Impact of Visceral Adipose Tissue on Clinical Outcomes After Acute Ischemic Stroke

Effects of elevated remnant cholesterol on outcomes of acute ischemic stroke patients receiving mechanical thrombectomy

OBJECTIVE

Large cohort studies provided evidence that elevated remnant cholesterol (RC) was an important risk factor for ischemic stroke. However, the association between high RC and clinical outcomes in acute ischemic stroke (AIS) individuals was still undetermined.

METHODS

This retrospective study enrolled 165 AIS patients undergoing mechanical thrombectomy in one tertiary stroke center. We divided patients into two groups based on the median of their RC levels (0.49 mmol/L). The modified Rankin Scale (mRS) was used to evaluate the primary outcome 90 days after the onset of symptoms. The mRS scores ≤ 2 and ≤ 1 at 90 days were deemed as favorable and excellent outcomes, respectively.

RESULTS

In the overall AIS patients undergoing mechanical thrombectomy, there was no obvious distinction between the high and low RC group at 90-day favorable outcome (41.0% vs. 47.1%, P = 0.431) or excellent outcome (23.1% vs. 31.0%, P = 0.252). In the subgroup analysis stratified by stroke etiology, non-large artery atherosclerosis (non-LAA) stroke patients yielded with less favorable or excellent prognosis in the high RC group (26.8% vs. 46.8%, adjusted OR = 0.31, 95%CI: 0.11-0.85, P = 0.023; or 12.2% vs. 29.0%, adjusted OR = 0.18, 95%CI: 0.04-0.80, P = 0.024, respectively.). Post hoc power analyses indicated that the power was sufficient for favorable outcome (80.38%) and excellent outcome (88.72%) in non-LAA stroke patients. Additionally, RC can enhance the risk prediction value of a poor outcome (mRS scores 3-6) based on traditional risk indicators (including age, initial NIHSS score, operative duration, and neutrophil-to-lymphocyte ratio) for non-LAA stroke patients (AUC = 0.86, 95%CI: 0.79-0.94, P < 0.001).

CONCLUSION

In AIS patients undergoing mechanical thrombectomy, elevated RC was independently related to poor outcome for non-LAA stroke patients, but not to short-term prognosis of LAA stroke patients.

Adiposity and Functional Outcome After Ischemic Stroke: A Mendelian Randomization Study

BACKGROUND AND OBJECTIVES

To investigate the causal relationships of abdominal adiposity (waist-to-hip ratio [WHR]) and overall adiposity (body mass index [BMI]) with functional outcome after ischemic stroke using Mendelian randomization.

METHODS

Genetic instruments for WHR and BMI were obtained from the largest available genome-wide association studies meta-analysis of the Genetic Investigation of ANthropometric Traits consortium and the UK Biobank (N max = 806,834). Functional outcome after ischemic stroke was assessed using the modified Rankin Scale (mRS) score at 3-month after stroke onset, with mRS >2 (mRS 3-6) defined as an unfavorable functional outcome. Corresponding genetic estimates for an unfavorable functional outcome were extracted from the Genetics of Ischemic Stroke Functional Outcome network (N = 6,021). We applied a random-effects inverse variance weighted method as our main analysis.

RESULTS

Genetically predicted higher WHR (per 0.09 ratio units) was associated with unfavorable functional outcome after ischemic stroke (mRS 3-6, OR = 1.48; 95% CI = 1.03-2.13; p = 0.033). The results remained directionally consistent in sensitivity analyses. Conversely, genetically predicted BMI (per 4.8 kg/m2) was not associated with unfavorable functional outcome after ischemic stroke (OR = 1.01; 95% CI = 0.75-1.36; p = 0.937).

DISCUSSION

This study provides genetic evidence supporting the hypothesis that abdominal adiposity has a detrimental effect on functional recovery after ischemic stroke.

Association between abdominal adiposity and clinical outcomes in patients with acute ischemic stroke

BACKGROUND

It is unclear whether abdominal adiposity has an additional effect on post-stroke outcomes. This study aimed to determine whether waist circumference (WC) is independently associated with clinical outcomes after acute ischemic stroke.

