Reduction In Mass Index Research Articles

Glucagon-like peptide-1 receptor agonists modestly reduced blood pressure among patients with and without diabetes mellitus: A meta-analysis and meta-regression.

The cardiovascular benefits provided by glucagon-like peptide-1 receptor agonists (GLP-1RAs) extend beyond weight reduction and glycaemic control. One possible mechanism may relate to blood pressure (BP) reduction. We aim to quantify the BP-lowering effects of GLP1-RAs. A comprehensive database search for placebo-controlled randomized controlled trials on GLP-1RA treatment was conducted until December 2023. Data extraction and quality assessment were carried out, employing a robust statistical analysis using a random effects model to determine outcomes with a mean difference (MD) in mmHg and 95% confidence intervals (CIs). The primary endpoint was the mean difference in systolic BP (SBP) and diastolic BP. Subgroup analyses and meta-regressions were done to account for covariates. Compared with placebo, GLP-1RAs modestly reduced SBP [semaglutide: MD -3.40 (95% CI -4.22 to -2.59, p < .001); liraglutide: MD -2.61 (95% CI -3.48 to -1.74, p < .001); dulaglutide: MD -1.46 (95% CI -2.20 to -0.72, p < .001); and exenatide: MD -3.36 (95% CI -3.63 to -3.10, p < .001)]. This benefit consistently increased with longer treatment durations. Diastolic BP reduction was only significant in the exenatide group [MD -0.94 (95% CI -1.78 to -0.1), p = .03]. Among semaglutide cohorts, mean changes in glycated haemoglobin and mean changes in body mass index were directly associated with SBP reduction. Patients on GLP-1RA experienced modest SBP lowering compared with placebo. This observed effect was associated with weight/body mass index reduction and better glycaemic control, which suggests that BP-lowering is an indirect effect of GLP-1RA and unlikely to be responsible for the benefits.

Randomised, placebo-controlled trial on topiramate add-on therapy for weight reduction and symptomatology in overweight/obese persons with schizophrenia.

Higher cardiovascular mortality is seen with schizophrenia due to the disorder itself and antipsychotic use. South Asians are more vulnerable to developing metabolic disorders than others. Resource-limited settings in South Asia have only a few mental health professionals, and individualised case management is mostly unavailable. Therefore, there is less monitoring and personalised support for diet and physical exercise programmes. Topiramate is useful for weight reduction and improvement of psychopathology in schizophrenia. However, there has been only one previous randomised controlled trial (RCT) done in South Asia, which possesses a quarter of the world's population. We conducted a double-blind RCT in an outpatient setting in Sri Lanka. We compared topiramate 100mg/day with a placebo in overweight/obese adults with schizophrenia who have been on antipsychotics for at least a year. We obtained monthly anthropometric measurements and assessed the symptomatology using the brief psychiatric rating scale (BPRS). Fifty patients each in the topiramate and placebo arms completed the study. Topiramate add-on therapy led to significant weight/Body Mass Index reduction and improved symptomatology as measured by the BPRS compared to the placebo. The topiramate group had significantly more reporting of loss of appetite. According to available data, this is the RCT with most participants assessing the use of topiramate in schizophrenia and only the second in South Asia. Topiramate was shown to be useful for weight reduction and symptomatic improvement in persons with schizophrenia in a resource-limited setting in South Asia.

Abstract 10185: Interaction Between Sex and Left Ventricular Reverse Remodeling and Its Association with Outcome After Transcatheter Aortic Valve Implantation

