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The metabolic syndrome represents a plethora of cardio-metabolic risk factors including obesity, arterial hypertension, atherogenic dyslipidemia, hyperglycemia, accompanied by pro-inflammatory and pro-thrombotic state. The metabolic syndrome is one of the key risk factors for certain types of cancer. Among these malignancies, breast cancer and endometrial neoplasms require special attention. Incriminated major causes for the development of breast and endometrial cancer in metabolic syndrome patients are: the proinflammatory status and related cytokines, adipokine imbalances, hyperestrogenism, growth factors, disturbances in cancer microenvironment, insulin resistance and hyperinsulinemia. The metabolic syndrome consists of molecular dysregulations that create a pro-oncogenic status. Our review aims at providing a better understanding of the mechanisms underlying the link between the metabolic syndrome and endometrial and breast cancer.

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Aim: We evaluated the association between anthropometric parameters and markers of insulin and leptin secretion/resistance in patients with type 2 diabetes mellitus (T2DM). Material and methods: This post-hoc data analysis from a cross-sectional study included 176 T2DM patients. Laboratory tests (serum leptin, soluble form of leptin receptor (sObR), C peptide, glycemic and lipid parameters) and anthropometric parameters were obtained, adiposity indexes (including body adiposity index (BAI), visceral adiposity index (VAI)), indicators of insulin resistance, β-cell function, and leptin resistance (Free Leptin Index, FLI) were calculated. Results: The body mass index (BMI), diabetes duration, VAI and leptin correlated independently with HOMA-IR, while BMI, diabetes duration and HbA1c with HOMA-B. The total body fat mass (TBFM), C peptide, diabetes duration, BMI and BAI correlated with leptin concentrations, while the first three with FLI. VAI was an indicator of insulin resistance (β=0.166, p=0.003), while BAI of leptin secretion (β=0.260, p=0.010). TBFM strongly associated with leptin resistance and secretion (β=0.037, r=0.688, p Conclusions: Parameters of peripheral adiposity correlated better with markers of leptin system, and those of visceral adiposity with markers of insulin secretion/resistance. The sObR correlated independently and negatively with C peptide.

Background and objectives: Polycystic ovary syndrome (PCOS) displays a phenotype-dependent cardio-metabolic risk. By performing a systematic search of the literature, we aimed to summarize metabolomic signatures associated with obesity in PCOS women. Data sources and study eligibility criteria: We conducted a comprehensive search including: Embase, PubMed, and Web of Science until 31st of May 2019. We used the terms: metabolomics and polycystic ovary syndrome. We excluded the following papers: animal studies, studies that included only lean PCOS women, reviews, meta-analyses, results of interventional studies, those that did not apply metabolomic techniques. Results: The lipid signature in obese women with PCOS showed increased levels of free fatty acids (carnitine, adipic acid, linoleic acid, oleic acid) and lower levels of lysophosphatidylcholines and glycerolphosphocholine compared with non-obese PCOS women. Regarding carbohydrate metabolism, a decrease in citric and lactic acid levels characterized obese PCOS women. Decreased lactic acid in obese PCOS women suggests augmented insulin stimulated glucose muscle use in lean, but not in obese women. Considering amino acid metabolomic markers, valine, glycine, serine, threonine, isoleucine and lysine were higher in obese PCOS women. Patients with visceral obesity presented a diminished uptake of essential amino acids, BCAA, leucine and serine in the skeletal muscle. α-ketoglutarate was significantly higher in obese women with PCOS in comparison with lean women with PCOS, distinguishing these 2 subgroups of PCOS with high ‘predictive accuracy’. Limitations: Overall, a small number of studies have focused on the impact of obesity on the metabolic fingerprints of PCOS women. There is need for properly controlled, high-quality studies. Conclusions: There is compelling evidence of significant alterations in carbohydrate, lipid, and amino acid metabolism in women with PCOS and obesity. Metabolomics may identify new metabolic pathways involved in PCOS and improve our understanding of the complex relation between PCOS and obesity in order to personalize PCOS therapy.

