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Tapking C, Houschyar KS, Rontoyanni VG, Hundeshagen G, Kowalewski KF, Hirche C, Popp D, Wolf SE, Herndon DN, Branski LK. The Influence of Obesity on Treatment and Outcome of Severely Burned Patients. J Burn Care Res 2020; 40:996-1008. [PMID: 31294797 DOI: 10.1093/jbcr/irz115] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Obesity and the related medical, social, and economic impacts are relevant multifactorial and chronic conditions that also have a meaningful impact on outcomes following a severe injury, including burns. In addition to burn-specific difficulties, such as adequate hypermetabolic response, fluid resuscitation, and early wound coverage, obese patients also present with common comorbidities, such as arterial hypertension, diabetes mellitus, or nonalcoholic fatty liver disease. In addition, the pathophysiologic response to severe burns can be enhanced. Besides the increased morbidity and mortality compared to burn patients with normal weight, obese patients present a challenge in fluid resuscitation, perioperative management, and difficulties in wound healing. The present work is an in-depth review of the current understanding of the influence of obesity on the management and outcome of severe burns.
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Affiliation(s)
- Christian Tapking
- Department of Surgery, University of Texas Medical Branch, Galveston.,Shriners Hospitals for Children, Galveston, Texas.,Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Germany
| | - Khosrow S Houschyar
- Department of Plastic Surgery, Hand Surgery, Sarcoma Center, BG University Hospital, Ruhr University, Bochum, Germany
| | - Victoria G Rontoyanni
- Department of Surgery, University of Texas Medical Branch, Galveston.,Metabolism Unit, Shriners Hospitals for Children, Galveston, Texas
| | - Gabriel Hundeshagen
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Germany
| | | | - Christoph Hirche
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Germany
| | - Daniel Popp
- Department of Surgery, University of Texas Medical Branch, Galveston.,Shriners Hospitals for Children, Galveston, Texas.,Department of Urology, University Medical Center Mannheim, University of Heidelberg, Germany
| | - Steven E Wolf
- Department of Surgery, University of Texas Medical Branch, Galveston.,Shriners Hospitals for Children, Galveston, Texas
| | - David N Herndon
- Department of Surgery, University of Texas Medical Branch, Galveston
| | - Ludwik K Branski
- Department of Surgery, University of Texas Medical Branch, Galveston.,Shriners Hospitals for Children, Galveston, Texas.,Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
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52
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Aravind P, Siotos C, Bernatowicz E, Cooney CM, Rosson GD. Breast Reduction in Adults: Identifying Risk Factors for Overall 30-Day Postoperative Complications. Aesthet Surg J 2020; 40:NP676-NP685. [PMID: 32506130 DOI: 10.1093/asj/sjaa146] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Breast reduction is a commonly performed procedure. Understanding the postoperative complication profile is important for preoperative planning and patient education. OBJECTIVES The authors sought to assess complication rates following breast reduction in females and identify potential risk factors. METHODS We assessed the records of the American College of Surgeons National Surgical Quality Improvement Program participant use files that include patients who underwent breast reduction for macromastia between 2005 and 2016. Relevant patient and postoperative data were extracted, and factors affecting complications were analyzed utilizing the logistic regression model. RESULTS We identified 20,001 women aged a mean 43.9 years who underwent breast reduction. The number of patients who developed ≥1 complication was 1009 (4.3%). Our adjusted analysis revealed that outpatient setting (odds ratio [OR] = 0.600) and performance of the surgery by the attending surgeon alone (OR = 0.678) were associated with lower odds, whereas higher body mass index (OR = 1.046) and smoking (OR = 1.518) were associated with higher odds for complications following breast reduction. Outpatient setting (OR = 0.317) was also associated with lower odds whereas smoking (OR = 1.613) and American Society of Anesthesiologists class were associated with higher odds of returning to the operative room. These findings were consistent in our subgroup analysis for wound-related complications. CONCLUSIONS Our study shows that patient characteristics such as smoking and body mass index may increase complication rates after breast reduction. Clinical factors such as inpatient setting may also increase risk of complications following breast reduction. It is critical to understand the effect of these factors to better predict postoperative outcomes and ensure thorough patient education.
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Affiliation(s)
- Pathik Aravind
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Charalampos Siotos
- Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, IL
| | - Elizabeth Bernatowicz
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Carisa M Cooney
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Gedge D Rosson
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
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53
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Bojanowski K, Swindell WR, Cantor S, Chaudhuri RK. Isosorbide Di-(Linoleate/Oleate) Stimulates Prodifferentiation Gene Expression to Restore the Epidermal Barrier and Improve Skin Hydration. J Invest Dermatol 2020; 141:1416-1427.e12. [PMID: 33181142 DOI: 10.1016/j.jid.2020.09.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 09/16/2020] [Accepted: 09/20/2020] [Indexed: 11/15/2022]
Abstract
The breakdown of the epidermal barrier and consequent loss of skin hydration is a feature of skin aging and eczematous dermatitis. Few treatments, however, resolve these underlying processes to provide full symptomatic relief. In this study, we evaluated isosorbide di-(linoleate/oleate) (IDL), which was generated by esterifying isosorbide with sunflower fatty acids. Topical effects of IDL in skin were compared with those of ethyl linoleate/oleate, which has previously been shown to improve skin barrier function. Both IDL and ethyl linoleate/oleate downregulated inflammatory gene expression, but IDL more effectively upregulated the expression of genes associated with keratinocyte differentiation (e.g., KRT1, GRHL2, SPRR4). Consistent with this, IDL increased the abundance of epidermal barrier proteins (FLG and involucrin) and prevented cytokine-mediated stratum corneum degradation. IDL also downregulated the expression of unhealthy skin signature genes linked to the loss of epidermal homeostasis and uniquely repressed an IFN-inducible coexpression module activated in multiple skin diseases, including psoriasis. In a double-blind, placebo-controlled trial enrolling females with dry skin, 2% IDL lotion applied over 2 weeks significantly improved skin hydration and decreased transepidermal water loss (NCT04253704). These results demonstrate mechanisms by which IDL improves skin hydration and epidermal barrier function, supporting IDL as an effective intervention for the treatment of xerotic pruritic skin.
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Affiliation(s)
- Krzysztof Bojanowski
- Sunny BioDiscovery, Santa Paula, California, USA; Symbionyx Pharmaceuticals, Boonton, New Jersey, USA
| | - William R Swindell
- Department of Internal Medicine, The Jewish Hospital, Cincinnati, Ohio, USA.
| | - Shyla Cantor
- Cantor Research Laboratories, Blauvelt, New York, USA
| | - Ratan K Chaudhuri
- Symbionyx Pharmaceuticals, Boonton, New Jersey, USA; Sytheon, Boonton, New Jersey, USA
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54
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Demographic and Socioeconomic Determinants of Body Mass Index in People of Working Age. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218168. [PMID: 33167352 PMCID: PMC7663841 DOI: 10.3390/ijerph17218168] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/27/2020] [Accepted: 11/03/2020] [Indexed: 12/13/2022]
Abstract
Obesity is currently the most common metabolic disease, causing numerous health problems and, if untreated, leading to premature mortality. Obesity is a significant issue among people of working age since their ability to work depends directly on their health condition and psychomotor fitness. Demographic and socioeconomic factors have a significant impact on the body weight of people of working age. The aim of this study is to identify relationships between the body mass index and selected demographic and socioeconomic variables in working-age residents of the city of Wrocław, Poland. The study involved 4315 respondents (2206 women and 2109 men) aged 18–64 years from Wrocław. The sample selection was random and purposive, using multilevel stratification. The applied research tool was the authors’ own cross-sectional diagnostic questionnaire of socioeconomic status. Based on the collected data, the respondents’ body weight was categorized according to WHO criteria. The majority of respondents (60%) had a normal body weight, while 40% were categorized as overweight or obese. The difference was statistically significant (p < 0.001). Sex, age, occupational status, marital status, number of people in the household, having a steady source of income, disposable (net) income, and savings were significantly correlated (p < 0.001) with respondents’ body mass index. Public health programs aimed at promoting healthy lifestyle behaviors should be addressed primarily to groups at the highest risk of overweight and obesity.
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55
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Shaath MK, Lim PK, Andrews R, Chip Routt ML. Morbid obesity and short-term complications following acetabular fracture surgery: A comparative cohort study. Injury 2020; 51:2622-2627. [PMID: 32826053 DOI: 10.1016/j.injury.2020.08.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/11/2020] [Accepted: 08/13/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Obesity is an epidemic facing the United States affecting nearly 40% of the population (93.3 million adults). The objective of this study was to compare early perioperative complications in patients with a normal BMI to patients who are pre-obese, obese, and morbidly obese. MATERIALS AND METHODS The study was conducted at a Level-I trauma center. Patients were separated into 4 groups based on their BMI. Group 1 had a BMI < 25 (normal), Group 2 had a BMI between 25-29.9 (pre-obesity), Group 3 had a BMI between 30-39.9 (obese), and Group 4 had a BMI ≥40 (morbidly obese). Outcome variables included total operative time (OT), estimated blood loss (EBL), length of stay (LOS), and early medical and surgical complications. A comparison between groups was performed for each outcome variable and surgical complication. RESULTS We identified 333 patients and the number of patients in Groups 1-4 were 86, 96, 121, and 30, respectively. The average BMI for Groups 1-4 was 22.3, 27.3, 35.9, and 44.9, respectively (p < 0.001). OT, EBL, and LOS did not differ between groups or between the surgical approach utilized. There were no significant relationships when comparing complication rates between groups. Patients in Group 4 experienced significantly more PE compared to patients in Group 2 (p=0.01). Additionally, patients in Group 4 experienced a significantly more PE than patients in Groups 1 and 2 combined (p<.01). The relative risk of having a PE if BMI is ≥40, compared to a BMI <30 is 18.40 (95% CI = 1.98 - 171.13). The PEs were not fatal in all cases. CONCLUSIONS In the treatment of the obese and morbidly obese with acetabular fractures, we find that these cohorts are not at a greater risk of wound complications or infection. The higher rate of pulmonary embolism seen in the morbidly obese should be considered when evaluating these patients for appropriate thromboembolic prophylaxis.
