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Tian M, Song Y, Guo Y, Jiang T. Association between sleep disorders and constipation Risk: A systematic review and Meta-Analysis. J Clin Neurosci 2024; 126:12-20. [PMID: 38821029 DOI: 10.1016/j.jocn.2024.05.030] [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: 03/28/2024] [Revised: 05/22/2024] [Accepted: 05/23/2024] [Indexed: 06/02/2024]
Abstract
OBJECTIVES The objective of this study was to evaluate the potential relationship between sleep disturbances and various types of constipation in patients. METHODS We conducted systematic searches in the research databases PubMed, EMBASE, Web of Science, and Cochrane Library to identify qualifying studies. Using Stata software version 14.0, we calculated the Odds Ratio (OR) and 95 % confidence interval (CI) for constipation in patients with sleep disorders. If P > 0.1 and I2 ≤ 50 %, we employed a fixed-effects model; otherwise, we applied a random-effects model. We assessed publication bias using funnel plots and Egger's test. RESULT The pooled analysis demonstrated that individuals with sleep disorders were associated with an increased risk of all-cause constipation (OR = 1.47; 95 %CI: 1.31-1.64; I2 = 88.8 %, P<0.001). Specifically, both children (OR = 1.29; 95 %CI: 1.16-1.42; I2 = 63.8 %, P<0.001) and adults (OR = 1.65; 95 %CI: 1.39-1.97; I2 = 92.4 %, P<0.001) with a history of sleep disorders exhibited an increased risk of all-cause constipation.. Furthermore, patients with a history of insufficient sleep were also associated with an increased risk of constipation (OR = 1.33; 95 %CI: 1.20-1.46; I2 = 6.7 %, P<0.001). Additionally, patients with poor sleep quality were found to have an increased risk of constipation (OR = 1.56; 95 %CI: 1.0-2.45; I2 = 90.9 %, P = 0.05). Lastly, patients with insomnia were found to have the highest risk of constipation (OR = 1.94; 95 %CI: 1.37-2.76; I2 = 97.8 %, P<0.001). CONCLUSION This meta-analysis indicates that sleep disorders are associated with an elevated risk of constipation. Insomnia, poor sleep quality, and insufficient sleep duration all contribute to elevating the risk of constipation. These findings emphasize the significance of recognizing sleep disorders as an independent risk factor for constipation in both children and adults.
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Affiliation(s)
- Minhui Tian
- School of Clinical Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Yongfu Song
- Department of Pediatrics, The Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Yan Guo
- School of Clinical Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Tongwei Jiang
- School of Clinical Medicine, Changchun University of Chinese Medicine, Changchun, China.
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Hariri M, Shamshirgaran SM, Amini A, Abasi H, Gholami A. Sleep duration and quality are associated with health-related quality of life in adults aged 60 years and older. Ir J Med Sci 2024:10.1007/s11845-024-03656-y. [PMID: 38489125 DOI: 10.1007/s11845-024-03656-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 02/27/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND The current study aimed to determine the association between sleep duration and quality with health-related quality of life (HRQoL) among the Iranian older persons. METHODS This study was conducted on a representative sample of 3452 Iranian older people (≥ 60 years) who participated in the Iranian Longitudinal Study on Ageing (IRLSA) launched in Neyshabur (Razavi Khorasan province, northeastern Iran). The Persian versions of 12-Item Short Form Survey (SF-12) and Pittsburgh Sleep Quality Index (PSQI) were utilized to measure the level of HRQoL and the level of sleep duration and quality, respectively. Multiple linear regression model was performed to analyze the data and clarify the independent association of sleep duration and quality with HRQoL. RESULTS More than half of the study population (52.4%) suffered from poor sleep quality. 57.3% and 3.9% of individuals were short sleepers (< 7 h) and long sleepers (equal or more than 9 h), respectively. The total score of HRQoL was achieved 65.87 ± 20.55. After adjusting the covariates, the results indicated that short sleep duration was negatively associated with HRQoL (P < 0.05), whereas no significant associations were found between long sleep duration and HRQoL (P > 0.05). Interestingly, the results of multiple linear regression model revealed a significant negative association between poor sleep quality and HRQoL (P < 0.001). CONCLUSION The current study confirmed that short sleep duration and poor sleep quality were independently associated with lower HRQoL in the older persons. Therefore, interventional courses should be planned to enrich sleep-related healthcare and general HRQoL in the older persons.