The objective of this scoping review was to summarize previous studies which examined the effect of day-to-day variability in sleep timing and social jetlag (SJL) on dietary intake. A systematic literature search was conducted in PubMed, Embase, and Clarivate Analytics Web of Science and we identified 22 records. No difference in caloric and macronutrient intake between SJL groups was observed in studies that enrolled healthy young adults. However, studies that enrolled participants with obesity and obesity-related chronic conditions reported a higher caloric intake and a higher intake of carbohydrates, total fat, saturated fats, and cholesterol in participants with SJL than in those without. Most studies reported a lower quality of diet, a delayed mealtime, and eating jetlag in participants with SJL vs. those without SJL. No correlation of day-to-day variability in sleep timing with average caloric intake was observed, but bed-time variability was negatively associated with diet quality. Methodological issues have been identified in sources assessed including study design, power calculation, population enrolled, and tools/metrics used for sleep timing variability assessment. Future well powered longitudinal studies, with clear protocols, standardized metrics, including all age groups from general population are needed to clarify the dietary intake consequences of variability in sleep timing.

The aim of the paper is to detect insulin resistance (IR) biomarkers via metabolomics. It is important to understand the PCOS pathophysiology, diagnosis measures and, subsequently, to improve treatment type and time of IR in PCOS. In most cases, almost half of the women with PCOS have IR which is triggered by inflammation, glucotoxicity and lipotoxicity. In this work was conducted a systematic review of all the papers that used metabolomics for detecting IR biomarkers in PCOS women. The exclusion criteria were: reviews, study population with women bellow 18 years of age, studies including animals and articles not in English, remaining 4 records. The results from the literature shown that phosphatidylcholines were decreased in IR PCOS women when compared to controls. Nonetheless, trans-2-hexenoylcoa, linoleic acid, leucine, myristic acid and palmitic acid regarding lipid metabolism and tyrosine, lysine, phenylalanine a-aminoadipic acid regarding amino acid metabolism were also corelated to IR in PCOS women when compared with healthy or IR controls. Lactate was the only increased metabolite related to glucose metabolism in IR PCOS women. Metabolic alteration in PCOS women with IR when are compared with controls and results that those are brought by both PCOS and IR. Lyso-phosphatidylcholine have an important pro-inflammatory and altered insulin signaling effect, both alterations being considered hallmarks of PCOS women. Serine hyperphosphorylation of the receptor accentuates IR by decreasing the signaling of insulin receptor. Moreover, high levels of lactate correlated with IR in PCOS women may indicate high muscle glycolysis, hepatic glucose production and peripheral glucose uptake. IR biomarkers in PCOS women were evidenced by metabolomics technique.

Diabetes is a major health problem worldwide. Glycemic control is the main goal in the management of type 2 diabetes. While many anti-diabetic drugs and guidelines are available, almost half of diabetic patients do not reach their treatment goal and develop complications. The glucose-lowering response to anti-diabetic drug differs significantly between individuals. Relatively little is known about the factors that might underlie this response. The identification of predictors of response to anti-diabetic drugs is essential for treatment personalization. Unfortunately, the evidence on predictors of drugs response in type 2 diabetes is scarce. Only a few trials were designed for specific groups of patients (e.g. patients with renal impairment or older patients), while subgroup analyses of larger trials are frequently unreported. Physicians need help in picking the drug which provides the maximal benefit, with minimal side effects, in the right dose, for a specific patient, using an omics-based approach besides the phenotypic characteristics.

Introduction. Enrollment of patients with cardiovascular disease in rehabilitation programs may contribute to implementation of a healthy lifestyle, including by promotion of a diet adequate for each patient’s profile. In this context, the current study is aimed at creating a traffic light system model allowing to obtain the development, innovation and diversification of menus and to improve the nutritional programs for this category of patients. Material and method. Based on the data provided by USDA Food Composition Databases, the composition in terms of different nutritive principles was determined for each ingredient and for each final menu. Comparison of menus depending on each nutritive principle, as well as comparison between menus and nutrient requirements according to indications for patients attending cardiovascular rehabilitation programs was made. Results. The traffic light system was developed, using color codes, comparing daily nutrient requirements with preparations’ content. Conclusions. The major benefit of the traffic light system would reside in the fact that starting from classic menus, an intervention on these can be achieved, and healthier, more nutritionally balanced models can be created, according to healthy nutrition principles. These new menus will be calorically and nutritionally adapted for patients attending cardiovascular rehabilitation programs. Key words: nutrition, rehabilitation, traffic light system

