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Liu Y, Wu H, Liu B, Chen S, Huang L, Liu Z, Wang J, Xie L, Wu X. Multi-omics analysis reveals the impact of gut microbiota on antipsychotic-induced weight gain in schizophrenia. Schizophr Res 2024; 270:325-338. [PMID: 38964078 DOI: 10.1016/j.schres.2024.06.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/16/2024] [Accepted: 06/22/2024] [Indexed: 07/06/2024]
Abstract
Emerging evidence indicates that gut microbial dysbiosis is associated with the development of antipsychotic-induced weight gain in schizophrenia (SZ). However, the exact taxonomic composition and functionality that constitute the "obesogenic" microbial profile remain elusive. Our retrospective survey identified two groups of the SZ population separated by BMI, with 1/3 of patients developing overweight/obesity after chronic antipsychotic treatment. Based on multi-omics analysis, we observed altered gut microbiota in SZ patients with overweight/obesity, characterized by a reduction in several beneficial bacteria genera, including Bacteroides, Parabacteroides, Akkermansia, and Clostridium. This microbial dysbiosis was accompanied by disrupted energy expenditure and nutritional metabolism, worsened metabolic indices, and reduced levels of beneficial metabolites, e.g. indole-3-carboxylic acid and propionic acid. Moreover, leveraging data from first-episode drug-naïve schizophrenia (FSZ) patients at one-month and one-year follow-up, both artificial neural network and random forest classifier-based prediction models demonstrated a strong ability of microbial profiles to predict antipsychotic-induced weight gain. Importantly, FSZ patients with higher relative abundance of Parabacteria distasonis were less susceptible to antipsychotic-induced weight gain. Thus, gut microbiota could serve as a noninvasive approach to predict antipsychotic-induced weight gain, guiding clinical antipsychotics administration and developing novel therapeutic strategies for weight management in SZ.
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Affiliation(s)
- Yaxi Liu
- Psychiatry Department, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China; Sleep Medicine Center of Psychiatry Department, The First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Hui Wu
- Radiology Department, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Bingdong Liu
- Department of Endocrinology and Metabolism, Zhujiang Hospital of Southern Medical University, Guangzhou 510280, China; State Key Laboratory of Applied Microbiology Southern China, Guangdong Institute of Microbiology, Guangdong Provincial Key Laboratory of Microbial Culture Collection and Application, Institute of Microbiology, Guangdong Academy of Sciences, Guangzhou 510070, China
| | - Shengyun Chen
- Psychiatry Department, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Liujing Huang
- State Key Laboratory of Applied Microbiology Southern China, Guangdong Institute of Microbiology, Guangdong Provincial Key Laboratory of Microbial Culture Collection and Application, Institute of Microbiology, Guangdong Academy of Sciences, Guangzhou 510070, China
| | - Zhihong Liu
- State Key Laboratory of Applied Microbiology Southern China, Guangdong Institute of Microbiology, Guangdong Provincial Key Laboratory of Microbial Culture Collection and Application, Institute of Microbiology, Guangdong Academy of Sciences, Guangzhou 510070, China
| | - Jie Wang
- Department of Life Sciences, Imperial College London, London SW7 2AZ, United Kingdom
| | - Liwei Xie
- State Key Laboratory of Applied Microbiology Southern China, Guangdong Institute of Microbiology, Guangdong Provincial Key Laboratory of Microbial Culture Collection and Application, Institute of Microbiology, Guangdong Academy of Sciences, Guangzhou 510070, China.
| | - Xiaoli Wu
- Psychiatry Department, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China.
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Zhao L, Zhang X, Guo S, Han K, Sun Y, Li X, Yan Z, WeiPeng. Relationship between composite dietary antioxidant index and depression among overweight and obese adults. J Affect Disord 2023; 341:358-365. [PMID: 37673289 DOI: 10.1016/j.jad.2023.08.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/22/2023] [Accepted: 08/31/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND The use of specific dietary patterns to alleviate depressive symptoms has gained increasing recognition. The Composite Dietary Antioxidant Index (CDAI) is a crucial criterion for assessing antioxidant diets. We examined the relationship between CDAI and depression among overweight and obese adults through a cross-sectional study conducted in the United States. METHODS We used weighted multivariate logistic regression models with subgroup analysis to study the relationship between CDAI and depression. Generalized additive models were used to determine whether there was a nonlinear association between them. We developed a two-piece linear regression model to calculate the inflection point utilizing a recursive strategy. RESULTS After adjusting for confounding variables, the odds ratios (ORs; 95 % CI) for the correlation between CDAI and depression were 0.75 (0.67, 0.84). A saturation effect emerged for the overweight group, following which we calculated the inflection point for the overweight population, which displayed ORs (95 % CI) of 0.62 (0.47, 0.80) before the inflection point of 0.83 and the ORs (95 % CI) of 1.01 (0.77, 1.31) after 0.83. The interaction was statistically significant in the sex stratification of the obese population. CONCLUSIONS Our study highlighted a negative association between CDAI and depression among overweight and obese adults. Saturation effects and sex differences were observed in the overweight population.