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Affiliation(s)
- M Kareem Shaath
- Orlando Health Orthopaedic Institute, Florida State College of Medicine, University of Central Florida College of Medicine, 122 S Orange Ave, 5 Floor, Orlando, FL, 32806, USA.
| | - Philip K Lim
- University of California Irvine, Department of Orthopedic Surgery, Irvine, CA, USA
| | - Reid Andrews
- McGovern Medical School at UTHealth, Department of Orthopedic Surgery, Houston, TX, USA
| | - Milton L Chip Routt
- Orlando Health Orthopaedic Institute, Florida State College of Medicine, University of Central Florida College of Medicine, 122 S Orange Ave, 5 Floor, Orlando, FL, 32806, USA
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56
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Yang WS, Chang YC, Chang CH, Wu LC, Wang JL, Lin HH. The Association Between Body Mass Index and the Risk of Hospitalization and Mortality due to Infection: A Prospective Cohort Study. Open Forum Infect Dis 2020; 8:ofaa545. [PMID: 33511222 PMCID: PMC7817078 DOI: 10.1093/ofid/ofaa545] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 11/04/2020] [Indexed: 12/24/2022] Open
Abstract
Background We aim to determine whether obesity increases the risk of various infections using a large prospective population-based cohort. Methods A total of 120 864 adults were recruited from the New Taipei City health screening program from 2005 to 2008. Statistics for hospitalization and mortality due to infection were obtained from the National Health Insurance Database and the National Death Registry in Taiwan. Results During a mean follow-up period of 7.61 years, there were 438, 7582, 5298, and 1480 first hospitalizations due to infection in the underweight, normal, overweight, and obese groups, respectively. Obesity significantly increases the risk of hospitalization for intra-abdominal infections (adjusted hazard ratio [aHR], 1.19; 95% CI, 1.00–1.40), including diverticulitis, liver abscess, acute cholecystitis and anal and rectal abscess, reproductive and urinary tract infection (aHR, 1.38; 95% CI, 1.26–1.50), skin and soft tissue infection (aHR, 2.46; 95% CI, 2.15–2.81), osteomyelitis (aHR, 1.70; 95% CI, 1.14–2.54), and necrotizing fasciitis (aHR, 3.54; 95% CI,1.87–6.67), and this relationship is dose-dependent. This study shows that there is a U-shaped association between body mass index (BMI) and hospitalization for lower respiratory tract infection, septicemia, and the summation of all infections and that underweight people are at the greatest risk, followed by obese people. There is a clear negative relationship between BMI and infection-related mortality. Conclusions The pattern that BMI affects the risk of hospitalization and mortality due to infection varies widely across infection sites. It is necessary to tailor preventive and therapeutic measures against different infections in hosts with different BMIs.
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Affiliation(s)
- Wei-Shun Yang
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Taipei, Taiwan
| | - Yi-Cheng Chang
- Graduate Institute of Medical Genomics and Proteomics, National Taiwan University, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Chia-Hsuin Chang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.,Institute of Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Li-Chiu Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jiun-Ling Wang
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.,College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsien-Ho Lin
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
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57
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Dupont G, Bordes SJ, Lachkar S, Wahl L, Iwanaga J, Loukas M, Tubbs RS. The effects of obesity on the human body, part I: Skin and musculoskeletal. Clin Anat 2020; 34:297-302. [PMID: 32986278 DOI: 10.1002/ca.23683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 09/11/2020] [Indexed: 11/07/2022]
Abstract
Obesity is a worldwide issue that many global health authorities consider a growing epidemic. Having a positive correlation between increases in the industrialization of processed foods and sedentary occupations as well as a lack of access to healthcare in poorer socioeconomic areas, obesity is a multifactorial disease affecting several organ systems. The tendency for obesity to cause detrimental changes to the human body is a focal point for healthcare providers to establish more effective clinical treatment and management plans. Implementing comprehensive global educational programs to decrease the prevalence of this unforgiving disease is imperative for a healthier future. Herein, we have provided a comprehensive review of the health effects of obesity upon the human body for the interest of many practicing clinicians managing this health crisis.
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Affiliation(s)
- Graham Dupont
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Stephen J Bordes
- Department of Anatomical Sciences, St. George's University School of Medicine, St. George's, Grenada
| | | | - Lauren Wahl
- Department of Cell and Developmental Biology, University of Colorado, Boulder, Colorado, USA
| | - Joe Iwanaga
- Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Fukuoka, Japan.,Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Neurology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Marios Loukas
- Department of Anatomical Sciences, St. George's University School of Medicine, St. George's, Grenada.,Department of Anatomy, University of Warmia and Mazury, Olsztyn, Poland
| | - R Shane Tubbs
- Department of Anatomical Sciences, St. George's University School of Medicine, St. George's, Grenada.,Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Neurology, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA
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58
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Kridin K, Solomon A, Tzur-Bitan D, Damiani G, Comaneshter D, Cohen AD. Acne Keloidalis Nuchae and the Metabolic Syndrome: A Population-Based Study. Am J Clin Dermatol 2020; 21:733-739. [PMID: 32748304 DOI: 10.1007/s40257-020-00541-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The association between acne keloidalis nuchae (AKN) and the metabolic syndrome (MS) has been reported anecdotally. However, it is yet to be investigated in the setting of controlled studies, leaving this topic inconclusive in the current literature. OBJECTIVE The aim was to estimate the association between AKN and the MS and its components, utilizing one of the largest cohorts of patients with AKN. METHODS A retrospective, population-based, cross-sectional study was performed between 2005 and 2018. We utilized the database of Clalit Health Services, the largest public healthcare provider organization in Israel. The current study encompassed data collected from general community clinics, primary care, and referral centers, as well as from ambulatory and hospital care. RESULTS A total of 2677 patients with AKN and 13,190 controls were included. The prevalence of the MS was greater in patients with AKN than in control subjects (16.1% vs. 6.6%, respectively; odds ratio [OR] 2.72; 95% confidence interval [CI] 2.40-3.08; P < 0.001). Obesity demonstrated the strongest association with AKN (OR 3.00; 95% CI 2.75-3.28), followed by type 2 diabetes mellitus (OR 2.47; 95% CI 2.20-2.77), hypertension (OR 1.82; 95% CI 1.63-2.05), and dyslipidemia (OR 1.60; 95% CI 1.46-1.75). Estimates were not altered significantly after controlling for putative confounding factors. CONCLUSIONS A strong association was observed between AKN and the MS on the one hand, and with every one of its four components on the other. Physicians treating patients with AKN should be aware of this possible comorbidity. Patients with AKN should be carefully assessed for comorbid metabolic disorders.
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Affiliation(s)
- Khalaf Kridin
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany.
| | | | - Dana Tzur-Bitan
- Department of Behavioral Sciences, Ariel University, Ariel, Israel
| | - Giovanni Damiani
- Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Doron Comaneshter
- Department of Quality Measurements and Research, Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel
| | - Arnon D Cohen
- Department of Quality Measurements and Research, Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
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59
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Walker JM, Garcet S, Aleman JO, Mason CE, Danko D, Butler D, Zuffa S, Swann JR, Krueger J, Breslow JL, Holt PR. Obesity and ethnicity alter gene expression in skin. Sci Rep 2020; 10:14079. [PMID: 32826922 PMCID: PMC7442822 DOI: 10.1038/s41598-020-70244-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 07/15/2020] [Indexed: 11/21/2022] Open
Abstract
Obesity is accompanied by dysfunction of many organs, but effects on the skin have received little attention. We studied differences in epithelial thickness by histology and gene expression by Affymetrix gene arrays and PCR in the skin of 10 obese (BMI 35-50) and 10 normal weight (BMI 18.5-26.9) postmenopausal women paired by age and ethnicity. Epidermal thickness did not differ with obesity but the expression of genes encoding proteins associated with skin blood supply and wound healing were altered. In the obese, many gene expression pathways were broadly downregulated and subdermal fat showed pronounced inflammation. There were no changes in skin microbiota or metabolites. African American subjects differed from European Americans with a trend to increased epidermal thickening. In obese African Americans, compared to obese European Americans, we observed altered gene expression that may explain known differences in water content and stress response. African Americans showed markedly lower expression of the gene encoding the cystic fibrosis transmembrane regulator characteristic of the disease cystic fibrosis. The results from this preliminary study may explain the functional changes found in the skin of obese subjects and African Americans.
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Affiliation(s)
- Jeanne M Walker
- The Rockefeller University Hospital, New York, NY, 10065, USA.
| | - Sandra Garcet
- Laboratory of Investigational Dermatology, The Rockefeller University, New York, NY, 10065, USA
| | - Jose O Aleman
- Laboratory of Biochemical Genetics and Metabolism, The Rockefeller University, New York, NY, 10065, USA
- Laboratory of Translational Obesity Research, New York University Langone Health, New York, NY, 10016, USA
| | | | - David Danko
- Weill Cornell Medical College, New York, NY, 10065, USA
| | - Daniel Butler
- Weill Cornell Medical College, New York, NY, 10065, USA
| | - Simone Zuffa
- Department of Metabolism, Digestion, and Reproduction, Imperial College London, London, UK
| | - Jonathan R Swann
- Department of Metabolism, Digestion, and Reproduction, Imperial College London, London, UK
- School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - James Krueger
- Laboratory of Investigational Dermatology, The Rockefeller University, New York, NY, 10065, USA
| | - Jan L Breslow
- Laboratory of Biochemical Genetics and Metabolism, The Rockefeller University, New York, NY, 10065, USA
| | - Peter R Holt
- Laboratory of Biochemical Genetics and Metabolism, The Rockefeller University, New York, NY, 10065, USA.
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Abstract
Intertrigo, also known as intertriginous dermatitis, is one of the four separate conditions that fall under the umbrella term of moisture-associated skin damage (MASD). It can affect individuals of all ages. Intertrigo is a common inflammatory skin disorder caused by skin-on-skin friction within skin folds, as a result of moisture becoming trapped because of poor air circulation. It can occur in any area of the body where two skin surfaces are in close contact with each other, such as the axillary, inframammary, umbilical and inguinal areas, and is strongly associated with obesity. Consensus clinical expert opinion suggests that investment in the development and adoption of clear skin care and skin fold management protocols can lead to improvements in the patient experience and better clinical outcomes.