The prevalence of diabetes mellitus (DM) has rapidly increased over the last decades, reaching epidemic magnitudes, particularly in lowand middle-income countries. Point-of-care (POC) technology enables decision making near or at the site of patient care. Portable blood glucose meters and HbA1c testing are used by the healthcare provider and millions of patients with diabetes to monitor the safety and effectiveness of the diabetes treatment. However, POC capillary blood glucose and POC HbA1c testing are not recommended for diabetes diagnosis. Rather, they have been used for screening diabetes in lowand middle-income countries to decrease the disease burden.

Were investigated the relationship between gender, cardiovascular risk factors and inflammation in metabolic syndrome (MetS) patients. 100 consecutive patients (75 women), 73 with MetS, mean age 57.52�9.77 years, were examined. Adhesion molecules (sICAM1, sVCAM1) were measured in the stored serum samples collected using the ELISA method. The classification of MetS was based on IDF guidelines. The study was carried out at the Department of Cardiology, Clinical Rehabilitation Hospital, Cluj-Napoca, Romania. MetS patients presented lower sICAM1 values (225.01�86.75 ng/mL vs 234.22�82.23 ng/mL, p=NS), but higher sVCAM1 values (605.34�298.69 ng/mL vs 552.29�233.77 ng/mL, p=NS). Differences between patients with vs without metabolic syndrome were found only in men for sICAM1 (194.73�37.92 ng/mL vs 282�27.15 ng/mL, p[0.001). Considering the HOMA index, a significant difference for sICAM1 was found in men (patients within the upper quartile vs the lower quartile, p=0.002), but also between women and men within the upper quartile of HOMA (for sICAM1 p=0.038). No significant differences were found for sVCAM1. In the case of males, sICAM1 was an independent predictor of metabolic syndrome, with a very good capacity to identify metabolic syndrome (AUROC=0.987, p=0.0001, Se=89.47%, Sp=100%). In conclusion, just in men, sICAM1 seems to have an excellent capacity to differentiate between MetS+ and MetS- patients, to predict MetS development.

Endothelial nitric oxide synthase (NOS3 or eNOS) is the enzyme responsible for the highest production of nitric oxide, with the greatest impact on the cardiovascular system, encoded by the eNOS gene, which presents various polymorphisms. ENOS gene polymorphisms play an important role in the response to drugs affecting nitric oxide (NO) signaling. This review discusses the pharmacogenetic impact of eNOS polymorphisms on the response to drugs affecting NO activity: angiotensin converting enzyme inhibitors, angiotensin II receptor antagonists, calcium blockers, beta-blockers, diuretics, phosphodiesterase inhibitors, and statins. The identification of biomarkers that accurately predict particular phenotypes is a challenge that needs additional large studies, in different populations. Efforts should be oriented towards a more accurate evaluation of the effects of eNOS genetic variants on biochemical parameters reflecting eNOS gene expression and enzymatic activity, in different diseases, as well as following drug treatment. This approach will allow for a better understanding of the role of eNOS genetic variants in cardiovascular disease progression and for cardiovascular drug therapy optimization.

Immune checkpoint inhibitors (ICIs) are an important advancement in the field of cancer treatment, significantly improving the survival of patients with a series of advanced malignancies, like melanoma, non-small cell lung cancer (NSCLC), hepatocellular carcinoma (HCC), renal cell carcinoma (RCC), and Hodgkin lymphoma. ICIs act upon T lymphocytes and antigen-presenting cells, targeting programmed cell death protein 1 (PD1), programmed cell death protein ligand 1 (PD-L1), and cytotoxic T-lymphocyte antigen 4 (CTLA-4), breaking the immune tolerance of the T cells against malignant cells and enhancing the body’s own immune response. A variety of cardiac-adverse effects are associated with ICI-based treatment, including pericarditis, arrhythmias, cardiomyopathy, and acute coronary syndrome, with myocarditis being the most studied due to its often-unexpected onset and severity. Overall, Myocarditis is rare but presents an immune-related adverse event (irAE) that has a high fatality rate. Considering the rising number of oncological patients treated with ICIs and the severity of their potential adverse effects, a good understanding and continuous investigation of cardiac irAEs is of the utmost importance. This systematic review aimed to revise recent publications (between 2016–2022) on ICI-induced cardiac toxicities and highlight the therapeutical approach and evolution in the selected cases.

