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Purpose: Adipokines produced by adipose tissue have been found to be involved in the pathophysiology of metabolic and cardiovascular diseases. We aimed to investigate the relationships of resistin, retinol-binding protein 4 (RBP4) and adiponectin produced by epicardial adipose tissue with coronary artery disease (CAD) and cardiac structure and function. Methods: Forty-one non-diabetic males scheduled for cardiothoracic surgery were examined. Anthropometric measurements, echocardiography, coronary angiography, and blood analysis were performed preoperatively. We measured the serum levels of resistin, RBP4, and adiponectin and their mRNA expression in thoracic subcutaneous adipose tissue and two epicardial adipose tissue samples, one close to left anterior descending artery (LAD) (resistin-LAD, RBP4-LAD, adiponectin-LAD), and another close to the right coronary artery (RCA) (resistin-RCA, RBP4-RCA, adiponectin-RCA). Results: Left ventricular (LV) ejection fraction correlated negatively with adiponectin-LAD (rho =  − 0.390, p= 0.025). The ratio of early to late diastolic transmitral flow velocity, as an index of LV diastolic function, correlated negatively with resistin-LAD (rho =  − 0.529, p= 0.024) and RBP4-LAD (rho =  − 0.458, p= 0.049). There was no difference in epicardial adipose tissue mRNA expression of resistin, RBP4, and adiponectin between individuals with CAD and those without CAD. When we compared the individuals with CAD in the LAD with those without CAD in the LAD, there was no difference in resistin-LAD, RBP4-LAD, and adiponectin-LAD. There was no difference in resistin-RCA, RBP4-RCA, and adiponectin-RCA between the individuals with CAD in the RCA and those without CAD in the RCA. Conclusion: Elevation of epicardial adipose tissue mRNA expression of adiponectin was associated with LV systolic dysfunction, while that of both resistin and RBP4 was linked to LV diastolic dysfunction.

In recent years, our knowledge regarding the physiological role of vitamin K has expanded beyond regulation of coagulation to include many other aspects of human health. In the present review, we aimed to evaluate the existing evidence for beneficial effects of vitamin K on type 2 diabetes and components of the metabolic syndrome as risk factors for cardiovascular disease. Increased dietary intake of vitamin K has been linked to lower incidence of type 2 diabetes mellitus (T2DM), possibly through its enhancement of insulin production and sensitivity. Additionally, higher plasma levels of vitamin K1 have been associated with lower T2DM risk and decreased insulin resistance, and supplementation trials also suggest a positive influence of vitamin K on glucose regulation. Vitamin K might also beneficially affect serum lipids and lipid metabolism. However, the available data remain controversial. Additionally, different studies use different approaches to assess vitamin K status owing to the absence of a generally accepted marker, which further complicates data evaluation. In conclusion, vitamin K possibly improves glucose and lipid metabolism and could be an emerging target in the context of prevention and control of T2DM, insulin resistance, and dyslipidemia.

Aim The investigation of the pathophysiological determinants of cardiac changes following ultra-long duration exercise.Methods Twenty-seven runners who finished a 246 km running race were examined both before and after the finish of the race. Examinations included echocardiography and measurement of body weight and blood biochemical parameters.Results Exercise increased left ventricular end-diastolic interventricular septum thickness (LVIVSd) (p< 0.001) and posterior wall thickness (LVPWTd) (p= 0.001) and right ventricular end-diastolic area (p= 0.005), while reduced tricuspid annular plane systolic excursion (TAPSE) (p= 0.004). A minor decrease in the peak absolute values of both left ventricular (from −20.9 ± 2.3% to −18.8 ± 2.0%, p= 0.009) and right ventricular (from −22.9 ± 3.6% to −21.2 ± 3.0%, p= 0.040) global longitudinal strains occurred. There was decrease in body weight (p< 0.001) and increase in both circulating high-sensitivity troponin I (p= 0.028) and amino-terminal pro-B type natriuretic peptide (NT-proBNP) (p= 0.018). The change in the sum of LVIVSd and LVPWTd correlated negatively with percentage change of body weight (r= −0.416, p= 0.049). The only independent determinant of post-exercise NT-proBNP was pulmonary artery systolic pressure (r= 0.797, p= 0.002). Post-exercise NT-proBNP correlated positively with percentage changes of basal (RVbas) (r= 0.582, p= 0.037) and mid-cavity (RVmid) (r= 0.618, p= 0.043) right ventricular diameters and negatively with percentage change of TAPSE (r= −0.720, p= 0.008). Similar correlations with RVbas, RVmid and TAPSE were found for pulmonary artery systolic pressure. Post-exercise high-sensitivity troponin I correlated negatively with percentage change of body weight (r= −0.601, p= 0.039), but was not associated with any cardiac parameter.Conclusion The main cardiac effects of ultra-long duration exercise were the decrease in left ventricular end-diastolic dimensions and increase in left ventricular wall thickness, as well as minimal dilatation and alteration in systolic function of right ventricle, possibly due to the altered exercise-related right ventricular afterload.