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Affiliation(s)
- David Voegeli
- Visiting Professor of Nursing, Department of Health and Care Professions, Faculty of Health & Wellbeing, University of Winchester
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61
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Kilany OE, Abdelrazek HMA, Aldayel TS, Abdo S, Mahmoud MMA. Anti-obesity potential of Moringa olifera seed extract and lycopene on high fat diet induced obesity in male Sprauge Dawely rats. Saudi J Biol Sci 2020; 27:2733-2746. [PMID: 32994733 PMCID: PMC7499387 DOI: 10.1016/j.sjbs.2020.06.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/17/2020] [Accepted: 06/14/2020] [Indexed: 02/07/2023] Open
Abstract
Present research explored the anti-obesity effect of Moringa olifera seed oil extract and lycopene (LYC). Forty eight male Sprauge Dawely rats were divided equally into 6 groups. Group Ι (C) served as control, group ΙΙ (MC) was given Moringa olifera seed oil extract (800 mg/kg b.wt) for 8 weeks, group ΙΙΙ (LC) was given (20 mg/kg b.wt) LYC for 8 weeks, group ΙV (O) received high fat diet (HFD) for 20 weeks, group Ѵ (MO), was given HFD for 20 weeks and received (800 mg/kg b.wt) Moringa olifera seed oil extract for last 8 weeks and group ѴΙ (LO), received HFD for 20 weeks and was given (20 mg/kg b.wt) LYC for last 8 weeks. Hematology, lipid peroxidation and antioxidants, non-esterified fatty acids (NEFA), glucose, lipid profile, serum liver and kidney biomarkers, inflammatory markers, leptin, resistin and heart fatty acid binding protein (HFABP) were determined. Also histopathology for liver, kidney and aorta were performed besides immunohistochemistry (IHC) for aortic inducible nitric oxide synthase (iNOS). Administration of Moringa olifera seed oil extract and LYC significantly ameliorated the HFD induced hematological and metabolic perturbations as well as reduced leptin and resistin. Both treatments exerted these effects through promotion of antioxidant enzymes and reducing lipid peroxidation as well as inflammatory cytokines along with reduced iNOS protein expression. Administration of Moringa olifera seed oil extract and LYC have anti-obesity potential in HFD induced obesity in male Sprauge Dawely rats.
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Affiliation(s)
- Omnia E Kilany
- Department of Clinical Pathology, Faculty of Veterinary Medicine, Suez Canal University, Ismailia, Egypt
| | - Heba M A Abdelrazek
- Department of Physiology, Faculty of Veterinary Medicine, Suez Canal University, Ismailia, Egypt
| | - Tahany Saleh Aldayel
- Nutrition and Food Science, Department of Physical Sport Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Shimaa Abdo
- Suez Canal Authority Hospital, Ismailia, Egypt
| | - Manal M A Mahmoud
- Nutrition and Clinical Nutrition Department, Faculty of Veterinary Medicine, Suez Canal University, Ismailia, Egypt
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Shimbo K, Okuhara Y, Yokota K. Hybrid Treatment Combining Lymphaticovenous Anastomoses and the Oriental Herbal Medicine Bofutsushosan for Obesity-Associated Lower Leg Elephantiasis Nostras Verrucosa: A Case Report. INT J LOW EXTR WOUND 2020; 20:282-284. [PMID: 32519905 DOI: 10.1177/1534734620932802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Elephantiasis nostras verrucosa (ENV) is a rare dermatological disease associated with chronic lymphedema caused by obesity, soft tissue infection, or chronic venous insufficiency. Although surgical debridement may be sufficient to treat the skin manifestations of ENV, treatment of ENV should focus on reducing lymph stasis to improve the skin changes and prevent recurrence. In this case report, we present the case of a 79-year-old woman who developed obesity-associated ENV in the lower leg. She was successfully treated by a combination of lymphaticovenous anastomoses and the oriental herbal medicine Bofutsushosan. To our knowledge, this is the first reported obesity-associated ENV case in which skin pathology was not only healed, but both edema relief and weight loss were successful. A treatment combining both surgery and the herbal medicine could be a potential therapeutic candidate for obesity-associated ENV.
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Wang J, Prenner J, Wang W, Sakuraba A, Hyman N, Dalal S, Hurst R, Cohen RD, Umanskiy K, Shogan BD, Alpert L, Rubin DT, Colwell J, Pekow J. Risk factors and treatment outcomes of peristomal pyoderma gangrenosum in patients with inflammatory bowel disease. Aliment Pharmacol Ther 2020; 51:1365-1372. [PMID: 32383278 DOI: 10.1111/apt.15766] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/12/2020] [Accepted: 04/13/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Insufficient data exist for peristomal pyoderma gangrenosum (PPG), which primarily affects patients with inflammatory bowel disease (IBD). AIMS To evaluate the risk factors and treatment response of PPG in IBD patients in a real-life cohort. METHODS Cases of PPG were identified retrospectively using ICD-9/10 codes in patients with IBD who had an ostomy at a tertiary care centre. Disease-specific characteristics were compared between groups with and without PPG, and response to therapy was evaluated in patients with PPG. RESULTS The cohort included 41 IBD patients with PPG and 123 IBD controls with an ostomy who never developed PPG. Patients with PPG were more likely to be female (76% vs 51%, P = 0.006), had higher BMIs (29.78 ± 0.89 vs 23.53 ± 0.51, P < 0.0001) and had increased usage of pouch belts (97% vs 71%, P = 0.0008) compared to controls. There were no differences in age at surgery (41.76 ± 2.60 vs 43.49 ± 1.50, P = 0.57) or IBD diagnosis (63% vs 54% Crohn's disease, P = 0.28) between PPG and controls. 85% of PPG patients achieved complete resolution with different treatments, including surgery. Complete resolution with topical corticosteroids and calcineurin inhibitors alone were low (14% and 13% respectively). Higher rates of complete resolution were reported with anti-tumour necrosis factor (TNF) agents (63%) and surgical interventions (80%). CONCLUSIONS Female gender, higher BMI and pouch belts were associated with increased risk of developing PPG. Most PPG cases resolved after treatment with the highest rates of complete resolution seen with anti-TNF agents and surgical intervention.
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Affiliation(s)
- Jingzhou Wang
- Department of Internal Medicine, University of Chicago, Chicago, IL, USA
| | - Joshua Prenner
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Wenfei Wang
- Department of Internal Medicine, University of Chicago, Chicago, IL, USA
| | - Atsushi Sakuraba
- Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, IL, USA
| | - Neil Hyman
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Sushila Dalal
- Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, IL, USA
| | - Roger Hurst
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Russell D Cohen
- Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, IL, USA
| | | | | | - Lindsay Alpert
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - David T Rubin
- Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, IL, USA
| | - Janice Colwell
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Joel Pekow
- Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, IL, USA
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The Influence of Obesity on Outcomes After Pediatric Reduction Mammaplasty: A Retrospective Analysis of the Pediatric National Surgical Quality Improvement Program-Pediatric Database. Ann Plast Surg 2020; 85:608-611. [PMID: 32472794 DOI: 10.1097/sap.0000000000002311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Symptomatic macromastia causes negative physical and psychosocial effects, which support the need for early intervention, even in the adolescent population (Plast Reconstr Surg 2012;130:785-789). Reduction mammaplasty is a proven treatment that reliably addresses symptoms from macromastia. The National Surgical Quality Improvement Program-Pediatric is the leading nationally validated, risk-adjusted, outcomes-based program to measure and improve the quality of surgical care (Pediatrics 2012;130:e339-e346). In adults, obesity is associated with increased early postoperative complications after mammaplasty (Pediatrics 2017;140(5)). We hypothesized that obesity would increase the incidence of postoperative complications in pediatric patients undergoing reduction mammaplasty. METHODS The National Surgical Quality Improvement Program-Pediatric database was queried for female patients 18 years or younger who underwent reduction mammaplasty from January 2012 to December 2017 using Current Procedural Terminology code 19318. Demographic, clinical, and outcomes data were abstracted from the database. A composite postoperative adverse events variable was created from a list of 21 individual adverse events. Patients were stratified by presence of obesity (body mass index ≥30 kg/m) on univariate analyses. Multivariable logistic regression was used to determine factors associated with any postoperative adverse events. RESULTS A total of 542 female patients underwent reduction mammaplasty, with 48% of the cohort being obese. Patients were similar in age (median, 17 years) and comorbidities between obese and nonobese groups. Obese patients were more likely to be African American, have higher American Society of Anesthesiologists class, and endure longer operations. Composite adverse event rates were significantly higher in the obese group (7% vs 2%, P = 0.013). Individual adverse events were similar between groups, with the exception of 30-day readmissions, which was higher in the obese group (3% vs 1%, P = 0.04). On multivariable logistic regression, obesity increased the odds of having a postoperative adverse event by 3-fold after adjusting for operative duration. CONCLUSIONS Obesity was significantly associated with greater postoperative adverse events in obese adolescent females after reduction mammaplasty compared with their nonobese counterparts. Although recorded rates of adverse events after reduction mammaplasty were low, preoperative weight loss programs may further improve outcomes for obese pediatric populations undergoing reduction mammaplasty.
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Budu-Aggrey A, Watkins SH, Brumpton B, Løset M, Tyrrell J, Modalsli EH, Vie GÅ, Palmer T, Fritsche LG, Nielsen JB, Romundstad PR, Davey Smith G, Åsvold BO, Paternoster L, Brown SJ. Assessment of a causal relationship between body mass index and atopic dermatitis. J Allergy Clin Immunol 2020; 147:400-403. [PMID: 32433920 PMCID: PMC7794861 DOI: 10.1016/j.jaci.2020.04.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/18/2020] [Accepted: 04/17/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Ashley Budu-Aggrey
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Sarah H Watkins
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Ben Brumpton
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom; K.G. Jebsen Center for Genetic Epidemiology, NTNU, Norwegian University of Science and Technology, Trondheim, Norway; Department of Thoracic and Occupational Medicine, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Mari Løset
- K.G. Jebsen Center for Genetic Epidemiology, NTNU, Norwegian University of Science and Technology, Trondheim, Norway; Department of Dermatology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Jess Tyrrell
- Genetics of Complex Traits, Institute of Biomedical and Clinical Science, University of Exeter Medical School, Royal Devon and Exeter Hospital, Exeter, United Kingdom
| | - Ellen H Modalsli
- Department of Dermatology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Clinical and Molecular Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway; Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Gunnhild Åberge Vie
- Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tom Palmer
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Lars G Fritsche
- K.G. Jebsen Center for Genetic Epidemiology, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jonas Bille Nielsen
- K.G. Jebsen Center for Genetic Epidemiology, NTNU, Norwegian University of Science and Technology, Trondheim, Norway; Center for Statistical Genetics, Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Mich
| | - Pål Richard Romundstad
- Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - George Davey Smith
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Bjørn Olav Åsvold
- K.G. Jebsen Center for Genetic Epidemiology, NTNU, Norwegian University of Science and Technology, Trondheim, Norway; Department of Endocrinology, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Lavinia Paternoster
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Sara J Brown
- Skin Research Group, School of Medicine, University of Dundee, Dundee, United Kingdom; Department of Dermatology, Ninewells Hospital and Medical School, Dundee, United Kingdom.