Metabolic syndrome (MetS) represents a cluster of disorders that increase the risk of a plethora of conditions, in particular type two diabetes, cardiovascular diseases, and certain types of cancers. MetS is a complex entity characterized by a chronic inflammatory state that implies dysregulations of adipokins and proinflammatory cytokins together with hormonal and growth factors imbalances. Of great interest is the implication of microRNA (miRNA, miR), non-coding RNA, in cancer genesis, progression, and metastasis. The adipose tissue serves as an important source of miRs, which represent a novel class of adipokines, that play a crucial role in carcinogenesis. Altered miRs secretion in the adipose tissue, in the context of MetS, might explain their implication in the oncogenesis. The interplay between miRs expressed in adipose tissue, their dysregulation and cancer pathogenesis are still intriguing, taking into consideration the fact that miRNAs show both carcinogenic and tumor suppressor effects. The aim of our review was to discuss the latest publications concerning the implication of miRs dysregulation in MetS and their significance in tumoral signaling pathways. Furthermore, we emphasized the role of miRNAs as potential target therapies and their implication in cancer progression and metastasis.

This research aimed to explore the relation of social jetlag (SJL) with perceived appetite, and hormones involved in hunger regulation in healthy subjects in free-living conditions (study registration number: ACTRN12618001182280). Eighty normally diurnally active men and women were enrolled in 4 study groups according to the presence of SJL and sleep deprivation (2 groups with SJL with or without sleep deprivations and 2 groups without SJL with or without sleep deprivation) matched 1:1:1:1 for age, gender, and body mass index. Appetite was assessed in fasting state, by measuring acylated ghrelin level and using 100 mm visual analog scales. Persons with SJL had a higher perceived appetite for pork, poultry, fish, eggs, milk, and dairy products and higher acylated ghrelin levels than those without SJL. When considering the presence of sleep deprivation, subjects with SJL, with and without sleep deprivation, reported a higher perceived appetite than group with sleep deprivation alone. They also reported later meal times for lunch and dinner, had more frequently a snack before sleep and reported eating more frequently while watching TV or playing on computer, suggesting poorer eating habits in these subjects. In conclusion, independent of sleep duration, SJL is associated with an increased appetite for caloric dense food, suggesting an increased incentive value of food in these subjects and an anticipated pleasure of ingesting these foods.

The outbreak of the COVID-19 pandemic represents an ongoing healthcare emergency responsible for more than 3.4 million deaths worldwide. COVID-19 is the disease caused by SARS-CoV-2, a virus that targets not only the lungs but also the cardiovascular system. COVID-19 can manifest with a wide range of clinical manifestations, from mild symptoms to severe forms of the disease, characterized by respiratory failure due to severe alveolar damage. Several studies investigated the underlying mechanisms of the severe lung damage associated with SARS-CoV-2 infection and revealed that the respiratory failure associated with COVID-19 is the consequence not only of acute respiratory distress syndrome but also of macro- and microvascular involvement. New observations show that COVID-19 is an endothelial disease, and the consequent endotheliopathy is responsible for inflammation, cytokine storm, oxidative stress, and coagulopathy. In this review, we show the central role of endothelial dysfunction, inflammation, and oxidative stress in the COVID-19 pathogenesis and present the therapeutic targets deriving from this endotheliopathy.

