Coronary age, based on coronary calcium measurement, is increased in patients with morbid obesity

Purpose: Obesity is a well-known of risk factor for atherosclerosis. However, recently an "obesity paradox" has been discussed, which is considered as a protective effect of obesity on the development coronary artery disease (CAD). An aim of the study was to investigate the risk of CAD in morbidly obese patients using coronary artery calcium measurement. Material and methods: Fifty-one patients with morbid obesity (BMI ≥ 40 kg/m2) and thirty controls were scanned to determine the amount of coronary artery calcification (CAC), which was expressed as calcium score (CS) and coronary age (CA). The control group consisted of patients scanned for the clinical suspicion of CAD, who did not fulfil the criteria of obesity. Results: Mean BMI of obese patients and controls was 47.3 and 26.5, respectively (p < 0.0001). Arterial hypertension, dyslipidaemia, and smoking were more frequent in the control group than in the obesity group (p < 0.02). The prevalence of CAC was higher in the obesity group (53% vs. 23%, p < 0.01). The groups did not differ regarding CS and CA. However, the difference between coronary age and metrical age was higher in obese patients than in controls (+5.6 vs. -4.8 years, respectively, p < 0.005). Conclusions: Patients with morbid obesity present an increased risk of CAD that is reflected by the difference between their coronary age and metrical age

Chest adipose tissue distribution in patients with morbid obesity

Purpose: Obesity is a well-known of risk factor for atherosclerosis and the amount of visceral adipose tissue is considered as an independent predictor of coronary artery disease (CAD). An aim of the study was to investigate the distribution of intrathoracic adipose tissue in morbidly obese patients. Material and methods: Fifty-one patients with morbid obesity (BMI ≥ 40 kg/m2) and thirty controls were scanned in a coronary calcium scoring protocol. Control group consisted of patients scanned due to a clinical suspicion of CAD, who did not fulfill obesity criteria. The amount of adipose tissue was measured as epicardial adipose tissue (EAT) thickness, pericoronary fat (PCF) thickness, total intra-pericardial fat (IPF) volume, and total intrathoracic fat (ITF) volume. Results: Mean BMI of obese patients and controls was 47.3 and 26.5, respectively (p 60 mm was the parameter that presented the strongest association with morbid obesity (AUC 0.95; p < 0.0001). Conlcusions: Increased chest soft tissue thickness but not the increased intrathoracic adipose tissue volume was associated with morbid obesity. Since the quantity of the pericardiac fat is not directly related to the obesity, its accumulation may be related to a mechanism different than that of subcutaneous adipose tissue growth

Longitudinal Analysis (1994–2020) of Prevalence and Trends of Underweight in Polish Children

Nutritional status disorders are a worldwide problem. Approximately 5.9 million children under the age of five die each year, and 45% of these deaths are related to malnutrition. The aim of the study was to analyse the prevalence of underweight children aged between 6 and 7 years old, living in the Gdańsk, Poland, in the years 1994–2020. The anthropometric parameters of 67,842 children were analysed. BMI (Body Mass Index) value &lt;5 percentile (pc) was defined as underweight. The BMI value was compared to the WHO (World Health Organization) centile charts and the OLAF (research project PL0080) national reference charts. The prevalence of underweight children in relation to the WHO charts was 1.9%; underweight status was found to be more significant in the group of boys (2.1%) than the group of girls (1.7%) (p &lt; 0.001). According to the OLAF centile charts, the underweight figure among all of the study population was 2.1% and no statistical significance between boys (2.1%) and girls (2.0%) was found (p = 0.670). The occurrence of underweight indviduals in the studied group slightly increased in the years 1994–2020. We found a statistically significant increasing linear trend in the analysis of underweight children in our group (p &lt; 0.001), in group of boys (p &lt; 0.001), but not girls (WHO p = 0.603; OLAF p = 0.787). This points to the need to conduct regular screening systems for children and adolescents

Hypercoagulability as Measured by Thrombelastography May Be Associated with the Size of Acute Ischemic Infarct—A Pilot Study

