Fármacos antipsicóticos de segunda generación y su impacto en el tejido adiposo / Second-generation antipsychotic drugs and their impact on adipose tissue

La esquizofrenia es un trastorno neuropsiquiátrico crónico que afecta a 21 millones de personas en todo el mundo. Actualmente, los fármacos antipsicóticos de segunda generación o atípicos (FASG) son los medicamentos de elección para el tratamiento de esta enfermedad. Sin embargo, a pesar de su alta eficacia en contrarrestar la sintomatología neuropsiquiátrica de la esquizofrenia, observaciones clínicas recientes en pacientes tratados con FASG evidencian un aumento en la prevalencia de diferentes alteraciones metabólicas, entre las que se incluyen el aumento de peso corporal, la hiperglucemia y la dislipidemia. A pesar de que no se conocen en detalle los mecanismos moleculares responsables de estos efectos secundarios, cada vez más investigaciones apuntan a una relación entre los tratamientos con FASG y las alteraciones en los diferentes depósitos de tejido adiposo blanco, marrón y beige. En esta revisión analizamos el conocimiento actual en esta área destacando aspectos moleculares de la biología de los adipocitos, entre los que se encuentran los procesos de diferenciación, metabolismo lipídico, función termogénica y el proceso de pardeamiento o beiging.(AU)

Schizophrenia is a chronic neuropsychiatric disorder that affects 21 million people worldwide. Currently, second-generation or atypical antipsychotics (SGAs) are the first-line medications for the treatment of this disease. However, despite its high efficacy in counteracting the neuropsychiatric symptoms of schizophrenia, recent clinical investigations in patients treated with SGAs show an increase in the prevalence of pivotal metabolic alterations, including increased body weight, hyperglycemia and dyslipidemia. Although the molecular mechanisms responsible for these side effects are not fully understood, cumulative evidences associate SGA administration with alterations in the different adipose tissue depots of white, brown and beige adipocytes. In this review, we have recapitulated the current knowledge in this area with a particular focus on the molecular aspects of the adipocyte biology, including differentiation, lipid metabolism, thermogenic function and browning processes.(AU)

Gestational diabetes mellitus early prediction by maternal body fat index: A cohort study.

OBJECTIVES: To compare the performance of maternal body fat index (BFI) assessed during the first 20+6 weeks among 138 pregnant women in an ultrasound outpatient clinic as a predictor of gestational diabetes mellitus (GDM) later in pregnancy. METHOD: Maternal visceral and subcutaneous fat was measured with a convex ultrasound probe placed in two locations on the maternal abdominal surface: the first in the mid-sagittal epigastric region, visualising epigastric fat, and the second 2cm above the maternal umbilical scar, visualising periumbilical fat. Ultrasound callipers measured the distance from dermal edge to the linea alba and after from the linea alba to the anterior hepatic surface (epigastric fat). Periumbilical fat was measured from the dermal edge to the linea alba and after from the linea alba to the anterior aortic surface. The BFI formula was [visceral adipose tissue (mm)×subcutaneous adipose tissue (mm)]/maternal height (cm). RESULTS: The best thresholds for predicting GDM outcome for epigastric and periumbilical BFI were 1.2 and 4.8, respectively. Odds ratio, sensitivity and specificity were 5.88 (95% CI 1.86-18.6), 80.9%, 58.0% for the epigastric site and 6.31 (95% CI 1.73-22.94), 84.2%, 54.2% for the periumbilical site. Pre-pregnancy body mass index compatible with adult obesity shows inadequate predictive performance for GDM outcome. Only epigastric BFI above 1.2 maintained statistical significance for GDM in the logistic regression analysis, when compared to periumbilical BFI above 4.8. CONCLUSION: Epigastric BFI above 1.2 during the first half of pregnancy may help identify women at risk of developing GDM later in pregnancy.

Comparison of abdominal adipose tissue versus Body Mass Index (BMI) as a predictor of complications and survival in liver transplantation.

INTRODUCTION: Because of the obesity epidemic, more obese patients are on liver transplant (LT) waiting lists. The diseases associated with obesity may increase complications and limit survival after LT. However, there is no established measure or cut-off point to determine this impact and aid decision making. The aim of the present study is to evaluate obesity in patients undergoing LT via BMI and CT-based measurement of adipose tissue (AAT). These parameters will be used to predict the risk of postoperative complications and 5-year survival. METHODS: A retrospective, single-center study was carried out at a tertiary Spanish hospital, including all patients who received LT between January 2012 and July 2019 (n = 164). The patients were adults who underwent LT using the 'piggyback' technique, preserving the recipient vena cava. Visceral adipose tissue (VAT) and BMI were calculated to examine correlations with postoperative complications and 5-year survival. RESULTS: No significant association was found between postoperative complications by Comprehensive Complication Index, BMI, AAT/height, subcutaneous fat/height and VAT/height. Kaplan-Meier curves for 5-year survival compared LT recipients with BMI < 30.45 vs ≥30.45, with an estimated survival of 58.97 months versus 43.11 months, respectively (P < .001) (Fig. 3) and for LT recipients with an AAT/height <27.35 mm versus ≥27.35 mm, with an estimated survival of 57.69 months versus 46.34 months (P = .001). CONCLUSIONS: This study does not show a higher rate of postoperative complications in obese patients. There is a significantly lower long-term survival in patients with AAT/height ≥27.35 mm and BMI ≥ 30.45. BMI is a valid estimate of obesity and is predictive of survival.