Endothelial function is considered an independent predictor for risk of future cardiovascular events in cardiovascular and noncardiovascular patients. Given the prevalence of cardiovascular disease (CVD), preclinical detection may help modify atherosclerosis and prevent events. Although traditional cardiovascular risk factors relate to future CVD, the predictive value of these risk factors can be relatively limited. Contemporary scientific attention has focused on alternative direct measures of arterial function . Studies have provided unique insights into the pathophysiology of disease processes, the response to treatment and prognostic information that may be helpful in risk prediction. Peripheral measures of endothelial function are now established surrogate markers of vascular risk and have become important markers for clinical research. Cardiac rehabilitation (CR) is of critical importance in the secondary prevention of cardiovascular disease. It has been reported that CR was negatively related to reinfarction, cardiac morbidity and all-cause mortality. The beneficial influence of cardiac rehabilitation on endothelial dysfunction has been demonstrated in many studies, but the the mechanisms by which exercise improves endothelial function are not fully clarified.

Background. Metabolic syndrome (MetS) represents a clustering of metabolic risk factors for cardiovascular disease. Many studies have shown the influence of an unhealthy lifestyle on the risk of MetS, yet some aspects remain controversial. Aim of the study: to investigate the relationship between an unhealthy lifestyle and the risk of MetS. Materials and Methods. The study was conducted using a sample of 181 patients, 54 (29.8%) males and 127 (70.2%) females, aged 59.95±10.8 years. The baseline survey involved the completion of structured questionnaires and clinical examination. Results. Rural environment, lower education level, past smoking, the absence of fruit/vegetables in the diet, carbonated soft drinks, and the consumption of significant amounts of alcohol were risk factors for the MetS. Conclusion. A precise etiology for the MetS remains unclear, but it is known to result from a complex interaction of genetic, metabolic, and socio-economic and environmental factors.

Introduction Recent statistics show an increase in the prevalence of the elderly population. The year 2012 was declared European Year for Active Ageing and Solidarity between Generations, and the European Commission launched campaigns like The Active and Assisted Living Joint Program (AAL JP). Rehabilitation in the elderly is a desideratum, but the problems of rehabilitation in the elderly are numerous. The aim of the study was to evaluate degree of acceptance/implementation of different technologies in Romania, of monitoring in the rehabilitation activity conducted at home. Material and methods the study comprised 154 persons with a mean age of 73.37 ± 7.33 years, of which 64 (41.6%) male and 90 (58.4%) female. All subjects completed a questionnaire regarding the living conditions and health status, about the degree of acceptance of intelligent technologies for monitoring current health status/reporting acute events. Results 18.2% used the Internet frequently, and the rest used it almost never or rarely. 71.9 % of patients agreed to wear a portable sensor (p=0.07 between men and women), 33.1% accepted videocam, 47.4% accepted a screen, 41.3% accepted living room monitoring, 68% sensor in the room on the wall and 69.1% accepted fall detection sensor. No significant differences were found regarding the acceptance vs rejection of personal sensors, living room monitoring, sensors in the room, fall detection sensors depending on the gender, income level, type of caregiving. Using of videocam and screen was influenced by type of care giving and income (p=0.002, p

Introduction. Early detection of atherosclerosis is important in patients with metabolic syndrome (MetS) because cardiovascular diseases are the main cause of mortality in these patients. Cardiac rehabilitation (CR) is one of the best known and studied interventions, which has been shown to be associated with decreased morbidity and mortality of cardiovascular disease. Salbutamol mediated effects on pulse wave represent a practical, valid and reliable non-invasive surrogate marker of subclinical atherosclerosis. Aim of the study We assessed subclinical atherosclerosis in patients with MetS vs. a control group, by measuring aortic pulse wave velocity (PWVAo), the augmentation index and central blood pressure, before and after salbutamol administration, which allows evaluation of the hemodynamic effects of inhaled salbutamol on the arterial parameters. Material and methods We conducted a clinical study on a representative sample of 30 subjects, 67% had metabolic syndrome and 33% did not have metabolic syndrome (control group). We measured all parameters of arterial stiffness: brachial augmentation index (Aixb), aortic augmentation index (Aixao), pulse wave velocity (PWVao), aortic pulse pressure (PPao), central blood pressure (SBPao), before and after administration of two inhalations of Ventolin® (salbutamol). Results The analysis of arterial stiffness parameters (Table 2) showed that PWVao before salbutamol administration was 10.60 m/s in the group with MetS, and 9.11 m/s in the control group, with no significant difference. After salbutamol administration, PWVao was 10.78 m/s in the group with MetS, and significantly lower 8.2 m/s (p=0.008), in the group without MetS. There was a significant difference between the groups regarding PPao (mmHg) before salbutamol (54.040 ± 8.5530, 66.215 ± 15.6326, p=0.03), SBPao (mmHg) before salbutamol (147.14±20.12 vs. 125.34±9.71; p

