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Derivation and Validation of a New Visceral Adiposity Index for Predicting Short-Term Mortality of Patients with Acute Ischemic Stroke in a Chinese Population. Brain Sci 2023; 13:brainsci13020297. [PMID: 36831840 PMCID: PMC9954352 DOI: 10.3390/brainsci13020297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 01/20/2023] [Accepted: 02/08/2023] [Indexed: 02/12/2023] Open
Abstract
The visceral adiposity index (VAI) is related to the occurrence of various cardiometabolic diseases, atherosclerosis, and stroke. However, few studies have analyzed the impact on the short-term prognosis of stroke. We assessed the effect of VAI on short-term prognoses in patients with acute ischemic stroke through a retrospective cohort study of 225 patients with acute stroke who were admitted to the neurological intensive care unit of our hospital. We collected metabolic indicators (blood pressure, fasting glucose, lipids), National Institutes of Health Stroke Scale (NIHSS) scores, symptomatic intracranial hemorrhage, and other disease evaluation indicators on 197 patients who were screened for inclusion. VAI was calculated by using baseline data (sex, height, weight, waist circumference (WC)). We assessed functional recovery according to modified Rankin scale scores after 90 days. The receiver operating characteristic (ROC) curve was used to calculate the VAI cutoff value that affects short-term outcomes. A nomogram that can predict the risk of short-term mortality in patients with acute ischemic stroke was drawn. In total, 28 patients died within 90 days. Those patients had higher VAI (p = 0.000), higher triglyceride (TG) (p = 0.020) and NIHSS scores (p = 0.000), and lower high-density lipoprotein cholesterol (HDL-C) (p = 0.000) than patients who survived. VAI had higher predictive value of short-term mortality than did body mass index (BMI), body fat mass index (BFMI), and WC. VAI and NIHSS scores were independent risk factors for the short-term mortality of patients with stroke. Patients with a VAI > 2.355 had a higher risk of short-term mortality. VAI has a predictive value higher than that of traditional metabolic indicators such as BMI, BFMI, and WC. The nomogram, composed of NIHSS, VAI, HDL-C, and TG, may predict the short-term mortality of cerebral infarction patients.
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Saad RK, Ghezzawi M, Horanieh R, Khamis AM, Saunders KH, Batsis JA, Chakhtoura M. Abdominal Visceral Adipose Tissue and All-Cause Mortality: A Systematic Review. Front Endocrinol (Lausanne) 2022; 13:922931. [PMID: 36082075 PMCID: PMC9446237 DOI: 10.3389/fendo.2022.922931] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/23/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Increased abdominal visceral adipose tissue (VAT) implies an adverse cardio-metabolic profile. We examined the association of abdominal VAT parameters and all-cause mortality risk. Methods We systematically searched four databases. We performed citations/articles screening, data abstraction, and quality assessment in duplicate and independently (CRD42020205021). Results We included 12 cohorts, the majority used computed tomography to assess abdominal VAT area. Six cohorts with a mean age ≤ 65 years, examining all-cause mortality risk per increment in VAT area (cm2) or volume (cm3), showed a 11-98% relative risk increase with higher VAT parameters. However, the association lost significance after adjusting for glycemic indices, body mass index, or other fat parameters. In 4 cohorts with a mean age >65 years, the findings on mortality were inconsistent. Conversely, in two cohorts (mean age 73-77 years), a higher VAT density, was inversely proportional to VAT area, and implied a higher mortality risk. Conclusion A high abdominal VAT area seems to be associated with increased all-cause mortality in individuals ≤ 65 years, possibly mediated by metabolic complications, and not through an independent effect. This relationship is weaker and may reverse in older individuals, most likely secondary to confounding bias and reverse causality. An individual participant data meta-analysis is needed to confirm our findings, and to define an abdominal VAT area cutoff implying increased mortality risk. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=205021, identifier CRD42020205021.