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Affiliation(s)
- Leiyong Zhao
- Department of Psychosomatic Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
| | - Xin Zhang
- The First Clinical Medical Academy, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
| | - Shanshan Guo
- Department of Psychosomatic Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
| | - Kunqi Han
- Department of Neurology, Rizhao Hospital of Traditional Chinese Medicine, Rizhao, Shandong Province, China
| | - Yiyan Sun
- College of traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
| | - Xiaotong Li
- College of traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
| | - Zhaojun Yan
- Department of Psychosomatic Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
| | - WeiPeng
- Department of Psychosomatic Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China.
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Mammadov G, Taskin U, Dindas F, Dogdus M. Demonstration of subclinical left ventricular electrical and mechanical dysfunction in overweight subjects by frontal QRS-T angle and 3D-speckle tracking echocardiography. Echocardiography 2023; 40:969-975. [PMID: 37547932 DOI: 10.1111/echo.15667] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 07/15/2023] [Accepted: 07/27/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Overweightness is a considerable step in the process leading to obesity. There are no sufficient studies on the effect of cardiomyopathy defined in obese patients about overweight subjects. We thought that it may be useful to examine the myocardial involvement in overweight individuals electro-mechanically with more sensitive techniques before the development of obesity cardiomyopathy. AIM The aim of the present study was to demonstrate whether or not there are subclinical left ventricular (LV) electrical and mechanical dysfunctions in overweight patients using frontal QRS-T (fQRS-T) angle (electrically) and 3D-speckle tracking echocardiography (mechanically). METHODS A total of 80 overweight patients and 80 age- and sex-matched normal weight individuals were enrolled into the study. 3D-STE examinations of the patients were performed. Electrocardiographic recordings were obtained for fQRS-T angle assessment. RESULTS The LV-GLS and LV-GCS were significantly depressed in the overweight group than in the normal weight group (-14.5 ± 3.4 vs. -21.7 ± 3.6, p < .001; -15.2 ± 4.6 vs. -24.3 ± 4.8, p < .001, respectively). The fQRS-T angle was found to be increased in the overweight group (142.5 ± 39.2 vs. 114.7 ± 43.5, p = < .001). Statistically significant positive linear correlations were observed between BMI with LV-GLS, LV-GCS, and fQRS-T angle. LV-GLS and LV-GCS were found to be disrupted linearly as BMI increased (r = .718 for BMI and LV-GLS, r = .653 for BMI and LV-GCS). As BMI increased, it was found that the fQRS-T angle increased (r = .692 for BMI and fQRS-T angle). CONCLUSION Our results support that, overweight individuals, despite their being apparently healthy, may have subclinical LV myocardial mechanical and electrical dysfunction.
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Affiliation(s)
- Ganbar Mammadov
- Faculty of Medicine, Department of Cardiology, Izmir University of Economics, Izmir, Turkey
| | - Ugur Taskin
- Faculty of Medicine, Department of Cardiology, Izmir University of Economics, Izmir, Turkey
| | - Ferhat Dindas
- Department of Cardiology, Training and Research Hospital, Usak University, Usak, Turkey
| | - Mustafa Dogdus
- Faculty of Medicine, Department of Cardiology, Izmir University of Economics, Izmir, Turkey
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Fornari Laurindo L, Minniti G, José Tofano R, Quesada K, Federighi Baisi Chagas E, Maria Barbalho S. Detection of Metabolic Syndrome Using Insulin Resistance Indexes: A Cross-Sectional Observational Cohort Study. ENDOCRINES 2023. [DOI: 10.3390/endocrines4020021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
Insulin resistance (IR) is considered cardinal to the pathophysiology of metabolic syndrome (MetS). Previously, several simple indexes of IR calculated from biochemical and anthropometric variables have been proposed. However, these indexes are population-dependent; therefore, further studies on a global scale are necessary. The present study assessed the diagnostic accuracy of eight IR indicators, namely, METS-IR, TG-HDL-c, TyG, TyG-BMI, TyG-NC, TyG-NHtR, TyG-WC, and TyG-WHtR, in indicating MetS among a Brazilian population. For this, 268 patients (152 men and 116 women, 53–59 years of age) were included in the study, out of which 111 were diagnosed with MetS according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III). All indexes achieved significant accuracy, with TyG-WC (0.849 (0.800–0.889)), TyG (0.837 (0.787–0.879)), and TG-HDL-c (0.817 (0.765–0.861)) having the highest area under the curve (AUC). Further, the most heightened diagnostic sensitivities were observed for TG-HDL-c (90.99%), TyG-WC (89.19%), and TyG-NC (84.68%), whereas the highest diagnostic specificities were noted for TyG (73.89%), TyG-WHtR (72.61%), and TyG-WC (66.88%). Thus, TyG-WC, TyG, and TG-HDL-c reached the greatest AUC values in our analyses, making them useful diagnostic indicators of MetS, and crucial for patients’ clinical management.