METHODS

We enrolled patients with acute ischemic stroke from a multicenter hospital-based stroke registry in Fukuoka, Japan. We measured WC on admission and categorized patients into four groups (Q1-Q4) according to the quartiles in females and males. The clinical outcomes were poor functional outcome (modified Rankin scale score 2-6) and death from any cause. Logistic regression analysis was performed to estimate the odds ratio and 95% confidence interval of the outcomes of interest after adjusting for potential confounding factors, including body mass index (BMI).

RESULTS

A total of 11,989 patients (70.3±12.2 years, females: 36.1%) were included in the analysis. The risk of poor functional outcome significantly decreased for Q2-Q4 (vs. Q1) at discharge and Q2-Q3 (vs. Q1) at 3 months, even after adjusting for potential confounders, including BMI. In contrast, adjustment of BMI eliminated the significant association between WC and all-cause death at discharge and 3 months. The association between high WC and favorable functional outcome was not affected by fasting insulin levels or homeostatic model assessment for insulin resistance and was only found in patients without diabetes (P = 0.02 for heterogeneity).

CONCLUSIONS

These findings suggest that abdominal adiposity has an additional impact on post-stroke functional outcome, independent of body weight and insulin action.

Association of Chinese visceral adiposity index with clinical outcome in patients after endovascular thrombectomy

BACKGROUND AND PURPOSE

The Chinese Visceral Adiposity Index (CVAI) is a reliable indicator of visceral adiposity dysfunction in the Chinese population. We aimed to evaluate the association between CVAI and clinical outcome in Chinese ischemic stroke patients who received endovascular thrombectomy (EVT).

METHODS

This study retrospectively included patients with large vessel occlusive stroke receiving EVT treatment in 2 China stroke centers. Baseline CVAI was calculated after admission. Patients with a modified Rankin scale score ≥ 3 at 3 months after ischemic stroke were defined as poor outcome. Binary multivariate logistic regression models were utilized to explore the association between CVAI and the risk of 90-day unfavorable outcome.

RESULTS

A total of 453 patients (mean age, 70.4  ± 12.1 years; 280 male) were included. During the 90-day follow-up, 236 (52.1 %) patients experienced poor outcome. After multivariable adjustment for potential confounders, increasing CVAI was associated with an increased risk of 90-day poor outcome (odds ratios, per-standard deviation increase: 1.521; 95 % confidence interval, 1.127-2.052; P = 0.006). Similar significant results were observed when the CVAI was analyzed as a categorical variable. Furthermore, the multiple-adjusted spline regression model showed an inverted J-shape association between CVAI and risk of unfavorable outcome (P = 0.048 for non-linearity).

CONCLUSIONS

This study demonstrated that CVAI is positively correlated with 90-day poor outcome in Chinese ischemic stroke patients after EVT.

Beneficial Short-Term Effects of Bariatric Surgery on Nutritional Inflammatory Profile and Metabolic Biomarkers

PURPOSE

Bariatric surgery (BS) has several potential metabolic benefits. However, little is known about its impact on changes in the inflammatory potential of diet and its effect on inflammatory and metabolic markers. This study aimed to assess the short-term beneficial effects of BS on dietary inflammatory potential and inflammatory and metabolic markers.

MATERIALS AND METHODS

Participants (n = 20) were evaluated 3 months before and after BS. Body mass, body mass index, anthropometric measurements, fat mass, fat-free mass, visceral fat, skeletal muscle mass, basal metabolic rate, serum lipids, HOMA-IR, QUICKI and inflammatory markers, including leptin, adiponectin, adiponectin/leptin ratio and plasminogen activator inhibitor-1 (PAI-1), were evaluated. Diet data were collected using a 3-day diet record and the dietary inflammatory index (DII®) and energy-adjusted dietary inflammatory index (E-DIITM) scores were computed.