Effect of Brassica rapa var. rapifera on Insulin Resistance and Inflammatory Analysis of Visceral Adipose Tissue of Obese Wistar Rats Under Glucolipotoxicity Condition / Efecto de Brassica rapa var. rapifera sobre la Resistencia a la Insulina y el Análisis Inflamatorio del Tejido Adiposo Visceral de Ratas Wistar Obesas en Condiciones de Glucolipotoxicidad

SUMMARY: Obesity-related pathophysiologies such as insulin resistance and the metabolic syndrome show a markedly increased risk for type 2 diabetes and atherosclerotic cardiovascular disease. This risk appears to be linked to alterations in adipose tissue function, leading to chronic inflammation and the dysregulation of adipocyte-derived factors. Brassica rapa have been used in traditional medicine for the treatment of several diseases, including diabetes. This study aimed to investigate the effect of nutritional stress induced by a high-fat and high-sucrose diet on the pathophysiology of visceral adipose tissue and the therapeutic effect of Brassica rapa in male Wistar rats. We subjected experimental rats to a high-fat (10 %) high-sucrose (20 %)/per day for 11 months and treated them for 20 days with aqueous extract Br (AEBr) at 200 mg/kg at the end of the experiment. At the time of sacrifice, we monitored plasma and tissue biochemical parameters as well as the morpho-histopathology of visceral adipose tissue. We found AEBr corrected metabolic parameters and inflammatory markers in homogenized visceral adipose tissue and reduced hypertrophy, hyperplasia, and lipid droplets. These results suggest that AEBr enhances anti-diabetic, anti-inflammatory and a protective effect on adipose tissue morphology in type 2 diabetes and obesity.

La fisiopatología relacionadas con la obesidad, como la resistencia a la insulina y el síndrome metabólico, muestran un riesgo notablemente mayor de diabetes tipo 2 y enfermedad cardiovascular aterosclerótica. Este riesgo parece estar relacionado con alteraciones en la función del tejido adiposo, lo que lleva a una inflamación crónica y a la desregulación de los factores derivados de los adipocitos. Brassica rapa se ha utilizado en la medicina tradicional para el tratamiento de varias enfermedades, incluida la diabetes. Este estudio tuvo como objetivo investigar el efecto del estrés nutricional inducido por una dieta rica en grasas y sacarosa sobre la fisiopatología del tejido adiposo visceral y el efecto terapéutico de Brassica rapa en ratas Wistar macho. Sometimos a ratas experimentales a una dieta rica en grasas (10 %) y alta en sacarosa (20 %)/por día durante 11 meses y las tratamos durante 20 días con extracto acuoso de Br (AEBr) a 200 mg/kg al final del experimento. En el momento del sacrificio, monitoreamos los parámetros bioquímicos plasmáticos y tisulares, así como la morfohistopatología del tejido adiposo visceral. Encontramos parámetros metabólicos corregidos por AEBr y marcadores inflamatorios en tejido adiposo visceral homogeneizado y reducción de hipertrofia, hiperplasia y gotitas de lípidos. Estos resultados sugieren que AEBr mejora el efecto antidiabético, antiinflamatorio y protector sobre la morfología del tejido adiposo en la diabetes tipo 2 y la obesidad.

Obesidad y monocitos macrófagos en el tejido adiposo / Adipose tissue monocytes and macrophages in obesity

Introducción: el tejido adiposo ha sido objeto de estudio en las últimas décadas y existen nuevos conceptos de su compleja biología. Se conoce que la obesidad está asociada con un estado inflamatorio crónico de bajo grado tanto local como sistémico y parece desempeñar un papel clave en las consecuencias del aumento en diferentes comorbilidades metabólicas y vasculares. Discusión: de los diversos tipos de células inmunes que contribuyen a la inflamación inducida por la obesidad, los monocitos/macrófagos en el tejido adiposo juegan un papel central. Las modificaciones estructurales y fenotípicas de ambas células pueden contribuir no solo a alteraciones inflamatorias y metabólicas, sino también ayudar a mantener la homeostasis del tejido adiposo en respuesta al aumento de la grasa corporal. Los macrófagos son células efectoras esenciales en la organización de la inflamación, ya que se cree que promueven la progresión de la obesidad y los trastornos relacionados. No está completamente establecido si dichas células ejercen un papel beneficioso o nocivo en el tejido adiposo. En cualquier caso, su presencia modifica la biología de las células adiposas especializadas. Conclusiones: en esta revisión se analiza el conocimiento sobre la contribución de los monocitos/macrófagos dentro del tejido adiposo en el desarrollo y mantenimiento de la obesidad y las complicaciones potenciales relacionadas.

Relationship between epicardial adipose tissue, systemic inflammatory diseases, and subclinical atheromatosis: A systematic review.

BACKGROUND AND AIMS: Systemic inflammatory diseases could act as an unfavorable condition in which epicardial adipose tissue (EAT) becomes harmful to cardiovascular health. The objectives were: (a) to quantitatively compare the presence of EAT between patients with systemic inflammatory diseases and controls; (b) to analyze the association between EAT and subclinical atheromatosis in individuals with systemic inflammatory diseases. METHODS: Studies that have quantified EAT in a population with systemic inflammatory diseases compared to a control group, or that describe the association between EAT and the presence of subclinical atheromatosis in patients with systemic inflammatory diseases were included. A quantitative analysis was performed for the first objective. This systematic review was performed according to PRISMA guidelines. RESULTS: Twenty-one studies including 1448 patients with systemic inflammatory diseases, were considered eligible for this study. Patients with systemic inflammatory disease have a higher volume (MD: 10.4cm3 [1.8-19.1]; p<0.01), higher thickness (MD: 1.0mm [0.8-1.2]; p<0.01), and a statistically non-significant higher area (MD: 3.1cm2 [1.0-5.2]; p=0.46) of EAT compared to the control group. Most studies reported a significant association between EAT and subclinical atheromatosis in patients with different systemic inflammatory diseases. CONCLUSION: This study demonstrated that EAT is increased in patients with systemic inflammatory diseases compared with healthy controls, and that EAT measurement is closely correlated with subclinical atherosclerosis in these patients. The causality of this association should be tested in prospective studies.

