection of the vertebral artery on angiotomography. Diagnosed with scapulothoracic dissociation and vertebral artery trauma.

Treatment and outcome:

Axillary arteriovenous reconstruction, fasciotomies, non-surgical approach of the vertebral artery trauma, and deferred treatment of the brachial plexus trauma were performed. Survival of the patient and his limb, with major neurologic sequelae

Clinical Relevance:

The case presented here is an example of scapulothoracic dissociation with associated trauma to the vertebral artery, injuries that are uncommon and associated with high morbidity and mortality. Early recognition of the injuries and a multidisciplinary approach for this complex case by surgical board reviews at various levels within the course of care were key determinants in the patient’s improved prognosis. This case report presents an analysis of the diagnostics, treatment, and course; considering in-hospital care and the decision-making process as determinants for the prognosis in a polytrauma patient.

Scapulothoracic dissociation and blunt vertebral vascular injury: case report

Case Description: A 24-year-old male suffers from a motor vehicle accident with penetrating neck trauma and concomitant closed left cervicothoracic trauma. Clinical Findings: High impact trauma causing hypovolemic shock, left zone I penetrating neck trauma, ischemia due to blunt trauma to the axillary vessels, and brachial plexus injury. Transection of the vertebral artery on angiotomography. Diagnosed with scapulothoracic dissociation and vertebral artery trauma. Treatment and outcome: Axillary arteriovenous reconstruction, fasciotomies, non-surgical approach of the vertebral artery trauma, and deferred treatment of the brachial plexus trauma were performed. Survival of the patient and his limb, with major neurologic sequelae Clinical Relevance: The case presented here is an example of scapulothoracic dissociation with associated trauma to the vertebral artery, injuries that are uncommon and associated with high morbidity and mortality. Early recognition of the injuries and a multidisciplinary approach for this complex case by surgical board reviews at various levels within the course of care were key determinants in the patient’s improved prognosis. This case report presents an analysis of the diagnostics, treatment, and course; considering in-hospital care and the decision-making process as determinants for the prognosis in a polytrauma patient.

TRP64ARG polymorphism of the beta 3-adrenergic receptor gene and obesity risk: effect modification by a sedentary lifestyle

AIM

We performed a case-control study to assess the association between obesity risk and the Trp64Arg polymorphism of the beta 3-adrenergic receptor gene.

METHODS

Obese subjects [n = 159; body mass index (BMI) > 30 kg/m2] and controls (n = 154; BMI < 25 kg/m2) were compared using multivariable logistic regression to control for potential confounders.

RESULTS

A higher obesity risk (adjusted OR: 2.98; 95% CI: 1.00-8.56; p = 0.05) was associated with the Trp64Arg polymorphism among sedentary, but not among more active people.

CONCLUSIONS

Our results suggest that the TRP64ARG polymorphism of the ADRB3 seems to be a risk factor for obesity that is dependent on a sedentary lifestyle.

[Relative role of physical inactivity and snacking between meals in weight gain]

BACKGROUND

Diet and life-styles are considered as the main factors that determine the high prevalence of obesity in Western societies. Although some countries have registered a decrease in fat intake, the percentage of overweight and obesity has increased. Therefore, it is thought that fat intake may not be the main factor that determines the current epidemic of obesity. The objective of this study was to determine the role of a sedentary life-style and eating between meals (snacking) as major determinants of a recent weight change (over last 5 years).

METHOD

By using cross-sectionally baseline data of the SUN cohort, we adjusted non-conditional logistic regression models to estimate the odds ratio (OR) of gaining weight according to age, physical activity in leisure time, watching television, taking a nap, smoking, snacking and the intake of macronutrients.

RESULTS

A statistically significant inverse association between leisure-time physical activity and the probability of gaining weight was found for men (OR = 0.93; CI 95%, 0.88-0.98) and a trend was also present among women. Snacking was positively associated with a higher probability of gaining weight among men (OR = 1.88; CI 95%, 1.40-2.53) and among women (OR = 1.38; CI 95%, 1.10-1.73).

CONCLUSIONS

Our data suggest a direct association between snacking and weight gain in middle-aged people.