RESULTS

There was a reduction in DII® (2.56 vs 2.13) and E-DIITM (2.18 vs 0.45) indicating an improvement in inflammatory nutritional profile. Moreover, there were increases in the adiponectin/leptin ratio (0.08 vs 0.21) and QUICKI scores (0.31 vs 0.37), and reductions in leptin (36.66 vs 11.41 ng/ml) and HOMA-IR scores (3.93 vs 1.50). There were also improvements in body composition and anthropometric parameters.

CONCLUSIONS

BS promotes changes in metabolic profile, inflammatory state and food intake and these modifications appeared to be associated with improvements in diet-related inflammation, an increase in the adiponectin/leptin ratio and a reduction in leptin. These results contribute to knowledge on the contribution bariatric surgery can make to the treatment of obesity and the reduction of related comorbidities.

Melatonin modulates the aggravation of pyroptosis, necroptosis, and neuroinflammation following cerebral ischemia and reperfusion injury in obese rats

Obesity is well-established as a common comorbidity in ischemic stroke. The increasing evidence has revealed that it also associates with the exacerbation of brain pathologies, resulting in increasingly severe neurological outcomes following cerebral ischemia and reperfusion (I/R) damage. Mechanistically, pyroptosis and necroptosis are novel forms of regulated death that relate to the propagation of inflammatory signals in case of cerebral I/R. Previous studies noted that pyroptotic and necroptotic signaling were exacerbated in I/R brain of obese animals and led to the promotion of brain tissue injury. This study aimed to investigate the roles of melatonin on pyroptosis, necroptosis, and pro-inflammatory pathways occurring in the I/R brain of obese rats. Male Wistar rats were given a high-fat diet for 16 weeks to induce the obese condition, and then were divided into 4 groups: Sham-operated, I/R treated with vehicle, I/R treated with melatonin (10 mg/kg), and I/R treated with glycyrrhizic acid (10 mg/kg). All drugs were administered via intraperitoneal injection at the onset of reperfusion. The development of neurological deficits, cerebral infarction, histological changes, neuronal death, and glial cell hyperactivation were investigated. This study revealed that melatonin effectively improved these detrimental parameters. Furthermore, the processes of pyroptosis, necroptosis, and inflammation were all diminished by melatonin treatment. A summary of the findings is that melatonin effectively reduces ischemic brain pathology and thereby improves post-stroke outcomes in obese rats by modulating pyroptosis, necroptosis, and inflammation.

Derivation and Validation of a New Visceral Adiposity Index for Predicting Short-Term Mortality of Patients with Acute Ischemic Stroke in a Chinese Population

The visceral adiposity index (VAI) is related to the occurrence of various cardiometabolic diseases, atherosclerosis, and stroke. However, few studies have analyzed the impact on the short-term prognosis of stroke. We assessed the effect of VAI on short-term prognoses in patients with acute ischemic stroke through a retrospective cohort study of 225 patients with acute stroke who were admitted to the neurological intensive care unit of our hospital. We collected metabolic indicators (blood pressure, fasting glucose, lipids), National Institutes of Health Stroke Scale (NIHSS) scores, symptomatic intracranial hemorrhage, and other disease evaluation indicators on 197 patients who were screened for inclusion. VAI was calculated by using baseline data (sex, height, weight, waist circumference (WC)). We assessed functional recovery according to modified Rankin scale scores after 90 days. The receiver operating characteristic (ROC) curve was used to calculate the VAI cutoff value that affects short-term outcomes. A nomogram that can predict the risk of short-term mortality in patients with acute ischemic stroke was drawn. In total, 28 patients died within 90 days. Those patients had higher VAI (p = 0.000), higher triglyceride (TG) (p = 0.020) and NIHSS scores (p = 0.000), and lower high-density lipoprotein cholesterol (HDL-C) (p = 0.000) than patients who survived. VAI had higher predictive value of short-term mortality than did body mass index (BMI), body fat mass index (BFMI), and WC. VAI and NIHSS scores were independent risk factors for the short-term mortality of patients with stroke. Patients with a VAI > 2.355 had a higher risk of short-term mortality. VAI has a predictive value higher than that of traditional metabolic indicators such as BMI, BFMI, and WC. The nomogram, composed of NIHSS, VAI, HDL-C, and TG, may predict the short-term mortality of cerebral infarction patients.