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Disease Specific to Chronic Lymphedema and Class III Obesity. Case Rep Med 2020; 2020:9234183. [PMID: 32351576 PMCID: PMC7182976 DOI: 10.1155/2020/9234183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 04/01/2020] [Indexed: 11/24/2022] Open
Abstract
Elephantiasis nostras verrucosa (ENV) is a unique, chronic condition found in patients with obesity and chronic secondary lymphedema. It develops due to chronic inflammation and recurrent infection, most commonly on gravity-dependent sites. Progressive tissue enlargement, deformity, and disability necessitate intervention. First, clinicians should explore the etiology of patients' secondary lymphedema, as this is paramount in determining treatment for ENV. The fundamental goal is alleviating lymphatic obstruction. Our literature review of available cases of ENV elucidates Class III obesity as a factor common to all available cases of ENV. As such, weight loss is a key component of treatment. Medical management and weight loss are most effective when combined with physiologic interventions such as compression garments and decongestive physiotherapy. If surgical intervention is required, one of the mainstays of patient management is a reductive approach, aimed at removing excess adipose and fibrotic tissue to improve lymphatic patency and flow. Optimal postoperative outcomes are achieved when patients also undergo physiologic procedures to bypass obstructions and connect functioning lymphatic vessels.
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Body mass index and risk of infections: a Mendelian randomization study of 101,447 individuals. Eur J Epidemiol 2020; 35:347-354. [DOI: 10.1007/s10654-020-00630-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 04/07/2020] [Indexed: 01/22/2023]
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Vargas-Arzola J, Segura-Salvador A, Torres-Aguilar H, Urbina-Mata M, Aguilar-Ruiz S, Díaz-Chiguer DL, Márquez-Navarro A, Morales-Reyes L, Alvarado-Vásquez N, Nogueda-Torres B. Prevalence and risk factors to Demodex folliculorum infection in eyelash follicles from a university population of Mexico. Acta Microbiol Immunol Hung 2020; 67:156-160. [PMID: 32223304 DOI: 10.1556/030.2020.01067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 11/18/2019] [Indexed: 11/19/2022]
Abstract
Demodex folliculorum shows a high occurrence in the general population, however, its pathologic relevance is still controversial. In this prospective study, we evaluated the prevalence of D. folliculorum on eyelashes from 8,033 subjects of a university population (including 7,782 students, and 251 academics). Additional information on some risk factors to infection by the mites was evaluated, as well. A prevalence of 1.47% was found, where 118 individuals were positive for D. folliculorum; and, among them, 63 (53.4%) were women and 55 (46.6%) were men. Results showed a negative correlation with the age (r = -0.45), the highest prevalence was found in individuals between 19 and 22 years of age (2.1%, 84 patients). The number of D. folliculorum mites did not differ between the right and left eye; however, the use of cosmetics or facial cream, contact lens, hair removers, were factors present in patients infected with D. folliculorum. Although Demodex prevalence did not increase in line with weight, we found significantly higher prevalence in the 51-60 kg and 71-80 kg weight groups, and a particularly high prevalence in the over 81 kg weight group (2.6%). In conclusion, it was observed that the main population positive to infection consisted of young adults; this is in contrast with the international evidence reporting a high rate of infection in older adults. Besides, our results suggest that items of daily use such as cosmetics, facial cream, eyeliner, glasses, or contact lenses may be some of the main culprits of the infection by D. folliculorum.
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Affiliation(s)
- Jaime Vargas-Arzola
- 1Faculty of Chemical Sciences, Autonomous University Benito Juárez of Oaxaca , City of Oaxaca, Oax, Mexico
| | - Aristeo Segura-Salvador
- 1Faculty of Chemical Sciences, Autonomous University Benito Juárez of Oaxaca , City of Oaxaca, Oax, Mexico
| | - Honorio Torres-Aguilar
- 1Faculty of Chemical Sciences, Autonomous University Benito Juárez of Oaxaca , City of Oaxaca, Oax, Mexico
| | - Mario Urbina-Mata
- 1Faculty of Chemical Sciences, Autonomous University Benito Juárez of Oaxaca , City of Oaxaca, Oax, Mexico
| | - Sergio Aguilar-Ruiz
- 1Faculty of Chemical Sciences, Autonomous University Benito Juárez of Oaxaca , City of Oaxaca, Oax, Mexico
| | | | | | | | - Noé Alvarado-Vásquez
- 4Department of Biochemistry, National Institute of Respiratory Diseases, Mexico City, Mexico
| | - Benjamín Nogueda-Torres
- 5Departamento de Parasitología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional,Ciudad de Méxicoy, México
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Abstract
GENERAL PURPOSE To provide information on obesity, bariatric surgery, and the nutrient deficiency-related dermatoses that may result from these surgeries. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, NPs, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant should be better able to:1. Examine issues related to obesity and bariatric surgery.2. Identify the sources and role of specific nutrients.3. Recognize the clinical signs and symptoms of nutrient deficiency following bariatric surgery. ABSTRACT Obesity is a global epidemic that increases the risk of weight-related comorbidities in modern society. It is complex, multifactorial, and largely preventable. Noninvasive treatments for obesity include diet, exercise, and medication. However, bariatric surgeries are becoming popular procedures for those who do not achieve success with noninvasive weight management treatment. Bariatric surgeries often result in dietary restriction and/or malabsorption, which lead to drastic weight loss. Individuals who had bariatric surgeries need lifelong follow-up and monitoring to ensure adequate intake of nutrients. Nutrient deficiencies can ensue when long-term vitamin and mineral supplementation is not followed. Severe nutrient deficiencies may lead to dermatoses that can be corrected by nutrient repletion and careful monitoring. A case report of nutrient deficiency-related dermatoses is followed by a review of obesity and its treatments with a focus on bariatric surgeries.
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Kim YM, Lee YJ, Kim SY, Cheon CK, Lim HH. Successful rapid weight reduction and the use of liraglutide for morbid obesity in adolescent Prader-Willi syndrome. Ann Pediatr Endocrinol Metab 2020; 25:52-56. [PMID: 32252218 PMCID: PMC7136503 DOI: 10.6065/apem.2020.25.1.52] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 08/09/2019] [Indexed: 11/20/2022] Open
Abstract
Prader-Willi syndrome (PWS), an imprinting disorder, results from the loss of expression of a paternal gene on chromosome 15q11-q13. Progressive obesity and its associated complications lead to increased morbidity and early death in PWS patients. The management techniques available for morbid obesity in adolescents and adults with PWS are limited. Herein, we report successful weight reduction in an adolescent PWS case showing morbid obesity and respiratory failure. An 18-year-old girl with PWS presented with diffuse cellulitis and dyspnea due to severe obesity. Her body weight had increased from 146 to 161 kg despite dietary restriction to 800 kcal/day, and a mechanical ventilator was required for dyspnea. During mechanical ventilation, the patient was managed using diuretics and by restricting fluid intake; her daily calorie intake was reduced to 200 kcal. This aggressive calorie and water restriction continued for 3 weeks and reduced her body weight to 118.6 kg. After transfer to the general ward, the patient was provided with growth hormone therapy and intensive aquatic rehabilitation and was administered liraglutide; as a result, her weight further decreased to 104 kg (body mass index [BMI], 50.8 kg/m2), and she was discharged. Following discharge, she maintained her BMI and adapted to 1,000 kcal/day for 1 year. Aggressive water and calorie restriction were observed as an effective method for rapid weight reduction in PWS patients, and liraglutide appeared useful in maintaining weight reduction in adolescent and adult PWS.
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Affiliation(s)
- Yoo-Mi Kim
- Department of Pediatrics, Chungnam National University Hospital, Chungnam National College of Medicine, Daejeon, Korea,Address for correspondence: Yoo-Mi Kim, MD, PhD Department of Pediatrics, College of Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon 35015, Korea Tel: +82-42-280-7288 Fax: +82-42-255-3158 E-mail:
| | - Yeoun Joo Lee
- Department of Pediatrics, Pusan National University Children’s Hospital, Pusan National College of Medicine, Yangsan, Korea
| | - Soo Yeon Kim
- Department of Rehabilitation, Pusan National University Children’s Hospital, Pusan National College of Medicine, Yangsan, Korea
| | - Chong Kun Cheon
- Department of Pediatrics, Pusan National University Children’s Hospital, Pusan National College of Medicine, Yangsan, Korea
| | - Han Hyuk Lim
- Department of Pediatrics, Chungnam National University Hospital, Chungnam National College of Medicine, Daejeon, Korea
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Abstract
BACKGROUND Autologous lipografting for improvement of facial skin quality was first described by Coleman in 2006. The current dogma dictates that adipose tissue-derived stromal cells that reside in the stromal vascular fraction of lipograft contribute to skin rejuvenation (e.g., increased skin elasticity), a more homogenous skin color, and softening of skin texture. Nowadays, many studies have been reported on this "skin rejuvenation" effect of autologous fat grafting. This systematic review was undertaken to assess the efficacy of autologous lipografting on skin quality. METHODS The MEDLINE, Embase, Cochrane Central, Web of Science, and Google Scholar databases were searched for studies evaluating the effect of autologous lipografting on facial skin quality (May 11, 2018). Outcomes of interest were skin texture, color, and elasticity in addition to histologic outcomes and number of complications. RESULTS Nine studies were included, with 301 patients treated in total. No meta-analysis could be performed because of heterogeneity of the metrics and outcomes. Eight studies reported increased skin elasticity; improvement in skin texture; and a more homogeneous skin color after treatment with lipografting, cellular stromal vascular fraction, or nanofat. One study reported no increased skin elasticity after lipografting. Histologic improvement was seen after lipografting and adipose tissue-derived stromal cell injections. However, in general, the level of evidence of the included studies was low. No serious complications were reported. CONCLUSION Autologous facial lipografting and cellular stromal vascular fraction and adipose tissue-derived stromal cell injections hardly seem to improve facial skin quality but can be considered a safe procedure.
