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Medyńska A, Chrzanowska J, Seifert M, Zwolińska D. Can Serum Salusin-α and Salusin-β Serve as Biomarkers for Early Atherosclerotic Lesions in Obese Children? Int J Mol Sci 2025; 26:3549. [PMID: 40332043 PMCID: PMC12027177 DOI: 10.3390/ijms26083549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2025] [Revised: 04/04/2025] [Accepted: 04/08/2025] [Indexed: 05/08/2025] Open
Abstract
Obesity increases the risk of atherosclerosis. Recent studies highlight the role of salusins, bioactive peptides, in its development. This study aimed to determine the risk factors for premature atherosclerosis in obese children based on obesity severity and assess the usefulness of serum salusin-α and salusin-β as early biomarkers. We examined 125 children with simple obesity, divided into two subgroups by BMI-SDS (I: 2-4, II: >4), and we compared them with 33 healthy-weight peers. Obese children had significantly higher serum salusin-α and salusin-β levels, as well as hsCRP, TG, SBP, DBP, and PWV, compared to controls. Only salusin-α levels increased with obesity severity. Salusin-α correlated with BMI SDS and hsCRP, while salusin-β showed no associations. Our findings suggest that salusin-α could be an early inflammation marker and a predictor of atherosclerosis, pointing to salusin-α, rather than salusin-β, as the earliest marker of atherosclerosis in obese children. Further research is needed to confirm these results.
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Affiliation(s)
- Anna Medyńska
- Department and Clinic of Pediatric Nephrology, Medical University of Wrocław, 50-367 Wrocław, Poland;
| | - Joanna Chrzanowska
- Department and Clinic of Pediatrics, Endocrinology, Diabetology and Metabolic Diseases, Medical University of Wrocław, 50-367 Wrocław, Poland; (J.C.); (M.S.)
| | - Monika Seifert
- Department and Clinic of Pediatrics, Endocrinology, Diabetology and Metabolic Diseases, Medical University of Wrocław, 50-367 Wrocław, Poland; (J.C.); (M.S.)
| | - Danuta Zwolińska
- Department and Clinic of Pediatric Nephrology, Medical University of Wrocław, 50-367 Wrocław, Poland;
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Močnik M, Golob Jančič S, Filipič M, Homšak E, Svetej M, Marčun Varda N. Evaluation of salusin-β in paediatric patients with chronic kidney disease or hypertension. Adv Med Sci 2025; 70:184-190. [PMID: 40020780 DOI: 10.1016/j.advms.2025.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 10/15/2024] [Accepted: 02/25/2025] [Indexed: 03/03/2025]
Abstract
PURPOSE Salusins are newly identified endogenous peptides implicated in the atherosclerotic process. Salusin-β, in particular, is recognized for its proatherogenic role. Given that atherosclerosis can commence in childhood, salusin-β holds promise as a potential biomarker for cardiovascular risk assessment. The objective of our study was to investigate salusin-β levels in children with early stages of chronic kidney disease (CKD) or hypertension (HTN), and compare them to healthy controls. Furthermore, we aimed to evaluate its association with obesity and pulse wave velocity (PWV), the latter being a well-established marker for determining arterial elasticity. MATERIALS AND METHODS This cross-sectional study involved 96 paediatric patients, including 46 with CKD and 50 with HTN, as well as 33 healthy controls. Anthropometric measurements, PWV assessments, serum salusin-β values, and basic laboratory investigations were conducted for all participants. RESULTS Salusin-β levels were found to be elevated in patients with CKD (p = 0.014), but not in patients with HTN when compared to healthy controls. When correlating salusin-β levels with PWV, a significant but weak correlation was observed (r = 0.211, p = 0.020). CONCLUSIONS Salusin-β levels were elevated in paediatric patients with CKD. Additionally, salusin-β levels correlated significantly with PWV. Obesity played a smaller role in these correlations, with significant correlations observed only after combining cardiovascular risk factors revealing certain associations between salusin-β levels and some cardiovascular variables, but with inconclusive findings and, in some instances, even contrary to anticipated outcomes.