Introduction: Women with severe aortic valve stenosis (AS) have better long-term prognosis after transcatheter aortic valve implantation (TAVI) compared to men. Whether this is caused by sex-related differences in left ventricular (LV) reverse remodeling after TAVI is unknown. Purpose: To examine the interaction between sex and LV reverse remodeling with outcome after TAVI. Methods: Patients with severe AS who had undergone transfemoral TAVI between 2007 and 2018 were selected. LV dimensions, volumes and ejection fraction (LVEF) were assessed by transthoracic echocardiography at baseline before TAVI, and at 6 and 12 months after TAVI. LV reverse remodeling was defined as %LV mass index (LVMi) reduction from baseline. The primary outcome was all-cause mortality. Results: A total of 459 patients (80±8 years; 52% male) were included. Before TAVI, indexed LV end-diastolic and end-systolic volume as well as LVMi were smaller in women versus men. At 6 and 12 months follow-up, both sexes showed significant reductions in LV volumes and LVMi accompanied by improvement in LVEF, without significant differences between the sexes over time (p for interaction=0.51, p=0.43, p=0.44 and p=0.30, respectively). During a median follow-up of 2.8 [IQR 1.9-4.3] years, 181 (39%) patients died. Women showed better outcome compared to men (log-rank p=0.024). In addition, male sex was independently associated with all-cause mortality in multivariable Cox regression (HR 1.423, 95% CI: 1.039-1.951, p=0.028). No association was observed between the interaction of %LVMi reduction and sex with outcome (p=0.64). Conclusions: Patients with severe AS had significant improvement in LVEF, reduction in LV volumes and LVMi at 6 and 12 months after TAVI, without significant differences between sexes over time. Women showed better survival after TAVI as compared to men despite being treated at older age. The interaction between %LVMi reduction and sex was not associated with survival.

Cardiac Structural Remodeling and Hemodynamic Patterns Following Transcatheter Aortic Valve Replacement.

BackgroundTranscatheter aortic valve replacement (TAVR) is increasingly utilized for most patients with symptomatic severe aortic stenosis. TAVR is linked to enhanced long-term cardiac hemodynamics, reversal of left ventricle (LV) hypertrophy, and improved aortic valve gradients. We present a retrospective observational study assessing cardiac remodeling and valvular flow patterns post-TAVR.MethodsRetrospective echocardiographic data were collected, evaluating cardiac function and valvular flow patterns before and after TAVR at a single institution. Data was compiled and statistically analyzed using a paired t-test evaluating variations at approximately 30 days and one-year post-TAVR.ResultsOn echocardiogram 30 days and one-year post-TAVR, there was a reduction in LV mass index from 132 g/m² to 110 g/m² (95%CI: 98-122; p=0.01) and 118 g/m² (95%CI: 102-133; p=0.03), and a reduction in relative wall thickness from 0.54 to 0.49 (95%CI: 0.46-0.52; p=0.05) and 0.44 (95%CI: 0.38-0.49; p=0.03), respectively. Doppler velocity indices (DVI) increased from 0.24 to 0.61 (95%CI: 0.49-0.73; p<0.001) and 0.57 (95%CI: 0.48-0.65; p<0.001). Expected improvement in aortic valve velocities and gradients were observed post-TAVR.ConclusionsFollowing TAVR, LV remodeling can be observed as early as 30 days. This is demonstrated by a reduction in LV mass index and relative wall thickness in conjugation with an anticipated improvement in valvular flow patterns and flow across the aortic valve.

Return to physical activity and change in body mass index after hypoallergenic medial mobile-bearing unicompartmental knee arthroplasty