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Affiliation(s)
- Randa K. Saad
- Calcium Metabolism and Osteoporosis Program, World Health Organization (WHO) Collaborating Center for Metabolic Bone Disorders, Division of Endocrinology and Metabolism, Department of Internal Medicine - American University of Beirut Medical Center, Beirut, Lebanon
- Departement of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Malak Ghezzawi
- Departement of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Renee Horanieh
- Departement of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Assem M. Khamis
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Katherine H. Saunders
- Division of Endocrinology, Diabetes & Metabolism, Weill Cornell Medicine, New York, NY, United States
| | - John A. Batsis
- Division of Geriatric Medicine and Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Marlene Chakhtoura
- Calcium Metabolism and Osteoporosis Program, World Health Organization (WHO) Collaborating Center for Metabolic Bone Disorders, Division of Endocrinology and Metabolism, Department of Internal Medicine - American University of Beirut Medical Center, Beirut, Lebanon
- Departement of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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3
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Xu R, Hu X, Wang T, Yang Y, Jiang N, Luo J, Zhang X, Patel AB, Dmytriw AA, Jiao L. Visceral Adiposity and Risk of Stroke: A Mendelian Randomization Study. Front Neurol 2022; 13:804851. [PMID: 35481268 PMCID: PMC9035635 DOI: 10.3389/fneur.2022.804851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 03/15/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose In recent years, metabolic syndrome has risen in prevalence and brought a heavy disease burden to modern society. As the representative aspect of metabolic syndrome, obesity has been shown to be related to an increased risk of stroke. Given that visceral adipose tissue (VAT) forms the fundamental basis of central obesity, we sought to explore a causal relationship between VAT and stroke by using mendelian randomization (MR) methods. Methods Based on two large genome-wide association studies (GWAS) including 325,153 and 35,762 cases of VAT and stroke, respectively, we conducted a MR study which has the inherent advantage of reducing the noise of confounding and reverse causation. Results VAT had a significant causal association with ischemic stroke (OR, per 1kg increase in VAT mass, 1.30; 95% CI, 1.18 ~ 1.45; P = 5.87E-07) as opposed to intracranial hemorrhage (ICH) (OR, 1.15; 95% CI, 0.70 ~ 1.88, P = 5.81E-01) as evaluated with inverse-variance weighting (IVW). Regarding subtypes of ischemic stroke, there was a significant causal effect for cardioembolic stroke (OR, 1.34; 95% CI, 1.13 ~ 1.58, P = 8.07E-04), and potential causal effect for small-vessel stroke (OR, 1.32; 95% CI, 1.06 ~ 1.65, P = 1.39E-02) and large-artery atherosclerotic stroke (OR, 1.33; 95% CI, 1.03 ~ 1.70, P = 2.59E-02). Conclusions This study provides potential evidence for a causal role of VAT in ischemic stroke and could suggest novel genetical therapeutic strategies for distinct subtypes of ischemic stroke.
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Affiliation(s)
- Ran Xu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Xinzhi Hu
- Department of Human Anatomy, Histology and Embryology, Peking Union Medical College Hospital, Peking Union Medical College, Institute of Basic Medical Sciences, Chinese Academy of Medical Science, Beijing, China
| | - Tao Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Yutong Yang
- Faculty of Medicine, Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - Nan Jiang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Jichang Luo
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Xiao Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Aman B. Patel
- Neuroendovascular Program, Massachusetts General Hospital, Boston, MA, United States
| | - Adam A. Dmytriw
- Neuroendovascular Program, Massachusetts General Hospital, Boston, MA, United States
- Neuroradiology and Neurointervention Service, Brigham and Women's Hospital Harvard Medical School, Boston, MA, United States
- *Correspondence: Adam A. Dmytriw
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
- Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, China
- Liqun Jiao
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Huang Y, Liu Y, Ma Y, Tu T, Liu N, Bai F, Xiao Y, Liu C, Hu Z, Lin Q, Li M, Ning Z, Zhou Y, Mao X, Liu Q. Associations of Visceral Adipose Tissue, Circulating Protein Biomarkers, and Risk of Cardiovascular Diseases: A Mendelian Randomization Analysis. Front Cell Dev Biol 2022; 10:840866. [PMID: 35186940 PMCID: PMC8850399 DOI: 10.3389/fcell.2022.840866] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 01/10/2022] [Indexed: 12/12/2022] Open
Abstract
