Determinants of Arterial Stiffness in Patients with Morbid Obesity. The Role of Echocardiography and Carotid Ultrasound Imaging.

Background and objective: Morbid obesity is accompanied by an increased cardiovascular (CV) risk, which justifies a multidisciplinary, integrative approach. Arterial stiffness has a well-defined additional role in refining individual CV risk. Given that echocardiography and carotid ultrasound are usual methods for CV risk characterization, we aimed to identify the imaging parameters with a predictive value for early-onset arterial stiffness. Material and methods: We conducted a study in which 50 patients (divided into two equal groups with morbid obesity and without obesity), age and gender matched, untreated for cardiovascular risk factors, were addressed to bariatric surgery or non-inflammatory benign pathology surgery. Before the surgical procedures, we evaluated demographics, anthropometric data and biochemical parameters including adipokines (chemerin, adiponectin). Arterial stiffness was evaluated using the Medexpert ArteriographTM TL2 device. Transthoracic echocardiography and carotid ultrasound were also performed. We also analyzed adipocyte size and vascular wall thickness in intraoperative biopsies. Results: Left ventricle (LV) mass index (p = 0.2851), LV ejection fraction (LVEF) (p = 0.0073), epicardial adipose tissue thickness (p = 0.0001) as echocardiographic parameters and carotid intima-media thickness (p = 0.0033), relative wall thickness (p = 0.0295), wall to lumen thickness ratio (p = 0.0930) and carotid cross-sectional area (p = 0.0042) as ultrasound parameters were significant measures in our groups and were assessed in relation to adipocyte size, blood vessel wall thickness and adipokines serum levels. Statistical analysis revealed directly proportional relationships between LV mass index (p = 0.008), carotid systolic thickness of the media (p = 0.009), diastolic thickness of the media (p = 0.007), cross-sectional area (p = 0.001) and blood vessel wall thickness. Carotid relative wall thickness positively correlates with adipocyte size (p = 0.023). In patients with morbid obesity, chemerin and adiponectin/chemerin ratio positively correlates with carotid intima-media thickness (p = 0.050), systolic thickness of the media (p = 0.015) and diastolic thickness of the media (p = 0.001). The multiple linear regression models revealed the role of epicardial adipose tissue thickness and carotid cross-sectional area in predicting adipocyte size which in turn is an independent factor for arterial stiffness parameters such as pulse wave velocity, subendocardial viability ratio and aortic augmentation index. Conclusions: Our results suggest that epicardial adipose tissue thickness, carotid intima-media thickness, relative wall thickness and carotid cross-sectional area might be useful imaging parameters for early prediction of arterial stiffness in patients with morbid obesity.

From Pleasure to Pathology: Understanding the Neural Basis of Food Addiction in the Context of Obesity.

As rates of severe obesity continue to rise globally, intense efforts are required both from the scientific community, physicians and health policy makers to better understand the mechanisms, prevent and treat obesity in order to stop the upcoming pandemic. Obesity is known to significantly reduce life expectancy and overall quality of life, thus becoming a leading cause of preventable deaths. This article focuses on the relationship between obesity and food addiction, the main neural mechanisms, brain regions, genes, hormones and neurotransmitters involved and on the similarities between food addiction and substance abuse. The definition of obesity is based on the body mass index (BMI). A BMI of 30 or higher is classified as obese. Obesity is not solely a result of overeating, but has multifactorial causes, thus, prevention being extremely difficult. The concept of food addiction implies extreme cravings, lack of self-control, and overeating, especially involving tasty foods. The addiction concept is supported both by clinicalbehavioural research and neurobiological research. These studies demonstrate similarities between binge eating and drug addiction, including cravings, loss of control, excessive intake, tolerance, withdrawal, and distress/dysfunction. Although generally food addiction is thought to be distinct from obesity, most studies identify that a significant percentage of individuals with food addiction are obese. Our aim was to emphasize the need to better understand the neurological basis of obesity and addiction, and its implications for research, treatment, and public health initiatives. Understanding the neural mechanisms underlying food addiction can inform future healthcare policies and interventions aimed at addressing the global obesity epidemic.