BackgroundThe primary purpose of the present prospective study was to consecutively analyse the outcomes of the return to sports activity of patients with positive patch tests undergoing a medial mobile-bearing titanium niobium nitride (TiNbN) unicompartmental knee arthroplasty (UKA). The secondary purpose was to ascertain if a higher grade of physical activity leads to a reduction in the body mass index (BMI) of the patients.Material and methodsForty-one patients with positive skin patch tests were included in this prospective study. The clinical evaluation consisted of the University of California, Los Angeles (UCLA) activity scale and the High-Activity Arthroplasty Score (HAAS). Each patient was evaluated the day before surgery (T0), after 12.37 ± 0.70 months (T1), and on the day of the final follow-up, after 67.03 ± 18.2 months (T2). Furthermore, the BMI of each patient was analysed before surgery and during the final follow-up.ResultsThe UCLA and HAAS mean preoperative values ranged from 3.68 ± 1.1.7 and 6.15 ± 0.76 to 6.1 ± 0.76 and 10.34 ± 1.3, respectively, at T1 (p < 0.0001) and to the final values of 6.34 ± 0.62 and 11.0 ± 8.9, respectively, at T2 (UCLA: T2 versus T1: p = 0.132; T2 versus T0: p < 0.0001; HAAS: T2 versus T1: p = 0.0027; T2 versus T0: p < 0.001). BMI ranged from a preoperative value of 27.97 ± 3.63 to a final value of 26.84 ± 3.11 (p < 0.0001). The only differences within the subgroups concerned patients with BMI ≥ 28, showing a superior HAAS at each follow-up (p < 0.05). A positive correlation was found between BMI and HAAS at T0 and T2 (p < 0.05).ConclusionsThis is the first study to evaluate the rate of the return to sports activities and change in BMI following hypoallergenic UKA. The majority of patients reduced their weight following UKA and improved their physical activity, showing outcomes that were comparable to the standard cobalt–chrome (CoCr) prostheses, regardless of gender, age, BMI and implant size.Level of evidenceIV – Prospective Cohort Study.Trial registration researchregistry5978—Research Registry www.researchregistry.com

Depth Dependent Variations in Human Achilles Tendon as a Result of Active Smoking: An Elastographic Study

Current study was set to determine the impact of active smoking on Achilles Tendon (AT) as soft tissue using an elastographic technique. This study comprises of 54 male individuals having sedentary lifestyle. Volunteers were categorized into two groups of smokers (n = 20) and non-smokers (n = 34). Body composition analysis was performed to evaluate the physiological changes in human body mass indexes. Ultrasound Strain Elastog-raphy (USE) technique was used to find the stiffness along with anatomical images to envisage the anomalous status of Achilles tendon. Statistical analysis of data obtained through body composition, tendon anatomy and Strain Elastography (SE) was used to scrutinize the physiological, anatomical and elasticity variations within the tendon. A reduction in Fat Free Mass Index (FFMI) was observed among smokers with a significant difference (P = 0.042). Further, an increased significant difference (P = 0.029) was found in AT Strain Ratios (SR) of smokers as compared to non-smokers. Lightening in tendon mass and dilution in tendon stiffness indicates that smoking mechanism may generate excessive apoptosis and decrease the density of tenocytes. Nicotine is the key element that inhibits the functional capacity of Tendon Stem Cells and is highly responsible for tendinopathy, eventually leading to tendon rupture and injury.

Addressing the Public Health Epidemic of Childhood Obesity Using Public Schools as Health Education Learning Laboratories

In our society, childhood obesity has become a pressing health issue. Childhood obesity occurs when children are considerably overweight for their age and height. Body mass index (BMI) is used to measure the percentage of body fat; therefore, the higher the BMI, the more body fat an individual has accompanied by the likelihood that the individual is obese. This research aims to address the factors that cause childhood obesity. A total of 116 journal articles were used for the development of this paper; the articles were analyzed and selected based on the occurrence of the following keywords and phrases: (1) childhood obesity, (2) social cognition theory, (3) telemedicine, and (4) nutrition education. The literature review showed a relationship between childhood obesity and body mass index (reduction, the use of telemedicine, and school food gardens). Using telemedicine video conferencing software and adding food gardens to public school curricula may be a strategy educators and policymakers can use to reduce the rate of childhood obesity.