Currently, adipose tissue is considered an endocrine organ, however, there are still many questions regarding the roles of adipokines—leptin and ghrelin being two adipokines. The purpose of the study was to assess the relationship between the adipokines and their ratio with obesity and diabetes. Methods: Sixty patients (mean age 61.88 ± 10.08) were evaluated. Cardiovascular risk factors, leptin, ghrelin, and insulin resistance score values were assessed. The patients were classified according to their body mass index (BMI) as normal weight, overweight, and obese. Results: 20% normal weight, 51.7% overweight, 28.3% obese, and 23.3% diabetic. Obese patients had higher leptin values (in obese 34,360 pg/mL vs. overweight 18,000 pg/mL vs. normal weight 14,350 pg/mL, p = 0.0049) and leptin/ghrelin ratio (1055 ± 641 vs. 771.36 ± 921 vs. 370.7 ± 257, p = 0.0228). Stratifying the analyses according to the presence of obesity and patients’ gender, differences were found for leptin (p = 0.0020 in women, p = 0.0055 in men) and leptin/ghrelin ratio (p = 0.048 in women, p = 0.004 in men). Mean leptin/BMI and leptin/ghrelin/BMI ratios were significantly higher, and the ghrelin/BMI ratio was significantly lower in obese and diabetic patients. In conclusion, obesity and diabetes are associated with changes not only in the total amount but also in the level of adipokines/kg/m2. Changes appear even in overweight subjects, offering a basis for early intervention in diabetic and obese patients.

Epigenetic regulation of gene expression allows the organism to respond/adapt to environmental conditions without changing the gene coding sequence. Epigenetic modifications have also been found to control gene expression in various diseases, including diabetes. Epigenetic changes induced by hyperglycemia in multiple target organs contribute to metabolic memory of diabetic complications. The long-lasting development of diabetic complications even after achieving glucose control has been partly attributed to epigenetic changes in target cells. Specific epigenetic drugs might rescue chromatin conformation associated to hyperglycemia possibly slowing down the onset of diabetes-related complications. The current review will describe the updated epigenetics in diabetes that can be used to personalize a more focused treatment.

Endothelial nitric oxide synthase (NOS3 or eNOS) is the enzyme responsible for the highest production of nitric oxide, with the greatest impact on the cardiovascular system, encoded by the eNOS gene, which presents various polymorphisms. ENOS gene polymorphisms play an important role in the response to drugs affecting nitric oxide (NO) signaling. This review discusses the pharmacogenetic impact of eNOS polymorphisms on the response to drugs affecting NO activity: angiotensin converting enzyme inhibitors, angiotensin II receptor antagonists, calcium blockers, beta-blockers, diuretics, phosphodiesterase inhibitors, and statins. The identification of biomarkers that accurately predict particular phenotypes is a challenge that needs additional large studies, in different populations. Efforts should be oriented towards a more accurate evaluation of the effects of eNOS genetic variants on biochemical parameters reflecting eNOS gene expression and enzymatic activity, in different diseases, as well as following drug treatment. This approach will allow for a better understanding of the role of eNOS genetic variants in cardiovascular disease progression and for cardiovascular drug therapy optimization.

A healthy diet rich in dietary fiber (DF) is considered beneficial for human health, and recommended dietary intake of dietary fiber is established all over the world. The physiological effect of dietary fiber is mostly related to its behavior during digestion. In this chapter, the behavior of dietary fiber in the human digestive tract is discussed and linked to its physiological effect with special attention to four aspects of such behavior: (1) the modulation of bioavailability by the plant cell walls, (2) the effect of dietary fiber on the rheological and colloidal state of digesta, (3) the binding of dietary fiber with phenolic compounds, bile salts, mineral ions, and digestive enzymes, and (4) dietary fiber fermentation in the large intestine and the corresponding effect on microbiota composition.