Aim: To evaluate the genetic associations of visceral adipose tissue (VAT) mass with metabolic risk factors and cardiovascular disease (CVD) endpoints and to construct a network analysis about the underlying mechanism using Mendelian randomization (MR) analysis. Methods and Results: Using summary statistics from genome-wide association studies (GWAS), we conducted the two-sample MR to assess the effects of VAT mass on 10 metabolic risk factors and 53 CVD endpoints. Genetically predicted VAT mass was associated with metabolic risk factors, including triglyceride (odds ratio, OR, 1.263 [95% confidence interval, CI, 1.203–1.326]), high-density lipoprotein cholesterol (OR, 0.719 [95% CI, 0.678–0.763]), type 2 diabetes (OR, 2.397 [95% CI, 1.965–2.923]), fasting glucose (OR, 1.079 [95% CI, 1.046–1.113]), fasting insulin (OR, 1.194 [95% CI, 1.16–1.229]), and insulin resistance (OR, 1.204 [95% CI, 1.16–1.25]). Genetically predicted VAT mass was associated with CVD endpoints, including atrial fibrillation (OR, 1.414 [95% CI, 1.332 = 1.5]), coronary artery disease (OR, 1.573 [95% CI, 1.439 = 1.72]), myocardial infarction (OR, 1.633 [95% CI, 1.484 =1.796]), heart failure (OR, 1.711 [95% CI, 1.599–1.832]), any stroke (OR, 1.29 [1.193–1.394]), ischemic stroke (OR, 1.292 [1.189–1.404]), large artery stroke (OR, 1.483 [1.206–1.823]), cardioembolic stroke (OR, 1.261 [1.096–1.452]), and intracranial aneurysm (OR, 1.475 [1.235–1.762]). In the FinnGen study, the relevance of VAT mass to coronary heart disease, stroke, cardiac arrhythmia, vascular diseases, hypertensive heart disease, and cardiac death was found. In network analysis to identify the underlying mechanism between VAT and CVDs, VAT mass was positively associated with 23 cardiovascular-related proteins (e.g., Leptin, Hepatocyte growth factor, interleukin-16), and inversely with 6 proteins (e.g., Galanin peptides, Endothelial cell-specific molecule 1). These proteins were further associated with 32 CVD outcomes. Conclusion: Mendelian randomization analysis has shown that VAT mass was associated with a wide range of CVD outcomes including coronary heart disease, cardiac arrhythmia, vascular diseases, and stroke. A few circulating proteins may be the mediators between VAT and CVDs.
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Affiliation(s)
- Yunying Huang
- Department of Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha, China
| | - Yaozhong Liu
- Department of Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha, China
| | - Yingxu Ma
- Department of Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha, China
| | - Tao Tu
- Department of Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha, China
| | - Na Liu
- Department of Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha, China
| | - Fan Bai
- Department of Cardiovascular Surgery, Second Xiangya Hospital, Central South University, Changsha, China
| | - Yichao Xiao
- Department of Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha, China
| | - Chan Liu
- Department of International Medicine, Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhengang Hu
- Department of Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha, China
| | - Qiuzhen Lin
- Department of Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha, China
| | - Mohan Li
- Department of Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha, China
| | - Zuodong Ning
- Department of Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha, China
| | - Yong Zhou
- Department of Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiquan Mao
- Department of Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Qiming Liu, ; Xiquan Mao,
| | - Qiming Liu
- Department of Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Qiming Liu, ; Xiquan Mao,
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Kauhanen SP, Saari P, Korpela T, Liimatainen T, Vanninen R, Hedman M. Excess of visceral adipose tissue with or without aortic elongation leads to a steeper heart position. Acta Radiol 2021; 63:1157-1165. [PMID: 34304632 DOI: 10.1177/02841851211034053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The heart's position determined as the heart-aorta angle (HAA) has been demonstrated to associate with ascending aortic (AA) dilatation. Visceral adipose tissue (VAT) and aortic elongation may shift the heart to the steeper position. PURPOSE To investigate whether VAT and aortic length influence the HAA. MATERIAL AND METHODS We examined 346 consecutive patients (58.4% men; mean age = 67.0 ± 14.1 years) who underwent aortic computed tomography angiography (CTA). HAA was measured as the angle between the long axis of the heart and AA midline. The amount of VAT was measured at the level of middle L4 vertebra from a single axial CT slice. Aortic length was measured by combining four anatomical segments in different CTA images. The amount of VAT and aortic length were determined as mild with values in the lowest quartile and as excessive with values in the other three quartiles. RESULTS A total of 191 patients (55.2%) had no history of aortic diseases, 134 (38.7%) displayed AA dilatation, 8 (2.3%) had abdominal aortic aneurysm (AAA), and 13 (3.8%) had both AA dilatation and AAA. There was a strong nonlinear regression between smaller HAA and VAT/height, and HAA and aortic length/height. Median HAA was 124.2° (interquartile range 119.0°-130.8°) in patients with a mild amount of VAT versus 120.5° (interquartile range 115.4°-124.7°) in patients with excessive VAT (P < 0.001). CONCLUSION An excessive amount of VAT and aortic elongation led to a steeper heart position. These aspects may possess clinical value when evaluating aortic diseases in obese patients.
