Normal Weight Patients Research Articles

Effect of body mass index on immune checkpoint inhibitor efficacy in patients with advanced cancer.

The need for predictive factors regarding the response to immune checkpoint inhibitors (ICIs) is increasing. Recent research indicates that an enhanced response to ICIs is associated with a higher body mass index (BMI). This study aims to evaluate the relationship between response to ICIs and BMI in solid tumors. We retrospectively analyzed patients with advanced cancer treated with ICIs at one academic center. We compared the treatment responses of patients classified as underweight/normal weight (BMI <25) and overweight/obese (BMI ⩾ 25) according to their BMI at the initiation of ICI treatment. After excluding underweight patients, we also compared the progression-free survival (PFS) and overall survival (OS) of normal-weight, overweight, and obese patients. Overall, 113 patients were evaluated. Forty-seven (41.6%) patients had BMI <25 and 66 (58.4%) patients had a BMI ⩾ 25. In underweight/normal patients, median PFS was 7.7 months (95% CI: 4.7-10.6) while it was 8.0 months (95% CI: 4.1-11.9) in overweight/obese patients (HR 1.16, 95% CI: (0.76-1.75), p=0.477). In underweight/normal patients, the median OS was 21.7 months (95% CI: 11.6-31.7) compared to 18.7 months (95% CI: 12.7-24.6) in overweight/obese patients (HR 1.06, 95% CI: (0.69-1.64), p=0.774). The objective response rate (ORR) was 38.3% in underweight/normal patients and 34.8% in overweight/obese patients (p = 0.707). After excluding underweight patients, there were also no significant differences in PFS (p = 0.914), OS (p = 0.642), and ORR (p = 0.909) between patients of normal weight, overweight, and obesity. Our research found no correlation between BMI and response to ICIs. Additional prospective studies are necessary to assess the effect of BMI on the response to ICIs.

Combining single-cell RNA sequencing and network pharmacology to explore the target of cangfu daotan decoction in the treatment of obese polycystic ovary syndrome from an immune perspective

BackgroundPolycystic ovary syndrome (PCOS) is a heterogeneous gynecological endocrine disorder linked to immunity. Cangfu Daotan Decoction (CFDT), a classic Chinese medicine prescription, is particularly effective in treating PCOS, specifically in patients with obesity; however, its specific mechanism remains unclear.MethodsPart 1: Peripheral blood mononuclear cells were collected on egg retrieval day from obese and normal-weight patients with PCOS and healthy women undergoing in vitro fertilization (IVF)-embryo transfer. Next, scRNA-seq was performed to screen the key genes of bese patients with PCOS. Part 2: Active ingredients of CFDT and obesity-related PCOS targets were identified based on public databases, and the binding ability between the active ingredients and targets was analyzed. Part 3: This part was a monocentric, randomized controlled trial. The obese women with PCOS were randomized to CFDT (6 packets/day) or placebo, and the healthy women were included in the blank control group (43 cases per group). The clinical manifestations and laboratory outcomes among the three groups were compared.ResultsBased on the scRNA-seq data from Part 1, CYLD, ARPC3, CXCR4, RORA, JUN, FGL2, ZEB2, GNLY, FTL, SMAD3, IL7R, KIR2DL1, CTSD, BTG2, CCL5, HLA, RETN, CTSZ, and NCF2 were potential key genes associated with obese PCOS were identified. The proportions of T, B, and natural killer cells were higher in patients with PCOS compared to healthy women, with even higher proportions observed in obese patients with PCOS. Gene ontology and the Kyoto encyclopedia of genes and genomes analysis depicted that the differentially expressed genes were related to immune regulation pathways. Network pharmacology analysis identified that the key active components in CFDT were quercetin, carvacrol, β-sitosterol, cholesterol, and nobiletin, and TP53, AKT1, STAT3, JUN, SRC, etc. were the core targets. The core targets and their enrichment pathways overlapped with those in Part 1. Clinical trials in Part 3 found that CFDT reduced the dosage of gonadotropins use in patients with PCOS, increased the number of high-quality embryos, and improved the ongoing pregnancy rate.ConclusionCFDT can improve the immune microenvironment of patients to some extent, reduce their economic burden, and enhance IVF outcomes. The improvement in the immune microenvironment in obese patients with PCOS may be linked to targets such as JUN and AKT.