The concept of personalized (precision) medicine (PM) emphasizes the scientific and technological innovations that enable the physician to tailor disease prediction, diagnosis and treatment to the individual patient, based on a personalized data-driven approach. The major challenge for the medical systems is to translate the molecular and genomic advances into clinical available means. Patients and healthcare providers, the pharmaceutical and diagnostic industries manifest a growing interest in PM. Multiple stakeholders need adaptation and re-engineering for successful clinical implementation of PM. Drawing primarily from the field of ‘diabetes’, this article will summarize the main challenges to implementation of PM into current medical practice and some of the approaches currently being implemented to overcome these challenges.

Background: Endothelial Nitric Oxide Synthase (eNOS) is responsible for Nitric Oxide (NO) bioavailability at endothelial level. Aging (even in healthy people) is involved in arterial stiffness increases. Materials and Methods: We investigated (in the service of Cardiology, 4th Medical Clinic) 100 patients, 55 with metabolic syndrome (MS), mean age 56.91 ± 14.39 years, 66% women. Identification of the T786C polymorphism was performed by enzymatic digestion of the fragment obtained by polymerase chain reaction (PCR) amplification. Evaluation of arterial parameters (aortic pulse wave velocity (PWV), as a measure of arterial stiffness and aortic [AixAo] and brachial [Aixb] augmentation index) was performed with the TensioMed™ Arteriograph. Results: Regarding T786C polymorphism, the distribution was the following: 57% did not have the mutation (TT), 30% were heterozygous, 13% were homozygous (CC). Patients with MS more frequently had C allele (54.5% vs. 28.9% in those without MS) and CC state (16.4% vs. 8.9%, p-NS). Significant differences (p = 0.005) regarding PWV were found in TT patients vs. heterozygous CT vs. homozygous CC: 9.75 ± 1.75 m/s vs. 9.86 ± 1.56 m/s vs. 11.65 ± 1.87 m/s. In case of the other parameters, no significant differences were found (AixAo, p = 0.35; Aixb, p = 0.22; pulse pressure, p = 0.14), but CC patients presented higher values. Conclusion: Arterial stiffness is influenced by eNOS gene polymorphisms, being a possible link between the increase in cardiovascular risk and presence of metabolic syndrome in these patients.

Metabolic syndrome (MS) is a clustering entity characterized by obesity, hypertension, hyperglycemia, dyslipidemia, and insulin resistance. Early detection of atherosclerosis is important in patients with MS because cardiovascular diseases are the main cause of mortality in these patients.We aimed to investigate the factors influencing arterial stiffness, pulse wave velocity, and the augmentation index, respectively, in 150 subjects with MS (94 women and 56 men; mean age 60.56 ± 9.8 years). Arterial stiffness was measured using the TensioMed™ Arteriograph. We tested the relationship between arterial parameters and insulin resistance measured by the determination of insulinemia (the ELISA method) and the homeostasis model assessment index (HOMA).In multivariate analysis we identified the independent factors that influence arterial stiffness: systolic blood pressure (coefficient of determination 3.586; P 0.0001), serum triglycerides (coefficient of determination 3.579; P 0.0001), and age (coefficient of determination 3.510; P = 0.001) are independent predictive factors for pulse wave velocity. The independent predictive factors of the augmentation index were the body mass index (coefficient of determination 0.55; P = 0.009), the presence of diabetes mellitus (coefficient of determination 4.7; P = 0.03), mean arterial pressure (coefficient of determination 0.44; P 0.0001), gender (coefficient of determination 9.2; P 0.0001), age (coefficient of determination 0.3; P 0.0001), and heart rate (coefficient of determination 0.66; P 0.0001). Insulin resistance (HOMA index) was a predictor of the brachial augmentation index (β coefficient 3.4; P 0.001) and was not a predictor of pulse wave velocity (β = -0.3; P = 0.6) in our study.Given the known predictive value of pulse wave velocity for cardiovascular events, identifying the factors responsible for the increase in arterial stiffness is extremely important.