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Sobhi RM, Adawy NAH, Zaky IS. “Comparative study between the efficacy of fractional CO2 laser, Q-switched Nd:YAG laser (1064 nm), and both types in treatment of keratosis pilaris”. Lasers Med Sci 2020; 35:1367-1376. [DOI: 10.1007/s10103-020-02956-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/02/2020] [Indexed: 01/09/2023]
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Matsunaga AM, Tortelly VD, Machado CJ, Pedrosa LR, Melo DF. High Frequency of Obesity in Acne Keloidalis Nuchae Patients: A Hypothesis from a Brazilian Study. Skin Appendage Disord 2020; 6:374-378. [DOI: 10.1159/000509203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 06/05/2020] [Indexed: 01/13/2023] Open
Abstract
Acne keloidalis nuchae (AKN) is a chronic inflammatory condition that almost exclusively affects the occipital and nape areas. Although not completely understood, its etiopathogenesis seems to be multifactorial, including association with metabolic syndrome (MetS). Despite being commonly seen in patients with MetS, obesity per se as a possible related factor for AKN has yet to be studied. The aim of this study was to evaluate the relationship between obesity and AKN in a series of patients. Eight male patients, with a median age of 38 years (range 15–48), were included. Overweight/obesity was found in 8/8 (100%), with median BMI of 32.2 (range 27.7–43.85 kg/m<sup>2</sup>), including 2 patients with class 3 obesity. We hypothesize adipose tissue accumulation in the nape, the only moving part of the scalp, leads to redundant skin folds, more friction, and inflammation, triggering AKN. This paper highlights the possible relationship between AKN and overweight/obesity, hypothesizing a mechanism for their contribution to the etiopathogenesis of this scalp disorder. To the best of our knowledge, this is the first study focused specifically in this association. While general physicians should pay attention to the appearing of AKN in overweight/obese patients, dermatologists must be aware that AKN patients should be assessed beyond the skin.
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Iacopi E, Riitano N, Dini V, Berta R, Pieruzzi L, Janowska A, Anselmino M, Piaggesi A, Romanelli M. Using Skin Bioengineering to Highlight How Weight and Diabetes Mellitus Modify the Skin in the Lower Limbs of Super-Obese Patients. Diabetes Metab Syndr Obes 2020; 13:729-738. [PMID: 32214836 PMCID: PMC7083633 DOI: 10.2147/dmso.s229042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 12/24/2019] [Indexed: 01/29/2023] Open
Abstract
AIM To evaluate the distinct contribution of obesity and diabetes (DM) to the skin modification in metabolic diseases. METHODS We analysed all patients admitted for bariatric surgery in our hospital with BMI between 38 and 47 kg/m2, with (Group 1) or without (Group 2) DM and compared them with a group of nonobese diabetic patients (Group 3) and healthy volunteers (Group 4). The following features were evaluated: hardness, temperature, hydration and thickness alongside with anthropometric measures of foot and leg. RESULTS For the general characteristics, patients differed in age and body mass index. As predictable all circumferences (dorsal foot, sovramalleolar and under the knee) were significantly higher in obese with no differences depending on DM (all parameters: p<0.01 in Group 1 and Group 2 vs Group 3 and Group 4). Skin temperature was significantly higher in all obese, irrespectively from the presence of DM (1st metatarsal head: p=0.02 Group 1 and Group 2 vs Group 3 and Group 4; 5th metatarsal head: p<0.01 in Group 1 and Group 2 vs Group 3 and Group 4). Skin hydration score showed increased anhydrosis in both diabetics and severe obesity (p<0.01 in Group 1 and Group 3 vs Group 2 and Group 4). Increase in thickness of skin and subcutaneous tissues was observed (at heel: p<0.01 in Group 1 and Group 2 vs Group 3 and Group 4 and under the scaphoid p=0.03 Group 1 and Group 2 vs Group 3 and Group 4) and plantar fascia (in both regions p=0.02 Group 1 and Group 2 vs Group 3 and Group 4) in all obese patients, with or without DM. CONCLUSION Severe obesity significantly affects both shape and structure of the foot, possibly exposing these patients to a higher risk of biomechanical stress. On such a background DM, modifying skin hydration and protective mechanisms exerts a synergistic role further increasing the risk of trauma and ulcers.
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Affiliation(s)
| | - Nicola Riitano
- Diabetic Foot Section, Pisa University Hospital, Pisa, Italy
- Dermatology Department, Pisa University Hospital, Pisa, Italy
| | - Valentina Dini
- Dermatology Department, Pisa University Hospital, Pisa, Italy
| | - Rossana Berta
- Bariatric Surgery Unit, Pisa University Hospital, Pisa, Italy
| | | | - Agata Janowska
- Dermatology Department, Pisa University Hospital, Pisa, Italy
| | - Marco Anselmino
- Bariatric Surgery Unit, Pisa University Hospital, Pisa, Italy
| | | | - Marco Romanelli
- Dermatology Department, Pisa University Hospital, Pisa, Italy
- Correspondence: Marco Romanelli Dermatology Unit, Via Roma, 67, Pisa56126, ItalyTel +39 050 992436Fax +39 050 551124 Email
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Affiliation(s)
- Yuko Eda
- Department of Cardiology, Japan Community Healthcare Organization (JCHO) Osaka Hospital, Japan
| | - Yoh Arita
- Department of Cardiology, Japan Community Healthcare Organization (JCHO) Osaka Hospital, Japan
| | - Nobuyuki Ogasawara
- Department of Cardiology, Japan Community Healthcare Organization (JCHO) Osaka Hospital, Japan
| | - Shinji Hasegawa
- Department of Cardiology, Japan Community Healthcare Organization (JCHO) Osaka Hospital, Japan
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Hirt PA, Castillo DE, Yosipovitch G, Keri JE. Skin changes in the obese patient. J Am Acad Dermatol 2019; 81:1037-1057. [DOI: 10.1016/j.jaad.2018.12.070] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 12/17/2018] [Accepted: 12/18/2018] [Indexed: 12/31/2022]
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Mayrovitz HN, Forbes J, Vemuri A, Krolick K, Rubin S. Skin tissue dielectric constant in women with high body fat content. Skin Res Technol 2019; 26:226-233. [DOI: 10.1111/srt.12784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 09/02/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Harvey N. Mayrovitz
- College of Medical Sciences Nova Southeastern University Ft. Lauderdale Florida
| | - Jessica Forbes
- KCP College of Osteopathic Medicine Nova Southeastern University Ft. Lauderdale Florida
| | - Adithi Vemuri
- KCP College of Osteopathic Medicine Nova Southeastern University Ft. Lauderdale Florida
| | - Katelyn Krolick
- KCP College of Osteopathic Medicine Nova Southeastern University Ft. Lauderdale Florida
| | - Samantha Rubin
- KCP College of Osteopathic Medicine Nova Southeastern University Ft. Lauderdale Florida
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Ismail S, Omar SS. Clinical and dermoscopic evaluation of fractional carbon dioxide laser in management of keratosis pilaris in Egyptian type skin. J Cosmet Dermatol 2019; 19:1110-1120. [DOI: 10.1111/jocd.13140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/27/2019] [Accepted: 08/15/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Shaimaa Ismail
- Department of Dermatology, Venereology & Andrology Faculty of Medicine Alexandria University Alexandria Egypt
| | - Salma Samir Omar
- Department of Dermatology, Venereology & Andrology Faculty of Medicine Alexandria University Alexandria Egypt
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Lu Y, Lu Q, Liu H, Yu J, Xin C, Liu Y, Liu Y, Fan L. Time-Series Expression Analysis of Epidermal Stem Cells from High Fat Diet Mice. J Comput Biol 2019; 27:769-778. [PMID: 31502860 DOI: 10.1089/cmb.2019.0172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
We aimed to identify differentially expressed genes (DEGs) in epidermal stem cells (epiSCs) in response to high fat diet (HFD). DEGs were identified by time-series analysis of the gene expression profile (GSE84510) in Gene Expression Omnibus (GEO) database. Functions and pathways affected by HFD were identified by functional annotation of DEGs. Key factors responding to HFD was identified by protein-protein interaction (PPI) network analysis. Two groups of genes with the same tendency in response to HFD were identified. ECM-related processes and PI3K pathway were altered in the early stage of obesity. A PPI network was constructed to delineate the interactions among proteins encoded by DEGs and ICAM1 and RELA were key epiSC factors respond to HFD. Our studies may provide valuable insights into the molecular mechanisms underlying how obesity affects the functions of epiSC.
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Affiliation(s)
- Ying Lu
- Department of Endocrinology, Jining No. 1 People's Hospital; Affiliated Jining No. 1 People's Hospital of Jining Medical University, Jining Medical University, Jining, Shandong Province, China
| | - Qixiu Lu
- Department of Ultrasonography, Jining No. 1 People's Hospital; Affiliated Jining No. 1 People's Hospital of Jining Medical University, Jining Medical University, Jining, Shandong Province, China
| | - Houlin Liu
- Department of Neurology, Jining No. 1 People's Hospital; Affiliated Jining No. 1 People's Hospital of Jining Medical University, Jining Medical University, Jining, Shandong Province, China
| | - Jixiang Yu
- Department of Vascular Surgery, Jining No. 1 People's Hospital; Affiliated Jining No. 1 People's Hospital of Jining Medical University, Jining Medical University, Jining, Shandong Province, China
| | - Chunlei Xin
- Department of Hematology, Jining No. 1 People's Hospital; Affiliated Jining No. 1 People's Hospital of Jining Medical University, Jining Medical University, Jining, Shandong Province, China
| | - Yingping Liu
- Department of Gastroenterology, Jining No. 1 People's Hospital; Affiliated Jining No. 1 People's Hospital of Jining Medical University, Jining Medical University, Jining, Shandong Province, China
| | - Yanfang Liu
- Department of Cardio-Thoracic Surgery, Jining No. 1 People's Hospital; Affiliated Jining No. 1 People's Hospital of Jining Medical University, Jining Medical University, Jining, Shandong Province, China
| | - Linlin Fan
- Department of Endocrinology, Jining No. 1 People's Hospital; Affiliated Jining No. 1 People's Hospital of Jining Medical University, Jining Medical University, Jining, Shandong Province, China
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80
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Antonelli B, Chen AF. Reducing the risk of infection after total joint arthroplasty: preoperative optimization. ARTHROPLASTY 2019; 1:4. [PMID: 35240760 PMCID: PMC8787890 DOI: 10.1186/s42836-019-0003-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 06/20/2019] [Indexed: 12/13/2022] Open
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81
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Golan T, Parikh R, Jacob E, Vaknine H, Zemser-Werner V, Hershkovitz D, Malcov H, Leibou S, Reichman H, Sheinboim D, Percik R, Amar S, Brenner R, Greenberger S, Kung A, Khaled M, Levy C. Adipocytes sensitize melanoma cells to environmental TGF-β cues by repressing the expression of miR-211. Sci Signal 2019; 12:12/591/eaav6847. [PMID: 31337739 DOI: 10.1126/scisignal.aav6847] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Transforming growth factor-β (TGF-β) superfamily members are critical signals in tissue homeostasis and pathogenesis. Melanoma grows in the epidermis and invades the dermis before metastasizing. This disease progression is accompanied by increased sensitivity to microenvironmental TGF-β. Here, we found that skin fat cells (adipocytes) promoted metastatic initiation by sensitizing melanoma cells to TGF-β. Analysis of melanoma clinical samples revealed that adipocytes, usually located in the deeper hypodermis layer, were present in the upper dermis layer within proximity to in situ melanoma cells, an observation that correlated with disease aggressiveness. In a coculture system, adipocytes secreted the cytokines IL-6 and TNF-α, which induced a proliferative-to-invasive phenotypic switch in melanoma cells by repressing the expression of the microRNA miR-211. In a xenograft model, miR-211 exhibited a dual role in melanoma progression, promoting cell proliferation while inhibiting metastatic spread. Bioinformatics and molecular analyses indicated that miR-211 directly targeted and repressed the translation of TGFBR1 mRNA, which encodes the type I TGF-β receptor. Hence, through this axis of cytokine-mediated repression of miR-211, adipocytes increased the abundance of the TGF-β receptor in melanoma cells, thereby enhancing cellular responsiveness to TGF-β ligands. The induction of TGF-β signaling, in turn, resulted in a proliferative-to-invasive phenotypic switch in cultured melanoma cells. Pharmacological inhibition of TGF-β prevented these effects. Our findings further reveal a molecular link between fat cells and metastatic progression in melanoma that might be therapeutically targeted in patients.