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Affiliation(s)
- Mitra Hariri
- Noncommunicable Diseases Research Center, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Seyed Morteza Shamshirgaran
- Healthy Ageing Research Centre, Neyshabur University of Medical Sciences, Neyshabur, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Asieh Amini
- Department of English Language Teaching, Razi University, Kermanshah, Iran
| | - Hamid Abasi
- Public Health Department, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Ali Gholami
- Noncommunicable Diseases Research Center, Neyshabur University of Medical Sciences, Neyshabur, Iran.
- Department of Epidemiology and Biostatistics, School of Public Health, Neyshabur University of Medical Sciences, Neyshabur, Iran.
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Hariri M, Shamshirgaran SM, Aminisani N, Abasi H, Gholami A. Is poor sleep quality associated with lipid profile in elderly population? Finding from Iranian Longitudinal Study on Ageing. Ir J Med Sci 2024; 193:123-129. [PMID: 37400651 DOI: 10.1007/s11845-023-03449-9] [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: 03/29/2023] [Accepted: 06/23/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Abnormal lipid profile as one of reversible cardiovascular disease risk factors might be affected by poor sleep quality. AIM This study aimed to assess the association between poor sleep quality and serum concentration of lipid profile in Iranian elderly population. METHODS The study was performed on a representative sample of 3452 Iranian older people (≥60 years) who contributed in the Iranian Longitudinal Study on Ageing (IRLSA). Sleep quality was measured through the validated Persian version of Pittsburgh Sleep Quality Index (PSQI). Fasting blood samples were collected from the participants to measure plasma levels lipid profile. We used multiple linear regression model to evaluate the independent association of poor sleep quality with lipid profile. RESULTS The mean age of participants was 68.0±6.7 years and 52.5% of them were male. In total, 52.4% of study population reported poor sleep quality (PSQI>5). Mean serum concentration of triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) was 143.2±74.2 mg/dl, 195.6±43.2 mg/dl, 112.9±31.0 mg/dl, and 57.3±12.4 mg/dl, respectively. Poor sleep quality was significantly associated with serum levels of TG (β=17.85; P=0.006), LDL-C (β=5.45; P=0.039) and HDL-C (β=-2.13; P=0.039) after adjusting for studied covariates. CONCLUSION Our study illustrates that poor sleep quality is a risk factor for poorer lipid profile. Therefore, early behavioral or pharmacological interventions that improve sleep quality are necessary to modify lipid profile in elderly population.
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Affiliation(s)
- Mitra Hariri
- Noncommunicable Diseases Research Center, Neyshabur University of Medical Sciences, Neyshabur, Iran
- Healthy Ageing Research Centre, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Seyed Morteza Shamshirgaran
- Healthy Ageing Research Centre, Neyshabur University of Medical Sciences, Neyshabur, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Nayyereh Aminisani
- Healthy Ageing Research Centre, Neyshabur University of Medical Sciences, Neyshabur, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Hamid Abasi
- Public Health Department, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Ali Gholami
- Noncommunicable Diseases Research Center, Neyshabur University of Medical Sciences, Neyshabur, Iran.
- Department of Epidemiology and Biostatistics, School of Public Health, Neyshabur University of Medical Sciences, Neyshabur, Iran.