Hepatocellular carcinoma (HCC) is a frequently encountered cancer type, and its alarming incidence is explained by genetic and epigenetic alterations. Epigenetic changes may represent diagnostic and prognostic biomarkers of HCC. In this review we discussed deoxyribonucleic acid (DNA) hypomethylation, DNA hypermethylation, and aberrant expression of small non-coding ribonucleic acid (RNA), which could be useful new biomarkers in the early diagnosis of HCC. We selected the articles on human subjects published in English over the past two years involving diagnostic markers detected in body fluids, cancer diagnosis made on histopathological exam, and a control group of those with benign liver disease or without liver disease. These biomarkers need further investigation in clinical trials to develop clinical applications for early diagnosis and management of HCC.

The current article outlines the main issues presented during the 4th Up Close and Personalized (UPCP), International Congress on Personalized Medicine, which took place in Tel Aviv (Israel) on 17–20 June 2015. The main topics presented included: phenotypic and ‘omics’ data in the personalized medicine of diabetes, obesity and oncology; updated reports on large-scale human genetics applied to drug discovery and precision medicine; new advances in disease targeted nano delivery systems, lessons derived from big clinical data and barriers for implementing personalized medicine in at the point of care.

There are very few studies in the English literature that evaluate the patient satisfaction after treatment using intense pulsed light (IPL) and there is no reported study comparing the results of the three major IPL applications: rejuvenation, hair removal, and treatment of small vascular lesions. This study was designed to compare results after IPL treatment for skin rejuvenation, hair removal, and vascular lesions. Three groups of 30 consecutive patients having skin rejuvenation, hair removal, and small vascular lesions were selected and treated with the same IPL system. The evaluation was performed 1 year after the last treatment for the following parameters: age, sex, skin type, satisfaction, willingness to continue the treatment, willingness to recommend the treatment, and complications. Most of the minor complications occurred in the rejuvenation group (86.6%). No complications were recorded for 67% of patients having hair removal and for 75% having vascular lesion treatment. There was no significant difference in the level of satisfaction between the 3 groups (Kruskal Wallis test; P = 0.257). No difference regarding satisfaction was recorded in this study, but complications were more frequently encountered after rejuvenation. The findings of this study are useful when discussing IPL treatments with patients considering IPL procedures.

Metabolic syndrome (MS) or insulin resistance syndrome is the result of multiple metabolic abnormalities associated with cardiovascular disease. Since 1988, when Reaven first described MS, many researches have been conducted in order to understand its pathophysiology, epidemiology, prognostic implications and therapeutic strategies. Numerous metabolic abnormalities found in the metabolic syndrome, including hyperglycemia, excessive fatty acids and insulin resistance, cause an endothelial cell dysfunction by affecting nitric oxide synthesis or degradation. Although the exact mechanism by which metabolic syndrome induces endothelial dysfunction remains to be clarified, there are many possibilities of vascular endothelial damage and increase in cardiovascular risk in these patients. The most frequent metabolic, hormonal, hemostatic abnormalities in patients with metabolic syndrome that may contribute to endothelial dysfunction are: hyperinsulinemia, hyperglycemia, increase in fatty acid levels, hypertriglyceridemia, decrease in HDL-cholesterol, increase in small dense LDL-cholesterol, increase in apolipoprotein B, increase in insulin-1 growth factor levels, increase in tissue angiotensin II levels, increase in plasminogen activator inhibitor-1, increase in C reactive protein, increase in oxidative stress.

The main purpose of this chapter is to discuss the place of telemedicine in the modern medicine, its present and future application in the clinical medicine. It covers aspects of clinical telemedicine practice, technical advances, principles and practices, health policy and regulation, and health services research dealing with clinical effectiveness, efficacy, and safety of telemedicine and its effects on quality, cost, and accessibility of care. The diabetic foot problem was chosen as a suitable model to examine whether the use of telemedicine technology will improve the quality of medicine and reduce medical costs.