Identification of the optimal method for measuring left atrium volume as a marker of undetected atrial fibrillation in patients with cryptogenic stroke and high prevalence of overweight

Abstract Introduction Paroxysmal atrial fibrillation (AF) is detected in approximately one-third of patients diagnosed with cryptogenic stroke undergoing prolonged ECG monitoring. Several risk factors for AF have been described, including left atrium (LA) enlargement, LA deformation, age, cardiovascular risk factors, and biomarkers as N-pro-BNP and troponin. Specifically, LA enlargement is a direct marker of atrial cardiopathy, which predisposes to AF. However, the methods to calculate LA enlargement vary. While LA biplane volume indexed to body surface area (BSA) remains the standardized method of choice according to current guidelines, it may underestimate the degree of enlargement in overweight patients. Additionally, overweight produces a systemic inflammatory state which is also associated with AF. Purpose The primary objective of the study was to define the best parameter among LA end systolic volume (LAESV), LAESV indexed to BSA (LAESV/BSA), and LAESV indexed to ideal BSA for identifying patients admitted for cryptogenic stroke with undetected paroxysmal AF. The secondary objective was to assess the accuracy of these parameters in both normal-weight and overweight patients. Methods Consecutive patients over 65 years-old diagnosed with cryptogenic stroke in our tertiary hospital were enrolled. All patients underwent 15-days ambulatory ECG monitoring to screen for undetected paroxysmal AF. Clinical, echocardiographic and laboratory data were prospectively collected. Ideal BSA was calculated using the Devine method. The accuracy of LA volume parameters in classifying patients with undetected paroxysmal AF was assessed using the area under the curve (AUC) of the receiver operating characteristic (ROC) curve. The analysis was stratified for overweight status (BMI &amp;lt; 25 or BMI ≥ 25). Results A total of 66 patients (Mean age 78.4 ± 7.6 years; 48% male) were included. Of them, 39 (59%) had hypertension, 16 (24%) had diabetes and 39 (59%) were overweight. AF was present in 21 (32%) patients. The mean LAESV, LAESV/BSA, LAESV/ideal BSA were 56.2 ± 23.0 ml, 34.2 ± 12.6 ml/m2, and 34.7 ± 14.1 ml/m2, respectively. Figure 1 illustrates the ROC curves for LA volume parameters in the main cohort and stratified by overweight status. Overall, no relevant differences in AUC were observed among LAESV, LAESV/BSA, LAESV/ideal BSA in each scenario. However, BMI significantly altered the discrimination performance of LA volume measures, which resulted optimal in normal-weight patients (AUC from 0.838 to 0.886) and absent in overweight patients (AUC from 0.838 to 0.521 to 0.564). Conclusions LAESV, LAESV/BSA, LAESV/ideal BSA show similar discrimination performance in identifying undetected AF in patients with cryptogenic stroke. However, the presence of overweight considerably impacts on the predictive value of LA volume parameters in this clinical scenario.ROC curves

The obesity paradox in patients with hypertrophic cardiomyopathy: A Korean nationwide cohort study

Abstract Background In cardiomyopathies, obesity is known to affect the cardiac remodeling and is associated with a poor prognosis. However, in hypertrophic cardiomyopathy, which is included in the category of heart failure with preserved ejection fraction, the risk of underweight has been suggested, and its impact in practice is controversial. Purpose The aim of this study was to investigate the potential relationship between obesity and cardiovascular outcomes in patients diagnosed with hypertrophic cardiomyopathy. Methods We conducted a retrospective national cohort study from 2013 to 2020 utilizing administrative claims data and health check-up database from the Korean National Health Insurance Service. Patients newly diagnosed with hypertrophic cardiomyopathy from January 2015 to December 2019 were included. Body mass index was stratified into five groups based on the World Health Organization's recommended criteria for Asian populations, and patients were followed until the date of each outcome or the end of the study period. Predefined clinical outcomes included heart failure hospitalization events, fatal arrest events, all-cause death, and composite clinical outcomes. Results A total of 6,361 patients were included in the study, with a mean age was 60 ± 13 years and 32.6% female. During a median follow-up of 3.0 years (interquartile range, 1.8 to 4.3), 921 heart failure hospitalization, 185 fatal arrest, and 340 deaths occurred. The underweight group had higher adjusted hazard ratios for heart failure hospitalization, fatal arrest, all-cause death, and the composite outcome compared to the normal range body mass index group (HR 1.69, 95% CI 1.16-2.47; HR 2.29, 95% CI 1.06-4.93; HR 2.74, 95% CI 1.77-4.24; HR 1.77, 95% CI 1.28-2.45). In addition, the adjusted hazard ratios for the composite outcome were lower in the overweight and obese I group compared to the normal range (HR 0.80, 95% CI 0.68-0.95; HR 0.84, 95% CI 0.72-0.98). Conclusions Among patients with hypertrophic cardiomyopathy, those classified as underweight had an increased risk of heart failure hospitalization, fatal arrest, all-cause death, and composite outcomes compared with normal weight patients, while those classified as overweight and obese had a decreased risk of composite outcomes.