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Affiliation(s)
- S Petteri Kauhanen
- School of Medicine, Clinical Radiology, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio University Hospital, Clinical Imaging Center, Finland
| | - Petri Saari
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio University Hospital, Clinical Imaging Center, Finland
| | - Tarmo Korpela
- School of Medicine, Clinical Radiology, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio University Hospital, Clinical Imaging Center, Finland
| | - Timo Liimatainen
- Research Unit of Medical Imaging, University of Oulu, Physics and Technology, University of Oulu, Oulu, Finland
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu University Hospital, Oulu, Finland
| | - Ritva Vanninen
- School of Medicine, Clinical Radiology, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio University Hospital, Clinical Imaging Center, Finland
| | - Marja Hedman
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio University Hospital, Clinical Imaging Center, Finland
- Department of Cardiothoracic Surgery, Heart Center, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, University of Eastern Finland
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Yan B, Yang J, Qian L, Gao F, Bai L, Wang G, Ma X. Effect of genetic liability to visceral adiposity on stroke and its subtypes: A Mendelian randomization study. Int J Stroke 2021; 17:172-179. [PMID: 33724079 DOI: 10.1177/17474930211006285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Observational studies have found an association between visceral adiposity and stroke. AIMS The purpose of this study was to investigate the role and genetic effect of visceral adipose tissue accumulation on stroke and its subtypes. METHODS In this two-sample Mendelian randomization study, genetic variants (221 single nucleotide polymorphisms; P < 5 × 10-8) using as instrumental variables for Mendelian randomization analysis was obtained from a genome-wide association study of visceral adipose tissue. The outcome datasets for stroke and its subtypes were obtained from the MEGASTROKE consortium (up to 67,162 cases and 453,702 controls). Mendelian randomization standard analysis (inverse variance weighted method) was conducted to investigate the effect of genetic liability to visceral adiposity on stroke and its subtypes. Sensitivity analyses (Mendelian randomization-Egger, weighted median, Mendelian randomization-pleiotropy residual sum and outlier) were also utilized to assess horizontal pleiotropy and remove outliers. Multi-variable Mendelian randomization analysis was employed to adjust potential confounders. RESULTS In the standard Mendelian randomization analysis, genetically determined visceral adiposity (per 1 SD) was significantly associated with a higher risk of stroke (odds ratio (OR) 1.30; 95% confidence interval (CI) 1.21-1.41, P = 1.48× 10-11), ischemic stroke (OR 1.30; 95% CI 1.20-1.41, P = 4.01 × 10-10) and large artery stroke (OR 1.49; 95% CI 1.22-1.83, P = 1.16 × 10-4). The significant association was also found in sensitivity analysis and multi-variable Mendelian randomization analysis. CONCLUSIONS Genetic liability to visceral adiposity was significantly associated with an increased risk of stroke, ischemic stroke, and large artery stroke. The effect of genetic susceptibility to visceral adiposity on the stroke warrants further investigation.