Does bariatric surgery change the risk of acute ischemic stroke in patients with a history of transient ischemic attack? A nationwide analysis

BACKGROUND

Stroke is the second leading cause of death worldwide and fifth in the United States, and it represents the major cause of disability in older adults.

OBJECTIVE

We aimed to determine the risk of acute ischemic stroke (AIS) in individuals with obesity with a history of transient ischemic attack (TIA) compared with patients with a history of bariatric surgery.

SETTING

Academic hospital, United States.

METHODS

Using the Nationwide Inpatient Sample (NIS) database from 2010 to 2015, we retrospectively identified patients with obesity and past medical history of TIA and divided them into 2 groups: a treatment group of patients who underwent bariatric surgery, and a control group of patients with obesity. We compared incidence of new AIS in both groups using a univariate analysis and multivariate regression model. Covariates included were lifestyle (smoking status, alcohol habits, cocaine use), family history of stroke, co-morbidities (diabetes, hypertension, hyperlipidemia, atrial fibrillation) and long-term medical treatment (antiplatelet/antithrombotic treatment).

RESULTS

A total of 91,640 patients met inclusion criteria, of which treatment patients were 12.3% (n = 11,284) and control patients 87.6% (n = 80,356). The average age of the treatment group was 62.9 ± 17.08 years, and the average of the control was 59.6 ± 12.74 years. The rate of AIS in the treatment group was significantly lower compared with the control group (2.8% versus 4.2%, P < .0001). After adjusting for covariables, the risk difference of AIS was still significant between groups (odds ratio = 1.33, P < .0001), showing that patients in the treatment group were less likely to have AIS compared with the control group.

CONCLUSIONS

After analyzing nationwide information, we conclude bariatric surgery helps decrease risk of AIS in patients with a history of TIA. However, this comparison is limited by the nature of the database; further studies are needed to better understand these results.

The potential role of insulin resistance in predicting outcome from intravenous thrombolytic therapy

Background

The potential impact of insulin resistance on stroke prognosis after IV thrombolysis is poorly understood. This study aimed to assess the effect of insulin resistance and metabolic syndrome on the outcome of IV thrombolysis in non-diabetic patients with acute ischaemic stroke.

Methods

This prospective observational study was conducted on 70 non-diabetic acute ischaemic stroke patients who received rt-PA within 3 h of stroke onset. Patients were subjected to baseline and follow-up NIHSS measurements at 24 h and 3 months post-treatment. Stroke outcome was assessed after 3 months using the Modified Rankin Scale (mRS). The homeostasis model assessment–insulin resistance (HOMA-IR) was calculated for the included patients at stroke onset.

Results

The mean age of included patients was 57.04 ± 14.39 years. Patients with unfavourable outcome had a significantly higher frequency of insulin resistance and metabolic syndrome, higher values of baseline NIHSS, insulin, HOMA-IR, uric acid and lower levels of HDL than those with favourable outcome (P value = 0.035, 0.007, ≤ 0.001, 0.001, ≤ 0.001, 0.002, 0.033, respectively). Each point increase in NIHSS before rt-PA increased the odds of an unfavourable outcome by 2.06 times (95% CI 1.22 − 3.478). Also, insulin resistance increased the odds of the unfavourable outcome by 11.046 times (95% CI 1.394–87.518). There was a statistically significant improvement in NIHSS 3 months after receiving rt-PA in all patients, significantly higher in patients who did not have insulin resistance or metabolic syndrome.

Conclusion

Insulin resistance and metabolic syndrome were associated with worse functional outcomes in non-diabetic stroke patients after receiving rt-PA.