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Affiliation(s)
- Mirjam Močnik
- Department of Paediatrics, University Medical Centre Maribor, Maribor, Slovenia.
| | - Sonja Golob Jančič
- Department of Paediatrics, University Medical Centre Maribor, Maribor, Slovenia
| | - Martina Filipič
- Department of Paediatrics, University Medical Centre Maribor, Maribor, Slovenia
| | - Evgenija Homšak
- Department of Laboratory Diagnostics, University Medical Centre Maribor, Maribor, Slovenia; Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Mateja Svetej
- Department of Laboratory Diagnostics, University Medical Centre Maribor, Maribor, Slovenia
| | - Nataša Marčun Varda
- Department of Paediatrics, University Medical Centre Maribor, Maribor, Slovenia; Faculty of Medicine, University of Maribor, Maribor, Slovenia
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Janecka A, Stefanowicz J, Owczarzak A, Tomaszewski M, Batko T, Irga-Jaworska N. Assessment of Metabolic Syndrome and Kidney and Heart Function in Childhood Cancer Survivors. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1073. [PMID: 37371304 DOI: 10.3390/children10061073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/26/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND The survivors of childhood cancer suffer from a number of long-term side effects. These include atherosclerosis and cardiovascular diseases (CVDs) that develop earlier in adulthood than in the rest of the population. The aim of this study was to identify prognostic factors of developing atherosclerosis before the development of symptomatic CVD. METHODS A total of 141 children that were 7-18 years old were examined; there were 116 survivors of childhood malignancies (hematopoietic and lymphoproliferative malignancies-52; neuroblastoma-22; Wilms tumor-24; other solid tumors-18) and 25 healthy controls. Anthropometric measurements, blood pressure measurements, ultrasonography of the abdomen, echocardiography, and laboratory tests were performed. RESULTS There were no significant differences in gender distribution, time from the end of the treatment, weight, BMI, prevalence of central obesity, blood pressure and resistive index of the renal arteries, lipid profile, or glucose and fibrinogen levels. Patients with solid tumors had a significantly lower height and worse renal function. Patients with hematological malignancies significantly presented the lowest shortening fraction of the left ventricle. The salusin β levels were significantly higher in the control group than among the patients. CONCLUSIONS The type and severity of side effects are closely related to the type of neoplasm and the treatment that has been undergone. Careful observation and regular follow-up are necessary.
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Affiliation(s)
- Aleksandra Janecka
- Department of Paediatrics, Haematology and Oncology, Faculty of Medicine, Medical University of Gdansk, Debinki 7, 80-211 Gdańsk, Poland
- Department of Paediatrics, Haematology and Oncology, University Clinical Centre, Debinki 7, 80-952 Gdansk, Poland
| | - Joanna Stefanowicz
- Department of Paediatrics, Haematology and Oncology, Faculty of Medicine, Medical University of Gdansk, Debinki 7, 80-211 Gdańsk, Poland
- Department of Paediatrics, Haematology and Oncology, University Clinical Centre, Debinki 7, 80-952 Gdansk, Poland
- Faculty of Health Sciences with Institute of Maritime and Tropical Medicine, Medical University of Gdansk, 80-211 Gdansk, Poland
| | - Anna Owczarzak
- Department of Clinical Nutrition, Faculty of Health Sciences with Institute of Maritime and Tropical Medicine, Medical University of Gdansk, Debinki 7, 80-211 Gdansk, Poland
| | - Marek Tomaszewski
- Department of Paediatrics, Haematology and Oncology, University Clinical Centre, Debinki 7, 80-952 Gdansk, Poland
| | - Tomasz Batko
- Department of Paediatrics, Haematology and Oncology, University Clinical Centre, Debinki 7, 80-952 Gdansk, Poland
| | - Ninela Irga-Jaworska
- Department of Paediatrics, Haematology and Oncology, Faculty of Medicine, Medical University of Gdansk, Debinki 7, 80-211 Gdańsk, Poland
- Department of Paediatrics, Haematology and Oncology, University Clinical Centre, Debinki 7, 80-952 Gdansk, Poland
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Chen MX, Deng BY, Liu ST, Wang ZB, Wang SZ. Salusins: advance in cardiovascular disease research. J Pharm Pharmacol 2023; 75:363-369. [PMID: 36508340 DOI: 10.1093/jpp/rgac087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 11/13/2022] [Indexed: 12/14/2022]
Abstract
Salusins are discovered in 2003 and divided into salusin-α and salusin-β, which are bioactive peptides with hemodynamic and mitotic activity and mainly distributed in plasma, urine, endocrine glands and kidneys. A large number of studies have shown that salusins can regulate lipid metabolism, inflammatory response and vascular proliferation. Despite the profound and diverse physiological properties of salusins, the exact mechanism of their cardiovascular effects remains to be determined. The potential mechanisms of action of salusins in cardiovascular-related diseases such as atherosclerosis, hypertension, heart failure, myocardial infarction and myocarditis, and their use as biomarkers of cardiovascular disease are discussed. This review aims to provide a new strategy for the diagnosis and prevention of clinical cardiovascular diseases.