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Affiliation(s)
- Bin Yan
- Department of Clinical Research Center, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Psychiatry, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jian Yang
- Department of Clinical Research Center, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Psychiatry, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Li Qian
- Department of Psychiatry, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Fengjie Gao
- Department of Psychiatry, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ling Bai
- Department of Clinical Research Center, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Cardiology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Gang Wang
- Department of Critical Care Medicine, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiancang Ma
- Department of Psychiatry, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Center of Brain Science, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Chen WY, Lin FH. Oxidized Hyaluronic Acid Hydrogels as a Carrier for Constant-Release Clenbuterol Against High-Fat Diet-Induced Obesity in Mice. Front Endocrinol (Lausanne) 2021; 12:572690. [PMID: 33776904 PMCID: PMC7996091 DOI: 10.3389/fendo.2021.572690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 01/25/2021] [Indexed: 11/25/2022] Open
Abstract
The global obesity population is increasing year-by-year, and the related cost is sharply increasing annually. There are several methods available to combat obesity; however, there is a lack of a single tool that is both safe and efficacious. The use of Clenbuterol in bodybuilding and by professional athletes is controversial owing to its side effects, including hepatotoxicity. This study administered Clenbuterol at a much lower dose than the established safety level, and rather than through oral administration, the treatments were delivered through controlled-release intra-adipose injection. The different dosing and mode of administration will lower the risk of side effects, increase the safety profile, and could facilitate use in the anti-obesity market. A thermo-sensitive hydrogel was used as the carrier uploaded with Clenbuterol to achieve controlled-release. In the in vitro study, the developed new formulae were not cytotoxic to 3T3-L1 cells and could inhibit lipogenesis effectively. In the animal study, the mice were fed a high-fat diet and treated with Clenbuterol by oral administration, or injected with Clenbuterol-modified hyaluronate hydrogel (HAC) regularly. Both groups showed reduction in whole-body, visceral, and gonadal fat contents and body weight. The abdominal fat was analyzed using MRI imaging in adipose mode and water mode. The abdominal fat ratio in the mice treated with normal diet and those given intra-adipose injections with HAC had the lowest value among the test groups. The mice treated with high-fat diet (HFD) showed the highest value of 53.78%. The chronic toxicity in-vivo test proved that controlled-release injections of 2-10 µg Clenbuterol daily were safe, as demonstrated in the blood elements and serological analyses. This study developed a new and promising method for anti-obesity treatment, using a monthly intra-adipose controlled-release injection of HAC. The developed new formulae of Clenbuterol not only effectively decreased body weight and body fat content but also inhibited lipogenesis on the harvested visceral tissue and reduced adipose tissue around the gonadal fat area. The side effects induced by traditional oral administration of Clenbuterol were not observed in this research; this has excellent potential to be a useful tool for future obesity treatment without safety concerns.
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Affiliation(s)
- Wei-Yao Chen
- Institute of Biotechnology, National Taiwan University, Taipei, Taiwan
| | - Feng-Huei Lin
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, Miaoli County, Taiwan
- *Correspondence: Feng-Huei Lin,
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8
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Nam KW, Kwon H, Kwon HM, Park JH, Jeong HY, Kim SH, Jeong SM, Kim HJ, Hwang SS. Abdominal fatness and cerebral white matter hyperintensity. J Neurol Sci 2019; 404:52-57. [PMID: 31326687 DOI: 10.1016/j.jns.2019.07.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 07/01/2019] [Accepted: 07/11/2019] [Indexed: 01/10/2023]
Abstract
Although obesity has been proven as a risk factor of metabolic and cardiovascular diseases, there have been few studies addressing the association between obesity and cerebral white matter hyperintensity (WMH) volume with controversial findings. In this study, we evaluated the relationship between abdominal fat distribution and WMH volume in a neurologically healthy population. We performed an observational study in a consecutive series of subjects who were examined during voluntary health check-ups between January 2006 and December 2013. We directly measured both visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) using abdominal computed tomography. The WMH volumes were also recorded quantitatively. A total of 2504 subjects were included in this study. In multivariate analysis, the relationship between SAT and WMH volume remained significant (β = -0.170, standard error [SE] = 0.065, P = .006) after adjusting for confounding factors. The protective effects of SAT on the WMH volume were more prominent in female participants (β = -0.295, SE = 0.138, P = .033) and in severely obese participants (β = -0.358, SE = 0.167, P = .033). Conclusively, we demonstrated a negative association between SAT and WMH volume in a healthy population.
