- StatPearls [BOOK]
- BOOKStatPearls Publishing: Treasure Island (FL)
- Atrial fibrillation (AF) is the most common cardiac arrhythmia encountered in the United States with about 3 million people reported being diagnosed with the disorder. The prevalence of atrial fib...
Atrial fibrillation (AF) is the most common cardiac arrhythmia encountered in the United States with about 3 million people reported being diagnosed with the disorder. The prevalence of atrial fibrillation dramatically increases with advancing age. As our population has enjoyed greater longevity, along with the increasing presence of risk factors known associated with atrial fibrillation such as hypertension and obesity, the incidence and prevalence of AF is expected to continue to increase. There is significant morbidity associated with the development and perpetuation of AF, including stroke, heart failure, cognitive impairment, renal failure, increased mortality and a negative impact to the quality of life. As such, controlling the arrhythmia is often essential to patient quality of life and prognosis, but has been difficult to attain. Since Haussaiguarre et al. reported that AF most often began in the posterior left atrium surrounding the ostia of the pulmonary veins, pulmonary vein electrical isolation via catheter ablation has been the cornerstone of nonpharmacological treatment of AF. Treatment of AF may be medical or surgical, depending on patient characteristics, duration of disease, symptoms, and patient preference. The two most frequently used energy sources used for ablation are electrocautery (known as radio-frequency), and cryoenergy,; although other energy sources are being actively investigated for their efficacy and safety. Both methods have been employed during open-heart surgery with equal efficacy. Catheter radiofrequency ablation, where electrocautery is delivered to the tip of a steerable wire, has been used to treat cardiac arrhythmias since the 1980s. Catheter cryoablation, where liquid nitrogen is introduced to scar arrhythmic cardiac tissue, was more recently introduced to deliver less severe burns and thus a more controlled degree of injury. It is most widely used in pediatrics due to the ability to reverse its effects if not applied for a long period due to its slow injury rate. As radio-frequency energy has been the primary energy source used to electrically isolate all four pulmonary veins, an extensive number of ablation lesions are needed to be delivered by wire to encircle the vein ostia. This posed a challenge of completely encircling the peri-ostial pulmonary veins to produce complete conduction block, leaving gaps in the ablation lines and less control in the degree of injury delivered, which could lead to injury to contiguous structures such as the esophagus. In 2012 the FDA approved a multicenter examination of second-generation cryoballoon which is delivered through a catheter over a wire and can deliver a continuous encircling freeze lesion to the left atrial tissue surrounding the ostia of the pulmonary veins, thus being more consistent in ablation delivery and being less prone to gaps in the ablation field. Cryoenergy's greater lesion control should also theoretically have less risk to injure deeper tissues and thus, safer. A large multicenter trial in Europe showed both methods were equally effective in electrically isolating pulmonary veins and were equally effective in preventing recurrent atrial fibrillation. This article reviews the methodology of catheter cryoballoon ablation using a multicenter examination of second-generation cryoballoon to treat symptomatic AF and its expected outcomes and risks.
- Developing a Process for Returning Medically Actionable Genomic Variants to Latino Patients in a Federally Qualified Health Center. [Journal Article]
- PHPublic Health Genomics 2018 Dec 06; :1-8
- CONCLUSIONS: Efforts to bring precision medicine to community-based health centers serving minority patients may require multilevel engagement activities to include individuals, providers, health systems, and the community.
- Gastric wall fat halo sign in patients without intestinal disease. [Journal Article]
- CIClin Imaging 2018 Nov 30; 54:31-36
- CONCLUSIONS: Gastric wall fat halo signs may be observed in overweight people, especially those with increased VFA and VF%. Additionally, these signs are usually observed along with fat halo signs of the colon or terminal ileum. However, extensive studies are needed to clarify the relationship between gastric wall fat halo signs and type 2 diabetes, cardiovascular diseases and metabolic syndrome.
- Enhanced anxiety-like behavior emerges with weight gain in male and female obesity-susceptible rats. [Journal Article]
- BBBehav Brain Res 2018 Dec 03
- Epidemiological data suggest that body mass index and obesity are strong risk factors for depression and anxiety. However, it is difficult to separate cause from effect, as predisposition to obesity ...