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Affiliation(s)
- Tamar Golan
- Department of Human Genetics and Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Roma Parikh
- Department of Human Genetics and Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Etai Jacob
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat Gan 5290002, Israel.,Department of Structural Biology, Weizmann Institute of Science, Rehovot 7610001, Israel.,Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA 02115, USA.,Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Hananya Vaknine
- Institute of Pathology, E. Wolfson Medical Center, Holon 58100, Israel
| | | | - Dov Hershkovitz
- Institute of Pathology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Hagar Malcov
- Department of Human Genetics and Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Stav Leibou
- Department of Human Genetics and Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Hadar Reichman
- Department of Human Genetics and Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Danna Sheinboim
- Department of Human Genetics and Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Ruth Percik
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel.,Institute of Endocrinology, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Sarah Amar
- Institute of Pathology, E. Wolfson Medical Center, Holon 58100, Israel
| | - Ronen Brenner
- Institute of Pathology, E. Wolfson Medical Center, Holon 58100, Israel
| | | | - Andrew Kung
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Mehdi Khaled
- INSERM 1186, Gustave Roussy, Université Paris-Saclay, Villejuif 94805, France
| | - Carmit Levy
- Department of Human Genetics and Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel.
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82
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Kasza I, Adler D, Nelson DW, Eric Yen CL, Dumas S, Ntambi JM, MacDougald OA, Hernando D, Porter WP, Best FA, Alexander CM. Evaporative cooling provides a major metabolic energy sink. Mol Metab 2019; 27:47-61. [PMID: 31302039 PMCID: PMC6717770 DOI: 10.1016/j.molmet.2019.06.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/08/2019] [Accepted: 06/27/2019] [Indexed: 11/30/2022] Open
Abstract
Objective Elimination of food calories as heat could help redress the excess accumulation of metabolic energy exhibited as obesity. Prior studies have focused on the induction of thermogenesis in beige and brown adipose tissues as the application of this principle, particularly because the β-adrenergic environment associated with thermogenic activation has been shown to have positive health implications. The counterpoint to this strategy is the regulation of heat loss; we propose that mammals with inefficient heat conservation will require more thermogenesis to maintain body temperature. Methods Surface temperature thermography and rates of trans-epidermal water loss were integrated to profile the total heat transfer of genetically-engineered and genetically variable mice. Results These data were incorporated with energy expenditure data to generate a biophysical profile to test the significance of increased rates of evaporative cooling. Conclusions We show that mouse skins vary considerably in their heat retention properties, whether because of naturally occurring variation (SKH-1 mice), or genetic modification of the heat-retaining lipid lamellae (SCD1, DGAT1 or Agouti Ay obese mice). In particular, we turn attention to widely different rates of evaporative cooling as the result of trans-epidermal water loss; higher rates of heat loss by evaporative cooling leads to increased demand for thermogenesis. We speculate that this physiology could be harnessed to create an energy sink to assist with strategies aimed at treating metabolic diseases.
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Affiliation(s)
- Ildiko Kasza
- McArdle Laboratory for Cancer Research, University of Wisconsin-Madison, United States
| | - Doug Adler
- Space Science and Engineering Center, University of Wisconsin-Madison, United States
| | - David W Nelson
- Department of Nutritional Sciences, University of Wisconsin-Madison, United States
| | - C-L Eric Yen
- Department of Nutritional Sciences, University of Wisconsin-Madison, United States
| | - Sabrina Dumas
- Department of Nutritional Sciences, University of Wisconsin-Madison, United States
| | - James M Ntambi
- Department of Nutritional Sciences, University of Wisconsin-Madison, United States; Department of Biochemistry, University of Wisconsin-Madison, United States
| | - Ormond A MacDougald
- Department of Molecular and Integrative Physiology, University of Michigan, United States
| | - Diego Hernando
- Department of Radiology, University of Wisconsin-Madison, United States
| | - Warren P Porter
- Department of Zoology, University of Wisconsin-Madison, United States
| | - Fred A Best
- Space Science and Engineering Center, University of Wisconsin-Madison, United States
| | - C M Alexander
- McArdle Laboratory for Cancer Research, University of Wisconsin-Madison, United States.
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83
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Metabolic Obesity Phenotypes and Risk of Cellulitis: A Cohort Study. J Clin Med 2019; 8:jcm8070953. [PMID: 31262086 PMCID: PMC6679047 DOI: 10.3390/jcm8070953] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/15/2019] [Accepted: 06/24/2019] [Indexed: 12/15/2022] Open
Abstract
No cohort studies have evaluated the effect of obesity on the risk of cellulitis according to metabolic health status. We investigated an association of BMI and metabolic health status with the development of cellulitis. We conducted a cohort study of 171,322 Korean adults who underwent a health checkup examination and were followed from 2011 to 2016 for cellulitis and hospital admission related to cellulitis, which were ascertained through the linkage to the Health Insurance and Review Agency database. Being metabolically healthy was defined as not having any metabolic syndrome component and having a homeostasis model assessment of insulin resistance <2.5. During 638,240.4 person-years of follow-up, 14,672 cases of incident cellulitis were identified with 225 cases of cellulitis-related admission. After adjustment for possible confounders, the multivariable-adjusted hazard ratios (95% CI) for incident cellulitis comparing BMIs 23–24.9, 25–29.9, and ≥30 with a BMI of 18.5–22.9 kg/m2 as the reference were 1.07 (1.02–1.11), 1.09 (1.04-1.13), and 1.19 (1.08–1.31), respectively, whereas the corresponding multivariable-adjusted hazard ratios (95% CI) for cellulitis-related admission were 1.55 (1.05–2.3), 2.47 (1.73–3.53), and 4.8 (2.86–8.05), respectively. These associations were consistently observed in both metabolically healthy and unhealthy individuals with no significant interaction. In a large cohort of apparently healthy adults, increased BMI was associated with an increased risk of cellulitis and hospitalization for cellulitis in both metabolically healthy and unhealthy individuals. Obesity appears to be an independent risk factor for cellulitis regardless of metabolic phenotype.
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84
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Metabolic Syndrome and Skin Disease: Potential Connection and Risk. INTERNATIONAL JOURNAL OF DERMATOLOGY AND VENEREOLOGY 2019. [DOI: 10.1097/01.jd9.0000559519.08557.fa] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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85
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Popa ML, Popa AC, Tanase C, Gheorghisan-Galateanu AA. Acanthosis nigricans: To be or not to be afraid. Oncol Lett 2019; 17:4133-4138. [PMID: 30944606 PMCID: PMC6444334 DOI: 10.3892/ol.2018.9736] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 08/14/2018] [Indexed: 12/12/2022] Open
Abstract
Acanthosis nigricans (AN), a skin disorder with high prevalence, represents a dermatological condition with esthetic implications, but otherwise mild symptoms. For any clinician, it is in fact the tip of the iceberg, leading him/her to investigate what lies beneath the surface, since AN points to a systemic problem or disease: metabolic disorder (most frequently), endocrine syndrome, medication side effects, malignancy, and genetic factors. Sometimes, it is the first observed sign of a malignancy or of diabetes mellitus, especially in patients with chronic metabolic disorder; therefore, it is not to be taken lightly. The present review summarizes the information in literature regarding the etiopathogenesis of AN. We propose a new classification that aims to better organize the different types of AN, with implications on the extent and urgency of the investigation plan, as well as various therapeutic algorithms. Therapy options are also presented, both systemic treatments that target the underlying disease, and local ones for esthetic reasons.
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Affiliation(s)
- Maria-Linda Popa
- Department of Cellular and Molecular Biology and Histology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Biochemistry-Proteomics, ‘Victor Babes’ National Institute of Pathology, 050096 Bucharest, Romania
| | | | - Cristiana Tanase
- Department of Biochemistry-Proteomics, ‘Victor Babes’ National Institute of Pathology, 050096 Bucharest, Romania
| | - Ancuta-Augustina Gheorghisan-Galateanu
- Department of Cellular and Molecular Biology and Histology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- ‘C.I. Parhon’ National Institute of Endocrinology, 001863 Bucharest, Romania
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86
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Messner M, Ghadge SK, Schuetz T, Seiringer H, Pölzl G, Zaruba MM. High Body Mass Index is Associated with Elevated Blood Levels of Progerin mRNA. Int J Mol Sci 2019; 20:ijms20081976. [PMID: 31018503 PMCID: PMC6515652 DOI: 10.3390/ijms20081976] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 04/06/2019] [Accepted: 04/21/2019] [Indexed: 12/11/2022] Open
Abstract
Obesity is a well-described risk factor resulting in premature aging of the cardiovascular system ultimately limiting longevity. Premature cardiac death and aging is the hallmark of Hutchinson-Gilford syndrome (HGPS), a disease caused by defined mutations in the lamin A gene leading to a shortened prelamin A protein known as progerin. Since small amounts of progerin are expressed in healthy individuals we aimed to investigate the association of Body-Mass-Index (BMI) with respect to expression of progerin mRNA in blood samples of patient with known cardiovascular disease. In this cross-sectional retrospective analysis, 111 patients were consecutively included of which 46 were normal (BMI < 25 kg/m2) and 65 overweight (BMI ≥ 25.0 kg/m2). Blood samples were analyzed for quantitative expression of progerin mRNA. Progerin as well as high-sensitive C-Reactive Protein (hs-CRP) levels were significantly upregulated in the overweight group. Linear regression analyses showed a significant positive correlation of BMI and progerin mRNA (n = 111; r = 0.265, p = 0.005), as well as for hs-CRP (n = 110; r = 0.300, p = 0.001) and for Hb1Ac (n = 110; r = 0.336, p = 0.0003). Our data suggest that BMI strongly correlates with progerin mRNA expression and inflammation. Progerin might contribute to well described accelerated biologic aging in obese individuals.