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Affiliation(s)
- Ki-Woong Nam
- Department of Neurology, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, South Korea
| | - Hyuktae Kwon
- Department of Family Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, South Korea
| | - Hyung-Min Kwon
- Department of Neurology, Seoul National University College of Medicine and Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea.
| | - Jin-Ho Park
- Department of Family Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, South Korea.
| | - Han-Yeong Jeong
- Department of Neurology, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, South Korea
| | - Sang Hyuck Kim
- Department of Family Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, South Korea
| | - Su-Min Jeong
- Department of Family Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, South Korea
| | - Hwa Jung Kim
- Department of Clinical Epidemiology and Biostatics, ASAN Medical Center, Seoul, South Korea
| | - Seung-Sik Hwang
- Department of Public Health Sciences, Seoul National University Graduate School of Public Health, Seoul, South Korea
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9
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Thrombomodulin, alarmin signaling, and copeptin: cross-talk between obesity and acute ischemic stroke initiation and severity in Egyptians. Neurol Sci 2018; 39:1093-1104. [DOI: 10.1007/s10072-018-3396-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 03/28/2018] [Indexed: 12/16/2022]
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10
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Onatsu J, Taina M, Mustonen P, Hedman M, Muuronen A, Arponen O, Korhonen M, Jäkälä P, Vanninen R, Pulkki K. Soluble Urokinase-type Plasminogen Activator Receptor Predicts All-cause 5-Year Mortality in Ischemic Stroke and TIA. ACTA ACUST UNITED AC 2018; 31:381-386. [PMID: 28438866 DOI: 10.21873/invivo.11070] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 02/26/2017] [Accepted: 03/01/2017] [Indexed: 12/26/2022]
Abstract
AIM We evaluated soluble urokinase-type plasminogen activator receptor (suPAR) levels in different stroke subtypes and assessed their prognostic value regarding 5-year outcomes. MATERIALS AND METHODS The study included 117 stroke patients (81 males; mean=age 61±11 years) with suspected cardioembolic stroke whose plasma suPAR concentration was assessed. Altogether, 20 (17.1%) patients suffered from stroke as a result of cardioembolism, 12 (10.3%) from large-artery atherosclerosis, 9 (7.7%) from small-vessel disease, 11 (9.4%) from both large-artery and cardioembolic etiology, and 65 (55.6%) had cryptogenic stroke. The mean follow-up period was 5 years. RESULTS suPAR concentration was higher in patients who suffered from stroke/transient ischemic attack due to large-artery atherosclerosis (3.2±0.9 ng/ml) compared to small-vessel disease (2.0±0.5 ng/ml, p<0.001). An elevated plasma suPAR concentration was associated with all-cause mortality during the follow-up period (p=0.003). CONCLUSION Elevated plasma suPAR concentrations predicted all-cause mortality during the 5-year follow-up after ischemic stroke. suPAR was not able to differentiate patients with cardioembolic stroke from those with other stroke types.