Epidemiological data suggest that body mass index and obesity are strong risk factors for depression and anxiety. However, it is difficult to separate cause from effect, as predisposition to obesity may enhance susceptibility to anxiety, or vice versa. Here, we examined the effect of diet and obesity on anxiety-like behaviors in male and female selectively bred obesity-prone and obesity-resistant rats, and outbred Sprague-Dawley rats. We found that when obesity-prone and obesity-resistant rats do not differ in weight or fat mass, measures of anxiety-like behavior in the elevated plus maze and open field are similar between the two groups. However, once weight and fat mass diverge, group differences emerge, with greater anxiety in obesity-prone relative to obesity-resistant rats. This same pattern was observed for males and females. Interestingly, even when obesity-resistant rats were "forced" to gain fat mass comparable to obesity-prone rats (via prolonged access to 60% high-fat diet), anxiety-like behaviors did not differ from lean chow fed controls. In addition, a positive correlation between anxiety-like behaviors and adiposity were observed in male but not in female obesity-prone rats. Finally, diet-induced weight gain in and of itself was not sufficient to increase measures of anxiety in outbred male rats. Together, these data suggest that interactions between susceptibility to obesity and physiological alterations accompanying weight gain may contribute to the development of enhanced anxiety.
- Body composition and sarcopenia: the next-generation of personalized oncology and pharmacology? [Review]
- P&TPharmacol Ther 2018 Dec 03
- Body composition has gained increasing attention in oncology in recent years due to fact that sarcopenia has been revealed to be a strong prognostic indicator for survival across multiple stages and ...
Body composition has gained increasing attention in oncology in recent years due to fact that sarcopenia has been revealed to be a strong prognostic indicator for survival across multiple stages and cancer types and a predictive factor for toxicity and surgery complications. Accumulating evidence over the last decade has unraveled the "pharmacology" of sarcopenia. Lean body mass may be more relevant to define drug dosing than the "classical" body surface area or flat-fixed dosing in patients with cancer. Since sarcopenia has a major impact on patient survival and quality of life, therapeutic interventions aiming at reducing muscle loss have been developed and are being prospectively evaluated in randomized controlled trials. It is now acknowledged that this supportive care dimension of oncological management is essential to ensure the success of any anticancer treatment. The field of sarcopenia and body composition in cancer is developing quickly, with (i) the newly identified concept of sarcopenic obesity defined as a specific pathophysiological entity, (ii) unsolved issues regarding the best evaluation modalities and cut-off for definition of sarcopenia on imaging, (iii) first results from clinical trials evaluating physical activity, and (iv) emerging body-composition-tailored drug administration schemes. In this context, we propose a comprehensive review providing a panoramic approach of the clinical, pharmacological and therapeutic implications of sarcopenia and body composition in oncology.
- Race and income moderate the association between depressive symptoms and obesity. [Journal Article]
- PMPrev Med 2018 Dec 03
- Complex interrelationships between race, sex, obesity and depression have been well-documented. Because of differences in associations between socioeconomic status (SES) and health by race, determini...
Complex interrelationships between race, sex, obesity and depression have been well-documented. Because of differences in associations between socioeconomic status (SES) and health by race, determining the role of SES may help to further explicate these relationships. The aim of this study was to determine how race and income interact with obesity on depression. Combining data from the 2007-2014 National Health and Nutrition Examination Survey, depressive symptoms was measured with the Patient Health Questionnaire-9 and obesity was assessed as body mass index ≥30 kg/m2. Three-way interactions between race, income and obesity on depressive symptoms were determined using ordered regression models. Significant interactions between race, middle income and obesity (OR = 0.66, 95% CI = 0.22-1.96) suggested that, among white women, obesity is positively associated with depressive symptoms across income levels, while obesity was not associated with depression for African American women at any income level. Obesity was only associated with depressive symptoms among middle-income white men (OR = 1.44, 95% CI = 1.02-2.03) and among high-income African American men (OR = 4.65, 95% CI = 1.48-14.59). The associations between obesity and depressive symptoms vary greatly by race and income. Findings from this study underscore the importance of addressing obesity and depression among higher income African American men.