The Impact of Body Mass Index Classification on Outcomes After Stroke Rehabilitation: A Retrospective Study

ABSTRACT

With improving stroke mortality rates, more individuals are living with the consequences of stroke. Obesity is a known risk factor for stroke, but its effect on functional outcomes poststroke is less clear. The aim of this study was to determine the association between body mass index classification (underweight, normal weight, overweight, and obese) and functional outcomes, as measured by Functional Independence Measure change, Functional Independence Measure efficiency, and rehabilitation length of stay after inpatient stroke rehabilitation. A retrospective cohort study of individuals with a diagnosis of stroke admitted to a high-intensity inpatient rehabilitation program was performed. Patients were divided into 4 groups based on body mass index category using normal body mass index as the reference. Overall, 34 individuals (4.5%) were classified as underweight, 303 (40.1%) had body mass indices within the normal range, 269 (35.6%) were overweight, and 149 (19.7%) were obese. Ischemic stroke was the most common stroke type across all body mass index categories. Patients in the overweight and obese groups tended to be younger. There were no statistically significant differences in rehabilitation length of stay, Functional Independence Measure change, or Functional Independence Measure efficiency with all groups demonstrating significant functional improvements. Based on these findings, patients admitted for inpatient rehabilitation after stroke can be expected to make similar functional improvements regardless of BMI class.

Visceral Adiposity and Risk of Stroke: A Mendelian Randomization Study

Purpose

In recent years, metabolic syndrome has risen in prevalence and brought a heavy disease burden to modern society. As the representative aspect of metabolic syndrome, obesity has been shown to be related to an increased risk of stroke. Given that visceral adipose tissue (VAT) forms the fundamental basis of central obesity, we sought to explore a causal relationship between VAT and stroke by using mendelian randomization (MR) methods.

Methods

Based on two large genome-wide association studies (GWAS) including 325,153 and 35,762 cases of VAT and stroke, respectively, we conducted a MR study which has the inherent advantage of reducing the noise of confounding and reverse causation.

Results

VAT had a significant causal association with ischemic stroke (OR, per 1kg increase in VAT mass, 1.30; 95% CI, 1.18 ~ 1.45; P = 5.87E-07) as opposed to intracranial hemorrhage (ICH) (OR, 1.15; 95% CI, 0.70 ~ 1.88, P = 5.81E-01) as evaluated with inverse-variance weighting (IVW). Regarding subtypes of ischemic stroke, there was a significant causal effect for cardioembolic stroke (OR, 1.34; 95% CI, 1.13 ~ 1.58, P = 8.07E-04), and potential causal effect for small-vessel stroke (OR, 1.32; 95% CI, 1.06 ~ 1.65, P = 1.39E-02) and large-artery atherosclerotic stroke (OR, 1.33; 95% CI, 1.03 ~ 1.70, P = 2.59E-02).

Conclusions

This study provides potential evidence for a causal role of VAT in ischemic stroke and could suggest novel genetical therapeutic strategies for distinct subtypes of ischemic stroke.

Two-dimensional CT measurements enable assessment of body composition on head and neck CT

OBJECTIVES

The aim of this study was to evaluate whether simple 2D measurements in axial slices of head and neck CT examinations correlate with generally established measurements of body composition in abdominal CT at the height of the third lumbar vertebra and thus allow for an estimation of muscle and fat masses.

METHODS

One hundred twenty-two patients who underwent concurrent CT of the head and neck and the abdomen between July 2016 and July 2020 were retrospectively included. For a subset of 30 patients, additional bioelectrical impedance analysis (BIA) was available. Areas of paraspinal muscles at the height of the third (C3) and fifth cervical vertebrae (C5) as well as the total cross-sectional area at the height of C3 and at the submandibular level were correlated with the results of abdominal measurements and BIA. Furthermore, intra- and interreader variabilities of all measurements were assessed.

RESULTS

Regarding adipose tissue, good correlations were found between the total cross-sectional area of the patient's body at the submandibular level and at the height of C3 between both abdominal measurements and BIA results (r = 0.8-0.92; all p < 0.001). Regarding muscle, the total paraspinal muscle area at the height of C3 and C5 showed strong correlations with abdominal measurements and moderate to strong correlations with BIA results (r = 0.44-0.80; all p < 0.001), with the muscle area on C5 yielding slightly higher correlations.