Effects of ketogenic diet intervention on selected obese IIUM students during Ramadhan

Obesity and overweight are one of the main problems faced by Malaysian society due to sedentary lifestyle and high-carbohydrate consumption. A “low glycemic diet” is suggested as a suitable alternative in preventing obesity, because of its low carbohydrate intake which can be referred to as Atkins or Ketogenic diet (KD). A case study was carried out to assess the effect of KD during Ramadan on obese individuals. KD meal intervention was developed upon consultation with a dietician and tailored for Sahur (a pre-dawn meal) and Iftar (evening meal for breaking fast). A total of six participants were involved in this study which consists of 2 groups. A control group of 3 selected obese male IIUM students received no specific diet, and a study group of 3 selected obese male IIUM students underwent KD meal intervention. The KD meal intervention was carried out one week before Ramadan to allow the participants’ body to familiarize with high fat and low carbohydrate diet. Results showed that most of the selected obese participants who applied KD meal intervention exhibited satisfactory results in weight and Body Mass Index (BMI) reduction, steady levels of blood glucose, normal blood pressure levels and the presence of ketone bodies at a p-value &lt; 0.01. However, the participants in the control group showed no significant changes at p&lt;0.01 in weight, BMI, blood glucose levels, blood pressure and not a trace of ketone bodies. The findings of this study indicated that KD showed a positive effect on obesity control when conducted during Ramadan fasting.

Four-year adiposity change and remission of hypertension: an observational evaluation from the Longitudinal Study of Adult Health (ELSA-Brasil).

The degree to which weight reduction leads to the remission of hypertension in population studies is not clear. We investigated whether the changes in adiposity measures predicted the remission of hypertension in a racially admixed population over a mean 4-year follow-up. All 4847 hypertensive individuals at baseline (2008-2010) from the multicenter Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) were included. Changes in weight, waist circumference (WC), or body mass index (BMI) (reduction or increase ≥5% from baseline values, vs stability) and remission of hypertension (SBP < 140 and DBP < 90 mmHg and no use of antihypertensive medication at follow-up visit, in 2012-2014) were investigated using mixed effects logistic regression models. Proportional attributable benefit was additionally calculated. Analyses were stratified by sex and antihypertensive medication use at baseline. Remission of hypertension was 11.3% (n = 546). Among men, after adjustments, the reduction of weight (OR = 1.52 95% CI 1.10-2.10), WC (OR = 1.56 95% CI 1.04-2.35) or BMI (OR = 1.60 95% CI 1.13-2.27) was associated with the remission of hypertension. Among those not taking antihypertensive medication at baseline, after adjustments, the reduction of weight (OR = 1.64 95% CI 1.18-2.27), WC (OR = 1.76 95% CI 1.18-2.61) or BMI (OR = 1.57 95% CI 1.10-2.25) was associated with the remission of hypertension. Proportional attributable benefit among those with adiposity reduction was about 30%, indicating its potential for prevention. In conclusion, our study reinforces the role of adiposity-reducing strategies (e.g., healthy diet and regular physical activity) for the treatment and prevention of hypertension, which might have potential applications for clinical practice.

Adiponectin concentration after a body mass reduction in a group of premenopausal obese women living in Lima, Peru

Objective: To investigate the changes in the plasma-circulating adiponectin concentration in 23 premenopausal obese women living in Lima after a body mass reduction as a result of an aerobic physical activity program and a low-calorie diet. Materials and methods: An analytical and quasi-experimental study was conducted in a group of obese women. In addition, another 24 women were considered as control or reference group for comparing their adiponectin concentration and other biochemical markers. The quantification of adiponectin was carried out using the ELISA test. Fasting blood glucose concentration, cholesterol, high-density lipoprotein and triglycerides levels were quantified by routine clinical analysis. Results: Before beginning the program, the control group showed high adiponectin levels (median, 8.54 µg/mL; range, 6.14 µg/ mL to 13.49 µg/mL) compared to the obesity group (median, 7.03 µg/mL; range, 3.77 µg/mL to 17.23 µg/mL). However, the difference was not statistically significant (P = 0.0563). Once the program was finished, the obesity group showed a statistically significant reduction in the body mass index (P = 5.98e-08) and abdominal circumference (P = 1.55e-08), and a statistically significant increase in the adiponectin levels (median, 8.79 µg/mL; range, 5.50 µg/mL to 19.37 µg/mL) (P = 0.0127). Conclusions: Based on the results, we conclude that the adiponectin concentration in premenopausal obese women increases when the body mass is reduced as a result of aerobic physical activity and a low-calorie diet.