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Affiliation(s)
- Ming-Xin Chen
- Institute of Pharmacy and Pharmacology, University of South China, Hengyang, China.,Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, University of South China, Hengyang, China
| | - Bo-Yan Deng
- Institute of Pharmacy and Pharmacology, University of South China, Hengyang, China.,Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, University of South China, Hengyang, China
| | - Shu-Ting Liu
- Institute of Pharmacy and Pharmacology, University of South China, Hengyang, China.,Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, University of South China, Hengyang, China
| | - Zong-Bao Wang
- Institute of Pharmacy and Pharmacology, University of South China, Hengyang, China.,Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, University of South China, Hengyang, China
| | - Shu-Zhi Wang
- Institute of Pharmacy and Pharmacology, University of South China, Hengyang, China.,Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, University of South China, Hengyang, China
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Močnik M, Marčun Varda N. Current Knowledge of Selected Cardiovascular Biomarkers in Pediatrics: Kidney Injury Molecule-1, Salusin-α and -β, Uromodulin, and Adropin. CHILDREN 2022; 9:children9010102. [PMID: 35053727 PMCID: PMC8774650 DOI: 10.3390/children9010102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/01/2022] [Accepted: 01/10/2022] [Indexed: 02/06/2023]
Abstract
Cardiovascular diseases are the leading cause of morbidity and mortality in the modern world. Their common denominator is atherosclerosis, a process beginning in childhood. In pediatrics, the aim of preventive measures is to recognize children and adolescents at risk for accelerated atherosclerosis and possible premature cardiovascular events in adulthood. Several diagnostic procedures and biomarkers are available for cardiovascular risk assessment in adults. However, reliable markers in pediatrics are still insufficiently studied. In this contribution, we discuss five potential biomarkers of particular interest: kidney injury molecule-1, salusin-α and -β, uromodulin, and adropin. Studies regarding the pediatric population are scarce, but they support the evidence from studies in the adult population. These markers might entail both a prognostic and a therapeutic interest.
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Affiliation(s)
- Mirjam Močnik
- Department of Paediatrics, University Medical Centre Maribor, Ljubljanska 5, 2000 Maribor, Slovenia;
- Correspondence:
| | - Nataša Marčun Varda
- Department of Paediatrics, University Medical Centre Maribor, Ljubljanska 5, 2000 Maribor, Slovenia;
- Medical Faculty, University of Maribor, Taborska 8, 2000 Maribor, Slovenia
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Demir I, Tekin S, Vardi N, Sandal S. Intracerebroventricular salusin-β infusion to rats increases hypothalamus-pituitary-testicular axis hormones. Gen Comp Endocrinol 2021; 310:113820. [PMID: 34015344 DOI: 10.1016/j.ygcen.2021.113820] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/30/2021] [Accepted: 05/13/2021] [Indexed: 12/15/2022]
Abstract
Salusin-β (Sal-β), which originates from preprosalusin, is a multifunctional hormone with a peptide structure. Sal-β exists in the hypothalamus and can stimulate the pituitary gland. The present study was conducted to determine the effects of Sal-β on hormones that play roles in the male reproductive system. Forty male Wistar Albino rats were used in the study. No infusions were performed on the control group, and infusions were applied to the infusion groups (artificial cerebrospinal fluid to the sham group, 2 and 20 nM Sal-β to the experimental group) through intracerebroventricular infusion for 7 days at 10 μl/hour rate. The animals were decapitated after 7 days of infusion; and the hypothalamus, testicles, and blood tissue samples were collected. The gonadotropin-releasing hormone (GnRH) mRNA levels were determined from the hypothalamus tissues by using the Real Time-PCR Method, and the serum luteinizing hormone (LH), follicle-stimulating hormone (FSH) and testosterone levels were determined using the ELISA method. Also, Hematoxylin-Eosin Staining Method was used for histopathological evaluations in the testicle tissues. As a result, Sal-β infusion increased GnRH mRNA levels in hypothalamus tissues (p < 0.05) besides, serum LH, FSH, and testosterone levels of the rats were higher at significant levels following Sal-β infusion compared to the control and sham group (p < 0.05). In the histological examination of the testicle tissues, Sal-β application was found to decrease the seminiferous tubule diameter and germinal epithelial thickness (p < 0.05). This evidence is the first, indicating that Sal-β, which is administered to male rats with central infusion, stimulates hypothalamus and pituitary tissues, and causes increased secretion of male reproductive hormones.