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Affiliation(s)
- Lucas Fornari Laurindo
- Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Avenida Hygino Muzzy Filho, 1001, Marília 17525-902, SP, Brazil
- Department of Biochemistry and Pharmacology, School of Medicine, Faculdade de Medicina de Marília (FAMEMA), Avenida Monte Carmelo, 800, Marília 17519-030, SP, Brazil
| | - Giulia Minniti
- Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Avenida Hygino Muzzy Filho, 1001, Marília 17525-902, SP, Brazil
| | - Ricardo José Tofano
- Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Avenida Hygino Muzzy Filho, 1001, Marília 17525-902, SP, Brazil
| | - Karina Quesada
- Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Avenida Hygino Muzzy Filho, 1001, Marília 17525-902, SP, Brazil
| | - Eduardo Federighi Baisi Chagas
- Postgraduate Program in Health and Aging, Faculdade de Medicina de Marília (FAMEMA), Avenida Monte Carmelo, 800, Marília 17519-030, SP, Brazil
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marília (UNIMAR), Avenida Hygino Muzzy Filho, 1001, Marília 17525-902, SP, Brazil
| | - Sandra Maria Barbalho
- Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Avenida Hygino Muzzy Filho, 1001, Marília 17525-902, SP, Brazil
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marília (UNIMAR), Avenida Hygino Muzzy Filho, 1001, Marília 17525-902, SP, Brazil
- Department of Biochemistry and Nutrition, School of Food and Technology of Marília (FATEC), Avenida Castro Alves, 62, Marília 17500-000, SP, Brazil
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Böyük F, Çalışkan S, Demirkıran A. The Relationship Between the Frontal QRS-T Angle and High Blood Pressure Response to Exercise. ISTANBUL MEDICAL JOURNAL 2023. [DOI: 10.4274/imj.galenos.2023.70846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
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Ciucurel C, Iconaru EI. The Relationship between the Frontal QRS-T Angle on ECG and Physical Activity Level in Young Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2411. [PMID: 36767776 PMCID: PMC9916196 DOI: 10.3390/ijerph20032411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/20/2023] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The heart's electrical activity has been the subject of numerous research concerning various physiological parameters. The frontal QRS-T angle (FQRST) is an advanced ECG variable with clinical epidemiological utility. This study aimed to determine the relationship between FQRST and physical activity exposure among young adults. METHODS We recorded the ECG with 12 leads of 124 participants (mean age 20.28 ± 2.23 years, age range 18-27 years). Next, we measured their physical activity level (PAL) with the International Physical Activity Questionnaire-Short Form (IPAQ), which categorizes activity into three classes: low, moderate, or high. RESULTS An inferential analysis, based on the Kruskal-Wallis H test and Mann-Whitney U test, revealed a statistically significant difference in FQRST between the three groups of subjects, classified by their PAL (p < 0.001). We also identified a significant regression model between the body mass index (BMI) and the FQRST (p < 0.001). CONCLUSIONS The physical activity regime of young adults significantly influences the concordance between ventricular depolarization and repolarization, reflected in the FQRST's width. Also, we found a regression model between FQRST and BMI with statistical significance.
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Wu H, Dai G, Aizezi M, Tang J, Zou K, Wu Y, Wu X. Gray matter reduction in bilateral insula mediating adverse psychiatric effects of body mass index in schizophrenia. BMC Psychiatry 2022; 22:639. [PMID: 36221050 PMCID: PMC9552355 DOI: 10.1186/s12888-022-04285-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 09/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Both schizophrenia (SZ) and overweight/obesity (OWB) have shown some structural alterations in similar brain regions. As higher body mass index (BMI) often contributes to worse psychiatric outcomes in SZ, this study was designed to examine the effects of OWB on gray matter volume (GMV) in patients with SZ. METHODS Two hundred fifty subjects were included and stratified into four groups (n = 69, SZ patients with OWB, SZ-OWB; n = 74, SZ patients with normal weight, SZ-NW; n = 54, healthy controls with OWB, HC-OWB; and n = 53, HC with NW, HC-NW). All participants were scanned using high-resolution T1-weighted sequence. The whole-brain voxel-based morphometry was applied to examine the GMV alterations, and a 2 × 2 full factorial analysis of variance was performed to identify the main effects of diagnosis (SZ vs HC), BMI (NW vs OWB) factors, and their interactions. Further, the post hoc analysis was conducted to compare the pairwise differences in GMV alterations. RESULTS The main effects of diagnosis were located in right hippocampus, bilateral insula, rectus, median cingulate/paracingulate gyri and thalamus (SZ < HC); while the main effects of BMI were displayed in right amygdala, left hippocampus, bilateral insula, left lingual gyrus, and right superior temporal gyrus (OWB < NW). There were no significant diagnosis-by-BMI interaction effects in the present study, but the results showed that both SZ and OWB were additively associated with lower GMV in bilateral insula. Moreover, mediation analyses revealed the indirect effect of BMI on negative symptom via GMV reduction in bilateral insula. CONCLUSION This study further supports that higher BMI is associated with lower GMV, which may increase the risk of unfavourable disease courses in SZ.