Salt, Not Always a Cardiovascular Enemy? A Mini-Review and Modern Perspective.

Dietary salt intake is a long-debated issue. Increased sodium intake is associated with high blood pressure, leading to salt-sensitive hypertension. Excessive salt intake leads to arterial stiffness in susceptible individuals via impaired nitric oxide action and increased endothelin-1 expression, overactivity of the renal sympathetic nervous system and also via aldosterone-independent activation of the mineralocorticoid receptor. Salt restriction in such individuals reduces blood pressure (BP) values. The optimal level of salt restriction that leads to improved cardiovascular outcomes is still under debate. Current BP and dietary guidelines recommend low sodium intake for the general population. However, a specific category of patients does not develop arterial hypertension in response to sodium loading. In addition, recent research demonstrates the deleterious effects of aggressive sodium restriction, even in heart failure patients. This mini review discusses current literature data regarding the advantages and disadvantages of salt restriction and how it impacts the overall health status.

Reply to Campbell et al. Comment on "Hogas et al. Salt, Not Always a Cardiovascular Enemy? A Mini-Review and Modern Perspective. Medicina 2022, 58, 1175".

We thank Campbell et al. for their comment [...].

Death Obsession, COVID-19-Related Fear and Religiosity in People Living with Type 2 Diabetes.

Patients diagnosed with type 2 diabetes were included among high-risk groups for more severe manifestations in case of COVID-19 infection and higher risk of mortality. The current study aims to (1) examine the relationship between death obsession, religiosity, and fear of COVID-19 among type 2 diabetes patients, and (2) assess if religiosity moderates the relationship between death obsession and fear of COVID-19. This cross-sectional online survey involved 306 type 2 diabetes patients. We found that 35.6 % of the participants were overweight and 14.6 % were suffering from obesity. Results showed that death obsession was positively associated with fear of COVID-19 and more religious individuals experience higher levels of fear. The overall level of religiosity did not moderate the relationship between death obsession and fear of COVID-19 but only the preoccupation with God dimension of the religiosity scale. The practical implications of these findings are discussed.

Connections between Different Sports and Ergogenic Aids-Focusing on Salivary Cortisol and Amylase.

Athletes are exposed to a tremendous amount of stress, both physically and mentally, when performing high intensity sports with frequent practices, pushing numerous athletes into choose to use ergogenic aids such as caffeine or ß-alanine to significantly improve their performance and ease the stress and pressure that is put onto the body. The beneficial or even detrimental effects of these so-called ergogenic aids can be appreciated through the use of numerous diagnostic tools that can analyze various body fluids. In the recent years, saliva samples are gaining more ground in the field of diagnostic as it is a non-invasive procedure, contains a tremendous amount of analytes that are subject to pathophysiological changes caused by diseases, exercises, fatigue as well as nutrition and hydration. Thus, we describe here the current progress regarding potential novel biomarkers for stress and physical activity, salivary α-amylase and salivary cortisol, as well as their use and measurement in combination with different already-known or new ergogenic aids.

Balancing orbital volume reduction and redistribution for a tailored surgical treatment in Graves' ophthalmopathy.

AIM: The purpose of this study is to share our experience on the use of different orbital decompression techniques, as well as the principles followed for deciding the most case-appropriate procedure that ensured the most favorable outcomes. METHODS: We reviewed the Graves' ophthalmopathy cases operated over the course of 14 years, regarding the presenting signs, the imaging evaluation, the degree of exophthalmos, the type of surgical orbital decompression performed, and the postoperative outcomes. RESULTS: All 42 patients identified presented with proptosis, with 92.8% cases of bilateral proptosis. The main addressing concern was functional in 54.8% cases and aesthetic in 45.2% patients. CT was used for the preoperative evaluation in all cases. In total, 81 orbits were operated. The orbital decompression surgery involved only the orbital fat in 7.4% of orbits and associated fat and bone decompression in the other 92.6% of orbits. The postoperative results were favorable in all cases regarding both appearance and function, with minimal postoperative complications. CONCLUSION: The adequate selection of the most suitable procedure based on the characteristics of each case is the prerequisite for a successful surgery. We found that the association of fat and bone decompression of various extents is most permissive in tailoring the degree of decompression to the existing requirements.