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Affiliation(s)
- Moritz Messner
- Department of Internal Medicine III, Cardiology and Angiology, Medical University Innsbruck, 6020 Innsbruck, Austria.
| | - Santhosh Kumar Ghadge
- Department of Internal Medicine III, Cardiology and Angiology, Medical University Innsbruck, 6020 Innsbruck, Austria.
| | - Thomas Schuetz
- Department of Internal Medicine III, Cardiology and Angiology, Medical University Innsbruck, 6020 Innsbruck, Austria.
| | - Herbert Seiringer
- Department of Internal Medicine III, Cardiology and Angiology, Medical University Innsbruck, 6020 Innsbruck, Austria.
| | - Gerhard Pölzl
- Department of Internal Medicine III, Cardiology and Angiology, Medical University Innsbruck, 6020 Innsbruck, Austria.
| | - Marc-Michael Zaruba
- Department of Internal Medicine III, Cardiology and Angiology, Medical University Innsbruck, 6020 Innsbruck, Austria.
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87
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Kojyl Cinnamate Ester Derivatives Increase Adiponectin Expression and Stimulate Adiponectin-Induced Hair Growth Factors in Human Dermal Papilla Cells. Int J Mol Sci 2019; 20:ijms20081859. [PMID: 30991711 PMCID: PMC6514963 DOI: 10.3390/ijms20081859] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 03/28/2019] [Accepted: 04/12/2019] [Indexed: 02/06/2023] Open
Abstract
Adiponectin (APN), released mainly from adipose tissue, is a well-known homeostatic factor for regulating glucose levels, lipid metabolism, and insulin sensitivity. A recent study showed that human hair follicles express APN receptors and the presence of APN-mediated hair growth signaling, thereby suggesting that APN is a potent hair growth-promoting adipokine. Previously, kojyl cinnamate ester derivatives (KCEDs) were synthesized in our institute as new anti-aging or adiponectin-/adipogenesis-inducing compounds. Here, we tested the activity of these derivatives to induce endogenous APN secretion. Among the derivatives, KCED-1 and KCED-2 showed improved activity in inducing APN mRNA expression, secretion of APN protein, and adipogenesis in human subcutaneous fat cells (hSCFs) when compared with the effects of Seletinoid G, a verified APN inducer. When human follicular dermal papilla cells were treated with the culture supernatant of KCED-1- or KCED-2-treated hSCFs, the mRNA expression of APN-induced hair growth factors such as insulin-like growth factor, hepatocyte growth factor, and vascular endothelial growth factor was upregulated compared with that in the control. Taken together, our study shows that among kojyl cinnamate ester derivatives, KCED-1, KCED-2, as well as Seletinoid G are effective inducers of endogenous APN production in subcutaneous fat tissues, which may in turn contribute to the promotion of hair growth in the human scalp.
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88
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Mehta A, Hasija Y. Meta-analyses of associations of obesity with risk of melanoma and acne based on case-control studies. BIOMEDICAL DERMATOLOGY 2019. [DOI: 10.1186/s41702-019-0041-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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89
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Haws RM, McIntee TJ, Green CB. Cutaneous findings in Bardet‐Biedl syndrome. Int J Dermatol 2019; 58:1160-1164. [DOI: 10.1111/ijd.14412] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 11/26/2018] [Accepted: 01/29/2019] [Indexed: 11/28/2022]
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90
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Woo K, Hill R, LeBlanc K, Schultz G, Swanson T, Weir D, Mayer DO. Technological features of advanced skin protectants and an examination of the evidence base. J Wound Care 2019; 28:110-125. [DOI: 10.12968/jowc.2019.28.2.110] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kevin Woo
- Associate Professor; Queen's University, Kingston, Canada
| | - Rosemary Hill
- Wound Ostomy Continence Clinician; Vancouver Coastal, Canada
| | | | - Gregory Schultz
- Researcher; Professor Ob/Gyn, Director Institute for Wound Research University of Florida, Gainesville, Florida, US
| | - Terry Swanson
- Nurse Practitioner; Warrnambool, Australia. 6 Catholic Health Advanced Wound Healing Centres, Buffalo, New York, US
| | - Dot Weir
- Catholic Health Advanced Wound Healing Centres, Buffalo, New York, US
| | - Dieter O. Mayer
- Head of Vascular Surgery Unit and Wound Centre; Department of Surgery, HFR Fribourg – Cantonal Hospital, Fribourg, Switzerland
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91
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Duyur Cakıt B, Pervane Vural S, Ayhan FF. Complex Decongestive Therapy in Breast Cancer-Related Lymphedema: Does Obesity Affect the Outcome Negatively? Lymphat Res Biol 2019; 17:45-50. [DOI: 10.1089/lrb.2017.0086] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Burcu Duyur Cakıt
- Division of Oncologic Rehabilitation and Lymphedema, Department of Physical Medicine and Rehabilitation, Ankara Training and Research Hospital, Ankara, Turkey
| | - Secil Pervane Vural
- Division of Oncologic Rehabilitation and Lymphedema, Department of Physical Medicine and Rehabilitation, Ankara Training and Research Hospital, Ankara, Turkey
| | - F. Figen Ayhan
- Division of Oncologic Rehabilitation and Lymphedema, Department of Physical Medicine and Rehabilitation, Ankara Training and Research Hospital, Ankara, Turkey
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Breslin JW, Yang Y, Scallan JP, Sweat RS, Adderley SP, Murfee WL. Lymphatic Vessel Network Structure and Physiology. Compr Physiol 2018; 9:207-299. [PMID: 30549020 PMCID: PMC6459625 DOI: 10.1002/cphy.c180015] [Citation(s) in RCA: 174] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The lymphatic system is comprised of a network of vessels interrelated with lymphoid tissue, which has the holistic function to maintain the local physiologic environment for every cell in all tissues of the body. The lymphatic system maintains extracellular fluid homeostasis favorable for optimal tissue function, removing substances that arise due to metabolism or cell death, and optimizing immunity against bacteria, viruses, parasites, and other antigens. This article provides a comprehensive review of important findings over the past century along with recent advances in the understanding of the anatomy and physiology of lymphatic vessels, including tissue/organ specificity, development, mechanisms of lymph formation and transport, lymphangiogenesis, and the roles of lymphatics in disease. © 2019 American Physiological Society. Compr Physiol 9:207-299, 2019.
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Affiliation(s)
- Jerome W. Breslin
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Ying Yang
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Joshua P. Scallan
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Richard S. Sweat
- Department of Biomedical Engineering, Tulane University, New Orleans, LA
| | - Shaquria P. Adderley
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - W. Lee Murfee
- Department of Biomedical Engineering, University of Florida, Gainesville, FL
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93
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Real-World Evidence of Disease Burden in Obese Patients Hospitalized With Acute Bacterial Skin and Skin-Structure Infections. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2018. [DOI: 10.1097/ipc.0000000000000688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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94
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Herbert D, Franz S, Popkova Y, Anderegg U, Schiller J, Schwede K, Lorz A, Simon JC, Saalbach A. High-Fat Diet Exacerbates Early Psoriatic Skin Inflammation Independent of Obesity: Saturated Fatty Acids as Key Players. J Invest Dermatol 2018; 138:1999-2009. [DOI: 10.1016/j.jid.2018.03.1522] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 03/12/2018] [Accepted: 03/18/2018] [Indexed: 12/13/2022]
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95
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Carson JT, Shah SG, Ortega G, Thamyongkit S, Hasenboehler EA, Shafiq B. Complications of pelvic and acetabular fractures in 1331 morbidly obese patients (BMI ≥ 40): a retrospective observational study from the National Trauma Data Bank. Patient Saf Surg 2018; 12:26. [PMID: 30181776 PMCID: PMC6114733 DOI: 10.1186/s13037-018-0172-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 08/20/2018] [Indexed: 01/19/2023] Open
Abstract
Background There have been no large-scale epidemiological studies of outcomes and perioperative complications in morbidly obese trauma patients who have sustained closed pelvic ring or acetabular fractures. We examined this population and compared their rate of inpatient complications with that of control patients. Methods We retrospectively reviewed the records of patients treated for closed pelvic ring or acetabular fracture, aged 16–85 years, with Injury Severity Scores ≤15 from the National Trauma Data Bank Research Dataset for the years 2007 through 2010. The primary outcome of interest was rate of in-hospital complications. Secondary outcomes were length of hospital stay and discharge disposition. Unadjusted differences in complication rates were evaluated using Student t tests and Chi-squared analyses. Multiple logistic and Poisson regression were used to analyze binary outcomes and length of hospital stay, respectively, adjusting for several variables. Statistical significance was defined as p < 0.05. Results We included 46,450 patients in our study. Of these patients, 1331 (3%) were morbidly obese (body mass index ≥40) and 45,119 (97%) were used as controls. Morbidly obese patients had significantly higher odds of complication and longer hospital stay in all groups considered except those with pelvic fractures that were treated operatively. In all groups, morbidly obese patients were more likely to be discharged to a skilled nursing/rehabilitation facility compared with control patients. Conclusions Morbidly obese patients had higher rates of complications and longer hospital stays and were more likely to be discharged to rehabilitation facilities compared with control patients after pelvic ring or acetabular fracture.