Adipocytes-derived exosomal miR-122 promotes non-alcoholic fat liver disease progression via targeting Sirt1 / El miR-122 exosomal derivado de los adipocitos promueve la progresión de la enfermedad hepática por grasa no alcohólica a través de la focalización de Sirt1

Aims: Nonalcoholic fatty liver disease (NAFLD) is a chronic liver disease that affects adipose function. This study aimed to explore the function of adipocytes-derived exosomal (ADEs) miR-122 in NAFLD. Methods: A high-fat and high-fructose diet-induced rat model and a palmitic acid (PA)-induced in vitro model were established. The RNA level of miR-122 and Sirt1 was measured using qRT-PCR. The protein levels of exosome biomarkers, and lipogenesis, inflammation and fibrosis biomarkers were determined by western blotting. Cell viability and apoptosis were assessed using cell counting kit-8 and flow cytometry, respectively. Serum alanine aminotransferase, aspartate aminotransferase, total cholesterol, triglyceride levels were measured. Liver tissue damage was assessed using haematoxylin and eosin staining. The interaction between miR-122 and Sirt1 3′UTR was assessed using a luciferase reporter gene assay. Results: ADEs exhibited abundant level of miR-122 and promoted lipogenesis, impaired hepatocyte survival, enhanced liver damage and increased serum lipid levels in vivo and in vitro. Inhibition of miR-122 in ADEs alleviated NAFLD progression, lipid and glucose metabolism, liver inflammation and fibrosis both in vivo and in vitro. miR-122 binds directly to the 3′UTR of Sirt1 to suppress its expression. Moreover, Sirt1 overexpression reversed the increase in cell apoptosis, glucose and lipid metabolism, liver inflammation and fibrosis induced by ADEs in vivo and in vitro. Conclusions: The ADEs miR-122 promotes the progression of NAFLD via modulating Sirt1 signalling in vivo and in vitro. The ADEs miR-122 may be a promising diagnostic biomarker and therapeutic target for NAFLD.(AU)

Objetivos: La enfermedad del hígado graso no alcohólico (EHGNA) es una enfermedad hepática crónica que afecta a la función adiposa. Este estudio tiene como objetivo explorar la función de los exosomas derivados de los adipocitos (ADEs) miR-122 en la EHGNA. Métodos: Se estableció un modelo de rata inducido por una dieta alta en grasas y fructosa y un modelo in vitro inducido por ácido palmítico (AP). Se midió el nivel de ARN de miR-122 y Sirt1 mediante qRT-PCR. Los niveles de proteína de los biomarcadores de exosomas y los biomarcadores de lipogénesis, inflamación y fibrosis se determinaron mediante western blotting. La viabilidad celular y la apoptosis se evaluaron mediante el kit de recuento de células-8 y la citometría de flujo, respectivamente. Se midieron los niveles séricos de alanina aminotransferasa, aspartato aminotransferasa, colesterol total y triglicéridos. El daño tisular del hígado se evaluó mediante tinción con hematoxilina y eosina. La interacción entre miR-122 y Sirt1 3’UTR se evaluó mediante un ensayo de gen reportero de luciferasa. Resultados: Los ADEs mostraron un nivel abundante de miR-122 y promovieron la lipogénesis, perjudicaron la supervivencia de los hepatocitos, potenciaron el daño hepático y aumentaron los niveles de lípidos séricos in vivo e in vitro. La inhibición de miR-122 en los ADEs alivió la progresión de la EHGNA, el metabolismo de los lípidos y la glucosa, la inflamación del hígado y la fibrosis tanto in vivo como in vitro. miR-122 se une directamente a la 3’UTR de Sirt1 para suprimir su expresión. Además, la sobreexpresión de Sirt1 revirtió el aumento de la apoptosis celular, el metabolismo de la glucosa y los lípidos, la inflamación del hígado y la fibrosis inducida por los ADEs in vivo e in vitro. Conclusiones: El ADEs miR-122 promueve la progresión de la EHGNA a través de la modulación de la señalización de Sirt1 in vivo e in vitro...(AU)

Relationship between epicardial adipose tissue, systemic inflammatory diseases, and subclinical atheromatosis: A systematic review / Relación entre tejido adiposo epicárdico, enfermedades inflamatorias sistémicas y ateromatosis subclínica: una revisión sistemática