Association of intracellular lipid accumulation in subcutaneous adipocyte precursors and plasma adipokines in bariatric surgery candidates.

BACKGROUND: The adipocyte expansion is a critical process with implications in the pathogenesis of obesity associated metabolic syndrome. Impaired adipogenesis leads to dysfunctional, hypertrophic adipocytes, local inflammation and peripheric insulin resistance. METHODS: We assessed the relationship between the adipogenic differentiation capacity of the subcutaneous adipose derived stem cells (ASCs), evaluated by total lipid accumulation, and the metabolic and hormonal profile in a group of obese female patients proposed for bariatric surgery (N = 20) versus normal weight female controls (N = 7). RESULTS: The lipid accumulation (measured as optical density at 492 nm) of ASCs during their differentiation to adipocytes was significantly lower in ASCs isolated from obese patients as compared to ASCs isolated from normal weight patients (0.49 ± 0.1 vs. 0.71 ± 0.1, p < 0.001). Significant negative correlations between lipid accumulation in adipogenic differentiated ASCs and plasma concentrations of triglycerides (p < 0.01), insulin (p < 0.001), HOMA-IR (p < 0.01), adiponectin (p < 0.05) and leptin/adiponectin ratio (p < 0.05) were found in obese group. CONCLUSIONS: In severely obese female patients, the abnormal adipogenesis is related to insulin resistance and leptin/adiponectin ratio. The abnormal lipid accumulation in the mature adipocyte derived from obese ASCs could possible predict the further development of type 2 diabetes mellitus in severely obese patients and influence the selection of patients for bariatric surgery.

Duodenoscope-Associated Infections beyond the Elevator Channel: Alternative Causes for Difficult Reprocessing.

OBJECTIVES: Duodenoscopes have been widely used for both diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) procedures, but recently, numerous outbreaks of multidrug-resistant organisms (MDRO) infections have been reported which has led to extensive research for their possible causes. Consequently, the aim of this study is to search for possible duodenoscope surface damages that could provide an alternative and plausible source of infections. MATERIALS AND METHODS: In order to assess both outer and inner surfaces, a duodenoscope was dismantled and samples were taken from the outer resin polymer and from the air/water, elevator, and working (biopsy) channels that were characterized by FTIR, DSC, TGA, AFM, SEM techniques and the antimicrobial activity were tested. RESULTS: Alterations were noticed on both the coating and working channel polymers, with external alterations increasing progressively from the proximal sample to the distal sample near the tip of the scope. However, the results showed that the coating surface was still efficient against bacterial adhesion. Changes in surface texture and also morphological changes were shown. CONCLUSIONS: The study describes the impact of routine procedural use and reprocessing cycles on the duodenoscope, showing that these may possibly make it susceptible to bacterial contamination and MDRO biofilm formation due to difficult reprocessing of the altered surfaces.

A Descriptive Review on the Prevalence of Gastrointestinal Disturbances and Their Multiple Associations in Autism Spectrum Disorder.