The impact of body mass index for atrial fibrillation ablation; real-world data on outcomes and quality of life

Abstract Background Pulmonary vein isolation (PVI) is a cornerstone in the management of atrial fibrillation (AF). Increasing numbers of overweight and obese patients undergo PVI, despite the association between a higher body mass index (BMI) and adverse ablation outcomes. The risks of perioperative complications and quality of life have hardly been studied for the different bodyweight groups. Purpose The purpose of this study is to clarify the impact of BMI on PVI outcomes, including both perioperative complications and change in quality of life after PVI. Methods This is an observational, multicentre cohort study of prospectively collected data, covering all 15 ablation centres in the Netherlands. The study included all patients who underwent their first catheter-PVI between January 2015 and December 2021. Patients with a BMI below 18.5 kg/m2, missing BMI data, or prior ablations were excluded. Patients were categorized by BMI; normal weight (BMI 18.5-24.9 kg/m2), overweight (BMI 25-29.9 kg/m2) and obesity (BMI ≥30 kg/m2). The primary outcome was repeat ablation within one year. A logistic regression model was used to adjust for patient characteristics. A generalized additive model was fitted to visualize the correlation between BMI and the risk of repeat ablation. Secondary outcomes were repeat ablation within 3 years, a composite of the periprocedural complications, and change in quality of life, assessed using the Atrial Fibrillation Effect on QualiTy-of-Life (AFEQT) questionnaire before and at one year after PVI. Results A total of 20,725 patients (33% female) were included; 72% had a paroxysmal AF pattern. Of all patients, 30% were normal weight, 47% overweight and 23% obese. Within the first year post-index PVI, obese patients had a higher incidence of repeat ablation than normal-weighing and overweight patients (17.8% versus 15.6% and 16.1%, P &amp;lt;0.05). Obesity independently predicted an increased risk of repeat ablation within 1 year (odds ratio 1.15; 95%-confidence interval 1.01-1.31, P =0.03). This increased risk was also apparent for repeat ablations within 3 years (hazards ratio 1.15; 95%-confidence interval 1.06-1.25; P &amp;lt;0.01). The composite complication rate was 3.8% in normal weighing, 3.0% in overweight, and 4.6% in obese patients, with weight class not being an independent predictor. All weight groups had a substantial improvement in quality of life one year after ablation. Post PVI, summarized AFEQT score was still lower in obese patients (81), than in normal weight (88; P &amp;lt;0.01) and overweight patients (88; P &amp;lt;0.01). Conclusions In a nation-wide contemporary cohort, obesity is an independent predictor for undergoing a repeat ablation within both 1 and 3 years. This relation is not apparent for overweight individuals. Catheter ablation can safely be performed in all weight classes. Despite an overall lower quality of life among obese individuals, substantial improvements in quality of life occur in all weight groups.Visual abstract

The Association between Vitamin D3 Deficiency and Cataract Formation in Baghdad Al-Karkh

Background: Visual impairment is a global issue that is particularly problematic for poor nations. It is linked to diminished physical activity, social isolation, reliance on everyday tasks, and even death. The clouding of the lens inside the eye is called a cataract. It is one of the main causes of blindness and visual impairment in the world. Because of its anti-inflammatory and antioxidant properties, vitamin D, a prohormone in the blood, is crucial to the pathophysiology of many ocular illnesses. Given that oxidative stress and inflammation are significant contributors to the development of cataracts, a number of research have evaluated the relationship between vitamin D3 deficiency and cataract formation. Objective: Determine whether a vitamin D3 deficiency and cataracts are related. Patients and Methods: A cross-sectional study that was carried out included a total of 100 cataract patients who are 60 years of age or younger from September 2023 to March 2024 in the Ophthalmology Department of Imamein Kadhimein Medical City, Baghdad, Iraq. Questionnaire form was used which consist of sociodemographic information, socioeconomic status, dietary sources of vitamin D3, sun exposure, anthropometric measures and ophthalmic examination. Vitamin D3 level had been investigated in laboratory of the hospital. Results: Thirty percent of patients had cortical cataracts, 57% had nuclear cataracts, and 13% had posterior subcapsular cataracts. Sixty-nine percent of patients had a vitamin D3 level that is less than 20 ng/ml. Of the patients, 13% had a vitamin D3 level between 20 and 30 ng/ml, while 18% had a level greater than 30 ng/ml. There is a significant association between the level of vitamin D3 and the type of cataract (p-value = 0.013). Sixty-nine percent of patients with deficient vitamin D3 levels had 9% posterior subcapsular cataracts, 36% cortical cataracts, and 55% nuclear cataracts. Patients with insufficient vitamin D3 levels had 8% posterior subcapsular cataracts, 8% cortical cataracts, and 84% nuclear cataracts. While patients with sufficient vitamin D3 levels had 33% posterior subcapsular cataracts, 22% cortical cataracts, and 45% nuclear cataracts. The body mass index and vitamin D3 level were significantly associated (p-value = 0.003). Patients with a vitamin D3 level less than 20 ng/ml comprised 31% overweight patients, 26% class I obese patients, 26% class II obese patients, and 4% class III obese patients. Thirteen percent of these patients had normal weights. Patients with a vitamin D3 level 20-30 ng/ml comprised 46% overweight patients, 23% class II obese patients, and 31% with normal weight. While patients with a vitamin D3 level more than 30 ng/ml comprised 33% normal weight patients and 67% overweight. Conclusion: Vitamin D3 deficiency has a significant association with cataract formation, especially nuclear and cortical types, sun exposure, educational level, socioeconomic status, and obesity.