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Li C, Shang S, Liang W. Sleep and risk of hypertension in general American adults: the National Health and Nutrition Examination Surveys (2015-2018). J Hypertens 2023; 41:63-73. [PMID: 36129105 DOI: 10.1097/hjh.0000000000003299] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The purpose of research is to investigate the associations of sleep factors separately and jointly with risk of hypertension. METHODS The National Health and Nutrition Examination Surveys (NHANES) is a nationally representative survey. Participants aged over 20 years with complete and credible data from the NHANES 2015-2016 and 2017-2018 waves were included. Hypertension was assessed based on self-report medical diagnoses, or antihypertensive medication use, or systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg. Sleep information (sleep duration, trouble sleeping, daytime sleepiness, self-reported snoring and sleep-related breathing issue) was obtained from household interview. RESULTS Of 7426 participants, the mean (standard deviation) age was 48.0 (17.3) years, 3845 (51.8%) were females. The prevalence of hypertension was 32.8%, and lower in those with 7-9 h sleep, no trouble sleeping, no excessive daytime sleepiness, no snoring or sleep apnea symptoms, decreased as the quantity of healthy sleep factors increased. The self-reported short sleep (odds ratio [OR]: 1.25, 95% confidence interval [CI]: 1.02-1.54, P = 0.032), trouble sleeping (OR: 1.53, 95% CI: 1.20 to 1.95, P = 0.001), excessive daytime sleepiness (OR: 1.17, 95% CI: 1.01-1.35, P = 0.041) and sleep apnea symptoms (OR: 1.33, 95% CI: 1.10-1.61, P = 0.004) were associated with 25%, 53%, 17% and 33% increased risk of hypertension, respectively. Participants with a poor sleep pattern was associated with higher hypertension risk (OR: 2.47, 95% CI: 1.90-3.22, P < 0.001). CONCLUSION Sleep behaviors were cross-sectionally associated with a considerably higher hypertension risk.
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Affiliation(s)
- Chunnan Li
- Vanke School of Public Health
- Institute for Healthy China, Tsinghua University
- School of Nursing, Peking University, Haidian District, Beijing, China
| | - Shaomei Shang
- School of Nursing, Peking University, Haidian District, Beijing, China
| | - Wannian Liang
- Vanke School of Public Health
- Institute for Healthy China, Tsinghua University
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Ye J, Xiao R, Wang X, He R, Liu Z, Gao J. Effects and mechanism of renal denervation on ventricular arrhythmia after acute myocardial infarction in rats. BMC Cardiovasc Disord 2022; 22:544. [PMID: 36510123 PMCID: PMC9743565 DOI: 10.1186/s12872-022-02980-4] [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: 05/03/2022] [Accepted: 11/25/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Renal denervation (RDN) can reduce ventricular arrhythmia after acute myocardial infarction (AMI), but the mechanism is not clear. The purpose of this study is to study its mechanism. METHODS Thirty-two Sprague-Dawley rats were divided into four groups: control group, AMI group, RDN-1d + AMI group, RDN-2w + AMI group. The AMI model was established 1 day after RDN in the RDN-1d + AMI group and 2 weeks after RDN in the RDN-2w + AMI group. At the same time, 8 normal rats were subjected to AMI modelling (the AMI group). The control group consisted of 8 rats without RDN intervention or AMI modelling. RESULTS The study confirmed that RDN can reduce the occurrence of ventricular tachycardia in AMI rats, reduce renal sympathetic nerve discharge, and inhibit the activity of local sympathetic nerves and cell growth factor (NGF) protein expression in the heart after AMI. In addition, RDN decreased the expression of norepinephrine (NE) and glutamate in the hypothalamus,and NE in cerebrospinal fluid, and increased the expression level of γ aminobutyric acid (GABA) in the hypothalamus after AMI. CONCLUSION RDN can effectively reduce the occurrence of ventricular arrhythmia after AMI, and its main mechanism may be via the inhibition of central sympathetic nerve discharge.