Background and aims: Systemic inflammatory diseases could act as an unfavorable condition in which epicardial adipose tissue (EAT) becomes harmful to cardiovascular health. The objectives were: (a) to quantitatively compare the presence of EAT between patients with systemic inflammatory diseases and controls; (b) to analyze the association between EAT and subclinical atheromatosis in individuals with systemic inflammatory diseases. Methods: Studies that have quantified EAT in a population with systemic inflammatory diseases compared to a control group, or that describe the association between EAT and the presence of subclinical atheromatosis in patients with systemic inflammatory diseases were included. A quantitative analysis was performed for the first objective. This systematic review was performed according to PRISMA guidelines. Results: Twenty-one studies including 1448 patients with systemic inflammatory diseases, were considered eligible for this study. Patients with systemic inflammatory disease have a higher volume (MD: 10.4cm3 [1.8–19.1]; p<0.01), higher thickness (MD: 1.0mm [0.8–1.2]; p<0.01), and a statistically non-significant higher area (MD: 3.1cm2 [1.0–5.2]; p=0.46) of EAT compared to the control group. Most studies reported a significant association between EAT and subclinical atheromatosis in patients with different systemic inflammatory diseases. Conclusion: This study demonstrated that EAT is increased in patients with systemic inflammatory diseases compared with healthy controls, and that EAT measurement is closely correlated with subclinical atherosclerosis in these patients. The causality of this association should be tested in prospective studies.(AU)

Objetivos: Las enfermedades inflamatorias sistémicas podrían aumentar el riesgo cardiovascular asociados a un aumento del tejido adiposo epicárdico (TAE). Los objetivos de este estudio, fueron: a) comparar cuantitativamente la presencia de TAE entre pacientes con enfermedades inflamatorias sistémicas y controles, y b) analizar la asociación entre TAE y atero“matosis subclínica en individuos con enfermedades inflamatorias sistémicas. Métodos: Se incluyeron estudios que hayan cuantificado la TAE en una población con enfermedades inflamatorias sistémicas frente a un grupo control, o que describan la asociación entre la TEA y la presencia de ateromatosis subclínica en pacientes con enfermedades inflamatorias sistémicas. Para el primer objetivo se realizó un análisis cuantitativo. Esta revisión sistemática se realizó de acuerdo con las guías PRISMA. Resultados: Veintiún estudios que incluyeron 1.448 pacientes con enfermedades inflamatorias sistémicas se consideraron elegibles para este estudio. Los pacientes con enfermedad inflamatoria sistémica tienen mayor volumen (DM: 10,4cm3 [1,8-19,1]; p<0,01), mayor grosor (DM: 1,0mm [0,8-1,2]; p<0,01) y un área mayor estadísticamente no significativa (DM: 3,1cm2 [1,0-5,2]; p=0,46) de EAT en comparación con el grupo de control. La mayoría de los estudios informaron una asociación significativa entre EAT y ateromatosis subclínica en pacientes con diferentes enfermedades inflamatorias sistémicas. Conclusión: Este estudio demostró que la TAE aumenta en pacientes con enfermedades inflamatorias sistémicas en comparación con controles sanos, y que la medición de EAT está estrechamente relacionada con la aterosclerosis subclínica en estos pacientes. La causalidad de esta asociación debe probarse en estudios prospectivos.(AU)

El tejido adiposo epicárdico no es un predictor independiente de recurrencia de fibrilación auricular tras ablación con catéter / Epicardial adipose tissue volume is not an independent predictor of atrial fibrillation recurrence after catheter ablation

Introducción y objetivos: Estudios previos han sugerido que el tejido adiposo epicárdico (TAE) podría ejercer un efecto paracrino en el miocardio. Sin embargo, pocos estudios han evaluado su papel en el riesgo de recurrencia de la fibrilación auricular (FA). El objetivo de ese estudio fue evaluar la asociación entre el volumen de TAE y su atenuación con el riesgo de recurrencia de FA tras la ablación de FA. Métodos: Se incluyó un total de 350 pacientes consecutivos sometidos a ablación de FA - mediana de edad 57 años [RIC 48-65], 21% FA persistente. La grasa epicárdica se cuantificó mediante tomografía computarizada multidetector utilizando el software Syngo.via Frontier-Cardiac Risk Assessment, midiendo el volumen tejido adiposo pericárdico (VTAP), el volumen de TAE y la atenuación de TAE posterior a la aurícula izquierda. La recurrencia de FA se definió como cualquier episodio documentado de FA, aleteo auricular, o taquicardia auricular más de 3 meses después del procedimiento. Resultados: Tras una mediana de seguimiento de 34 meses [rango de 12 a 57 meses], 114 pacientes (33%) tuvieron recurrencia de FA. La regresión de Cox univariable mostró que los pacientes con un volumen de TAE ≥ 80ml tenían un mayor riesgo de recurrencia de FA (HR=1,65; IC95%, 1,14-2,39; p=0,007). Sin embargo, después del ajuste multivariable, el volumen de TAE no fue un predictor independiente de recurrencia de FA (HR=1,24; IC95%, 0,83-1,87; p=0,3). Se observaron resultados similares con VTAP. Los pacientes con menor atenuación de TAE no tenían un mayor riesgo de recurrencia de FA (prueba de rango logarítmico p=0,75). Conclusiones: Los parámetros de TAE, incluida la evaluación del volumen de TAE, VTAP y la atenuación de TAE, no fueron predictores independientes de recurrencia de FA después de la ablación con catéter. (AU)