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Affiliation(s)
- James T Carson
- 1Department of Orthopaedic Surgery, Howard University College of Medicine, Washington, DC, USA
| | - Sabin G Shah
- 2Department of Orthopaedic Surgery, University of California Irvine, Orange, CA USA
| | - Gezzer Ortega
- 3Outcomes Research Center, Department of Surgery, Howard University College of Medicine, Washington, DC, USA
| | - Sorawut Thamyongkit
- 4Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 N Caroline St, Fl 5, Baltimore, MD 21205 USA
| | - Erik A Hasenboehler
- 4Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 N Caroline St, Fl 5, Baltimore, MD 21205 USA
| | - Babar Shafiq
- 4Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 N Caroline St, Fl 5, Baltimore, MD 21205 USA
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Tran T, Yang J, Gardner J, Xiong Y. GDF15 deficiency promotes high fat diet-induced obesity in mice. PLoS One 2018; 13:e0201584. [PMID: 30070999 PMCID: PMC6072047 DOI: 10.1371/journal.pone.0201584] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 07/18/2018] [Indexed: 12/28/2022] Open
Abstract
Pharmacological treatment of recombinant growth differentiation factor 15 (GDF15) proteins reduces body weight in obese rodents and primates. Paradoxically, circulating GDF15 levels are increased in obesity. To investigate the role of endogenous GDF15 in obesity development, we put GDF15 knockout mice and wildtype controls on high fat diet for the mice to develop diet-induced obesity. Compared to wildtype animals, GDF15 knockout mice were more prone to high fat diet-induced obesity. Male knockout mice showed worse glucose tolerance, lower locomotor activity and lower metabolic rate than wildtype mice. Additionally, GDF15 deficiency increased occurrences of high fat diet-induced skin lesions. Our data suggests that endogenous GDF15 has a protective role in obesity development and lack of GDF15 aggravates the progression of obesity and associated pathological conditions. Elevated GDF15 levels in obesity may have resulted from a response to overcome GDF15 resistance.
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Affiliation(s)
- Thanhvien Tran
- Departments of Cardiometabolic Disorders; Amgen Inc., South San Francisco, CA, United States of America
| | - Jingping Yang
- Departments of Cardiometabolic Disorders; Amgen Inc., South San Francisco, CA, United States of America
| | - Jonitha Gardner
- Departments of Cardiometabolic Disorders; Amgen Inc., South San Francisco, CA, United States of America
| | - Yumei Xiong
- Departments of Cardiometabolic Disorders; Amgen Inc., South San Francisco, CA, United States of America
- * E-mail:
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97
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Bliss ES, Whiteside E. The Gut-Brain Axis, the Human Gut Microbiota and Their Integration in the Development of Obesity. Front Physiol 2018; 9:900. [PMID: 30050464 PMCID: PMC6052131 DOI: 10.3389/fphys.2018.00900] [Citation(s) in RCA: 114] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 06/21/2018] [Indexed: 12/17/2022] Open
Abstract
Obesity is a global epidemic, placing socioeconomic strain on public healthcare systems, especially within the so-called Western countries, such as Australia, United States, United Kingdom, and Canada. Obesity results from an imbalance between energy intake and energy expenditure, where energy intake exceeds expenditure. Current non-invasive treatments lack efficacy in combating obesity, suggesting that obesity is a multi-faceted and more complex disease than previously thought. This has led to an increase in research exploring energy homeostasis and the discovery of a complex bidirectional communication axis referred to as the gut-brain axis. The gut-brain axis is comprised of various neurohumoral components that allow the gut and brain to communicate with each other. Communication occurs within the axis via local, paracrine and/or endocrine mechanisms involving a variety of gut-derived peptides produced from enteroendocrine cells (EECs), including glucagon-like peptide 1 (GLP1), cholecystokinin (CCK), peptide YY3-36 (PYY), pancreatic polypeptide (PP), and oxyntomodulin. Neural networks, such as the enteric nervous system (ENS) and vagus nerve also convey information within the gut-brain axis. Emerging evidence suggests the human gut microbiota, a complex ecosystem residing in the gastrointestinal tract (GIT), may influence weight-gain through several inter-dependent pathways including energy harvesting, short-chain fatty-acids (SCFA) signalling, behaviour modifications, controlling satiety and modulating inflammatory responses within the host. Hence, the gut-brain axis, the microbiota and the link between these elements and the role each plays in either promoting or regulating energy and thereby contributing to obesity will be explored in this review.
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Affiliation(s)
- Edward S. Bliss
- School of Health and Wellbeing, University of Southern Queensland, Toowoomba, QLD, Australia
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98
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Chin SJ, Moore GA, Zhang M, Clarke HD, Spangehl MJ, Young SW. The AAHKS Clinical Research Award: Intraosseous Regional Prophylaxis Provides Higher Tissue Concentrations in High BMI Patients in Total Knee Arthroplasty: A Randomized Trial. J Arthroplasty 2018; 33:S13-S18. [PMID: 29655497 DOI: 10.1016/j.arth.2018.03.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 02/26/2018] [Accepted: 03/01/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Obesity is an established risk factor for periprosthetic joint infections after total knee arthroplasty (TKA). In obese patients, a larger dose of prophylactic vancomycin based on actual body weight is required to reach therapeutic concentrations. It is unclear how tissue concentrations are affected when intraosseous regional administration (IORA) is used in this population. This study compared tissue concentrations of low-dose vancomycin via IORA vs actual body weight-adjusted systemic intravenous (IV) dose in primary TKA. METHODS Twenty-two patients with a body mass index (BMI) >35 undergoing TKA were randomized into 2 groups. The IV group received 15 mg/kg (maximum of 2 g) of systemic IV vancomycin and the IORA group received 500 mg vancomycin into the tibia. Subcutaneous fat and bone samples were taken at regular intervals. Tissue antibiotic concentrations were measured using liquid chromatography coupled with tandem mass spectrometry. A blood sample was taken 1 to 2 hours after tourniquet deflation to measure systemic concentration. RESULTS The mean BMI was 41.1 in the IORA group and 40.1 in the IV systemic group. The overall mean tissue concentration in subcutaneous fat was 39.3 μg/g in the IORA group and 4.4 μg/g in the IV systemic group (P < .01). Mean tissue concentrations in bones were 34.4 μg/g in the IORA group and 6.1 μg/g in the IV systemic group (P < .01). CONCLUSION Low-dose IORA was effective in the high-BMI population group, providing tissue concentrations of vancomycin 5-9 times higher than systemic administration. IORA optimizes timing of vancomycin administration and provides high tissue antibiotic concentrations during TKA in this high-risk patient group.
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Affiliation(s)
- Seung Joon Chin
- Department of Anaesthesia, Middlemore Hospital, Auckland, New Zealand
| | - Grant A Moore
- Department of Toxicology, Canterbury Health Laboratories, Christchurch, New Zealand
| | - Mei Zhang
- Clinical Pharmacology, University of Otago, Christchurch, New Zealand
| | - Henry D Clarke
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, United States
| | - Mark J Spangehl
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, United States
| | - Simon W Young
- Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
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99
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MESH Headings
- Adipokines/metabolism
- Adipose Tissue, White/metabolism
- Adipose Tissue, White/physiopathology
- Adiposity
- Animals
- Comorbidity
- Energy Metabolism
- Humans
- Inflammation Mediators/metabolism
- Kidney/metabolism
- Kidney/physiopathology
- Obesity/epidemiology
- Obesity/metabolism
- Obesity/physiopathology
- Obesity/therapy
- Obesity, Metabolically Benign/epidemiology
- Obesity, Metabolically Benign/metabolism
- Obesity, Metabolically Benign/physiopathology
- Obesity, Metabolically Benign/therapy
- Prognosis
- Renal Insufficiency, Chronic/epidemiology
- Renal Insufficiency, Chronic/metabolism
- Renal Insufficiency, Chronic/physiopathology
- Renal Insufficiency, Chronic/therapy
- Risk Factors
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Affiliation(s)
- Jay I Lakkis
- University of Hawaii John A. Burns School of Medicine, 95 Maui Lani Pkwy, Wailuku, HI 96793-2416
| | - Mathew R Weir
- Division of Nephrology, University of Maryland School of Medicine, 22 S. Greene St., Room N3W143, Baltimore, MD 21201.
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100
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Cascio V, Hon M, Haramati LB, Gour A, Spiegler P, Bhalla S, Katz DS. Imaging of suspected pulmonary embolism and deep venous thrombosis in obese patients. Br J Radiol 2018; 91:20170956. [PMID: 29762047 DOI: 10.1259/bjr.20170956] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Obesity is a growing problem around the world, and radiology departments frequently encounter difficulties related to large patient size. Diagnosis and management of suspected venous thromboembolism, in particular deep venous thrombosis (DVT) and pulmonary embolism (PE), are challenging even in some lean patients, and can become even more complicated in the setting of obesity. Many obstacles must be overcome to obtain imaging examinations in obese patients with suspected PE and/or DVT, and to ensure that these examinations are of sufficient quality to diagnose or exclude thromboembolic disease, or to establish an alternative diagnosis. Equipment limitations and technical issues both need to be acknowledged and addressed. Table weight limits and scanner sizes that readily accommodate obese and even morbidly obese patients are not in place at many clinical sites. There are also issues with image quality, which can be substantially compromised. We discuss current understanding of the effects of patient size on imaging in general and, more specifically, on the imaging modalities used for the diagnosis and treatment of DVT and PE. Emphasis will be placed on the technical parameters and protocol nuances, including contrast dosing, which are necessary to refine and optimize images for the diagnosis of DVT and PE in obese patients, while remaining cognizant of radiation exposure. More research is necessary to develop consistent high-level evidence regarding protocols to guide radiologists, and to help them effectively utilize emerging technology.
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Affiliation(s)
- Vincent Cascio
- 1 Stony Brook University School of Medicine , Stony Brook, NY , USA.,2 Department of Radiology, NYU Winthrop, Stony Brook University School of Medicine , Mineola, NY , USA
| | - Man Hon
- 3 Interventional Radiology, NYU Winthrop, Stony Brook University School of Medicine , Stony Brook, NY , USA
| | - Linda B Haramati
- 4 Division of Cardiothoracic Imaging, Montefiore Medical Center and the Albert Einstein College of Medicine , Bronx, NY , USA
| | - Animesh Gour
- 5 Division of Pulmonaryand Critical Care Medicine, Department of Internal Medicine, NYU Winthrop , Mineola, NY , USA
| | - Peter Spiegler
- 1 Stony Brook University School of Medicine , Stony Brook, NY , USA
| | - Sanjeev Bhalla
- 6 Mallinckrodt Institute of Radiology, Washington University School of Medicine , St Louis, MO , USA
| | - Douglas S Katz
- 2 Department of Radiology, NYU Winthrop, Stony Brook University School of Medicine , Mineola, NY , USA
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