Background and Objectives: Gastrointestinal disturbances have been frequently, but not unanimously, reported in autism spectrum disorder (ASD) individuals. Thus, digestive symptoms, such as constipation, diarrhea, abdominal bloating, and pain have been reported to correlate to the various maladaptive behaviors in ASD children, such as irritability, social withdrawal, stereotypy, hyperactivity, and even language regression. In this context, the present study provides an overview on the prevalence of the gastrointestinal (GI) disorders in ASD and the correlation between these and ASD symptoms and comorbidities and subsequently discusses the metabolic and microbiome factors underlying the effects of GI disorders in ASD. Materials and Methods: For our analysis of GI symptoms in children with ASD, we have searched peer-reviewed journals from 2005 to 2017 in PubMed databases that addressed the specificity of GI symptoms in ASD and included correlations of GI and ASD symptoms. The criteria for inclusion were clear quantitative mentioning of GI modifications, GI symptoms correlation with specific ASD symptoms or comorbidities, an appropriate methodology for defining ASD, and larger size samples. For this topic, only studies on human patients and original research were considered. A subsequent search in PubMed databases in journals from 2000 to 2017 we analyzed 13 articles on the mechanisms underlying the impact of GI dysfunctions in ASD, including gut microbial dysbiosis, immune reactivity, genetics, and altered neurotransmitters on the gut-brain axis. Results: In the 18 original research studies that we selected out of an initial 327 studies, despite the different methodology, a predominant 83% highlighted the increased prevalence of GI symptoms in ASD patients. Constipation was most frequently cited, appearing in 12 of the studies (80%), followed by diarrhea reports in eight studies (53%). The association between cognitive and behavioral deficits and GI disorders was suggested in certain groups of ASD individuals. Conclusion: The evidence presented so far by numerous studies seems to indicate that GI dysfunctions are of particular relevance in ASD, underlined by various abnormalities along the nervous connections between the central nervous system and the gut, such as impaired parasympathetic activity and increased endocrine stress response. Sufficiently large size samples and standardized methodology are required for future studies to clarify the complex interactions between GI disturbances and ASD symptoms.

Autologous Fat Grafting for Craniofacial Reconstruction in Oncologic Patients.

Due to the anatomical and functional complexity of the region, craniofacial tumor removal requires some of the most challenging surgical approaches, often complemented with advanced chemo-radiotherapy techniques. However, these modern therapies often lead to sequelae that can drastically reduce the quality of life for the surviving patients. Recent advances in the field of regenerative medicine opened new avenues for craniofacial reconstruction following head and neck cancer treatment. One of the most promising recent strategies relies on the use of autologous fat transplant. In this mini review, we briefly present some of the fat's biological properties that make it an ideal tissue for craniofacial reconstruction following cancer treatment. We then outline the recent advances that led to a better understanding of the detailed anatomy of the craniofacial fat depots. Furthermore, we provide a succinct review of the methods used for fat harvesting, processing and engrafting in the craniofacial area after head and neck tumor removal, discussing their main applications, advantages and limitations.

Preliminary Biochemical Description of Brain Oxidative Stress Status in Irritable Bowel Syndrome Contention-Stress Rat Model.

Background and objectives: Oxidative stress and inflammation have been implicated in the etiology of irritable bowel syndrome (IBS), a common gastrointestinal functional disease. This study aimed to further characterize the contention-stress rat model by exploring a possible correlation between oxidative stress markers measured in brain tissues with behavioral components of the aforementioned model. Thus, it is hereby proposed a possible IBS animal model relevant to pharmacological and complementary medicine studies. Materials and Methods: Wild-type male Wistar rats (n = 5/group) were chronically exposed to 6-hour/day contention, consisting of isolating the animals in small, vital space-granting plastic devices, for seven consecutive days. Following contention exposure, temporal lobes were extracted and subjected to biochemical analyses to assess oxidative stress-status parameters. Results: Our results show increased brain oxidative stress in contention-stress rat model: decreased superoxide dismutase and glutathione peroxidase activities and increased malondialdehyde production in the IBS group, as compared to the control group. Furthermore, the biochemical ratios which are used to evaluate the effectiveness of an antioxidant system on oxidative stress could be described in this model. Conclusions: The correlations between the behavioral patterns and biochemical oxidative stress features could suggest that this may be a complex model, which can successfully mimic IBS symptomatology further providing evidence of a strong connection between the digestive system, enteric nervous system, and the central nervous system.

Laparoscopic Gastric Plication vs Laparoscopic Sleeve Gastrectomy - A Single Center, Prospective and Case-Control Study.