Migalastat for the treatment of Fabry disease

ABSTRACTIntroduction: Fabry disease, a rare X-linked disorder of α-galactosidase A deficiency, leads to progressive multiorgan damage.Areas covered: Enzyme replacement therapy (ERT) is the current standard of care for Fabry disease; however, many patients progress despite treatment and the intravenous infusions present several challenges. Migalastat, an orally administered, small molecule pharmacological chaperone, binds to and stabilizes specific mutant forms of α-galactosidase A. Migalastat is approved in several countries for Fabry disease in patients with amenable GLA mutations; amenable mutations are identified using a good laboratory practice-validated assay. Data from clinical trials demonstrated that migalastat effectively reduces disease substrate, stabilizes renal function, decreases cardiac mass and improves gastrointestinal signs and symptoms in patients with Fabry disease and amenable mutations. Across trials, migalastat was generally well tolerated; headache was the most frequently reported treatment-emergent adverse event. Long-term treatment with migalastat was associated with sustained reduction in left ventricular mass index and evidence of left ventricular hypertrophy regression; migalastat was generally well tolerated over 48 months of treatment. An ongoing Phase III extension study will provide further evidence of the long-term safety and efficacy of migalastat.Expert opinion: Given the convenience of the orally administered small molecule and the efficacy and safety demonstrated in pivotal Phase III trials, migalastat offers a viable alternative to ERT for patients with Fabry disease and migalastat-amenable mutations.

Scale-out of a community-based behavioral intervention for childhood obesity: pilot implementation evaluation

BackgroundExpanding the use of evidence-based behavioral interventions in community settings has met with limited success in various health outcomes as fidelity and dose of clinical interventions are often diluted when translated to communities. We conducted a pilot implementation study to examine adoption of the rigorously evaluated Healthier Families Program by Parks and Recreation centers in 3 cities across the country (MI, GA, NV) with diverse socio-cultural environments.MethodsUsing the RE-AIM framework, we evaluated the program both quantitatively (pre/post surveys of health behavior change; attendance & fidelity) and qualitatively (interviews with Parks and Recreation staff and participants following the program).ResultsThe 3 partner sites recruited a total of 26 parent-child pairs. REACH: Among the 24 participants who completed pre/post surveys, 62.5% were 25–34 years old, and average child age was 3.6 (SD 0.7) years. The distribution of self-reported race/ethnicity was 54% non-Hispanic White, 38% non-Hispanic Black, and 8% Latino. EFFECTIVENESS: Qualitative interviews with participants demonstrated increased use of the built environment for physical activity and continued use of key strategies for health behavior change. ADOPTION: Three of five (60%) collaborating sites proceeded with implementation of the program. IMPLEMENTATION: The average attendance for the 12-week program was 7.6 (SD 3.9) sessions, with 71% attending > 50% of sessions. Average fidelity for the 12 weekly sessions was 25.2 (SD 1.2; possible range 9–27). MAINTENANCE: All 3 partner sites continued offering the program after grant funding was complete.ConclusionsThis pilot is among the first attempts to scale-out an evidence-based childhood obesity intervention in community Parks and Recreation centers. While this pilot was not intended to confirm the efficacy of the original trial on Body Mass Index (BMI) reduction, the effective and sustained behavior change among a geographically and ethnically diverse population with high attendance and fidelity demonstrates an effective approach on which to base future large-scale implementation efforts to reduce childhood obesity in community settings.