CONCLUSIONS

Body composition information can be obtained with comparable reliability from head and neck CT using simple biplanar measurements as from abdominal CT.

KEY POINTS

• The total paraspinal muscle area at the height of C3 and C5 correlates strongly with abdominal muscle mass. • The total cross-sectional area at the submandibular level and at the height of C3 shows good correlations with abdominal fat mass. • The described measurements facilitate a rapid, opportunistic assessment of relevant body composition parameters.

Relationship Between Body Composition and Death in Patients with COVID-19 Differs Based on the Presence of Gastrointestinal Symptoms

BACKGROUND

Patients with SARS-CoV-2 who present with gastrointestinal symptoms have a milder clinical course than those who do not. Risk factors for severe COVID-19 disease include increased adiposity and sarcopenia.

AIMS

To determine whether body composition risk factors are associated with worse outcomes among patients with gastrointestinal symptoms.

METHODS

This was a retrospective study of hospitalized patients with COVID-19 who underwent abdominal CT scan for clinical indications. Abdominal body composition measures including skeletal muscle index (SMI), intramuscular adipose tissue index (IMATI), visceral adipose tissue index (VATI), subcutaneous adipose tissue index (SATI), visceral-to-subcutaneous adipose tissue ratio (VAT/SAT ratio), and liver and spleen attenuation were collected. The association between body composition measurements and 30-day mortality was evaluated in patients with and without gastrointestinal symptoms at the time of positive SARS-CoV-2 test.

RESULTS

Abdominal CT scans of 190 patients with COVID-19 were evaluated. Gastrointestinal symptoms including nausea, vomiting, diarrhea, or abdominal pain were present in 117 (62%). Among patients without gastrointestinal symptoms, those who died had greater IMATI (p = 0.049), less SMI (p = 0.010), and a trend toward a greater VAT/SAT ratio. Among patients with gastrointestinal symptoms, those who died had significantly greater IMATI (p = 0.025) but no differences in other measures.

CONCLUSIONS

Among patients with COVID-19, those without gastrointestinal symptoms showed the expected associations between mortality and low SMI, high IMATI, and trend toward higher VAT/SAT ratio, but those with gastrointestinal symptoms did not. Future studies should explore the mechanisms for the altered disease course in patients with COVID-19 who present with gastrointestinal symptoms.

Association between abnormal body weight and stroke outcome: A meta-analysis and systematic review

BACKGROUND AND PURPOSE

To test the hypothesis that "obesity paradox" exists in stroke patients, we conducted a meta-analysis and systematic review on the association between abnormal body weight (obesity, overweight, or underweight) and the outcome of different types of stroke.

METHODS

This meta-analysis and systematic review was performed in conformity to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines in Appendix S2. Studies investigating the association between abnormal body weight and the outcome of different types of stroke were searched for in the PubMed and Embase databases from their inception to 20 March 2021.

RESULTS

Thirty-three articles including 84,660 patients were included in this study. Obesity and overweight were associated with longer survival in mixed-stroke patients (acute ischemic stroke [AIS] combined with one or more other stroke subtypes) than was normal weight, whereas underweight was related to shorter survival; the pooled hazard ratios (HRs) of mortality were 0.77 (95% confidence interval [CI] = 0.71-0.83) for obesity, 0.76 (95% CI = 0.72-0.80) for overweight, and 1.71 (95% CI = 1.56-1.87) for underweight. However, only obesity was associated with longer survival in AIS patients compared with normal weight, and underweight was related to shorter survival; the pooled HR of mortality was 0.75 (95% CI = 0.64-0.88) for obesity and 1.53 (95% CI = 1.27-1.85) for underweight. After merging mixed-stroke and AIS patients, we obtained similar results as in mixed-stroke patients.

CONCLUSIONS

Our results suggested that in patients with mixed stroke or AIS, obesity was associated with a longer survival time than normal weight, whereas underweight was associated with a shorter survival time.