This systematic review and meta-analysis aims to explore in heart failure (HF) patients with reduced ejection fraction (EF) undergoing exercise-based cardiac rehabilitation the following: 1) the comparison of temporal changes between peak oxygen uptake (VO2peak) and first ventilatory threshold (VO2VT1), 2) the association of VO2peak and VO2VT1 changes with physiological factors, and 3) the differential effects of continuous aerobic exercise (CAE) and interval training (IT) on VO2peak and VO2VT1.

The elucidation of the changes of fetuin-A in the context of bariatric surgery. Twenty obese patients (8 males, 12 females; body mass index = 42.5±3.4 kg/m2) were studied at baseline and 6 months after bariatric surgery. Serum fetuin-A levels did not differ with regard to the presence of each individual component of the Metabolic Syndrome (MetS) at baseline, except for hypertriglyceridaemia [increased serum fetuin-A levels (p=0.011)]. Circulating fetuin-A was positively correlated with serum triglycerides (TG) (r=0.461, p=0.047) and negatively correlated with serum globulins (r=−0.477, p=0.033) and C-reactive protein (CRP) (r=−0.604, p=0.010), while it independently predicted TG at baseline. Circulating fetuin-A did not change during the 6 months either in the whole population or in the subgroups of patients who were positive for each individual component of MetS at baseline and negative for this component at 6 months of follow-up, except for hypertriglyceridaemia [reduction of serum fetuin-A levels (p=0.046)]. The subgroup of patients with a decrease in circulating fetuin-A during the 6 months was characterized by a smaller reduction of serum globulins (p=0.003) and CRP (p=0.049). The change in serum fetuin-A levels over the 6 months was positively correlated with the change in TG (r=0.592, p=0.006) and negatively correlated with the change in serum globulins (r=−0.523, p=0.018) and CRP (r=−.494, p=0.037). Circulating fetuin-A predicted serum triglycerides before as well as 6 months after bariatric surgery.

The beneficial effects of chronic exercise training on lipoprotein metabolism include a considerable increase in serum high density lipoprotein-cholesterol and a reduction in serum triglyceride levels. These changes are mostly reported in athletes participating in dynamic sports, especially in the endurance ones. Diagnosis and treatment of dyslipidaemias in athletes should follow the main principles of management of dyslipidaemias for the general population, while specific considerations for athletes should be taken into account. Dyslipidaemias in athletes are usually characterized by a significant genetic predisposition. Clinicians who evaluate the lipoprotein profile of athletes should keep in mind the possibility of an illegal use of performance-enhancing drugs, which can influence lipoprotein metabolism. Lifestyle intervention should be the cornerstone of treatment of dyslipidaemias in athletes, but it should be tailored to the needs of individual athletic activity. Hypolipidaemic medications may not be well-tolerated by competitive athletes and should be reserved only for athletes with inadequate response to lifestyle measures. The treatment of dyslipidaemias in athletes should aim at reducing cardiovascular risk without compromising athletic performance.

New data collection technologies have all, but replaced traditional, site-based data collection methods for trip matrix development in the UK. Event data produced by Mobile Network Operators provides adequate information to identify time and location of trip origin and destination (OD), but only limited information on transport mode, vehicle type or trip purpose. In addition, GPS-based data provides another source of OD and user data.

We describe a case report of a 30-year-old bodybuilder suffering acute myocardial infarction (AMI). He had been taking stanozolol and testosterone for two months. The coronary angiogram showed high thrombotic burden in the left anterior descending artery without underlying atherosclerosis. Few case reports of AMI in athletes taking anabolic androgenic steroids (AASs) have been reported so far. AAS-related AMI is possibly underreported in the medical literature due to the desire of the affected individuals to hide AAS use. Physicians should always consider the possibility of AAS abuse in the context of a young athlete suffering AMI. AASs can predispose to AMI through the acceleration of coronary atherosclerosis. Additionally, thrombosis without underlying atherosclerosis or vasospasm is highly possible to cause AMI in AAS users. Complications after AMI may be more frequent in AAS users.