Comparison of the Clinical Outcomes and Hemodynamic Performance between the 19-Mm Mosaic and 19-Mm TrifectaTM Bioprosthesis

Background: We evaluated and compared short- (≤ 3 months) and mid-term (≥ 4 months) clinical outcomes and hemodynamic performances of the 19-mm Mosaic® and 19-mm TrifectaTM bioprostheses for aortic valve replacement. Methods: 193 patients underwent aortic valve replacement: 37 received the 19-mm Mosaic® prosthesis (Group M) and 12 received the 19-mm TrifectaTM prosthesis (Group T). Pre- and postoperative echocardiographic parameters and New York Heart Association classes were evaluated in both groups. Results: Baseline characteristics and preoperative echocardiographic parameters were similar between the groups. The New York Heart Association class improved in both groups. The mean left ventricular-aortic pressure gradient was 22.6 mmHg ± 8.4 mmHg in Group M and 15.0 mmHg ± 6.2 mmHg in Group T. The left ventricular mass index was 99.6 ± 27.6 g/m2 and 99.0 ± 20.0 g/m2 respectively, with significant improvements in both groups. Left ventricular mass index regression during the mid-term period showed no significant difference between the groups, despite a higher-pressure gradient and smaller effective orifice area index in the Mosaic® group. Patient-prosthesis mismatch occurred in 20 patients in the Mosaic® group, with no significant differences in the postoperative left ventricular mass indices and New York Heart Association classes between the patientprosthesis mismatch and no patient-prosthesis mismatch subgroups in the Mosaic® group. Conclusion: Compared with the 19-mm TrifectaTM bioprosthesis, the 19-mm Mosaic® bioprosthesis showed similar satisfactory improvement in the New York Heart Association class grade and reduction in the left ventricular mass index, despite a higher-pressure gradient and smaller effective orifice area index.

Predictive model for knee traumatic arthritis secondary to tibial plateau fracture surgery

Objective Establish a predictive model for investigating the risk factors of Knee traumatic arthritis (KTA) secondary to tibial plateau fracture surgery. Methods 258 consecutive patients with tibial plateau fracture between December 2009 and April 2015 were collected, 117 cases were male, 141 cases were female. All the patients were divided into the training cohort (2009-2012) and the validation cohort (2013-2015). In the training cohort, univariate and multivariate logistic regression was used to analyze the risk factors for traumatic arthritis; then Nomogram predicting model was built based on logistic regression model. In the validation cohort, goodness of fit test and ROC curve were used for testing calibration and discrimination power respectively. Results All the patients were divided into 151 cases for the training cohort and 107 cases for the validation cohort. In the training cohort (151 patients), 11 patients were diagnosed as KTA with the incidence of 7.3%. The results showed that body mass index, type of fracture, osteoporosis and poor reduction were risk factors of postoperative KTA. In the validation cohort (107 patients), 9 patients were confirmed as KTA, with the incidence of 8.4%. Goodness of fit test showed Pearson χ2 was 321.64, which indicated good calibration. The area under the receiver operating characteristic curve (ROC) was 0.7551, which indicated moderate discrimination. Conclusion High body mass index, unstable fractures, osteoporosis and non-anatomic reduction are independent risk factors for KTA secondary to open reduction internal fixation of tibial plateau fractures. The predictive model has good calibration and moderate discrimination power in predicting KTA secondary to tibial plateau fractures. Key words: Tibial fractures; Osteoarthritis, knee; Forecasting; Calibration

Adipokines in metabolic processes regulating during obesity treatment

Bariatric surgery serves as a model for the assessment of the relationship between body mass index (BMI) reduction and changes in adipokine production and for exploring the endocrine function of the pancreas in patients who do not have the proximal part of the small intestine. Aim. of the study was to assess the biochemical parameters and plasma levels of adipokines [adiponectin, adipsin, leptin, plasminogen activator inhibitor (PAI-1), resistin and visfatin], insulin, C-peptide, ghrelin and incretins [glucose insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1)] in patients with morbid obesity after surgery (gastric bypass) and therapeutic correction. Materials and methods. A total of 75 patients (34 men and 41 women; age range: 24?67 years) diagnosed as obese were divided into two groups according to the treatment they received. Biochemical analysis was performed to estimate carbohydrate and lipid metabolism rates and plasma levels of adipokines (adiponectin, adipsin, leptin, PAI-1, resistin, visfatin), insulin, C-peptide, ghrelin and incretins (GIP and GLP-1) using the flow fluorometry. Results. Surgical treatment of obesity resulted in a significant decrease in BMI (from 45.67?9.87 to 32.45?5.35 kg/m2, p