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Affiliation(s)
- Hui Wu
- grid.412558.f0000 0004 1762 1794Psychiatry Department, The Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong China ,The Affiliated Kashi Hospital of Sun Yat-Sen University, Kashi, China
| | - Guochao Dai
- The Affiliated Kashi Hospital of Sun Yat-Sen University, Kashi, China ,Radiology Department, The First People’s Hospital of Kashi Prefecture, Kashi, China
| | - Muyeseer Aizezi
- The Affiliated Kashi Hospital of Sun Yat-Sen University, Kashi, China ,Psychiatry Department, The First People’s Hospital of Kashi Prefecture, 120 Yingbin Avenue, Kashi, Xinjiang China
| | - Juan Tang
- The Affiliated Kashi Hospital of Sun Yat-Sen University, Kashi, China ,Psychiatry Department, The First People’s Hospital of Kashi Prefecture, 120 Yingbin Avenue, Kashi, Xinjiang China
| | - Ke Zou
- The Affiliated Kashi Hospital of Sun Yat-Sen University, Kashi, China ,Radiology Department, The First People’s Hospital of Kashi Prefecture, Kashi, China
| | - Yuhua Wu
- The Affiliated Kashi Hospital of Sun Yat-Sen University, Kashi, China. .,Psychiatry Department, The First People's Hospital of Kashi Prefecture, 120 Yingbin Avenue, Kashi, Xinjiang, China.
| | - Xiaoli Wu
- Psychiatry Department, The Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong, China. .,The Affiliated Kashi Hospital of Sun Yat-Sen University, Kashi, China.
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Kong M, Xu M, Zhou Y, Geng N, Lin N, Song W, Li S, Piao Y, Han Z, Guo R, Yang C, Luo N, Wang Z, Ma L, Xu Q, Wang L, Qiu W, Li J, Shi D, Cheung EC, Li R, Chen Y, Duan Z. Assessing Visceral Obesity and Abdominal Adipose Tissue Distribution in Healthy Populations Based on Computed Tomography: A Large Multicenter Cross-Sectional Study. Front Nutr 2022; 9:871697. [PMID: 35548570 PMCID: PMC9082940 DOI: 10.3389/fnut.2022.871697] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/21/2022] [Indexed: 12/21/2022] Open
Abstract
Objective Abdominal adipose is closely related to many endocrine and metabolic diseases. The aim of this study was to analyze the distribution of abdominal adipose tissue in a healthy population in northern China determined by abdominal computed tomography (CT). Methods Data for this study were obtained from a multicenter, retrospective, cross-sectional study that collected abdominal CT scans of 1787 healthy individuals from 4 representative cities in northern China. Areas of visceral adipose tissue (VATA) and subcutaneous adipose tissue (SATA) were obtained by measuring CT images at the level of the 3rd lumbar vertebra. Visceral adipose tissue index (VATI) and subcutaneous adipose index (SATI) were obtained by normalizing the square of height to analyze the distribution of the above indexes and visceral obesity among different body mass index (BMI), gender and age. Results The mean age of this healthy population was 45.3 ± 15.2 years and the mean BMI was 23.5 ± 3.2 kg/m2, with 902 men and 885 women. Compared with women, men had a significantly higher median VATA (120.9 vs. 67.2 cm2), VATI (39.1 vs. 25.6 cm2/m2) and a significantly higher percentage of visceral adiposity (VATA ≥ 100 cm2) (60.8 vs. 30.4%), while women had significantly higher SATA (116.9 vs. 146.7 cm2) and SATI (38.8 vs. 55.8 cm2/m2) than men. Whether men or women, VATI was positively correlated with age. Interestingly, SATI was weakly positively correlated with age in women, while SATI was weakly negatively correlated with age in men. In persons with a normal BMI, the proportion of visceral adiposity increases with age, whereas in men with a normal BMI, the proportion of visceral adiposity decreases after the age of 60 years but remains >50%. Conclusions The distribution of abdominal visceral and subcutaneous adipose tissue parameters measured by CT differed among gender, age, and BMI. Even men and women with normal BMI have a high proportion of visceral obesity.