- Vascular and metabolic profiles in offspring born to pregnant mice with metabolic syndrome treated with inositols. [Journal Article]
- AJAm J Obstet Gynecol 2018 Dec 03
- CONCLUSIONS: Inositols supplementation improved glucose tolerance, SBP and vascular responses in adult eNOS+/- and WT offspring born to dams with MS. Interestingly, WT born to MS dams show an altered vascular profile similar to eNOS+/- offspring and exhibit an improved response to INOs treatment. Our findings suggest that the benefits of INOs treatment are more pronounced in offspring exposed to environmental factors in utero, and less likely in those due to genetic factors.
- Healthcare Providers' Advice on Lifestyle Modification in the US Population: Results from the National Health and Nutrition Examination Survey 2011-2016. [Journal Article]
- AJAm J Med 2018 Dec 03
- CONCLUSIONS: Prevalence of lifestyle modification advised by healthcare providers is generally low among US adults with chronic conditions, and worryingly low among those without chronic conditions however overweight or obese. Prescribed lifestyle modification is a missing opportunity in implementing sustainably strategies reducing chronic condition burden.
- Pharmacological treatment of obesity [English Abstract]
- RMRev Med Inst Mex Seguro Soc 2018 11 30; 56(4):395-409
- More than 70% of the population in Mexico is overweight or obese, affecting mainly people in productive age. Obesity is associated with the development of diseases that increase cardiovascular risk (...
More than 70% of the population in Mexico is overweight or obese, affecting mainly people in productive age. Obesity is associated with the development of diseases that increase cardiovascular risk (diabetes mellitus, hypertension or atherogenic dyslipidemia), diseases that limit the quality of life of the patient (osteoarthrosis or sleep apnea) and even with the increase in the incidence of certain types of cancer (breast or colon). It is evident that the decrease of at least 5% of body weight induces improvement in all these factors; however, in some patients it is difficult to achieve this goal only with lifestyle modifications. In this review we analyze some drugs approved for weight control by national and international agencies that can serve as an auxiliary in conjunction with diet and exercise. Treatment must be individualized according to each patient characteristics, with an adequate evaluation of their risks and benefits.
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- Anthocyanins from Cornus kousa ethanolic extract attenuate obesity in association with anti-angiogenic activities in 3T3-L1 cells by down-regulating adipogeneses and lipogenesis. [Journal Article]
- PlosPLoS One 2018; 13(12):e0208556
- Cornus kousa the Korean dogwood has been traditionally used in East Asia as therapeutic traditional medicine however biological activities of Cornus kousa have not been investigated previously. The a...
Cornus kousa the Korean dogwood has been traditionally used in East Asia as therapeutic traditional medicine however biological activities of Cornus kousa have not been investigated previously. The aim of the present study was to evaluate anti-obesity activities coupled with anti-angiogenic activities of anthocyanins rich fraction of ethanolic leaf extract of Cornus kousa (ELECk) in HUVECs and 3T3- L1 cells. Dried plants leaves were extracted with 70% ethanol and anthocyanin fraction (AnT Fr) was obtained by eluting the ethanolic extract through non-polar macroporous resin and further purification by HPLC. Antiangiogenic activities were determined by antiproliferative effect of AnT Fr on HUVECs. In the presence of various concentrations of AnT Fr, 3T3-L1 preadipocytes were induced to differentiate. Lipid accumulation in differentiated adipocytes were quantified by Oil-Red O staining. AnT Fr significantly suppressed angiogenesis by inhibiting proliferation and tube formation of HUVECs via downregulating VEGRF 2, PI3K, β-catenin, NF-kB, and Akt1 in a dose dependent manner. AnT Fr inhibited lipid accumulation by down-regulating adipogenesis and lipogenesis promoting signaling proteins, PPARγ, CCAAT, C/EBPα, aP2, FAS, and LPL, however enhanced AMPK activation to p-AMPK in 3T3 cells quantified and expressed by western blotting. AnT Fr inhibit lipid accumulation by regulating adipogenesis and lipogenesis related genes and signaling proteins. The anti-obesity activities exerted by Cornus kousa are associated with antiangiogenic activities of anthocyanins rich fraction of Cornus kousa. Hence the presence of bioactive anthocyanins, Cornus kosa, is a good candidate for nutraceutical and pharmaceutical formulation for treating or controlling obesity.