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Affiliation(s)
- Juha Onatsu
- Department of Neurology, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Mikko Taina
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Pirjo Mustonen
- Department of Cardiology, Keski-Suomi Central Hospital, Jyväskylä, Finland
| | - Marja Hedman
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Antti Muuronen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Otso Arponen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Miika Korhonen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Pekka Jäkälä
- Department of Neurology, NeuroCenter, Kuopio University Hospital, Kuopio, Finland.,Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Ritva Vanninen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland.,Department of Clinical Radiology, University of Eastern Finland, Kuopio, Finland
| | - Kari Pulkki
- Department of Clinical Chemistry, University of Eastern Finland, Kuopio, Finland.,Eastern Finland Laboratory Centre, Kuopio, Finland
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11
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Muuronen AT, Taina M, Onatsu J, Korhonen M, Pulkki K, Jäkälä P, Vanninen R, Mustonen P. vWF correlates with visceral and pericardial adipose tissue in patients with a recent stroke of suspected cardiogenic etiology. PLoS One 2017; 12:e0178508. [PMID: 28570705 PMCID: PMC5453529 DOI: 10.1371/journal.pone.0178508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 05/15/2017] [Indexed: 01/31/2023] Open
Abstract
Aims A chronically elevated level of von Willebrand factor (vWF) is a common finding in patients with cardiovascular diseases. Obesity is a well-recognized risk factor for thrombotic cardiovascular complications including ischemic stroke, and it has been linked with increased plasma vWF. We evaluated whether elevated plasma levels of vWF associate with areas of visceral (VAT), pericardial (PAT), and subcutaneous adipose tissue (SAT) compartments in patients with acute/subacute stroke. Methods and results A total of 69 patients with stroke of suspected cardiogenic etiology were examined. The plasma level of vWF antigen (vWF-ag) was measured both in the acute phase and in the chronic phase three months after stroke. The areas of VAT and/or PAT were assessed with computed tomography. As expected, in stroke patients, the levels of plasma vWF-ag were significantly higher than in the national reference population both in the acute and in the chronic phase. The level of vWF-ag in the chronic phase correlated with the amounts of VAT and PAT, but not with subcutaneous adipose tissue. Conclusions These results agree with previous observations of the chronic inflammation/prothrombotic tendency in patients with cerebrovascular disease. Future studies should seek to clarify the role of visceral type adipose tissue in the pathophysiology of ischemic stroke.
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Affiliation(s)
- Antti Tapani Muuronen
- Diagnostic Imaging Centre, Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, Unit of Radiology, University of Eastern Finland, Kuopio, Finland
- Department of Medicine, Keski-Suomi Central Hospital, Jyväskylä, Finland
- * E-mail:
| | - Mikko Taina
- Diagnostic Imaging Centre, Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, Unit of Radiology, University of Eastern Finland, Kuopio, Finland
| | - Juha Onatsu
- Neuro Center, Kuopio University Hospital, Kuopio, Finland
| | - Miika Korhonen
- Diagnostic Imaging Centre, Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, Unit of Radiology, University of Eastern Finland, Kuopio, Finland
| | - Kari Pulkki
- Department of Clinical Chemistry, University of Eastern Finland, Kuopio, Finland
- Eastern Finland Laboratory Centre, Kuopio, Finland
| | - Pekka Jäkälä
- Neuro Center, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, Unit of Neurology, University of Eastern Finland, Kuopio, Finland
| | - Ritva Vanninen
- Diagnostic Imaging Centre, Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, Unit of Radiology, University of Eastern Finland, Kuopio, Finland
| | - Pirjo Mustonen
- Department of Medicine, Keski-Suomi Central Hospital, Jyväskylä, Finland
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12
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Hart RG, Catanese L, Perera KS, Ntaios G, Connolly SJ. Embolic Stroke of Undetermined Source: A Systematic Review and Clinical Update. Stroke 2017; 48:867-872. [PMID: 28265016 DOI: 10.1161/strokeaha.116.016414] [Citation(s) in RCA: 366] [Impact Index Per Article: 52.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 01/13/2017] [Accepted: 01/20/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND PURPOSE Embolic stroke of undetermined source (ESUS) designates patients with nonlacunar cryptogenic ischemic strokes in whom embolism is the likely stroke mechanism. It has been hypothesized that anticoagulation is more efficacious than antiplatelet therapy for secondary stroke prevention in ESUS patients. We review available information about ESUS. METHODS Systematic literature review to assess the frequency of ESUS, patient features, and prognosis using PubMed from 2014 to present, unrestricted by language. RESULTS On the basis of 9 studies, the reported frequency of ESUS ranged from 9% to 25% of ischemic strokes, averaging 17%. From 8 studies involving 2045 ESUS patients, the mean age was 65 years and 42% were women; the mean NIH stroke score was 5 at stroke onset (4 studies, 1772 ESUS patients). Most (86%) ESUS patients were treated with antiplatelet therapy during follow-up, with the annualized recurrent stroke rate averaging 4.5% per year during a mean follow-up of 2.7 years (5 studies, 1605 ESUS patients). CONCLUSIONS ESUS comprises about 1 ischemic stroke in 6. Patients with ischemic stroke meeting criteria for ESUS were relatively young compared with other ischemic stroke subtypes and had, on average, minor strokes, consistent with small emboli. Retrospective methods of available studies limit confidence in stroke recurrence rates but support a substantial (>4% per year) rate of stroke recurrence during (mostly) antiplatelet therapy. There is an important need to define better antithrombotic prophylaxis for this frequently occurring subtype of ischemic stroke.