Introduction and objectives: Previous studies have suggested that epicardial adipose tissue (EAT) could exert a paracrine effect in the myocardium. However, few studies have assessed its role in the risk of atrial fibrillation (AF) recurrence. This study aimed to evaluate the association between EAT volume, and its attenuation, with the risk of AF recurrence after AF ablation. Methods: A total of 350 consecutive patients who underwent AF ablation were included. The median age was 57 [IQR 48-65] years and 21% had persistent AF. Epicardial fat was quantified by multidetector computed tomography using Syngo.via Frontier-Cardiac Risk Assessment software, measuring pericardial fat volume (PATV), EAT volume, and attenuation of EAT posterior to the left atrium. AF recurrence was defined as any documented episode of AF, atrial flutter, or atrial tachycardia more than 3 months after the procedure. Results: After a median follow-up of 34 [range, 12-57] months, 114 patients (33%) had AF recurrence. Univariable Cox regression showed that patients with an EAT volume ≥ 80mL had an increased risk of AF recurrence (HR, 1.65; 95%CI, 1.14-2.39; P=.007). However, after multivariable adjustment, EAT volume did not remain an independent predictor of AF recurrence (HR, 1.24; 95%CI, 0.83-1.87; P=.3). Similar results were observed with PATV. Patients with lower attenuation of EAT did not have a higher risk of AF recurrence (log-rank test, P=.75). Conclusions: EAT parameters including the evaluation of EAT volume, PATV and EAT attenuation were not independent predictors of AF recurrence after catheter ablation. (AU)

Complicaciones Asociadas a la Remoción Estética del Cuerpo Adiposo de la Boca (de Bichat) - Revisión Narrativa / Complications Associated with Aesthetic Removal of the Buccal Adipose Body (Bichat's fat-pad) - Narrative Review

El cuerpo adiposo de la boca (CAB) es un componente adiposo multilobulado bien delimitado, localizado de manera bilateral en la región facial íntimamente relacionado a estructuras nerviosas y vasculares. La remoción de CAB es un procedimiento ampliamente estudiado en el campo de la cirugía maxilofacial, utilizado principalmente para cubrir defectos. Su influencia en la estética facial ha iniciado una popularización de la remoción de la extensión bucal de CAB para obtener un rostro más estilizado, intervención difundida como poco invasiva y sin complicaciones. El objetivo de este estudio fue recopilar y evaluar estudios que reporten y evalúen complicaciones asociadas a la remoción por razones estéticas de CAB. Se revisó la evidencia en las bases de datos Medline vía PubMed, Epistemonikos, Scopus y Google Scholar, utilizando términos predefinidos, seleccionando estudios primarios de reportes de casos. Se incluyeron 7 artículos con un total de 10 pacientes; de estos, ocho pacientes se realizaron este procedimiento en Brasil, uno en Estados Unidos y uno en Chile. La distribución de la población fue de 3:7 entre hombres y mujeres con edad promedio de 35 años y un rango entre los 23 a los 49 años. En relación a las complicaciones reportadas, 100 % de los pacientes presentaron asimetría facial, un 80 % presentó edema facial, 30 % manifestaron sialocele, Trismus 20 %, 40 % presentó hematoma, 20 % compromiso del estado general, 20 % presentaron disfagia, en los casos de hipoestesia, parestesia, absceso, seroma, parálisis facial, odinofagia, fiebre se expresaron en 10 % de la población estudiada. En todos los estudios se describió una reintervención quirúrgica posterior a la remoción estética del cuerpo adiposo de bichat. La escasa literatura y la baja calidad de esta, no permite estimar el porcentaje real de posibles complicaciones, tampoco es posible determinar sus resultados a largo plazo ya que no existe en la evidencia un seguimiento apropiado para estos pacientes.

The buccal adipose body (BAB) is a well- defined multilobulated adipose component, located bilaterally in the facial region, closely related to nervous and vascular structures. BAB removal is a widely studied procedure in the field of maxillofacial surgery, used mainly to cover defects. Its influence on facial aesthetics has started to popularize the removal of the BAB buccal extension to obtain a more stylized face, an intervention widely known as minimally invasive and without complications. The objective of this study was to collect and evaluate studies that report and evaluate complications associated with the removal of BAB for cosmetic reasons. The evidence was reviewed in the Medline databases via PubMed, Epistemonikos, Scopus, and Google Scholar, using predefined terms, selecting primary studies from case reports. 7 articles with a total of 10 patients were included; Of these, eight patients underwent this procedure in Brazil, one in the United States, and one in Chile. The distribution of the population was 3:7 between men and women with an average age of 35 years and a range between 23 to 49 years. In relation to the reported complications, 100 % of the patients presented facial asymmetry, 80 % presented facial edema, 30 % manifested sialocele, trismus 20 %, 40 % presented hematoma, 20 % compromised general state, 20 % presented dysphagia, in the cases of hypoesthesia, paresthesia, abscess, seroma, facial paralysis, odynophagia, fever were expressed in 10 % of the studied population. All the studies described a surgical reintervention after cosmetic removal of the bichat adipose body. The scarce literature and its low quality do not allow estimating the real percentage of possible complications, nor is it possible to determine their long-term results since there is no evidence of appropriate follow-up for these patients.

Tejido adiposo epicárdico en personas que viven con VIH: ¿una ventana hacia el riesgo cardiovascular? / Epicardial adipose tissue in people living with HIV: a window towards cardiovascular risk?

Introducción: En las personas que viven con el virus de la inmunodeficiencia humana (PVVIH) se han descripto desregulaciones metabólicas que podrían vincularse a un mayor riesgo cardiovascular.Objetivo: Evaluar el espesor del tejido adiposo epicárdico (ETAE) y la relación del mismo con parámetros clínicos y bioquímicos de riesgo cardiovascular en adultos que viven con VIH, comparados con controles seronegativos.Materiales y métodos: Observacional, inclusión prospectiva. Se incluyeron PVVIH >18 años y controles seronegativos para VIH, a los cuales se les midió el espesor de TAE en dos ejes por ecocardiograma transtorácico, así como el espesor de íntima media carotídea por ecografía doppler color.Resultados: 75 pacientes, 58,7% del sexo masculino, edad de 36 años (RIQ 22). 50,7% con VIH (CD4+: 512 cél/mm3 RIQ 382; 80% indetectables). IMC de 25,2 kg/m2 (RIQ 5,3) y circunferencia de cintura de 88,5 cm (DS 12,4), sin diferencias. Las PVVIH tuvieron menor HDL, mayor proteína C reactiva, mayor dímero D y mayor glucemia en ayunas. El ETAE fue mayor en las PVVIH (4,05 vs. 3,49 mm p=0,021), y se correlacionó con la edad, glucemia en ayunas y dímero D. En las PVVIH, se correlacionó con insulinemia, índice HOMA2-IR, HDL-c y dímero D. El tratamiento con Efavirenz se asoció a un mayor ETAE.Conclusión: Las PVVIH presentaron mayor inflamación sistémica de bajo grado y un mayor espesor de TAE que los controles sanos, el cual se asoció en este grupo a insulinorresistencia