Health-related quality of life in morbid obesity: the impact of laparoscopic sleeve gastrectomy

Abstract Our aim in this prospective study was to determine the impact of laparoscopic sleeve gastrectomy on the quality of life of patients with morbid obesity in comparison with population standards. The study evaluated 76 morbidly obese patients who underwent laparoscopic sleeve gastrectomy. The short version of the World Health Organization Quality of Life questionnaire (WHOQOL-BREF) was used to evaluate quality of life in the following four areas: physical health, mental health, social relations, and environment. Patients completed the questionnaire before their planned operation and again 3 and 6 months after surgery. Compared with the population standard, patients with morbid obesity had significantly lower quality of life scores in the physical and mental health domains, including on independent questions related to of overall health and quality of life (p&lt;0.001). Women scored lower on indicators of mental health than men. Three and 6 months following surgery a significant trend of body mass index (BMI) reduction was seen, as well as increased quality of life in all indicated areas (p&lt;0.001). Laparoscopic sleeve gastrectomy treatment in morbidly obese patients reduced BMI on a long-term basis, a change seen as early as 3 months after surgery. By 6 months after surgery, patients had the same quality of life scores as the reference population.

Surgical Repair of Atrio-Oesophageal Fistula Secondary to Transcatheter Ablation for Atrial Fibrillation: A Case Report and Literature Review

other prosthesis types. Over 6000 individual patients were included in the selected case series’. Mean patient age ranged from 64.0 to 76.0 years. 48.1% of patients were in New York Heart Association class 3–4 pre-operatively; the majority (75.7%) of cases used the subcoronary implantation technique. Operativemortality ranged from 1.8% to 9.6%, and five-year actuarial survival ranged from 71 3.0% to greater than 90.0%. Post-operative neurological event and prosthetic endocarditis rates ranged from 0% to 6.5% and 0.7% to 2.0% (respectively). Discussion: Despite a lack of randomised studies, in those identified the FSB performed comparably against alternative prosthesis options regarding inhospital mortality, long-term survival and reduction in left ventricular mass index. Included case series demonstrated robust post-operative outcomes in both the short and long-term also.With longer-term clinical and echocardiographic follow-up of the FSB, additional outcomes will assist in confirming its place in aortic valve and root surgery.

Biliopancreatic diversion is more effective than sleeve gastrectomy

The study by Sucandy and coworkers[1] deals with a frequently neglected topic in bariatric surgery, related to the importance of the results in terms of weight loss in the selection of the procedure to be performed. The recently developed and highly fashionable sleeve gastrectomy (SG) is compared to the time honored and successful biliopancreatic diversion in the duodenal switch version (BPD-DS).. The article presents two series each of 100 obese patients submitted to SG or BPD-DS. A significant percentage of patients have been lost to the follow-up; nevertheless data show that BPD-DS attains greater success in terms of body mass index (BMI) reduction 18 months after surgery. The effects of malabsorption appear very early, with differences between the two procedures already evident after 6 months. The great diffusion of SG is mainly due to its technical ease and to its “natural” ending in patients with inadequate weight loss: being SG the first step of BPD-DS, an eventual failure can be corrected performing the duodenal switch. Several papers deal with the failure in weight loss after SG and disclose the related statistics. Patients in these reports often show young age and relatively low BMI values, and thus the results are quite good.[2] In the present paper[1] both group showed mean age and BMI values around 50. The treatment of the more severe cases of obesity actually emphasizes the more successful procedure. A second relevant point concerns the presentation of the results. Bariatric surgery is expected to bring obese patients towards a condition of lower morbidity and mortality and possibly of a lower healthcare expenditure.[3,4] reaching BMI values <30 or <35, that means absence of obesity or slight obesity, according to the definition of success of the surgical treatment.[5,6] In the present article.[1] The authors show the percentage of patients reaching BMI < 35 after surgery. They found values of 60% after SG and 85% after BPD-DS. This allows a more readily understandable comparison of the results between the two different procedures. It is very unusual to find in the literature universally accepted criteria to define success of bariatric operations and this paper shows the role of BMI, not only in selecting patients for surgery, as generally practiced, but also in checking the results of the treatment.[7] Moreover, the distribution of the BMI is not of the Gaussian type and thus the variations of mean values do not reflect the real clinical results. Generally, in presenting data, it is more significant the number of patients reaching a specific BMI during the follow-up, as the authors actually did. This study[1] confirms the superiority of BPD-DS in dealing with obese patients with high BMI values. The role of SG has to be further investigated, particularly to identify in advance the population with low risk of weight loss failure to avoid reoperative surgery. It is highly desirable that, in clinical papers, authors present their data referring success of surgical procedures to the percentage of patients reaching a specific value of BMI during the follow - up.