Background: Thromboelastography (TEG®) measures coagulation function in venous blood. Previous studies have reported that this device providing an integrated data on dynamics of clot formation may be useful for predicting clinical outcome in ischemic stroke. We investigated whether a hypercoagulability detected by thrombelastography may be associated with larger size of acute ischemic infarct. Methods: We included 40 ischemic stroke subjects with large artery atherosclerosis or small-vessel disease to a cross-sectional pilot study. Thrombelastography parameters related to time of clot formation (R- reaction time, K-clot kinetics), clot growth and strengthening (angle-alpha and MA-maximum amplitude) and lysis (Ly30) were performed within first 24 h after the onset of stroke. A volume of ischemic infarct was assessed on the basis of diffusion-weighted imaging (DWI) sequence of magnetic resonance imaging. Results: In the entire group, we reported that subjects with a large ischemic focus (&gt;2 cm3) had a higher diameter of a clot (measured as MA) than subjects with a small ischemic focus (p = 0.0168). In the large artery atherosclerosis subgroup, we showed a significant correlation between MA and size of acute infarct (R = 0.64, p = 0.0138), between angle (alpha) and size of acute infarct (R = 0.55, p = 0.0428) and stroke subjects with hypercoagulability (MA &gt; 69 mm) had significantly higher probability of a larger size of acute ischemic focus compared to normalcoagulable subjects (5.45 cm3 vs. 1.35 cm3; p = 0.0298). In multivariate logistic regression hypercoagulability was a predictor of a large size of ischemic infarct (Odds ratio OR = 59.5; 95% confidence interval (CI) 1.08–3558.8; p = 0.0488). Conclusions: We emphasized that thrombelastography, based on the parameters related to clot strength, may have clinical utility to identify the risk of the extensive ischemic infarct

Unfavorable changes of platelet reactivity on clopidogrel therapy assessed by impedance aggregometry affect a larger volume of acute ischemic lesions in stroke

Background: High on-treatment platelet reactivity or its equivalent—resistance to the antiplatelet agent—significantly reduces the efficacy of the therapy, contributing to a negative impact on stroke course. Previous studies demonstrated that aspirin resistance is associated with a larger size of acute ischemic infarct. Due to the increasing use of clopidogrel in the secondary prevention of stroke, we aimed to assess the impact of clopidogrel resistance on the size and extent of ischemic lesions, both acute and chronic. Methods: This prospective, single-center and observational study involved 74 ischemic stroke subjects, treated with 75 mg of clopidogrel. We used impedance aggregometry to determine platelet reactivity 6–12 h after a dose of clopidogrel as a first assessment and 48 h later as the second measurement. A favorable dynamics of platelet reactivity over time was the decrease in the minimum value equal to the median in the entire study. The volume of acute ischemic infarct was estimated within 48 h after onset in diffusion-weighted imaging and fluid-attenuated inversion recovery sequences of magnetic resonance and the severity of chronic vascular lesions by Fazekas scale. Results: Subjects with mild severity of chronic vascular lesions (Fazekas 1) exhibited a significant decrease of platelet reactivity over time (p = 0.035). Dynamics of platelet re-activity over time differed between subjects with large, moderate, mild and insignificant size of acute ischemic lesion (Kruskall-Wallis H = 3.2576; p = 0.048). In multivariate regression models, we reported unfavorable dynamics of platelet reactivity alone and combined with a high initial value of platelet reactivity as independent predictors of higher risk of a significant ischemic infarct volume (OR 7.16 95%CI 1.69-30.31, p = 0.008 and 26.49 95%CI 1.88-372.4, p = 0.015, respectively). Conclusions: We emphasized that unfavorable dynamics of platelet reactivity over time during clopidogrel therapy in acute phase of stroke affect the volume of acute infarct and the severity of chronic vascular lesions

Endothelial Progenitor Cells as a Marker of Vascular Damage But not a Predictor in Acute Microangiopathy-Associated Stroke