BACKGROUND AND OBJECTIVES: The laparoscopic gastric plication (LGP) is a restrictive bariatric procedure, still under investigation, considered to be an alternative to laparoscopic sleeve gastrectomy (LSG). The aim of the present study was to compare the outcome of LGP with the results of LSG. Materials and Methods: The study was conducted on a total of 100 patients, from which 50 patients underwent LGP and other 50 patients had the LSG operation. To analyze the effectiveness of both procedures total weight loss (%TWL), change in body mass index ( BMI) and percentage of excess weight loss (%EWL) were measured and calculated for four distinct timelines: 6 months, 12 months, 24 months and 36 months after the procedure. Comorbidities were evaluated based on clinical and laboratory investigation. Results: Starting from 6 months after surgery, weight reduction was statistically significant in favor of the LSG group, with the highest differences found after two and three years postoperatively (p=0.0001). No differences were found between the two procedures in terms of compliance or improvement of the main comorbidities. Conclusions: As compared to LSG, LGP has similar outcomes in terms of the length of hospitalization, major complications and improvement of the main comorbidities. LSG procedure was found to be superior in terms of medium- to long-term weight reduction. LGP is a technique that may provide better results in obese patients with a lower BMI (less than 40 kg/m2).

New mechanisms of vesicles migration.

In multicellular organisms, both health and disease are defined by means of communication patterns involving the component cells. Despite the intricate networks of soluble mediators, cells are also programed to exchange complex messages pre-assembled as multimolecular cargo of membranous structures known as extracellular vesicles (EVs). Several biogenetic pathways produce EVs with different properties able to orchestrate neighboring cell reactions or to establish an environment ripe for spreading tumor cells. Such an effect is in fact an extension of similar physiological roles played by exosomes in guiding cell migration under nontumoral tissue remodeling and organogenesis. We start with a biological thought experiment equivalent to Bénard's experiment, involving a fluid layer of EVs adherent to an extracellular matrix, in a haptotactic gradient, then, we build and present the first Lorenz model for EVs migration. Using Galerkin's method of reducing a system of partial differential equations to a system of ordinary differential equations, a biological Lorenz system is developed. Such a physical frame distributing individual molecular or exosomal type cell-guiding cues in the extracellular matrix space could serve as a guide for tissue neoformation of the budding pattern in nontumoral or tumoral instances.

Alendronate-Loaded Modified Drug Delivery Lipid Particles Intended for Improved Oral and Topical Administration.

The present paper focuses on solid lipid particles (SLPs), described in the literature as the most effective lipid drug delivery systems that have been introduced in the last decades, as they actually combine the advantages of polymeric particles, hydrophilic/lipophilic emulsions and liposomes. In the current study, we present our most recent advances in the preparation of alendronate (AL)-loaded SLPs prepared by hot homogenization and ultrasonication using various ratios of a self-emulsifying lipidic mixture of Compritol 888, Gelucire 44/14, and Cremophor A 25. The prepared AL-loaded SLPs were investigated for their physicochemical, morphological and structural characteristics by dynamic light scattering, differential scanning calorimetry, thermogravimetric and powder X-ray diffraction analysis, infrared spectroscopy, optical and scanning electron microscopy. Entrapment efficacy and actual drug content were assessed by a validated HPLC method. In vitro dissolution tests performed in simulated gastro-intestinal fluids and phosphate buffer solution pH 7.4 revealed a prolonged release of AL of 70 h. Additionally, release kinetics analysis showed that both in simulated gastrointestinal fluids and in phosphate buffer solution, AL is released from SLPs based on equal ratios of lipid excipients following zero-order kinetics, which characterizes prolonged-release drug systems.

Pain manifestations in schizophrenia - clinical and experimental aspects in human patients and animal models.