Influence of endothelin-1 and nitric oxide on left ventricular remodelling in patients on peritoneal dialysis

Background: Left ventricular hypertrophy is the most common structural cardiac alteration in chronic dialysis patients. The aim of this study was to determine the possible association of endotelin-1 (ET-1) and nitric oxide (NO) with parameters of echocardiography in order to assess their participation in left ventricular (LV) remodeling in patients on peritoneal dialysis (PD). Methods: This prospective longitudinal study included 40 PD patients. Serum levels of ET-1 and NO baseline and after 12 months of PD treatment were measured and compared with echocardiography parameters done at the same time of PD treatment. Linear regression analysis was used to detect independent correlations of variables. Results: Mean ET-1 serum concentration decreased significantly after 12 months of PD treatment compared to baseline values (p < 0.01). NO serum concentration increased significantly 12 months after treatment compared to baseline values (p < 0.01). Left ventricular hypertrophy (LVH) was observed in 72.5% of patients at baseline with significant reduction in LV mass index after 12 months of PD treatment (p < 0.001). On linear regression analysis serum concentration of ET-1 was independent predictors of LV mass index, as well as NO at the end of observed period. Conclusions: According to our data ET-1 and NO are independently related to the process of left ventricular remodeling in PD patients

Changes in Carotid Intima-media Thickness and Left Ventricular Mass by Control of Blood Pressure and Hyperlipidemia in Hypertensive Patients

❙ABSTRACT❙ Background: Hypertensive patients often present with carotid atherosclerosis, and especially those with left ventricular hypertrophy (LVH) are known to have twice the prevalence of carotid atheroma. The aims of this study were to evaluate the changes in the severity of carotid atherosclerosis and left ventricular (LV) mass by control of blood pressure (BP) and hyperlipidemia in hypertensive patients. Methods: A total of 87 treated hypertensive patients who had been diagnosed as stage 2 hypertension on Joint National Committee 7 classification in past 1 year or LVH on electrocardiographic criteria were enrolled. Both at baseline and the end of study, repetitive measurements of carotid intima-media thickness (IMT) and LV mass indexed by body surface area were performed. Measurement of carotid IMT was conducted at bilateral sides of distal common carotid artery. Results: After the follow-up period of mean 16-months, there were significant lowering in systolic and diastolic BP, respectively (144.6 ± 19.2 to 131.3 ± 13.6 mm Hg, p < 0.001; 87.5 ± 11.3 to 79.6 ± 9.4 mm Hg, p < 0.001). Carotid IMT showed no significant change (0.75 ± 0.18 to 0.76 ± 0.18 mm, p = 0.310). Although there was significant reduction in LV mass index (107.9 ± 22.0 to 101.0 ± 18.4 g/m 2 , p < 0.001), it was not correlated with the changes in carotid IMT (r = 0.141, p = 0.197). Conclusions: Anti-hypertensive therapy combined with statin if indicated did not show significant reduction in atherosclerotic burden of carotid artery, but it seemed to prevent further progression in hypertensive patients. Decrement in LV mass achieved by BP control was not correlated with changes in carotid IMT. (J Korean Soc Hypertens 2011;17(4):177-184)