Background: The aim of the study was to assess the number of endothelial progenitor cells (EPCs) in patients with acute stroke due to cerebral microangiopathy and evaluate whether there is a relationship between their number and clinical status, radiological findings, risk factors, selected biochemical parameters, and prognosis, both in ischemic and hemorrhagic stroke. Methods: In total, 66 patients with lacunar ischemic stroke, 38 patients with typical location hemorrhagic stroke, and 22 subjects from the control group without acute cerebrovascular incidents were included in the prospective observational study. The number of EPCs was determined in serum on the first and eighth day after stroke onset using flow cytometry and identified with the immune-phenotype classification determinant (CD)45&minus;, CD34+, CD133+. Results: We demonstrated a significantly higher number of EPCs on the first day of stroke compared to the control group (med. 17.75 cells/&micro;L (0&ndash;488 cells/&micro;L) vs. 5.24 cells/&micro;L (0&ndash;95 cells/&micro;L); p = 0.0006). We did not find a relationship between the number of EPCs in the acute phase of stroke and the biochemical parameters, vascular risk factors, or clinical condition. In females, the higher number of EPCs on the first day of stroke is related to a favorable functional outcome on the eighth day after the stroke onset compared to males (p = 0.0355). We found that a higher volume of the hemorrhagic focus on the first day was correlated with a lower number of EPCs on the first day (correlation coefficient (R) = &minus;0.3378, p = 0.0471), and a higher number of EPCs on the first day of the hemorrhagic stroke was correlated with a lower degree of regression of the hemorrhagic focus (R = &minus;0.3896, p = 0.0367). Conclusion: The study showed that endothelial progenitor cells are an early marker in acute microangiopathy-associated stroke regardless of etiology and may affect the radiological findings in hemorrhagic stroke. Nevertheless, their prognostic value remains doubtful in stroke patients

Contrast-enhanced ultrasonography for the determination of Crohn's disease activity : preliminary experience

Background: Contrast-enhanced ultrasound (CEUS) is a recent non-invasive modality, which may partially replace currently used techniques (endoscopy, CT enterography and MR enterography) in the diagnostics and assessment of Crohn's disease (CD). The aim of the study was to analyze early experience in the use of CEUS for the measurement of activity and staging of CD. Material and Methods: Eleven patients previously diagnosed with CD were included in the study. They underwent contrast-enhanced ultrasonography (SonoVue, Bracco), low-dose CT enterography (LDCTE), assessment of laboratory markers of inflammation and clinical CD activity index (CDAI). Contrast enhancement was evaluated using a semi-quantitative method and a quantitative method that included measurement of peak enhancement (PE), enhancement curve rise time (RT) and wash-in-rate (WiR). Results: Ileal wall thickening was observed in all patients. Semi-quantitative method was used to observe CD activity in CEUS in 10 cases that perfectly matched LDCTE findings. There was a moderate positive correlation between PE and CDAI (r=0.65, p<0.001). There was no significant relationship between perfusion parameters and laboratory markers of inflammation. Conclusions: CEUS is a promising modality for non-invasive assessment of pathologic ileal vascularization in the course of Crohn's disease. Intensity of enhancement in CEUS reflects activity of the disease detected in LDCTE and correlates with CDAI

Diffusion-weighted MR imaging of transplanted kidneys : preliminary report

Background: An aim of this study was to assess the feasibility of DWI in the early period after kidney transplantation. We also aimed to compare ADC and eADC values in the cortex and medulla of the kidney, to estimate image noise and variability of measurements, and to verify possible relation between selected labolatory results and diffusion parameters in the transplanted kidney. Material and Methods: Examinations were performed using a 1.5 T MR unit. DWI (SE/EPI) was performed in the axial plane using b-values of 600 and 1000. ADC and eADC measurements were performed in four regions of interest within the renal cortex and in three regions within the medulla. Relative variability of results and signal-to-noise ratio (SNR) were calculated. Results: The analysis included 15 patients (mean age 52 years). The mean variability of ADC was significantly lower than that of eADC (6.8% vs. 10.8%, respectively; p30 ml/min./1.73 m2 (p<0.05). Conclusions: Diffusion-weighted imaging of transplanted kidneys is technically challenging, especially in patients in the early period after transplantation. From a technical point of view, the best quality parameters offer quality ADC measurement in the renal cortex using b1000. ADC and eADC values in the renal cortex measured at b1000 present a relationship with eGFR

Dual-Energy and Photon-Counting Computed Tomography in Vascular Applications—Technical Background and Post-Processing Techniques

The field of computed tomography (CT), which is a basic diagnostic tool in clinical practice, has recently undergone rapid technological advances. These include the evolution of dual-energy CT (DECT) and development of photon-counting computed tomography (PCCT). DECT enables the acquisition of CT images at two different energy spectra, which allows for the differentiation of certain materials, mainly calcium and iodine. PCCT is a recent technology that enables a scanner to quantify the energy of each photon gathered by the detector. This method gives the possibility to decrease the radiation dose and increase the spatial and temporal resolutions of scans. Both of these techniques have found a wide range of applications in radiology, including vascular studies. In this narrative review, the authors present the principles of DECT and PCCT, outline their advantages and drawbacks, and briefly discuss the application of these methods in vascular radiology