Introduction: For people living with Human Immunodeficiency Virus (PLHIV), metabolic deregulations have been described, which could be related to a higher cardiovascular risk.Objective: To assess the epicardial adipose tissue thickness (EATT), and the relationship between this value and clinical and biochemical parameters of cardiovascular risk in adults living with HIV, if compared to a healthy control group. Methods: Observational, with prospective inclusion. It included PLHIV >18 years and seronegative controls. All of them had their EAT measured in two axes by transthoracic echocardiogram, as well as the carotid intima-media thickness determined by color doppler ultrasound.Results: 75 patients, 58.7% male, age of 36 years (RIQ 22). 50.7% patients with HIV (CD4+ of 512 cells/mm3; and 80% undetectable). BMI was of 25.2 kg/m2 and waist circumference of 88.5 cm, without between-groups differences. PLHIV had lower HDL, higher C reactive protein, higher D-dimer and higher fasting blood glucose. EATT was higher in PLHIV (4.05 vs 3.49 mm, p=0.021), and this correlated with age, fasting blood glucose and D-dimer. In PLHIV, it correlated with insulinemia, HOMA2-IR index, HDL-c ; and D-dimer. Treatment with Efavirenz was associated with a higher EATT.Conclusion: PLHIV presented increased systemic inflammation of low grade and higher EATT than the seronegative control group. EATT was associated in PLHIV to insulin resistance

Complications in liposuction: systematic review / Complicações em lipoaspiração: revisão sistemática

Liposuction is among the most performed plastic surgery procedures in Brazil. According to data from the International Society of Aesthetic Plastic Surgery (ISAPS), 231,604 liposuctions were performed, 15.5% of all aesthetic procedures in the country in 2019. Adopting liposuction as a single procedure or adjunct to other cosmetic procedures stimulated its technical evolution from simple fat aspiration to more sophisticated body shaping. Thus, this review aimed to systematically evaluate the published data regarding the complications found in liposuction. A review was conducted using PubMed, SciELO, LILACS, Cochrane Library, SCOPUS, Web of Science, and gray literature databases, published between 2016 and 2021, using the descriptors "Liposuction" and "Complications." A total of 187 articles were found in the searched databases, of which 16 were selected according to the outcome "to assess safety through the prevalence of complications in liposuction as a single procedure and associated with other procedures such as abdominoplasty and fat grafting." We found a mortality rate ranging from 0 to 0.06 among all procedures and a predominance of venous thromboembolism, hematoma, seroma, and hyperpigmentation concerning all complications, being more common when liposuction is associated with other procedures. Therefore, through this review, it was possible to verify that liposuction as a single procedure has lower complication rates when compared to liposuction combined with other procedures.

A lipoaspiração está entre os procedimentos da cirurgia plástica mais realizados no Brasil. Segundo dados da International Society of Aesthetic Plastic Surgery (ISAPS), foram totalizadas 231.604 lipoaspirações, 15,5% dentre todos os procedimentos estéticos realizados no país em 2019. A adoção da lipoaspiração como procedimento único ou coadjuvante a outros procedimentos cosméticos estimulou sua evolução técnica da simples aspiração de gordura para uma modelagem corporal mais sofisticada. Desse modo, esta revisão objetivou avaliar sistematicamente os dados publicados em relação às complicações encontradas na lipoaspiração. Foi realizada uma revisão utilizando os bancos de dados PubMed, SciELO, LILACS, Cochrane Library, SCOPUS, Web of Science e grey literature, publicados entre os anos de 2016 e 2021, através dos descritores "Liposuction" and "Complications". Foram encontrados 187 artigos nas bases de dados pesquisadas, dos quais 16 foram selecionados de acordo com o desfecho "avaliar a segurança através da prevalência de complicações na lipoaspiração como procedimento único e a associada a outros procedimentos como abdominoplastia e lipoenxertia". Encontramos uma taxa de mortalidade que varia de 0 a 0,06 dentre todos os procedimentos e um predomínio de tromboembolismo venoso, hematoma, seroma e hiperpigmentação em relação a todas as complicações, sendo mais encontradas quando a lipoaspiração é associada a outros procedimentos. Logo, por meio desta revisão foi possível constatar que a lipoaspiração como procedimento único apresenta menores taxas de complicações quando comparada à lipoaspiração combinada com outros procedimentos.

¿Es la actividad metabólica del tejido adiposo un predictor de respuesta histopatológica al tratamiento neoadyuvante en el cáncer de mama? / Is adipose tissue metabolic activity a predictor of pathological responses to neoadjuvant treatment in breast cancer?