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Affiliation(s)
- Ilker Demir
- Department of Physiology, Faculty of Medicine, Inonu University, Malatya 44280, Turkey.
| | - Suat Tekin
- Department of Physiology, Faculty of Medicine, Inonu University, Malatya 44280, Turkey.
| | - Nigar Vardi
- Department of Histology and Embryology, Faculty of Medicine, Inonu University, Malatya 44280, Turkey.
| | - Suleyman Sandal
- Department of Physiology, Faculty of Medicine, Inonu University, Malatya 44280, Turkey.
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Močnik M, Marčun Varda N. Cardiovascular Risk Factors in Children with Obesity, Preventive Diagnostics and Possible Interventions. Metabolites 2021; 11:551. [PMID: 34436493 PMCID: PMC8398426 DOI: 10.3390/metabo11080551] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/30/2021] [Accepted: 08/10/2021] [Indexed: 12/16/2022] Open
Abstract
The increasing burden of obesity plays an essential role in increased cardiovascular morbidity and mortality. The effects of obesity on the cardiovascular system have also been demonstrated in childhood, where prevention is even more important. Obesity is associated with hormonal changes and vascular dysfunction, which eventually lead to hypertension, hyperinsulinemia, chronic kidney disease, dyslipidemia and cardiac dysfunction-all associated with increased cardiovascular risk, leading to potential cardiovascular events in early adulthood. Several preventive strategies are being implemented to reduce the cardiovascular burden in children. This paper presents a comprehensive review of obesity-associated cardiovascular morbidity with the preventive diagnostic workup at our hospital and possible interventions in children.
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Affiliation(s)
- Mirjam Močnik
- Department of Paediatrics, University Medical Centre Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia;
| | - Nataša Marčun Varda
- Department of Paediatrics, University Medical Centre Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia;
- Medical Faculty, University of Maribor, Taborska 8, 2000 Maribor, Slovenia
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Argun D, Argun F, Borku Uysal B. Evaluation of salusin-α and salusin-β levels in patients with type 2 diabetes mellitus and determination of the impact of severity of hyperglycemia on salusin levels. Ir J Med Sci 2021; 190:1403-1411. [PMID: 34109528 DOI: 10.1007/s11845-021-02674-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 05/28/2021] [Indexed: 11/26/2022]
Abstract
AIMS To investigate the usefulness of salusin-α and salusin-β as biomarkers in patients with type 2 diabetes mellitus (T2DM) and to determine whether diabetes severity and obesity have an effect on the salusin levels in diabetic patients. METHODS The study included a total of 90 patients, comprising 55 diagnosed with T2DM and 35 healthy volunteers with similar demographic characteristics. Salusins were assayed by a commercially available ELISA kit. RESULTS The salusin-β levels were found to be significantly higher in T2DM group compared to control group, while the salusin-α levels were lower (p < 0.05, for both). Furthermore, in patient group, Spearman analysis showed a statistically significant negative correlation between salusin-α and fasting glucose and glycated hemoglobin (HbA1c), whereas salusin-β had a statistically significant positive correlation with fasting glucose and HbA1c (p < 0.05, for both). When analyzed according to the HbA1c groups, the patients with HbA1c > 9% had significantly lower salusin-α and higher salusin-β levels levels compared to those with HbA1c < 9% (p < 0.05, for both). When examined according to body-mass-index groups, there was no significant difference in the salusin levels of the patient and control groups (p > 0.05). CONCLUSION We demonstrated that the serum salusin-α level was decreased whereas the salusin-β level was increased in patients with T2DM compared to healthy subjects, and this was more pronounced as T2DM-deteriorated. We also showed that obesity had no effect on salusin levels among diabetics. This study may provide a basis for the availability of salusin-targeted therapies, especially in uncontrolled T2DM.