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Affiliation(s)
- Ming Kong
- Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Fourth Department of Liver Disease, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Manman Xu
- Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Fourth Department of Liver Disease, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Ying Zhou
- Postgraduate Training Base of Jinzhou Medical University, Department of Gastroenterology and Hepatology, The Chinese People's Liberation Army Rocket Force Characteristic Medical Center, Beijing, China
| | - Nan Geng
- Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Fourth Department of Liver Disease, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Ning Lin
- Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Fourth Department of Liver Disease, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Wenyan Song
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Shanshan Li
- Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Fourth Department of Liver Disease, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Yuetong Piao
- Department of Infection, Dalian Medical University, Dalian, China
| | - Zuoqing Han
- Department of Infection, Dalian Medical University, Dalian, China
| | - Rong Guo
- Department of Infection, Dalian Medical University, Dalian, China
| | - Chao Yang
- Department of Radiology, The Second Hospital of Dalian Medical University, Dalian, China
| | - Nan Luo
- Department of Infection, The Second Hospital of Dalian Medical University, Dalian, China
| | - Zhong Wang
- Diagnosis and Treatment Center of Hepatobiliary Diseases, Nanyang First People's Hospital, Nanyang, China
| | - Lei Ma
- Diagnosis and Treatment Center of Hepatobiliary Diseases, Nanyang First People's Hospital, Nanyang, China
| | - Quanxiao Xu
- Diagnosis and Treatment Center of Hepatobiliary Diseases, Nanyang First People's Hospital, Nanyang, China
| | - Lili Wang
- Department of Radiology, The First Hospital of Lanzhou University, Lanzhou, China
| | - Wanchun Qiu
- Department of Infection, The First Clinical Medical School of Lanzhou University, Lanzhou, China
| | - Junfeng Li
- Department of Infectious Diseases, Institute of Infectious Diseases, The First Hospital of Lanzhou University, Lanzhou, China
| | - Daimeng Shi
- Diagnosis and Treatment Center of Hepatobiliary Diseases, Nanyang First People's Hospital, Nanyang, China
| | - Eddie C Cheung
- Division of Gastroenterology, School of Medicine, University of California, Davis, Davis, CA, United States.,Center for Digestive Disease, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Rongkuan Li
- Department of Infection, The Second Hospital of Dalian Medical University, Dalian, China
| | - Yu Chen
- Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Fourth Department of Liver Disease, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Zhongping Duan
- Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Fourth Department of Liver Disease, Beijing Youan Hospital, Capital Medical University, Beijing, China
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Bağcı A, Aksoy F, Baş HA, Işık İB, Orhan H. The effect of Systolic and diastolic blood pressure on Tp-e interval in patients divided according to World Health Organization classification for body mass index. Clin Exp Hypertens 2021; 43:642-646. [PMID: 34018865 DOI: 10.1080/10641963.2021.1925684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Tp-e interval, Tp-e/QT ratio and Tp-e/QTc ratio are electrocardiographic markers and indices of ventricular arrhythmogenic events. We aimed to investigate ventricular repolarization in normal weight, overweight, obese and morbidly obese individuals by using ECG parameters including the above markers.Methods: A total of 310 obese patients with various cardiac complaints, who were admitted to our outpatient clinic between May 2020 and January 2021, were prospectively included in the study. Using the World Health Organization (WHO) body mass index (BMI) classification, patients were divided into four groups: normal weight (18.5-24.9 kg/m2, n = 48), overweight (25-29.9 kg/m2, n = 98), obese (30-39.9 kg/m2, n = 119), and morbidly obese (>40 kg/m2, n = 45).Results: The morbidly obese and normal groups were younger in age than the other two groups. The Tp-e interval values for Groups I-IV were 72.1 ± 6.9, 73.1 ± 6.2, 75.7 ± 7.3 and 81.1 ± 6.9, respectively, and significantly different (P < .001). We found that age, BMI, systolic blood pressure (BP) and diastolic BP were independent predictors of a prolonged Tp-e interval.Conclusions: The principal finding of our study was the gradual increase in Tp-e interval, Tp-e/QT ratio and Tp-e/QTc ratio starting from the overweight stage and these parameters gradually increase in obese and morbidly obese patients. Additionally, systolic and diastolic blood pressure predicted Tp-e interval, Tp-e/QT ratio and Tp-e/QTc ratio.
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Affiliation(s)
- Ali Bağcı
- Department of Cardiology, Suleyman Demirel University, Medical School, Isparta, Turkey
| | - Fatih Aksoy
- Department of Cardiology, Suleyman Demirel University, Medical School, Isparta, Turkey
| | - Hasan Aydin Baş
- Department of Cardiology, Isparta City Hospital, Isparta, Turkey
| | | | - Hikmet Orhan
- Department of Biostatistics, Suleyman Demirel University, Medical School, Isparta, Turkey
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Kurisu S, Nitta K, Watanabe N, Ikenaga H, Ishibashi K, Fukuda Y, Nakano Y. Effects of Newly Developed Right Versus Left Bundle Branch Block on the QRS Axis, T-wave Axis and Frontal QRS-T Angle in Patients with a Narrow QRS. Intern Med 2021; 60:25-30. [PMID: 32788526 PMCID: PMC7835454 DOI: 10.2169/internalmedicine.5442-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Objective The QRS-T angle has been established as a repolarization marker. In the present study, we determined whether or not newly developed bundle branch block (BBB) affected the QRS-T angle in patients with a narrow QRS. Methods Twenty-four patients with newly developed BBB and no adverse cardiac events were retrospectively included. The frontal QRS-T angle was defined as the absolute value of the difference between the frontal plane QRS axis and the T-wave axis. These electrocardiogram parameters were serially measured in the settings of narrow QRS and BBB. Results Twelve patients had newly developed right BBB (RBBB), and 12 had newly developed left BBB (LBBB). The development of RBBB did not affect the QRS axis, T-wave axis of QRS-T angle (41° ±42° to 53° ±65°, p = 0.63). In contrast, the development of LBBB shifted the QRS axis to the left (25° ±29° to -18° ±31°, p = 0.003), resulting in an increased QRS-T angle (72° ±50° to 123° ±39°, p = 0.001). Regarding RBBB, an excellent correlation and agreement were found between the QRS-T angles in the setting of narrow QRS and RBBB (r = 0.88; p <0.001; bias, 2.9° ±20.9°). However, there was a significant bias between the QRS-T angles in the setting of narrow QRS and LBBB (51.9° ±40.4°; p = 0.001). Conclusion Our data suggested that the QRS-T angle in the setting of RBBB reflected the original QRS-T angle in the setting of narrow QRS well, whereas the QRS-T angle in the setting of LBBB did not.