Background The tilt test is used for the diagnosis of reflex syncope (RS) and is characterized by low sensitivity, especially in athletes. The objective of the study was the implementation of a novel diagnostic strategy for the tilt test without pharmacologic provocation in athletes based on haemodynamic criteria.Methods A passive tilt test for 30 min was performed in 132 athletes (53 with a history of RS, 79 without RS). Measurement of haemodynamic, heart rate variability (HRV) and baroreflex sensitivity parameters was performed.Results Tilt testing yielded 34% sensitivity and 94% specificity. Among negative tilt test responders, the ones with RS had increased heart rate (HR) (89 ± 11 vs 81 ± 10 bpm, p< 0.001), stroke index (SI) (40.2 ± 7.1 vs 35.5 ± 9.7 ml/m2, p= 0.013), cardiac index (CI) (3.5 ± 0.6 vs 2.8 ± 0.8 l/(min·m2), p< 0.001) and decreased total peripheral resistance index (TPRI) (2230 ± 362 vs 2965 ± 725 dyne·s m2/cm5, p< 0.001), low frequency component of HRV (76.2% (49.0–88.4) vs 79.7% (10.2–91.1), p= 0.045) during head-up tilt, compared with those without RS. Receiver-operating characteristic (ROC) curve analysis showed that among athletes with a negative tilt test the area under the curve (AUC) values were 0.727 (0.626–0.828) for HR (p< 0.001), 0.707 (0.611–0.804) for SI (p= 0.001), 0.847 (0.774–0.920) for CI (p< 0.001), 0.830 (0.754–0.905) for TPRI (p< 0.001). Further stratification of negative tilt test responders, characterizing their results as positive when TPRI <2800 dyne·s m2/cm5and CI >3 l/(min·m2), resulted in 85% sensitivity and 76% specificity.Conclusion Our results provide supportive evidence that a novel stratification based on haemodynamic criteria can improve the sensitivity of the tilt test for the diagnosis of RS in athletes.

Objective: Liraglutide 3.0 mg daily dose is marketed under the brand name Saxenda and was recently approved by both the Food and Drug Administration (FDA) and the European Medicine Agency (EMA) as adjunct to a comprehensive lifestyle intervention to achieve weight loss. Design: Human studies using liraglutide 3.0 mg daily dose were selected through search based on PubMed listings and the Clinical trials.gov database using the term “liraglutide”. Results: During 56 weeks of treatment, liraglutide 3.0 mg treatment resulted in 5.9-8.0% weight reduction, while the placebo-subtracted weight loss was 3.9-6.0%. The proportion of treated patients with ≥ 5% weight loss was 50-76%, while the placebo-subtracted proportion was 29-46%. Liraglutide 3.0 mg treatment also induced a decrease in waist circumference, serum triglycerides, insulin resistance, blood pressure and an increase in high density lipoprotein-cholesterol (HDL-C). The most common side effects were nausea, hypoglycemia, diarrhea, constipation, vomiting and headache. In the majority of patients liraglutide 3.0 mg was well tolerated. Conclusion: Liraglutide 3.0 mg appears to be an effective adjunct to a comprehensive lifestyle intervention to achieve weight reduction and treat obesity-related comorbidities.

OBJECTIVE: The investigation of the association between retinol-binding protein 4 (RBP4) and lipoproteins in subjects with hypertriglyceridemia. DESIGN: Forty-six obese or overweight hypertriglyceridemic patients were studied at baseline and 20 of them underwent a hypocaloric low-fat diet for 3 months. RESULTS: Plasma RBP4levels were positively correlated with serum triglycerides (TG) in the subgroup of patients with TG <200 mg/dL (r=0.453, p=0.039) and negatively correlated with TG in patients with TG ≥200 mg/dL (r=−0.487, p=0.019). In the subgroup with TG <200 mg/dL, subjects with circulating RBP4above the median 46 mg/L had higher levels of intermediate density lipoprotein-cholesterol (IDL-C), low-density lipoprotein-cholesterol (LDL-C) and apolipoprotein B (ApoB), while these differences were absent in patients with TG ≥200 mg/dL. The associations of percentage changes of circulating RBP4with the percentage changes of LDL-C, very low-density lipoprotein-cholesterol (VLDL-C) and ApoB were positive after the first month and 3 months of diet for patients with baseline TG <200 mg/dL, while no correlations existed for patients with TG ≥200 mg/dL. CONCLUSIONS: The positive association between circulating RBP4and ApoB-containing lipoproteins in a steady metabolic state, as well as during a hypocaloric diet, appears to be attenuated in patients with very high TG.