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Affiliation(s)
- Jian Ye
- grid.412540.60000 0001 2372 7462Department of Cardiology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200062 People’s Republic of China
| | - Rongxue Xiao
- grid.186775.a0000 0000 9490 772XShanghai Putuo Central School of Clinical Medicine, Anhui Medical University, Shanghai, 200062 People’s Republic of China ,grid.186775.a0000 0000 9490 772XThe Fifth School of Clinical Medicine, Anhui Medical University, Shanghai, 200062 People’s Republic of China ,grid.412540.60000 0001 2372 7462Department of Cardiology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200062 People’s Republic of China
| | - Xu Wang
- grid.412540.60000 0001 2372 7462Department of Cardiology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200062 People’s Republic of China
| | - Ruiqing He
- grid.412540.60000 0001 2372 7462Department of Cardiology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200062 People’s Republic of China
| | - Zongjun Liu
- grid.186775.a0000 0000 9490 772XShanghai Putuo Central School of Clinical Medicine, Anhui Medical University, Shanghai, 200062 People’s Republic of China ,grid.186775.a0000 0000 9490 772XThe Fifth School of Clinical Medicine, Anhui Medical University, Shanghai, 200062 People’s Republic of China ,grid.412540.60000 0001 2372 7462Department of Cardiology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200062 People’s Republic of China
| | - Junqing Gao
- grid.412540.60000 0001 2372 7462Department of Cardiology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200062 People’s Republic of China
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Zhong X, Gou F, Jiao H, Zhao D, Teng J. Association between night sleep latency and hypertension: A cross-sectional study. Medicine (Baltimore) 2022; 101:e31250. [PMID: 36281125 PMCID: PMC9592274 DOI: 10.1097/md.0000000000031250] [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] [Indexed: 11/14/2022] Open
Abstract
Sleep disorders have been shown to increase the risk of hypertension, while the relationship between night sleep latency and hypertension is less well-known. We aimed to investigate the association between night sleep latency and hypertension, as well as related sleep factors by gender in the Chinese population. We conducted a cross-sectional study of the relationship between night sleep latency and hypertension. The sample size included 619 consecutive hospitalized patients (M/F: 302/317, 64.01 ± 12.27 years). T test, Chi-square test, and ANOVA were performed to analyze baseline data and intergroup comparisons. Spearman correlation analysis was performed to find the interrelationships. Multivariate logistic regression analysis was performed to adjust for covariables. The findings showed hypertension patients had longer night sleep latency (P < .001). After adjusting for confounding factors, night sleep latency was positively correlated with hypertension in both men and women (odds ratio: 1.065, 95% confidence interval: 1.044-1.087). Spearman correlation analysis suggested that night sleep latency was positively correlated with systolic blood pressure (r = 0.186, P < .001), diastolic blood pressure (r = 0.136, P < .001), sleep initiation time (r = 0.091, P = .023), and global Pittsburg Sleep Quality Index score (r = 0.371, P < .001), was negatively correlated with sleep duration (r = -0.186, P < .001), sleep time on weekdays (r = -0.183, P < .001), and sleep time on weekends (r = -0.179, P < .001). Longer night sleep latency was associated with an increased risk of hypertension in men and women, which might involve the pathological progression of hypertension along with other sleep factors.
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Affiliation(s)
- Xia Zhong
- Department of First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, PR China
| | - Fuyue Gou
- Department of First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, PR China
| | - Huachen Jiao
- Department of Cardiology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, PR China
- *Correspondence: Huachen Jiao, the Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Room 101, Unit 3, Building 1, No. 125, Huanshan Road, Lixia District, Jinan, Shandong 250014, PR China (e-mail: )
| | - Dongsheng Zhao
- Department of First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, PR China
| | - Jing Teng
- Department of First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, PR China
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Association between Poor Quality of Sleep and Metabolic Syndrome in Ghanaian University Students: A Cross-Sectional Study. SLEEP DISORDERS 2022; 2022:8802757. [PMID: 36276192 PMCID: PMC9581681 DOI: 10.1155/2022/8802757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/21/2022] [Indexed: 11/18/2022]
Abstract
Aim. This study aimed to determine the association between quality of sleep and metabolic syndrome (MetS) and physical activity level in young adults at the University of Ghana. Method. In a cross-sectional design, 340 university students, aged between 20-30 years were recruited. Quality of sleep was assessed using the Pittsburgh Sleep Quality index (PSQI) and physical activity with the short form of the International Physical Activity Questionnaire (IPAQ-SF). Poor quality of sleep was defined as a global PSQI score>5 and low physical activity level as those not meeting the criteria for vigorous-moderate physical activity. Anthropometric features and blood pressures were measured, and fasting blood samples were collected from the participants to measure plasma levels of glucose, lipid profile, urea, and creatinine. MetS was defined using the Joint Scientific Statement criteria. Results. In our study population of young adults from Ghana, the prevalence of poor quality of sleep as measured by PSQI was 54.1%, and MetS was 12.4%. MetS was associated with poor quality of sleep in females [
(1.04–4.25),
] and entire study participants [2.18 (1.09–4.37)
] in both crude and adjusted models; no association was found in male participants. Low physical activity status was not associated with poor sleep status. Obesity [1.32 (1.02–3.56),
], but not overweight [0.99 (0.58–2.34),
], was associated with poor quality of sleep. Conclusion. Young adults in a Ghanaian university have a high prevalence of poor quality of sleep and is associated with MetS and obesity. Physical activity status was not associated with poor quality of sleep.