Impact of Body Mass Index on Outcomes in Pediatric Allogeneic Hematopoietic Stem Cell Transplantation Recipients: A Single-Center Retrospective Study

Background: Pediatric patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) face several risk factors influencing transplantation success, including nutritional status as measured by body mass index (BMI). Methods: This study analyzed BMI data collected from patients transplanted between 2003 and 2023, and aimed to evaluate whether deviations from normal BMI are associated with poorer clinical outcomes. BMI levels assessed before and after first-line treatment and pre-transplantation were analyzed retrospectively to determine a correlation with survival and post-transplant complications. Results: Underweight patients had significantly lower 12- and 36-month overall survival rates compared to normal-weight and overweight patients (p = 1.22 × 10−8 and p = 8.88 × 10−8, respectively). Event-free survival was also lower for underweight patients at all time points. A higher pre-transplant BMI increases the risk of acute graft-versus-host disease (GVHD, p = 0.00068). Otherwise, pre-transplant BMI was not significantly correlated with early TRCs and cGVHD. As secondary objectives, this study identified differences in BMI across primary disease groups, with solid tumor patients having the highest BMI and myelodysplastic syndrome patients having the lowest. BMI cut-offs were identified to predict or protect against serious outcomes, including delayed engraftment, TRCs, and acute and chronic GVHD. Conclusions: This study highlights the importance of nutritional assessment and management in pediatric patients undergoing allo-HSCT to optimize post-transplant outcomes, as deviations from a normal BMI can significantly impact post-transplant health. These findings underscore the importance of integrating BMI assessment throughout the entire pre-HSCT therapeutic course to identify patients at higher risk for complications and to define more effective nutritional management strategies.

Impact of body mass index on mortality, limb amputation, and bleeding in patients with lower extremity artery disease undergoing endovascular therapy.

The relation between Body Mass Index (BMI) and adverse outcomes after endovascular therapy (EVT) for patients with lower extremity artery disease (LEAD) remains incompletely understood. From April 2010 to March 2020, 199 consecutive patients who underwent EVT for LEAD were retrospectively analyzed. The patients were divided into three groups based on BMI; underweight < 18.5 kg/m2, normal weight ≥ 18.5 and < 25.0 kg/m2, and overweight ≥ 25.0 kg/m2. The endpoint of this study was a composite of all-cause mortality, major amputation, and major bleeding. Patients who were underweight often exhibited anemia (53.3 vs. 22.3 vs. 15.4%, respectively; p = 0.001) and severe chronic kidney disease (50.0 vs. 30.8 vs. 20.5%, respectively; p = 0.03). Furthermore, these patients had higher incidences of Trans-Atlantic Inter-Society Consensus class C or D lesions (40.0 vs. 20.0 vs. 10.3%, respectively; p = 0.01). During the median follow-up duration of 3.6 years (interquartile range: 1.2 to 6.7 years), there were 73 incidents of the composite endpoint. When the overweight group was assigned as the reference group, the adjusted hazard ratios for the composite endpoint for the underweight and normal weight patients were 3.67 (95% confidence interval [CI] 1.39-10.83, p = 0.008) and 2.35 (95% CI 1.06-6.23, p = 0.03), respectively. Kaplan-Meier curve demonstrated that the freedom from the composite endpoint for underweight, normal weight, and overweight patients was 41.6%, 60.0%, 83.8%, respectively (p < 0.001). These results suggest that there was an inverse association between BMI and adverse outcomes composed of mortality, limb amputation, and bleeding in patients with LEAD undergoing EVT.

Association between Mediterranean diet adherence and dyslipidemia among type-2 diabetes mellitus patients in Dhaka, Bangladesh: a hospital-based study

BackgroundMediterranean diet (MD) adherence is critical for an individual's physical and mental health. Cardiovascular diseases (CVDs) are the leading cause of death in Bangladesh and are closely associated with diabetes mellitus (DM) and dyslipidemia. This study aims to determine the level of adherence to the MD among patients with type 2 diabetes mellitus (T2DM) and identify any association between poor adherence to the MD and dyslipidemia.MethodsThis facility-based cross-sectional study was conducted in the outpatient department of a tertiary care hospital from March to May 2021. A total of 251 T2DM patients were interviewed. Bivariate and multivariate analyses were carried out using a logistic regression model with SPSS 23 statistical package software.ResultsThe prevalence of dyslipidaemia was 83% among T2DM patients. There was a high prevalence of hypertension (61%), overweight or obesity (57%), cardiovascular problems (30%), kidney disease (19%), and sleep problems (28%). Low adherence to MD was highly prevalent (49%) among participants, and another 28% had medium adherence. Patients with poor MD adherence had higher odds of developing dyslipidaemia (AOR: 2.8, 95% CI 1.18–6.63). Normal-weighted patients had lower odds of developing dyslipidaemia (AOR: 0.40, 95% CI 0.18–0.89) compared to overweight or obese individuals.ConclusionsThere was a relatively low adherence to MD among T2DM patients, which is a significant predictor of dyslipidemia. Therefore, T2DM patients should be more conscious of their dietary habits to control dyslipidemia and cardiovascular diseases effectively.