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Affiliation(s)
- Satoshi Kurisu
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | - Kazuhiro Nitta
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | - Noriaki Watanabe
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | - Hiroki Ikenaga
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | - Ken Ishibashi
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | - Yukihiro Fukuda
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
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11
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Blinova EV, Sakhnova TA, Yurasova ES. [Diagnostic and prognostic significance of QRS-T angle]. TERAPEVT ARKH 2020; 92:85-93. [PMID: 33346436 DOI: 10.26442/00403660.2020.09.000752] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 12/28/2022]
Abstract
The angle between theQRSandTvectors reflects the consistency or inconsistency of the processes of de- and repolarization of the ventricles of the heart and is considered one of the indicators of global electrical heterogeneity of myocardium. In recent years, the prognostic value of theQRS-Tangle has been demonstrated in relation to total and cardiovascular mortality, both in the population and in various groups of patients. The mechanisms of this phenomenon are not completely clear. The review analyses studies published over the past five years on the relationship between theQRS-Tangle and mortality, as well as coronary heart disease and heart failure. Possible mechanisms for increasing theQRS-Tangle are discussed. Data are given on the use of theQRS-Tangle in diagnostic and prognostic scales, including in combination with other indicators of global electrical heterogeneity of myocardium.
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Affiliation(s)
- E V Blinova
- National Medical Research Center for Cardiology
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12
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Usalp S, Kemal H, Cerit L, Duygu H. Do sporting activities and using protein supplements change the frontal QRS-T angle? Minerva Cardiol Angiol 2020; 69:244-250. [PMID: 32472986 DOI: 10.23736/s2724-5683.20.05166-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to investigate whether the frontal QRS-T angle was different between the athletes and normal healthy people. METHODS The study included 122 healthy athletes (the mean age was 29.7±7.7 years, of them, were 73.8% male) and a control group consisted of 60 healthy people (the mean age was 29.8±7.8 years, 26% of them were male). Then, the athletes were divided into two groups as who used protein supplements (PS) and those who did not. In the 12-lead ECG, heart rate (HR), P, QRS, QT, corrected QT (QTc) duration, QT and corrected QT dispersion (QTD, QTcD), the sum of V1 or V2S amplitude and V5 or V6R amplitude (V1/2S+V5/6R), frontal QRS-T angle were calculated. RESULTS There was no significant difference between the athletes and control groups regarding age, gender, smoking, body mass index, systolic blood pressure (SBP) and diastolic blood pressure (DBP), echocardiographic features, P, PR duration, P, QRS, T axis, QTD and QTcD (P>0.05).HR and QTc were significantly lower (P<0.05) and QRS, QT duration was longer in athletes group (P<0.001). The V1/2S+V5/6R and frontal QRS-T angle values were higher in the athlete's group (P<0.001). There was no significant difference between PS users and non PS users regarding demographic characteristics, duration of sports years, SBP and DBP (P>0.05). However, male gender was dominant in the PS users group (P=0.018). The P axis, PR and QRS duration were longer in the PS users group (P<0.05).It was found that the T axis was negatively correlated (r=-0.431,P<0.001) but the QRS axis was positively correlated (r=0.395,P<0.001) with frontal QRS-T angle. CONCLUSIONS The frontal QRS-T angle, was found to be wider in athletes compared to normal healthy participants. However, there was no significant difference between who used PS and those who did not.