Pain is a subjective phenomenon, not fully understood, which is manifesting abnormally in most of the disorders. Also, in the case of schizophrenia, a psychiatric disorder marked by gross distortion from reality, disturbances in thinking, feeling and behavior, pain behaves in an unpredictable manner, just like the evolution of this mental disorder. In this way, findings on this matter are contradictory, some pleading for decreased pain perception in schizophrenia, others for increased pain sensitivity, while there are also reports stating no differences between healthy controls and schizophrenic patients. Still, it is now generally accepted that pain perception is impaired in various ways in schizophrenics. Nevertheless, pain is a very important clinical issue in this population that needs to be clarified. Throughout this paper, we are going to review these contradictory information regarding pain manifestations in the context of schizophrenia in both human patients and animal models, emphasizing the importance of determining pain mechanism, its particularities and evolution in the context of schizophrenic disease, so that this phenomenon could be evaluated, quantified and controlled with the intention of obtaining a superior management for this disorder and to possibly raise hopes of higher life quality and expectancy in patients suffering from schizophrenia. Also, we would like to raise awareness on this matter, making psychiatrists, general practitioners, and other medical specialists more conscious of the importance of this problem, so that medical care could improve for these patients in the future.

Obesity, Metabolic Syndrome, and Osteoarthritis Require Integrative Understanding and Management.

Osteoarthritis (OA) is a progressive chronic disease affecting the articular joints, leading to pain and disability. Unlike traditional views that primarily link OA to aging, recent understanding portrays it as a multifactorial degenerative disease of the entire joint. Emerging research highlights metabolic and immune dysregulation in OA pathogenesis, emphasizing the roles of obesity, dyslipidemia, and insulin resistance in altering joint homeostasis. Recent studies have increasingly focused on the complex role of white adipose tissue (WAT) in OA. WAT not only serves metabolic functions but also plays a critical role in systemic inflammation through the release of various adipokines. These adipokines, including leptin and adiponectin, have been implicated in exacerbating cartilage erosion and promoting inflammatory pathways within joint tissues. The overlapping global crises of obesity and metabolic syndrome have significantly impacted joint health. Obesity, now understood to contribute to mechanical joint overload and metabolic dysregulation, heightens the risk of developing OA, particularly in the knee. Metabolic syndrome compounds these risks by inducing chronic inflammation and altering macrophage activity within the joints. The multifaceted effects of obesity and metabolic syndrome extend beyond simple joint loading. These conditions disrupt normal joint function by modifying tissue composition, promoting inflammatory macrophage polarization, and impairing chondrocyte metabolism. These changes contribute to OA progression, highlighting the need for targeted therapeutic strategies that address both the mechanical and biochemical aspects of the disease. Recent advances in understanding the molecular pathways involved in OA suggest potential therapeutic targets. Interventions that modulate macrophage polarization, improve chondrocyte function, or normalize adipokine levels could serve as preventative or disease-modifying therapies. Exploring the role of diet, exercise, and pharmacological interventions in modulating these pathways offers promising avenues for reducing the burden of OA. Furthermore, such methods could prove cost-effective, avoiding the increase in access to healthcare.

Accidental Hypothermia in the Largest Emergency Hospital in North-Eastern Romania.

INTRODUCTION: Accidental hypothermia (AH) presents a significant mortality risk, even in individuals with good health. Early recognition of the parameters associated with negative prognosis could save more lives. METHODS: This was a pilot, retrospective observational study, conducted in the largest Emergency Hospital in North Eastern Romania, which included all patients with AH (defined as body temperature below 35°C), hospitalized and treated in our hospital between 2019 and 2022. RESULTS: A total of 104 patients with AH were included in our study, 90 of whom had data collected and statistically analyzed. The clinical, biological, and therapeutic parameters associated with negative outcomes were represented by a reduced GCS score (p=0.024), diminished systolic and diastolic blood pressure (p=0.007 respectively, 0.013), decreased bicarbonate (p=0.043) and hemoglobin levels (p=0.002), the presence of coagulation disorders (p=0.007), as well as the need for administration of inotropic or vasopressor medications (p=0.04). CONCLUSION: In this pilot, retrospective, observational study, the negative outcomes observed in patients with AH hospitalized in the largest Emergency Hospital in North-Eastern Romania were associated with several clinical, biochemical, and therapeutic factors, which are easy to identify in clinical practice. Recognizing the significance of these associated factors empowers healthcare practitioners to intervene at an early stage to save more lives.