An Analysis of the Potential Relationship of Triglyceride Glucose and Body Mass Index With Stroke Prognosis

Background: The inverse association between obesity and outcome in stroke patients (known as the obesity paradox) has been widely reported, yet mechanistic details explaining the paradox are limited. The triglyceride glucose (TYG) index has been proposed as a marker of insulin resistance. We sought to explore possible associations of the TYG index, body mass index (BMI), and stroke outcome. Methods: We identified 12,964 ischemic stroke patients without a history of diabetes mellitus from the China National Stroke Registry and classified patients as either low/normal weight, defined as a BMI <25 kg/m², or overweight/obese, defined as a BMI ≥ 25 kg/m². We calculated TYG index and based on which the patients were divided into four groups. A Cox or logistic regression model was used to evaluate the association between BMI and TYG index and its influence on stroke outcomes, including stroke recurrence all-cause mortality and poor outcome (modified Rankin Scale score of 3-6) at 12 months. Results: Among the patients, 63.3% were male, and 36.7% were female, and the mean age of the patient cohort was 64.8 years old. The median TYG index was 8.62 (interquartile range, 8.25-9.05). After adjusting for multiple potential covariates, the all-cause mortality of overweight/obese patients was significantly lower than that of the low/normal weight patients (6.17 vs. 9.32%; adjusted hazard ratio, 0.847; 95% CI 0.732-0.981). The difference in mortality in overweight/obese and low/normal weight patients with ischemic stroke was not associated with TYG index, and no association between BMI and TYG index was found. Conclusion: Overweight/obese patients with ischemic stroke have better survival than patients with low/normal weight. The association of BMI and stroke outcome is not changed by TYG index.

Ischemic stroke, obesity, and the anti-inflammatory role of melatonin

Obesity is a predominant risk factor in ischemic stroke and is commonly comorbid with it. Pathologies following these conditions are associated with systemic and local inflammation. Moreover, there is increasing evidence that the susceptibility for ischemic brain damage increases substantially in experimental models of ischemic stroke with concomitant obesity. Herein, we explore the proinflammatory events that occur during ischemic stroke and obesity, and we discuss the influence of obesity on the inflammatory response and cerebral damage outcomes in experimental models of brain ischemia. In addition, because melatonin is a neurohormone widely reported to exhibit protective effects in various diseases, this study also demonstrates the anti-inflammatory role and possible mechanistic actions of melatonin in both epidemic diseases. A summary of research findings suggests that melatonin administration has great potential to exert an anti-inflammatory role and provide protection against obesity and ischemic stroke conditions. However, the efficacy of this hormonal treatment on ischemic stroke with concomitant obesity, when more serious inflammation is generated, is still lacking.

Differences in Body Composition among Patientsafter Hemorrhagic and Ischemic Stroke

The aim of the study was to assess differences in the body composition of patients after hemorrhagic and ischemic stroke. There were 74 male participants in the study, of which 13 (18%) experienced hemorrhagic stroke, while 61 (82%) were after ischemic stroke. Significantly (p < 0.05) higher values of body composition variables were noted for ischemic compared to hemorrhagic strokes, and concerned: body mass (BM) (kg), basal metabolic rate (BMR) (kJ), fat-free mass (FFM) (kg), total body water (TBW) (kg), muscle mass (MM) (kg), visceral fat level (VFL), bone mass (BoM) (kg), extracellular water(ECW) (kg),intracellular water (ICW) (kg), trunk fat-free mass (TFFM) (kg) and trunk muscle mass (TMM) (kg)in the paretic upper limb; FFM (kg) and MM (kg) in the non-paretic upper limb; FFM (kg) and MM (kg) in the paretic lower limbas well as FFM (kg) and MM (kg) in the non-paretic lower limb without paresis. Only for the variables fat mass (FM) (kg), body mass index (BMI), metabolic age (MA), trunk fat mass (TFM) (kg), and FM (kg) in the paretic upper limb and FM (kg) in the non-paretic upper limb were there no significant differences. Significant differences in body composition of patients after hemorrhagic and ischemic stroke have been demonstrated. Individuals after ischemic stroke had significantly worse body composition. Incorrect body composition is a significant risk factor, especially of ischemic stroke.