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Affiliation(s)
- Songül Usalp
- Department of Cardiology, Faculty of Medicine, Near East University, Nicosia, Cyprus -
| | - Hatice Kemal
- Department of Cardiology, Faculty of Medicine, Near East University, Nicosia, Cyprus
| | - Levent Cerit
- Department of Cardiology, Faculty of Medicine, Near East University, Nicosia, Cyprus
| | - Hamza Duygu
- Department of Cardiology, Faculty of Medicine, Near East University, Nicosia, Cyprus
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13
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Gungoren F, Tanrİverdİ Z, Beslİ F, Tascanov MB, Altiparmak IH, Demİrbag R. Effect of anemia on the frontal QRS-T angle. Minerva Cardiol Angiol 2020; 69:36-42. [PMID: 32100987 DOI: 10.23736/s2724-5683.20.05105-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Anemia is a common health problem worldwide and is associated with a poor prognosis for cardiovascular diseases. It can alter myocardial depolarization and repolarization by affecting the generation and propagation of electrical impulses. The frontal QRS-T angle is a novel marker of the absolute difference between myocardial depolarization and repolarization. This study investigated the effects of anemia on the frontal QRS-T angle. METHODS The study included 66 anemic subjects with no cardiac disorders, and 50 age- and gender-matched controls. Twelve-lead electrocardiography (ECG) was obtained for all subjects, and the frontal QRS-T angle was calculated based on the automatic report of the ECG machine. RESULTS Subjects with anemia had a significantly higher frontal QRS-T angle than subjects without anemia (28.9±14.1 vs. 22.5±11.8, P=0.011). In correlation analysis, the frontal QRS-T angle was positively correlated with the Body Mass Index (BMI; r=0.287, P=0.002), left ventricular mass (LVM; r=0.264, P=0.004), and heart rate (r=0.275, P=0.003) and negatively correlated with the hemoglobin level (r=-0.349, P<0.001). Multivariate regression analysis showed that the hemoglobin level (β=-0.254, tβ=-2.805, P=0.006), BMI (β=0.240, t=2.770, P=0.007), and LVM (β=0.201, t=2.303, P=0.023) were independently associated with the frontal QRS-T angle. CONCLUSIONS The hemoglobin level was found to be an independent predictor of the frontal QRS-T angle.
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Affiliation(s)
- Fatih Gungoren
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey -
| | - Zulkif Tanrİverdİ
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Feyzullah Beslİ
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Mustafa B Tascanov
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Ibrahim H Altiparmak
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Recep Demİrbag
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
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14
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Tosta ADM, Borges MDC, Silva ÉMCD, Silva AAD, Crema E. Pre- and postoperative respiratory muscle strength, body mass index and fasting glucose profile of patients with type 2 diabetes mellitus submitted to metabolic surgery. FISIOTERAPIA EM MOVIMENTO 2020. [DOI: 10.1590/1980-5918.033.ao51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: The lung is considered a target organ in diabetes mellitus as a consequence of alterations secondary to chronic hyperglycemia that compromise respiratory muscle strength. Metabolic surgery for improving diabetes mellitus has beneficial effects on weight loss and glucose metabolism. Objective: The objective of this study was to evaluate the respiratory muscle strength, assessed by MIP and MEP, body mass index (BMI) and fasting glucose profile of patients with type 2 diabetes mellitus before and after metabolic surgery without gastric resection. Method: Seventeen patients with type 2 diabetes mellitus participated in the study. The participants had a mean age of 44.8 ± 11.81 years. Results: The results showed a significant decrease of MEP values in the immediate postoperative period when compared to the preoperative period (p=0.001), while no significant results were obtained for MIP. Regarding BMI and fasting glucose, significant weight loss and a significant reduction in fasting glucose levels were observed in the late postoperative period (p=0.006 and p=0.007, respectively). Conclusion: The MIP and MEP were reestablished and satisfactory results were obtained for BMI and fasting glucose in the late postoperative period. Further studies are needed to monitor patients in the pre- and postoperative period of metabolic surgery, identifying complications and acting on the care and recovery of these patients.
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15
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Nasser FA, Algenabi AA, Hadi NR, Hussein MK, Fatima G, Al-Aubaidy HA. The association of the common fat mass and obesity associated gene polymorphisms with type 2 diabetes in obese Iraqi population. Diabetes Metab Syndr 2019; 13:2451-2455. [PMID: 31405659 DOI: 10.1016/j.dsx.2019.06.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 06/27/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND & OBJECTIVES This study investigates the association of two potential Fat mass and obesity associated gene (FTO) gene polymorphisms (rs9939609 and rs918031) as potential predictors of type 2 diabetes (T2D) in obese Iraqi population and their metabolic effects on hyperglycemia and insulin sensitivity. MATERIALS & METHODS The study included 400 participants with obesity & T2D, with a matching 400 obese non-diabetic cohort. Venous blood samples were collected for DNA extraction. Using specific primers and restriction enzymes, genotyping was performed to identify the various alleles for each gene. The genotype and allele frequencies determined by multinomial logistic regression analysis for FTO single nucleotide polymorphisms (rs9939609) among all the study groups. RESULTS There is a two-fold increase in the risk of T2D within the homozygous genotype (TT) group (OR = 2.43, CI 95% 3.57-11.2, P ≤ 0.001) as compared to the wild type (TA). In addition, there was a significantly higher level of the minor allele genotype (T) in T2D patients when compared to the control group, (P ≤ 0.001). CONCLUSION We conclude that the FTO rs9939609 genotype significantly affect the development of insulin resistance, therefore the future occurrence of T2D, in obese individuals.
