Association between BMI and osteoporotic fractures at different sites in Chinese women: a case-control retrospective study in Changsha.

BACKGROUND: Osteoporotic fractures are a growing problem in an aging society. The association between body mass index (BMI) and osteoporotic fractures varies by fracture site and ethnicity. Limited knowledge exists regarding this association in native Chinese, particularly utilizing local databases as reference sources. OBJECTIVE: To investigate the association between BMI and osteoporotic fractures at different sites in Chinese women. METHODS: Three thousand ninety-eight female patients with radiographic fractures and 3098 age- and sex-matched healthy controls without fractures were included in the study. Both of them underwent assessment using dual-energy X-ray absorptiometry (DXA), with BMD measurements calculated using our own BMD reference database. Participants were classified into underweight (BMI < 18.5 kg/m2), normal weight (18.5 ≤ BMI < 24.0 kg/m2), overweight (24 ≤ BMI < 28 kg/m2) and obese (BMI ≥ 28 kg/m2) according to the Chinese BMI classification standard. RESULTS: There were 2296 (74.1%) vertebral fractures, 374 (12.1%) femoral neck fractures, and 428 (13.8%) other types of fractures in the case group. Bone mineral density (BMD) was almost lower in the fracture groups compared to the control groups (p = 0.048 to < 0.001). Compared with normal weight, underweight had a protective effect on total [odds ratio (OR) = 0.61; 95% confidence interval (CI), 0.49 -0.75; P< 0.001], and lumbar fractures (OR = 0.52; 95% CI, 0.41 - 0.67; P < 0.001), while obesity was associated with an increased risk for total (OR = 2.26; 95% CI, 1.85 - 2.76; P < 0.001), lumbar (OR = 2.17; 95% CI, 1.72 - 2.73; P < 0.001), and femoral neck fractures (OR = 4.08; 95% CI, 2.18 - 7.63; P < 0.001). Non-linear associations were observed between BMI and fractures: A J-curve for total, lumbar, and femoral neck fractures, and no statistical change for other types of fractures. Underweight was found to be a risk factor for other types of fracturess after adjusting for BMD (OR = 2.29; 95% CI, 1.09 - 4.80; P < 0.001). Osteoporosis and osteopenia were identified as risk factors for almost all sites of fracture when compared to normal bone mass. CONCLUSIONS: Underweight has a protective effect on total and lumbar spine fractures in Chinese women, while obesity poses a risk factor for total, lumbar, and femoral neck fractures. The effect of BMI on fractures may be mainly mediated by BMD.

Transient blocking of both pulmonary artery and veins for surgical treatment of stage Ⅲ central lung cancer / 中华胸心血管外科杂志

Objective To investigate the feasibility of transient blocking of both pulmonary artery and veins for surgical treat- ment of central lung cancer with stage Ⅲ to preserve the normal pulmonary.Methods Firstly,the relation of the pulmonary artery, the lung neoplasm and the enlarged mediastinal lymph nodes was investigated.If the hilum of lung remained frozen,the pericardium was opened and the pulmonary artery,the upper and lower lobe pulmonary veins were dissected.Then those three vessels were blocked.When the pulmonary cireulation was stopped,bloodless lobectomy and pulmonary artery angioplasty and/or anastomosis were performed.Then the blockers were released,and pulmonary circulation was restored.The time of blocking was(35?15)minutes (16～66 minutes).Results All 20 patients suffer from stage Ⅲ central lung cancer,which' s the hila of lung remained frozen,re- ceived complete resection of the tumor.The normal functioning pulmonary tissue in the 20 patients was preserved instead of pneumone- ctomy.The average amount of bleeding was 256 ml(180～420 ml)during operation.All 20 patients recovered well.Conclusion Transient blocking of both pttlmonary artery and veins for surgical treatment of stage Ⅲ central lung cancer is and innovation in surgical technique,which makes the operation safe and easy.This technique may provide a chance to patients,with poor cardio-pulmonary function.In addition,this technique widens the surgical indications for patients suffering from lung cancer.