Weight Loss and Changes in Adipose Tissue and Skeletal Muscle Volume after Laparoscopic Sleeve Gastrectomy and Roux-en-Y Gastric Bypass: a Prospective Study with 12-Month Follow-Up

BACKGROUND

This study aimed to evaluate changes in body tissue composition with obesity surgery regarding visceral fat, subcutaneous fat, and skeletal muscle.

DESIGN

Prospective non-randomized single-center cohort study METHODS: Whole-body magnetic resonance imaging (MRI) measured volumes of subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and skeletal muscle (SM) in 31 patients with laparoscopic sleeve gastrectomy (LSG, 20) or Roux-en-Y gastric bypass (RYGB, 11) preoperatively, at three- and 12-months follow-up.

RESULTS

Body mass index (BMI) went down from 45.2 ± 6.5 preoperatively to 37.2 ± 5.6 (p < 0.001) at three months and 32.2 ± 5.3 kg/m² (p < 0.001) at 12 months. SAT went down from 55.0 ± 14.0 L (liter) to 42.2 ± 13.3 L (p < 0.001) at three months and 31.7 ± 10.5 L (p < 0.001) at 12 months (- 42.3%). VAT went down from 6.5 ± 2.3 to 4.5 ± 1.7 (p < 0.001) at three months and 3.1 ± 1.7 L (p < 0.001) at 12 months (- 52.3%). SM went down from 22.7 ± 4.8 to 20.4 ± 3.6 (p = 0.008) at three months and remained 20.2 ± 4.6 L at 12 months (p = 0.17 relative three-month; p = 0.04 relative preop, - 11.1%). Relative loss was higher for VAT than that for SAT (52.3 ± 18.2% vs. 42.3 ± 13.8%; p = 0.03). At 12 months, there was no difference between LSG and RYGB for relative changes in BMI or body tissue composition.

CONCLUSION

Postoperatively, there was higher net loss of SAT but higher relative loss of VAT with weight loss. SM was lost only during the first three months. MRI provides accurate evaluation of surgeries' effect on individual patients' tissue composition. This can benefit risk assessment for related cardiovascular and metabolic health but cost-related factors will likely reserve the used methods for research.

Challenges of Thrombolysis in a Developing Country: Characteristics and Outcomes in Peru

BACKGROUND

The availability of intravenous tissue plasminogen activator (IV-tPA) remains limited worldwide, especially in low-income countries, where the burden of disability due to ischemic stroke is the highest.

AIMS

To evaluate outcomes and safety of IV-tPA at the only Peruvian reference institute for neurologic diseases.

METHODS

We conducted a prospective, observational study of stroke patients who received IV-tPA between 2009 and 2016. We assessed characteristics associated with good outcome (modified Rankine scale 0-2) at 3 months using a multivariate regression model; and factors correlated with clinical improvement (delta National Institute of Health Stroke Scale (NIHSS)) using linear regression.

RESULTS

Only 1.98% (39/1,1962) of patients presenting with ischemic stroke received IV-tPA. Nearly half (41%) were younger than 60 years, 56.4 % were men, and most strokes were cardioembolic (46.2%). The majority (64.1%) were treated within 3-4.5 hours. The median NIHSS on admission and discharge was 9 and 4, respectively; 42.1% of patients had an mRS of 0-1 at 3 months. Three patients (7.7%) developed hemorrhagic conversion, and 1 patient died (2.6%). Patients with good outcomes had lower pretreatment systolic blood pressure (138.9 versus 158.1 mm Hg, P < .007), fewer complications during hospitalization (5 versus 9 events, P < .001), shorter hospital stay (14 versus 21 days, P < .03) and, paradoxically, longer last known well -to-door times (148.3 versus 105 minutes, P < .0022). Clinical improvement was associated with shorter door-to-tPA times and obesity.

CONCLUSIONS

Our findings indicate that IV-tPA has similar safety and outcomes compared to developed countries. All internal metrics (door-to-tPA, door-to-CT, and CT-to-tPA time) improved over time, highlighting areas for future implementation science studies to further expedite the administration of IV-tPA.