Histologic Characterization of Tumor-Adjacent Mammary Adipose Tissue in Normal-Weight and Overweight/Obese Patients with Triple-Negative Breast Cancer

Background: Obesity is a risk factor of several types of cancer, including breast cancer. In this study, we aimed to histologically characterize the adipose tissue of the tumor microenvironment (TME) of triple-negative breast cancer (TNBC) in overweight/obese versus normal-weight patients. Methods: TNBC tissue sections from normal-weight (BMI&lt;25) and overweight/obese patients (BMI≥25) were stained with antibodies against CD68, CD163, CD31, CD34, and vimentin. At the invasive tumor front, positive cells were counted in tumor adjacent adipose tissue (AT) and within cancer tissue (CT). Further, the size of the tumor-adjacent and distant mammary adipocytes was determined in perilipin stained sections. Expression of ANGPTL4, CD36 and FABP4, proteins involved in fatty acid metabolism, was analyzed in marginal tumor cells using an immune reactive score. Results: Overweight/obese TNBC patients had significantly larger adipocytes, higher numbers of CD163+ macrophages (BMI&lt;25: 2.80 vs. BMI≥25: 10.45; p = 0.011) and lower numbers of CD31+ (BMI&lt;25: 4.20 vs. BMI≥25: 2.40; p = 0.018) and CD34+ (BMI&lt;25: 14.60 vs. BMI≥25: 5.20; p = 0.045) cells as markers of angiogenesis in the AT as well as a higher frequency of cancer-associated-fibroblast-like cells in the AT and CT (BMI&lt;25: 7.60 vs. BMI≥25: 25.39 in total; p = 0.001). Moreover, expression of CD36 (BMI&lt;25: 2.15 vs. BMI≥25: 2.60; p = 0.041) and ANGPTL4 (BMI&lt;25: 6.00 vs. BMI≥25: 9.80; p = 0.026) was elevated in the TNBC cells of overweight/obese patients. Conclusions: Our data suggest BMI-related changes in the TME of overweight/obese TNBC patients, including hypertrophied adipocytes, reduced vascularization, more M2-like macrophages and CAF-like cells, and an increase in the expression of fatty acid metabolizing proteins in marginal tumor cells, all contributing to a more tumor-promoting, immunosuppressive environment.

From Mother to Child: Epigenetic Signatures of Hyperglycemia and Obesity during Pregnancy.

In utero exposure to maternal hyperglycemia and obesity can trigger detrimental effects in the newborn through epigenetic programming. We aimed to assess the DNA methylation levels in the promoters of MC4R and LPL genes from maternal blood, placenta, and buccal swab samples collected in children born to mothers with and without obesity and Gestational Diabetes Mellitus (GDM). A total of 101 Caucasian mother-infant pairs were included in this study. Sociodemographic characteristics, clinical parameters, physical activity, and adherence to the Mediterranean diet were evaluated in the third trimester of pregnancy. Clinical parameters of the newborns were recorded at birth. A negative relationship between MC4R DNA methylation on the fetal side of the GDM placenta and birth weight (r = -0.630, p = 0.011) of newborns was found. MC4R DNA methylation level was lower in newborns of GDM women (CpG1: 2.8% ± 3.0%, CpG2: 3.8% ± 3.3%) as compared to those of mothers without GDM (CpG1: 6.9% ± 6.2%, CpG2: 6.8% ± 5.6%; p < 0.001 and p = 0.0033, respectively), and it was negatively correlated with weight (r = -0.229; p = 0.035), head circumference (r = -0.236; p = 0.030), and length (r = -0.240; p = 0.027) at birth. LPL DNA methylation was higher on the fetal side of the placenta in obese patients as compared to normal-weight patients (66.0% ± 14.4% vs. 55.7% ± 15.2%, p = 0.037), and it was associated with maternal total cholesterol (r = 0.770, p = 0.015) and LDL-c (r = 0.783, p = 0.012). These results support the role of maternal MC4R and LPL methylation in fetal programming and in the future metabolic health of children.

The association of dietary insulinemic indices with PI3K, PTEN, and Akt gene expressions in visceral and subcutaneous adipose tissues among individuals undergoing abdominal surgery.

The current study investigates the association between dietary insulinemic indices and Akt, PTEN, and PI3K gene expressions in visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) among individuals undergoing abdominal surgery. This cross-sectional study was conducted on 176 individuals, aged 18-84 years, who had undergone abdominal surgery. The participants were classified based on body mass index (BMI) as normal (BMI < 25 kg/m2), overweight (BMI = 25-29.9 kg/m2), and obese (BMI ≥ 30 kg/m2). The food frequency questionnaire was used to determine dietary glycemic and insulinemic indices. Real-time polymerase chain reaction was conducted for the expression of PI3K, PTEN, and Akt genes. In the final adjusted model, in normal-weight patients, there was an inverse relationship between the lifestyle with a higher insulinemic potential and the PI3K gene expression in VAT. In addition, there was an inverse association between dietary insulin load and the Akt gene expression in VAT. However, a higher glycemic index was positively associated with the PTEN gene expression in VAT. In overweight patients, a high insulinemic potential of the diet was associated with higher PTEN gene expression in VAT. In obese individuals, there were positive associations between lifestyle index for insulin resistance and hyperinsulinemia and the PI3K gene expression in VAT. Moreover, the higher insulinemic potential of diet and lifestyle was positively related to a higher expression of the PTEN and Akt genes in VAT. Our findings revealed that high insulinemic lifestyles and dietary patterns may be related to the expression of PI3K, PTEN, and Akt in adipose tissues.