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Liu J, Wang W, Tian J, Lv C, Fu Y, Fass R, Song G, Yu Y. Sleep Deficiency Is Associated With Exacerbation of Symptoms and Impairment of Anorectal and Autonomic Functions in Patients With Functional Constipation. Front Neurosci 2022; 16:912442. [PMID: 35873821 PMCID: PMC9301120 DOI: 10.3389/fnins.2022.912442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/07/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveSleep deficiency (SD) is commonly seen in patients with functional constipation (FC). Our aim was to determine whether the presence of SD would influence symptoms, anorectal motility, sensation, and autonomic function in FC patients.Materials and MethodsA total of 85 FC patients with SD and 193 FC patients without SD underwent high-resolution anorectal manometry. SD was assessed by using the Pittsburgh Sleep Quality Index (PSQI) score. Participants were required to fill in the entire questionnaires, including Patients’ Constipation-symptoms, State-Trait Anxiety Inventory, and Hamilton Depression Scale. Autonomic dysfunction was studied by recording the heart rate variability. Multiple logistic regression was performed to explore the potential risk factors for anorectal function.ResultsFunctional constipation patients with SD had a higher total score of constipation symptom (P < 0.001), in comparison with those without SD. FC patients with SD demonstrated significantly lower threshold volume for first sensation (P < 0.001) and urge (P < 0.001), as compared to those without SD. The PSQI score positively correlated with constipation symptom total score (P < 0.001), and negatively correlated with threshold volume for first sensation (P < 0.001) and urge (P < 0.001). FC patients with SD had a reduced vagal activity (P = 0.016) and a higher sympathetic activity as compared to those without SD (P = 0.003). Multivariate logistic regression revealed that SD, anxiety and depression were independent risk factors for anorectal function, with SD exhibiting the highest degree of association with first sensation (OR: 4.235).ConclusionSleep deficiency is associated with worse constipation related symptoms, altered anorectal function and perception, and impaired autonomic function in FC patients.
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Affiliation(s)
- Jie Liu
- Department of Gastroenterology, Affiliated Anhui Provincial Hospital, Anhui Medical University, Hefei, China
| | - Wei Wang
- Department of Gastroenterology, Affiliated Anhui Provincial Hospital, Anhui Medical University, Hefei, China
| | - Jiashuang Tian
- Department of Gastroenterology, Affiliated Anhui Provincial Hospital, Anhui Medical University, Hefei, China
| | - Chaolan Lv
- Division of Life Sciences and Medicine, Department of Gastroenterology, The First Affiliated Hospital of University of Science and Technology of China (USTC), University of Science and Technology of China, Hefei, China
| | - Yuhan Fu
- Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, United States
| | - Ronnie Fass
- Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, United States
| | - Gengqing Song
- Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, United States
- Gengqing Song,
| | - Yue Yu
- Department of Gastroenterology, Affiliated Anhui Provincial Hospital, Anhui Medical University, Hefei, China
- Division of Life Sciences and Medicine, Department of Gastroenterology, The First Affiliated Hospital of University of Science and Technology of China (USTC), University of Science and Technology of China, Hefei, China
- *Correspondence: Yue Yu,
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Cuspidi C, Carla S, Tadic M. Sleep, hypertension, and autonomic dysfunction. J Clin Hypertens (Greenwich) 2020; 22:1491-1493. [PMID: 32710680 DOI: 10.1111/jch.13952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/07/2020] [Accepted: 07/07/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Cesare Cuspidi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy.,Istituto Auxologico Italiano, Milano, Italy
| | - Sala Carla
- Department of Clinical Sciences and Community Health, University of Milano and Fondazione Ospedale Maggiore IRCCS Policlinico di Milano, Milano, Italy
| | - Marijana Tadic
- University Hospital "Dr. Dragisa Misovic-Dedinje" Department of Cardiology, Belgrade, Serbia
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