Cardiovascular and Cerebrovascular Disease Mortality in Asian American Subgroups.

BACKGROUND: Asian American individuals comprise the fastest-growing race and ethnic group in the United States. Certain subgroups may be at disproportionately high cardiovascular risk. This analysis aimed to identify cardiovascular and cerebrovascular disease mortality trends in Asian American subgroups. METHODS: Age-standardized mortality rates (ASMR), average annual percent change of ASMR calculated by regression, and proportional mortality ratios of ischemic heart disease, heart failure, and cerebrovascular disease were calculated by sex in non-Hispanic Asian American subgroups (Chinese, Filipino, Asian Indian, Japanese, Korean, and Vietnamese), non-Hispanic White, and Hispanic individuals from US death certificates, 2003 to 2017. RESULTS: Among 618 004 non-Hispanic Asian American, 30 267 178 non-Hispanic White, and 2 292 257 Hispanic deaths from all causes, ASMR from ischemic heart disease significantly decreased in all subgroups of Asian American women and in non-Hispanic White and Hispanic women; significantly decreased in Chinese, Filipino, Japanese, and Korean men and non-Hispanic White and Hispanic men and remained stagnant in Asian Indian and Vietnamese men. The highest 2017 ASMR from ischemic heart disease among Asian American decedents was in Asian Indian women (77 per 100 000) and men (133 per 100 000). Heart failure ASMR remained stagnant in Chinese, Korean, and non-Hispanic White women, and Chinese and Vietnamese men. Heart failure ASMR significantly increased in both sexes in Filipino, Asian Indian, and Japanese individuals, Vietnamese women, and Korean men, with highest 2017 ASMR among Asian American subgroups in Asian Indian women (14 per 100 000) and Asian Indian men (15 per 100 000). Cerebrovascular disease ASMR decreased in Chinese, Filipino, and Japanese women and men between 2003 and 2017, and remained stagnant in Asian Indian, Korean, and Vietnamese women and men. The highest cerebrovascular disease ASMR among Asian American subgroups in 2017 was in Vietnamese women (46 per 100 000) and men (47 per 100 000). CONCLUSIONS: There was heterogeneity in cardiovascular and cerebrovascular mortality among Asian American subgroups, with stagnant or increasing mortality trends in several subgroups between 2003 and 2017.

Laparoscopic cholecystectomy in a patient with a ventriculoperitoneal shunt.

With the advent of ventriculo-peritoneal shunting and improved medical therapies, patients with hydrocephalus are living Ionger and presenting with unrelated medical problems. It can be disconcerting to discover that the patient who needs a routine laparoscopic procedure also has a ventriculoperitoneal (VP) shunt. Although the literature is limited there is a small body of evidence indicating that it is safe to perform laparoscopic surgery on these patients with routine anesthetic monitoring. The authors report the case of a laparoscopic cholecystectomy in a patient with a VP shunt.

The influence of metabolic heat production on body temperature of a small lizard, Anolis carolinensis.

Little is known about the impact of increased metabolism on body temperatures of small ectotherms. We found that postprandial metabolic rates of 5 g Anolis carolinensis lizards were elevated by factorial increases of 2.3+/-1.0 (mean+/-S.E.) at 26 degrees C and 3.8+/-2.1 at 30 degrees C over their fasting rates. Cloacal body temperatures exceeded environmental temperatures by a small amount in fasted individuals (26 degrees C: 0.3+/-0.02 degrees C, 30 degrees C: 0.3+/-0.02 degrees C), and by a significantly larger amount in fed individuals (26 degrees C: 1.0+/-0.06 degrees C, 30 degrees C: 0.8+/-0.08 degrees C). We conclude that an increased metabolic rate due to specific dynamic action leads to a small but significant elevation of body temperature in this species. Comparisons with thermal increments reported for a large (750 g) varanid lizard suggest that body size has only a minor influence on body-air temperature differentials of ectotherms. This is consistent with theoretical predictions. Finally, endogenous heat production could help elevate body temperatures in the wild and therefore play a minor role in thermoregulation.