Obesity and Primary Total Knee Arthroplasty: The Absolute versus Relative Risk of Periprosthetic Joint Infection at 15 Years

When indicating patients for primary total knee arthroplasty (TKA), surgeons and patients must understand the absolute and relative risks of periprosthetic joint infection (PJI) to make an informed decision. We sought to evaluate the long-term risk of PJI following primary TKA stratified by body mass index (BMI) and PJI-related risk factors. We identified 25,160 primary TKAs performed from 2000 to 2021 at a single institution. Patients were stratified as having 0, 1, or ≥ 2 PJI risk factors (diabetes, chronic kidney disease, non-primary osteoarthritis, immunosuppression, or active smoking) and into BMI categories. The 15-year cumulative risk of PJI was evaluated by BMI and PJI risk factors. For the entire cohort, the 15-year absolute risk of PJI was 3%. For patients who did not have PJI risk factors, the absolute risk of PJI at 15 years was 3% in normal weight, 4% in class III obesity, and 4% in class IV obesity. Patients who had class III obesity had a 3-times higher relative risk of PJI when compared to normal-weight patients (P = 0.01). Among patients who had ≥ 2 PJI risk factors, the absolute risk of PJI at 15 years was 5% in normal weight and 6% in patients who have class III obesity. Healthy patients who had class III obesity had a 3-times increased risk of PJI relative to healthy, normal-weight patients; however, the absolute risk of PJI at 15 years after primary TKA was 4% in this group. Surgeons and patients must consider both a 3-times increased relative risk of PJI and a 4% absolute risk of PJI at 15 years after primary TKA when considering surgery in otherwise healthy patients who have BMI ≥ 40.

Outpatient Versus Inpatient Total Hip and Knee Arthroplasty in Morbidly Obese Patients

Morbidly obese patients undergoing total joint arthroplasty (TJA) face increased postoperative complications, yet studies assessing the safety of this surgery in the outpatient setting for this population are lacking. This study aimed to fill this gap by assessing the safety and benefits of outpatient TJA in morbidly obese patients. This study is a retrospective review of a commercial claims database. Based on the setting of the procedure, the patients were divided into four groups: inpatient-TKA (total knee arthroplasty), outpatient-TKA, inpatient-THA (total hip arthroplasty), and outpatient-THA. The two TKA groups were matched based on age, sex, and the Charlson comorbidity index (CCI). The THA groups were matched similarly. The 30- and 90-day medical and surgical complications were compared between these groups. There were 5,500 patients included in each of the outpatient and inpatient TKA groups, and 1,550 in each of the outpatient and inpatient THA groups RESULTS: Patients undergoing inpatient TKA had higher rates of pulmonary embolism, UTI (urinary tract infection), transfusions, ICU (intensive care unit) admissions, ED (emergency department) visits, readmissions at 30 days, surgical site infections, periprosthetic joint infection, prosthetic dislocations, and costs. As for the inpatient THA group, they had higher rates of pulmonary embolism, UTI, transfusions, ICU admissions, ED visits, and costs. It is well established that morbidly obese patients undergoing total joint arthroplasty have higher complication rates than normal-weight patients, and patients should be counseled before arthroplasty. This study highlights the safety and benefits of outpatient TJA in morbidly obese patients. However, one should note that this was done using an insurance database, in which results may differ if it was done in a public and lower socioeconomic setting. Therefore, future prospective studies are needed to confirm the findings before implementing outpatient TJA in morbidly obese patients.

Obesity classification predicts early complications and mortality after acetabular fracture.

Obesity remains a global epidemic. The effect of obesity on the risk of complications after acetabular fracture is unknown. Here, we evaluate the effect of BMI on early complications and mortality after acetabular fracture. We hypothesize that the risk of inpatient complications and mortality will be greater in patients with high BMI when compared to those with normal BMI. Adult patients with acetabular fracture were identified via the Trauma Quality Improvement Program data from 2015 to 2019. The primary outcome was overall complication rate with reference to normal-weight patients (BMI = 25-30kg/m2). The secondary outcome was rates of death. The association of obesity class on the primary and secondary outcomes was assessed using Bonferroni-corrected multiple logistic regression models considering patient, injury, and treatment covariates. A total of 99,721 patients with acetabular fracture were identified. Class I obesity (BMI = 30-35kg/m2) was associated with 1.2 greater adjusted relative risk (aRR; 95% confidence interval (CI) 1.1-1.3) of any adverse event, without significant increases in adjusted risk of death. Class II obesity (BMI = 35-40kg/m2) was associated with aRR = 1.2 (95% CI 1.1-1.3) of any adverse event and aRR = 1.5 (95% CI 1.2-2.0) of death. Class III obesity (BMI ≥ 40kg/m2) was associated with aRR = 1.3 (95% CI 1.2-1.4) of any adverse event and aRR = 2.3 (95% CI 1.8-2.9) of death. Obesity is associated greater risk of adverse events and death following acetabular fracture. Obesity severity classification scales with these risks.