The combination of 32 mg naltrexone and 360 mg bupropion prolonged release (NB32) was recently approved by both the food and drug administration (FDA) and the European medicines agency (EMA) as an adjunct to a comprehensive lifestyle intervention to achieve weight loss. Randomized controlled trials with naltrexone/bupropion prolonged release were selected through a search based on PubMed listings using the terms “bupropion AND naltrexone”. NB32 treatment resulted in 5.0–9.3% weight loss, while the placebo-subtracted weight loss was 3.2–5.2% during 56 weeks of treatment. The proportion of treated patients with ≥5% weight loss was 45–66%, while the placebo-subtracted proportion was 23–34%. NB32 was associated with a decrease in waist circumference, serum triglycerides and insulin resistance and an increase in high-density lipoprotein-cholesterol (HDL-C). Blood pressure mainly remained stable but there was a small increase in heart rate. The most common side effects were nausea, constipation, headache and vomiting. Serious adverse effects, which were very rare, included suicidal thoughts and seizures. In the majority of patients NB32 treatment was well tolerated. Naltrexone/bupropion combination appears to be an effective adjunct to a comprehensive lifestyle intervention in order to achieve weight loss and treat obesity-related comorbidities.

This paper presents a taxonomy of design guidelines for robot teleoperation developed from a focused literature review of robot teleoperation. A list of user interface design guidelines was assembled, open card sorting and a focus group were used to classify them, and closed card sorting was employed to validate and further refine the proposed taxonomy. The initially obtained set of 70 guidelines is grouped into eight categories: platform architecture and scalability, error prevention and recovery, visual design, information presentation, robot state awareness, interaction effectiveness and efficiency, robot environment/surroundings awareness, and cognitive factors. Agricultural robots were used as an application case study for implementation and field evaluation. The proposed guideline taxonomy was used heuristically to evaluate the usability of an existing user interface of a teleoperated agricultural robot.

Diabetics are regarded a special category of patients known to experience higher rates of cardiovascular complications as compared to the non-diabetic ones. Despite substantial efforts to minimize these risks, with aggressive antiplatelet and lipid lowering therapy, some of the diabetic patients still have a considerable residual risk for cardiovascular adverse events. Important preclinical data with potent lipid-lowering agents, like fibrates, omega-3-fatty acids, and niacin, have shown that they can provide sufficient help in reducing rates of cardiovascular events. In the present review, we are aim to explain their basic mechanisms of action, to present all the available clinical data regarding the efficacy of those agents, and to identify specific diabetic patients’ subsets, in whom supplementary therapy with those agents could provide substantial benefit in terms of clinical outcome and not only lipid profile improvement.

The investigation of the relationship between high density lipoprotein (HDL) and adiponectin. Thirty-seven obese or overweight [body mass index ≥27 Kg/m2], hypertriglyceridemic patients underwent one of the following interventions for 3 months: 1) Low-calorie diet (n=19), 2) Low-calorie diet plus fenofibrate (n=18). Circulating total adiponectin did not change significantly in the low-calorie diet group. However, in the subgroup of patients whose high density lipoprotein cholesterol (HDL-C) decreased over the first month of diet, a statistically significant reduction of the circulating total adiponectin was observed (p=0.010), while in the subgroup of patients whose HDL-C increased over the latter 2 months of the diet, an increase in circulating total adiponectin over the 2 months was found (p=0.043). The percentage change of HDL-C over the first month of diet was positively correlated with the percentage change of circulating total adiponectin (r=0.579, p=0.019). The percentage change of HDL-C over the 3 months of diet was positively correlated with the percentage changes of circulating total adiponectin (r=0.527, p=0.030) and high molecular weight (HMW) adiponectin (r=0.524, p=0.031). The change in circulating total adiponectin over the first month of diet was positively correlated with the HDL-C at 1 month (r=0.606, p=0.013). The change in HMW adiponectin over the 3 months of diet was positively correlated with the HDL-C at 3 months (r=0.602, p=0.011). The percentage change of circulating HMW adiponectin over the first month of fenofibrate treatment was positively correlated with the percentage change of HDL-C (r=0.594, p=0.012). HDL is positively correlated with the changes in circulating adiponectin during dietary and fenofibrate treatment.