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Affiliation(s)
- Derya Argun
- Department of Internal Medicine, Istanbul Aydın University Medical Faculty, Istanbul, Turkey.
| | - Ferit Argun
- Department of Internal Medicine, Istanbul Aydın University Medical Faculty, Istanbul, Turkey
| | - Betul Borku Uysal
- Department of Internal Medicine, Biruni University Medical Faculty, Istanbul, Turkey
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Yassien M, Fawzy O, Mahmoud E, Khidr EG. Serum salusin-β in relation to atherosclerosis and ventricular dysfunction in patients with type 2 diabetes mellitus. Diabetes Metab Syndr 2020; 14:2057-2062. [PMID: 33113473 DOI: 10.1016/j.dsx.2020.10.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/17/2020] [Accepted: 10/22/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND AIMS Salusin-β is a newly defined biomarker that plays a role in atherogenesis and in homeostasis. The study aimed to assess serum salusin-β level in relation to atherosclerosis and ventricular dysfunction in type 2 diabetes mellitus (T2DM) patients. METHODS Sixty T2DM patients and twenty-five age-matched healthy controls were included. Serum salusin-β was determined by ELISA. Echocardiography and carotid ultrasonography were carried out for all individuals. RESULTS Serum salusin-β level was significantly elevated in patients with T2DM than in controls (P < 0.001). It was positively correlated with obesity parameters, insulin resistance index (r = 0.280,P < 0.001), atherogenic dyslipidemia and with carotid intima media thickness (CIMT) (r = 0.411, P < 0.001). Echocardiographic findings showed a positive correlation between salusin-β and left ventricular hypertrophy (LVH) parameters and a negative correlation with left ventricular (LV) diastolic and systolic functions. Regression analysis showed that serum salusin-β level was a significant predictor of diastolic dysfunction. CONCLUSION Serum salusin-β may be associated with atherosclerosis and LV dysfunction in T2DM.
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Affiliation(s)
- Marwa Yassien
- Department of Endocrinology and Metabolism, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Olfat Fawzy
- Department of Endocrinology and Metabolism, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Eman Mahmoud
- Department of Endocrinology and Metabolism, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Emad Gamil Khidr
- Department of Biochemistry and Molecular Biology, Faculty of Pharmacy for Boys, Al-Azhar University, Nasr City, Cairo, 13465, Egypt.
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Nazari M, Minasian V, Hovsepian S. Effects of Two Types of Moderate- and High-Intensity Interval Training on Serum Salusin-α and Salusin-β Levels and Lipid Profile in Women with Overweight/Obesity. Diabetes Metab Syndr Obes 2020; 13:1385-1390. [PMID: 32425570 PMCID: PMC7188200 DOI: 10.2147/dmso.s248476] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 04/07/2020] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE The current study aimed to compare the effects of two modes of moderate- and high-intensity interval training on serum Salusin-α and Salusin-β and lipid profile in women with overweight/obesity. SUBJECTS AND METHODS A number of forty females were assigned to each of (1) Control (BMI= 30.2 ± 2.8 kg/m2, n=14), (2) Moderate-intensity (BMI= 31.2 ±3.3 kg/m2, n=13) and (3) High-intensity interval training (BMI=30.9±3.4 kg/m2, n=13) groups. The subjects of experimental groups participated in the selected interval trainings for eight weeks. The first blood sampling was performed within 48 hours prior to the first training session and the second samples were obtained 48 hours after the last training session. RESULTS The findings revealed that there were significant increases in Salusin-α (36% vs. 3%; p = 0.001) and high-density lipoprotein levels (7% vs. 5%; P = 0.039), while significant reductions in the levels of Triglyceride (-8% vs. -9%; p= 0.012) and total cholesterol (-1% vs. -8%; P =0.01) levels of moderate- and high-intensity interval training groups, respectively. Also, there were insignificant changes in Salusin-β (-7% vs. -5%; P = 0.108), low-density lipoproteins (-3% vs. -11%; P =0.046) and very-low-density lipoprotein (-10% vs. -8%; P = 0.056) compared to control group. There were only significant differences between Salusin-α and high-density lipoprotein levels of training groups (P<0.05). CONCLUSION It is suggested that, although improvements in lipid profile was nearly similar for two training modes, moderate intensity interval training was more effective to prevent and control atherosclerosis.
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Affiliation(s)
- Maryam Nazari
- Department of Exercise Physiology, Faculty of Sport Sciences, University of Isfahan, Isfahan, Iran
| | - Vazgen Minasian
- Department of Exercise Physiology, Faculty of Sport Sciences, University of Isfahan, Isfahan, Iran
- Correspondence: Vazgen Minasian Email
| | - Silva Hovsepian
- Imam Hossein Children's Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
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