Prognostic impact of body mass index on metastatic HER2-positive breast cancer survival

Background. The association between body mass index and prognosis in patients with HER2-positive metastatic breast cancer (mBC) is unclear. Purpose – the first purpose of our study was to determine whether BMI is an independent prognostic factor for progression-free survival (PFS) and overall survival (OS) in HER2-positive mBC patients. The second objective was to assess the mutual impact of baseline clinicopathological characteristics on survival outcomes. Materials and Methods. The study group included patients treated at the Sumy Regional Clinical Oncology Center. We considered the underweight patients if their BMI was &lt;18.5 kg/m2, normal weight 18.5–24.9 kg/m2, overweight 25.0–29.9 kg/m2, and obese ≥ 30 kg/m2. The following formula was used for calculations: weight/height2 (kilograms/meter2). Information about the height, weight, and other clinicopathological characteristics of the patient at the time of the start of drug therapy was taken from the primary medical documentation. Pearson’s test and Chi2 test for categorical variables were used to compare baseline clinicopathological characteristics in groups with normal, overweight, and obesity. The Kaplan-Meier method was used to establish the medians of PFS and OS. Cox regression analysis assessed the mutual impact on the survival of various clinicopathological characteristics. The statistical significance threshold was considered P ≤0.05. Results. Seventy-eight patients with HER2-positive mBC were enrolled and categorized according to their BMI in normal weight, overweight, and obese groups. BMI had a different impact on PFS and OS. Median PFS was 14.9, 11.9, and 14.2 months for normal-weight, overweight, and obese patients, respectively. There is no statistically significant difference in PFS between groups (Р = 0.110). Multivariable regression analysis confirmed no impact of BMI on PFS. Nevertheless, metastases in bones and kidneys and the nuclear grade were statistically significant determinants of PFS. Median OS was 26.4, 28.8, and 37.9 months for normal-weight, overweight, and obese patients, respectively. BMI, kidney metastases, and nuclear grade were prognostically significant determinants of OS. Conclusions. BMI is an independent prognostic factor of OS in patients with HER2-positive mBC. Obesity is associated with better OS but does not impact PFS. Metastases in bones and kidneys and the nuclear grade can predict survival outcomes.

Impact of metformin versus metformin plus omega_3 on inflammatory outcomes in a tester of Iraqi women with PCOS

Background: Polycystic ovary syndrome signifies a state of chronic inflammation, which is partly caused by excessive visceral adipose tissue and the pro-inflammatory mechanisms associated with it. Interestingly, even normal-weight women with PCOS exhibit long-lasting low-flat inflammation characterized via raised ranks cytokines of pro-inflammatory. This can be attributed to the presence of surplus visceral adipose tissue and intraperitoneal fat depots in normal-weight PCOS patients as well. Aim of the study: To estimate the influence of metformin and omega-3 treatment on serum ranks of IL-18 and highly sensitive CRP in females with PCOS. Patients and methods: The present interventional prospective study included 90 sick with an age assortment of 18 to less than 40 years. Those patients were analyzed with polycystic ovarian disease (PCOS) founded on Rotterdam principles (Rotterdam, 2004) by 2 specialists in obstetrics and gynecology. The patients were recruited from the Maternity and Pediatrics Teaching Hospital in Adiwaniyah Province, Iraq. The training is outmoded back to September the 21st 2023 and extended to March 31st 2024. Results: Following treatment, both metformin+Omega3 and metformin alone were able to reduce mean IL-18 significantly (p &lt; 0.001 versus p &lt; 0.001, separately); however, the amount of decrease caused by combination was more than that caused by metformin alone significantly, 158.62 pg/ml versus 71.14 pg/ml , respectively (p = 0.048). Both metformin+Omega3 and metformin alone were able to reduce mean hs-CRP significantly (p &lt; 0.001 versus p &lt; 0.001, respectively); however, the amount of decrease caused through combination was more than that caused by metformin alone significantly, 157.69 mg/L versus 61.27 mg/L , separately (p = 0.032). Conclusion: The use of Omega3 has an efficient and safe synergistic effect when added to metformin in reducing IL-18 and hs-CRP in sick with PCOS, thus, suggesting an anti-inflammatory property for such combination.

Metal ion levels after metal-on-metal hip resurfacing: A single-center longitudinal study of Chinese patients.