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Affiliation(s)
- Robert G Hart
- From the Department of Medicine (Neurology) (R.G.H., L.C., K.S.P.), Population Health Research Institute and Department of Medicine (Cardiology) (S.J.C.), McMaster University, Hamilton Health Sciences, Ontario, Canada; Department of Medicine, Larissa University Hospital, University of Thessaly, Larissa, Greece (G.N.).
| | - Luciana Catanese
- From the Department of Medicine (Neurology) (R.G.H., L.C., K.S.P.), Population Health Research Institute and Department of Medicine (Cardiology) (S.J.C.), McMaster University, Hamilton Health Sciences, Ontario, Canada; Department of Medicine, Larissa University Hospital, University of Thessaly, Larissa, Greece (G.N.)
| | - Kanjana S Perera
- From the Department of Medicine (Neurology) (R.G.H., L.C., K.S.P.), Population Health Research Institute and Department of Medicine (Cardiology) (S.J.C.), McMaster University, Hamilton Health Sciences, Ontario, Canada; Department of Medicine, Larissa University Hospital, University of Thessaly, Larissa, Greece (G.N.)
| | - George Ntaios
- From the Department of Medicine (Neurology) (R.G.H., L.C., K.S.P.), Population Health Research Institute and Department of Medicine (Cardiology) (S.J.C.), McMaster University, Hamilton Health Sciences, Ontario, Canada; Department of Medicine, Larissa University Hospital, University of Thessaly, Larissa, Greece (G.N.)
| | - Stuart J Connolly
- From the Department of Medicine (Neurology) (R.G.H., L.C., K.S.P.), Population Health Research Institute and Department of Medicine (Cardiology) (S.J.C.), McMaster University, Hamilton Health Sciences, Ontario, Canada; Department of Medicine, Larissa University Hospital, University of Thessaly, Larissa, Greece (G.N.)
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13
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18F-FDG PET/CT imaging factors that predict ischaemic stroke in cancer patients. Eur J Nucl Med Mol Imaging 2016; 43:2228-2235. [DOI: 10.1007/s00259-016-3460-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 07/05/2016] [Indexed: 12/26/2022]
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14
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Nouh A, Hussain M, Mehta T, Yaghi S. Embolic Strokes of Unknown Source and Cryptogenic Stroke: Implications in Clinical Practice. Front Neurol 2016; 7:37. [PMID: 27047443 PMCID: PMC4800279 DOI: 10.3389/fneur.2016.00037] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 03/07/2016] [Indexed: 12/31/2022] Open
Abstract
Up to a third of strokes are rendered cryptogenic or of undetermined etiology. This number is specifically higher in younger patients. At times, inadequate diagnostic workups, multiple causes, or an under-recognized etiology contributes to this statistic. Embolic stroke of undetermined source, a new clinical entity particularly refers to patients with embolic stroke for whom the etiology of embolism remains unidentified despite through investigations ruling out established cardiac and vascular sources. In this article, we review current classification and discuss important clinical considerations in these patients; highlighting cardiac arrhythmias and structural abnormalities, patent foramen ovale, paradoxical sources, and potentially under-recognized, vascular, inflammatory, autoimmune, and hematologic sources in relation to clinical practice.
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Affiliation(s)
- Amre Nouh
- Hartford Hospital, University of Connecticut , Hartford, CT , USA
| | - Mohammed Hussain
- Hartford Hospital, University of Connecticut , Hartford, CT , USA
| | - Tapan Mehta
- Hartford Hospital, University of Connecticut , Hartford, CT , USA
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