Objetivo La respuesta histopatológica a la quimioterapia neoadyuvante (NAC) es esencial en pacientes con cáncer de mama. La predicción de la respuesta histopatológica a la NAC en pacientes con cáncer de mama localmente avanzado es esencial para una estrategia de tratamiento óptima. El enfoque actual del tratamiento adyuvante o neoadyuvante se basa en el subtipo molecular. La obesidad puede afectar la respuesta a la quimioterapia. El objetivo de este estudio es evaluar la relación entre la actividad metabólica del tejido adiposo (AT) y la respuesta histopatológica de la NAC. Definir, la asociación del índice de masa corporal (IMC) y el valor del «Standard Uptake Value» (SUV) de AT medido por tomografía por emisión de positrones (PET/TC) con la respuesta a la quimioterapia neoadyuvante. Material y métodos Hemos incluido 116 pacientes consecutivos con cáncer de mama, estadio II y III, que acudieron para la realización de un PET/TC previo a NAC entre 2016 y 2020. Hemos calculado los parámetros metabólicos del tejido adiposo visceral (SUV del VAT), del tejido adiposo subcutáneo (SUV del SAT) y la relación entre ambos (relación V/S). Todos estos biomarcadores los hemos relacionado con la respuesta histopatológica de los pacientes. Resultados El análisis univariante muestra una correlación significativa entre la respuesta histopatológica con el estadio clínico (p<0,001), HER2 positivo (p<0,001), SUV del VAT (p=0,037), densidad del VAT (p=0,043) y la relación V/S (p=0,003). El análisis multivariante muestra una significación estadística entre HER2 positivo y la relación V/S con la respuesta histopatológica. Se evidencia una correlación positiva del IMC con el volumen del IVA (p<0,001), SUV del IVA (p<0,016), volumen del SAT (p<0,001) y el SUV del SAT (p<0,001). Se evidencia una correlación negativa del IMC con la relación V/S (p=0,039) y la densidad del SAT (p=0,003) (AU)

Introduction and objective Prediction of the pathologic response to neoadjuvant chemotherapy (NAC) in patients with locally advanced breast cancer is essential for optimal treatment strategy. The current approach of adjuvant or neoadjuvant treatment is based on the molecular subtype. Obesity may have affected chemotherapy response. This study aims to evaluate the relationship between metabolic activity of adipose tissue (AT) and pathological responses to NAC. And to define the association with body mass index (BMI) and metabolic parameters of standardized uptake value (SUV) of adipose tissue measured by positron emission computed tomography (PET/CT). Material and methods One-hundred and sixteen consecutive patients with stage II and III breast cancer who underwent PET/CT before receiving NAC, were evaluated in the study. Metabolic parameters of visceral adipose tissue (VAT-SUV), subcutaneous adipose tissue (SAT-SUV), and calculated SUV of visceral-to-subcutaneous ratio (V/S-ratio) were regarded. The relationship between SUV of AT and pathologic response was evaluated from medical records retrospectively. Results Univariate-analysis revealed that good pathological response was significantly associated with clinical stage (p<0.001), HER-2 positivity (p<0.001), VAT-SUV (p=0.037), VAT-density (p=0.043) and V/S-ratio (p=0.003). In multivariate-analysis clinical stage, HER-2 positivity and V/S-ratio were found to have statistically effect on pathological response. VAT-volume (p<0.001), VAT-SUV (p=0.016), SAT-volume (p<0.001) and SAT-SUV (p<0.001) has positive correlation with BMI value. On the other hand, V/S-ratio (p=0.039) and SAT-density (p=0.003) has negative correlation with BMI. Conclusion Metabolic activity of AT is associated with BMI and effected chemotherapy responses. Low V/S ratio was associated with high BMI and poor pathological response to NAC. V/S ratio may be a useful marker for the prediction of NAC responses (AU)

Epicardial adipose tissue volume is not an independent predictor of atrial fibrillation recurrence after catheter ablation.

INTRODUCTION AND OBJECTIVES: Previous studies have suggested that epicardial adipose tissue (EAT) could exert a paracrine effect in the myocardium. However, few studies have assessed its role in the risk of atrial fibrillation (AF) recurrence. This study aimed to evaluate the association between EAT volume, and its attenuation, with the risk of AF recurrence after AF ablation. METHODS: A total of 350 consecutive patients who underwent AF ablation were included. The median age was 57 [IQR 48-65] years and 21% had persistent AF. Epicardial fat was quantified by multidetector computed tomography using Syngo.via Frontier-Cardiac Risk Assessment software, measuring pericardial fat volume (PATV), EAT volume, and attenuation of EAT posterior to the left atrium. AF recurrence was defined as any documented episode of AF, atrial flutter, or atrial tachycardia more than 3 months after the procedure. RESULTS: After a median follow-up of 34 [range, 12-57] months, 114 patients (33%) had AF recurrence. Univariable Cox regression showed that patients with an EAT volume ≥ 80mL had an increased risk of AF recurrence (HR, 1.65; 95%CI, 1.14-2.39; P=.007). However, after multivariable adjustment, EAT volume did not remain an independent predictor of AF recurrence (HR, 1.24; 95%CI, 0.83-1.87; P=.3). Similar results were observed with PATV. Patients with lower attenuation of EAT did not have a higher risk of AF recurrence (log-rank test, P=.75). CONCLUSIONS: EAT parameters including the evaluation of EAT volume, PATV and EAT attenuation were not independent predictors of AF recurrence after catheter ablation.

Adipocytes-derived exosomal miR-122 promotes non-alcoholic fat liver disease progression via targeting Sirt1.