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Affiliation(s)
- Fadhil A Nasser
- Department of Clinical Biochemistry, College of Medicine, Kufa University, Najaf, Iraq
| | | | - Najah R Hadi
- Department of Pharmacology, College of Medicine, Kufa University, Najaf, Iraq
| | - Majid K Hussein
- Department of Clinical Biochemistry, College of Medicine, Kufa University, Najaf, Iraq
| | - Ghizal Fatima
- Department of Biochemistry, Era's Medical College & Hospital, Lucknow, India
| | - Hayder A Al-Aubaidy
- School of Life Sciences, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC, 3086, Australia.
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16
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Son NE. Influence of ferritin levels and inflammatory markers on HbA1c in the Type 2 Diabetes mellitus patients. Pak J Med Sci 2019; 35:1030-1035. [PMID: 31372137 PMCID: PMC6659066 DOI: 10.12669/pjms.35.4.1003] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective: Diabetes Mellitus (DM) is a significant public health issue worldwide due to the associated comorbidities. Recent studies have demonstrated a strong relationship between blood glucose levels and serum ferritin levels in patients with type 2 DM. The aim of the study was to investigate the association between Ferritin Levels and Inflammatory Markers on HbA1c in the Type 2 Diabetes Mellitus Patients. Methods: This single-center, cross-sectional, controlled study included patients who were admitted to the Endocrine and Metabolic Disorders outpatient clinics of the Private Kütahya Hospital in the province of Kutahya in the Western Turkey. The study included a total of 172 patients, 84 of whom had type 2 DM and 88 without diabetes and constituted the control group. A total of 190 patients with DM were admitted to the Adult Endocrine and Metabolic Diseases Outpatient Clinics of the hospital between July 1, 2018 and September 1, 2018, and among these, the study was conducted on 172 volunteer patients who met the study inclusion criteria and who did not have any missing data. The HbA1c levels, serum ferritin, hemoglobin (Hb), insulin, Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), C-Reactive Protein (CRP), lipid profiles, and uric acid levels were compared between the groups. Results: The serum ferritin levels of the patients with type 2 DM significantly increased with increasing HbA1c levels (p<0.01). A strong positive correlation was found between serum ferritin levels and HbA1c and fasting blood glucose (FBG) levels (p<0.01). Conclusions: Our study results show a significant relationship between HbA1c levels and serum ferritin and CRP levels, suggesting that serum ferritin and CRP levels can be used as a routine screening tool for the early diagnosis of DM. However, further large-scale, prospective studies are needed to confirm these findings.
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Affiliation(s)
- Nazan Erenoglu Son
- Dr. Nazan Son, Assistant Professor, Afyonkarahisar Saglik Bilimleri University, Afyonkarahisar, Turkey
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17
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Kurisu S, Nitta K, Sumimoto Y, Ikenaga H, Ishibashi K, Fukuda Y, Kihara Y. Effects of deep inspiration on QRS axis, T-wave axis and frontal QRS-T angle in the routine electrocardiogram. Heart Vessels 2019; 34:1519-1523. [PMID: 30868215 DOI: 10.1007/s00380-019-01380-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 03/08/2019] [Indexed: 01/24/2023]
Abstract
The frontal QRS-T angle on the electrocardiogram has been described as a variable of ventricular repolarization. We evaluated how deep inspiration affected QRS axis, T-wave axis and frontal QRS-T angle. We also assessed the effects on left ventricular volume on the association using myocardial perfusion SPECT. Fifty patients undergoing ECGs both in resting state and in deep inspiration and subsequent SPECT were enrolled. Frontal QRS-T angle was defined as the absolute value of the difference between the frontal QRS axis and T-wave axis. Change in frontal QRS-T angle was calculated using (QRS-T angle in deep inspiration-QRS-T angle in resting state). In resting state, QRS axis and T-wave axis were 20.9° ± 30.0° and 40.9° ± 36.1°, respectively. Frontal QRS-T angle was 35.9° ± 36.1°. Deep inspiration caused rightward shifts of QRS axis (42.3° ± 29.5°, p < 0.001) and T-wave axis (49.5° ± 39.7°, p < 0.001). However, deep inspiration did not affect frontal QRS-T angle (33.9° ± 35.8°, p = 0.44). Frontal QRS-T angle in deep inspiration had good correlation (r = 0.87, p < 0.001) and agreement with that in resting state. Left ventricular (LV) end-diastolic volume had a significant association with change in frontal QRS-T angle (r = 0.29, p = 0.04). Our data suggest that frontal QRS-T angle in deep inspiration has a good correlation with that in resting state, and the agreement is acceptable. In patients with dilated LV, QRS-T angle in deep inspiration may be susceptible to the overestimation.
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Affiliation(s)
- Satoshi Kurisu
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3, Kasumi-cho, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Kazuhiro Nitta
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3, Kasumi-cho, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yoji Sumimoto
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3, Kasumi-cho, Minami-ku, Hiroshima, 734-8551, Japan
| | - Hiroki Ikenaga
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3, Kasumi-cho, Minami-ku, Hiroshima, 734-8551, Japan
| | - Ken Ishibashi
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3, Kasumi-cho, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yukihiro Fukuda
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3, Kasumi-cho, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3, Kasumi-cho, Minami-ku, Hiroshima, 734-8551, Japan
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