Role of Chemerin and Perivascular Adipose Tissue Characteristics on Cardiovascular Risk Assessment by Arterial Stiffness Markers in Patients with Morbid Obesity.

BACKGROUND AND OBJECTIVE: The development of arterial stiffness (AS) in obesity is a multifactorial and complex process. The pleomorphic actions of adipokines and their local activity in perivascular adipose tissue (PVAT) are potential modulators of AS appearance and progression. We aimed to assess the correlations between two adipokines (chemerin, adiponectin), PVAT morphological changes (adipocyte size, blood vessel wall thickness) and AS parameters in the special subgroup of patients with morbid obesity. MATERIAL AND METHODS: We enrolled 25 patients with morbid obesity and 25 non-obese patients, who were age- and gender-matched, untreated for cardiovascular risk factors, and admitted to hospital for laparoscopic surgical procedures (bariatric surgery for morbid obesity and non-inflammatory benign pathology surgery for non-obese patients). Before the surgical procedures, we evaluated demographic and anthropometric data and biochemical parameters including the studied adipokines. Arterial stiffness was evaluated using a Medexpert ArteriographTM TL2 device. In both groups, adipocyte size and vascular wall thickness as well as local adiponectin activity were analyzed in PVAT from intraoperative biopsies. RESULTS: In our study, adiponectin (p = 0.0003), chemerin (p = 0.0001) and their ratio (p = 0.005) had statistically significant higher mean values in patients with morbid obesity compared to normal-weight patients. In patients with morbid obesity there were significant correlations between chemerin and AS parameters such as aortic pulse wave velocity (p = 0.006) and subendocardial viability index (p = 0.009). In the same group adipocyte size was significantly correlated with another AS parameter, namely, aortic systolic blood pressure (p = 0.030). In normal-weight patients, blood vessel wall thickness positively correlated with AS parameters such as brachial (p = 0.023) and aortic augmentation index (p = 0.023). An important finding was the negative adipoR1 and adipoR2 immunoexpression in PVAT adipocytes of patients with morbid obesity. Additionally, we found significant correlations between blood vessel wall thickness and blood fasting glucose (p < 0.05) in both groups. CONCLUSIONS: Chemerin and adipocyte size could be predictive biomarkers for AS in patients with morbid obesity. Given the small number of patients included, our results need further validation.

Retroperitoneal liposarcoma: unveiling diagnostic delays and multimodal treatment dilemmas.

Liposarcomas are a prevalent subtype of soft tissue sarcomas, constituting less than 1% of all malignancies. Originating in the adipose tissue, they can manifest in various locations and are categorized by the World Health Organization into several subtypes: well-differentiated liposarcomas, dedifferentiated liposarcomas, myxoid liposarcomas, pleomorphic liposarcomas and mixed-type liposarcomas. These tumors typically affect middle-aged and older individuals, and their incidence has been progressively increasing over the years. As liposarcomas advance they tend to encase blood vessels and major organs, particularly in the retroperitoneal area. Often asymptomatic initially, symptoms arise as the tumor reaches a considerable size, exerting pressure on adjacent tissues and organs. This report features a 54-year-old patient incidentally diagnosed with a substantial retroperitoneal tumor extending to the antero-lateral abdominal wall and inner thigh via the right inguinal ligament. The patient, with a previous three-year history of a right inguinal mass, sought acute care for a perianal abscess The histological examination revealed morphological aspects consistent with a low-grade myxoid liposarcoma. While surgery remains the primary treatment for retroperitoneal liposarcomas, controversies exist regarding the role of radiotherapy and chemotherapy in improving survival rates. This case highlights the challenges in managing retroperitoneal tumors and underscores the importance of a personalized, multidisciplinary approach to optimize patient outcomes.