This study aimed to investigate the long-term serum metal ion levels of patients who received metal-on-metal hip resurfacing arthroplasty (MoM HRA). We conducted a retrospective study of 99 patients (110 hips) from March 2006 to May 2017 who underwent MoM HRA. The Harris Hip Score (HHS) and the University of California at Los Angeles (UCLA) activity score were measured, and the patients underwent clinical and radiological management. Serum levels of cobalt (Co), chromium (Cr), and molybdenum (Mo) were measured using inductively coupled plasma mass spectrometry (ICPMS) at 1, 6, and 12 months, and each year follow-up after prosthesis implantation. Patients were followed up from 1 to 156 months, with a mean of 98 months. No complications occurred. Metal ion analysis revealed significantly elevated levels compared to preoperative levels. The metal ions levels increased and reached a peak after surgery, and then the levels began to decline gradually. Approximately 84-108 months after surgery, the metal ion levels increased again to approximately peak levels. Then, up to 156 months after surgery, the metal ions levels will drop approximately to preoperative levels. The serum levels of Cr in women were higher than those in men, with the difference being statistically significant. Patients with a body mass index (BMI) of ≥24.9 kg/m2 Co levels were significantly higher than those of normal-weight patients. The serum levels of metal ions showed no significant differences between the prostheses. The use of the MoM HRA was clinically effective, and the Co, Cr, and Mo levels increased significantly after HRA; however, upon long-term follow-up, serum metal ion levels tended to decrease to preoperative levels. Longer follow-up periods and larger study samples are needed to establish the long-term outcome of patients undergoing HRA with MoM bearings. Level IV, Therapeutic Study.

The association between nutritional status measured by body mass index and outcomes in the pediatric intensive care unit.

The relationship between nutritional status upon admission to a pediatric intensive care unit (PICU) and clinical outcomes remains unclear. We examined the relationship between nutrition status, as indicated by body mass index-for-age (BMI-for-age), and clinical outcomes in the PICU. In this retrospective study at a tertiary care center, records of 1,015 critically ill children and adolescents aged one month to 18 years old with available anthropometric parameters were included. The nutritional status upon admission was determined by calculating the BMI-for-age z-score using the WHO growth charts as the reference. The participants were categorized as underweight (BMI-for-age z-score < -2), normal weight (-2 ≤ BMI-for-age z-score ≤ +1), and overweight/obese (BMI-for-age z-score > +1). Multi-variate odds ratios (OR) with 95% confidence intervals (CI) were used to investigate the association between malnutrition (being underweight and overweight/obese) and odds of Prolonged PICU stay (≥7 days) and PICU mortality after controlling for descriptive characteristics, Glasgow Coma Scale score status, fluctuations in serum sodium, and acute kidney injury confounders. The proportions of patients in underweight, normal weight, and overweight/obese categories were 34.2%, 45.8%, and 20%, respectively. During the study period, 21.5% of patients had prolonged PICU stay, and 5.6% of patients in PICU died. Compared to normal-weight patients, underweight patients had higher odds of prolonged PICU stay (OR: 1.52; 95% CI: 1.05-2.22) and PICU mortality (OR: 2.12; 95% CI: 1.22-4.01). Age- and gender-stratified full-adjusted analysis showed that the increased odds of prolonged PICU stay remained significant among underweight boys and underweight individuals aged 5-19 years old. Furthermore, the increased odds of PICU mortality remained significant among underweight individuals aged 2-5 years old. However, being overweight or obese during PICU admission did not demonstrate a significant association with our outcomes in the total sample or subgroup analysis. Our findings showed that PICU patients who were underweight had higher odds of prolonged PICU stay and PICU mortality than their normal-weight counterparts. This underscores the importance of closely monitoring underweight patients in the PICU upon admission in order to improve clinical outcomes.

Standardization of Dual-Energy CT Iodine Uptake of the Abdomen and Pelvis: Defining Reference Values in a Big Data Cohort.

Background: To establish dual-energy-derived iodine density reference values in abdominopelvic organs in a large cohort of healthy subjects. Methods: 597 patients who underwent portal venous phase dual-energy CT scans of the abdomen were retrospectively enrolled. Iodine distribution maps were reconstructed, and regions of interest measurements were placed in abdominal and pelvic structures to obtain absolute iodine values. Subsequently, normalization of the abdominal aorta was conducted to obtain normalized iodine ratios. The values obtained were subsequently analyzed and differences were investigated in subgroups defined by sex, age and BMI. Results: Overall mean iodine uptake values and normalized iodine ratios ranged between 0.31 and 6.08 mg/mL and 0.06 and 1.20, respectively. Women exhibited higher absolute iodine concentration across all organs. With increasing age, normalized iodine ratios mostly tend to decrease, being most significant in the uterus, prostate, and kidneys (p < 0.015). BMI was the parameter less responsible for variations in iodine concentrations; normal weighted patients demonstrated higher values of both absolute and normalized iodine. Conclusions: Iodine concentration values and normalized iodine ratios of abdominal and pelvic organs reveal significant gender-, age-, and BMI-related differences, underscoring the necessity to integrate these variables into clinical practice.