AIMS: Nonalcoholic fatty liver disease (NAFLD) is a chronic liver disease that affects adipose function. This study aimed to explore the function of adipocytes-derived exosomal (ADEs) miR-122 in NAFLD. METHODS: A high-fat and high-fructose diet-induced rat model and a palmitic acid (PA)-induced in vitro model were established. The RNA level of miR-122 and Sirt1 was measured using qRT-PCR. The protein levels of exosome biomarkers, and lipogenesis, inflammation and fibrosis biomarkers were determined by western blotting. Cell viability and apoptosis were assessed using cell counting kit-8 and flow cytometry, respectively. Serum alanine aminotransferase, aspartate aminotransferase, total cholesterol, triglyceride levels were measured. Liver tissue damage was assessed using haematoxylin and eosin staining. The interaction between miR-122 and Sirt1 3'UTR was assessed using a luciferase reporter gene assay. RESULTS: ADEs exhibited abundant level of miR-122 and promoted lipogenesis, impaired hepatocyte survival, enhanced liver damage and increased serum lipid levels in vivo and in vitro. Inhibition of miR-122 in ADEs alleviated NAFLD progression, lipid and glucose metabolism, liver inflammation and fibrosis both in vivo and in vitro. miR-122 binds directly to the 3'UTR of Sirt1 to suppress its expression. Moreover, Sirt1 overexpression reversed the increase in cell apoptosis, glucose and lipid metabolism, liver inflammation and fibrosis induced by ADEs in vivo and in vitro. CONCLUSIONS: The ADEs miR-122 promotes the progression of NAFLD via modulating Sirt1 signalling in vivo and in vitro. The ADEs miR-122 may be a promising diagnostic biomarker and therapeutic target for NAFLD.

Is adipose tissue metabolic activity a predictor of pathological responses to neoadjuvant treatment in breast cancer.

INTRODUCTION AND OBJECTIVE: Prediction of the pathologic response to neoadjuvant chemotherapy (NAC) in patients with locally advanced breast cancer is essential for optimal treatment strategy. The current approach of adjuvant or neoadjuvant treatment is based on the molecular subtype. Obesity may have affected chemotherapy response. This study aims to evaluate the relationship between metabolic activity of adipose tissue (AT) and pathological responses to NAC. And to define the association with body mass index (BMI) and metabolic parameters of standardized uptake value (SUV) of adipose tissue measured by positron emission computed tomography (PET/CT). MATERIAL AND METHODS: One-hundred and sixteen consecutive patients with stage II and III breast cancer who underwent PET/CT before receiving NAC, were evaluated in the study. Metabolic parameters of visceral adipose tissue (VAT-SUV), subcutaneous adipose tissue (SAT-SUV), and calculated SUV of visceral-to-subcutaneous ratio (V/S-ratio) were regarded. The relationship between SUV of AT and pathologic response was evaluated from medical records retrospectively. RESULTS: Univariate-analysis revealed that good pathological response was significantly associated with clinical stage (P<.001), HER-2 positivity (P<.001), VAT-SUV (P=.037), VAT-density (P=.043) and V/S-ratio (P=.003). In multivariate-analysis clinical stage, HER-2 positivity and V/S-ratio were found to have statistically effect on pathological response. VAT-volume (P<.001), VAT-SUV (P=.016), SAT-volume (P<.001) and SAT-SUV (P<.001) has positive correlation with BMI value. On the other hand, V/S-ratio (P=.039) and SAT-density (P=.003) has negative correlation with BMI. CONCLUSION: Metabolic activity of AT is associated with BMI and effected chemotherapy responses. LowV/S ratio was associated with high BMI and poor pathological response to NAC. V/S ratio may be a useful marker for the prediction of NAC responses.

Anthropometric indicators of adiposity as predictors of systemic arterial hypertension in older people: a cross-sectional analysis / Indicadores antropométricos de adiposidade como preditores de hipertensão arterial sistêmica em pessoas idosas: uma análise transversal

ABSTRACT Objective: To analyze the association of anthropometric indicators of adiposity in older people, according to sex, with hypertension; to compare the scores of these variables between participants with and without hypertension; and to identify among them those with better predictive ability for screening the outcome. Methods: Epidemiological, population-based, cross-sectional study conducted with 210 older people. The anthropometric indicators analyzed were: body mass index, waist circumference, abdominal circumference, body adiposity index, triceps skinfold, waist-to-hip ratio, waist-to-height ratio, and conicity index. Hypertension diagnosis was self-reported. Results: The indicators of adiposity increased the probability of hypertension. Additionally, hypertensive older people of both sexes showed higher scores on adiposity indicators than non-hypertensive subjects (p < 0.05). For men, the most sensitive indicator for the outcome was conicity index (81.82%; cut-off point: 1.30) and the most specific was body mass index (69.77%; cut-off point: 25.05 kg/m2). For women, the most sensitive indicator for the outcome was the body adiposity index (86.08%; cut-off point: 31.03%), and the most specific was the abdominal circumference (82.82%; cut-off point: 98.70 cm). Conclusion: In both sexes, the indicators of adiposity were positively associated with hypertension; hypertensive participants showed higher values in the scores of the indicators. Additionally, the body adiposity index (women) and conicity index (men) demonstrated greater ability to screen for hypertension, while the abdominal circumference and body mass index demonstrated greater ability to screen for non-hypertensive women and men, respectively.

RESUMO Objetivo: Analisar a associação de indicadores antropométricos de adiposidade com a hipertensão, em pessoas idosas, de acordo com o sexo; comparar os escores dessas variáveis entre os participantes com e sem hipertensão; e identificar os indicadores com melhor capacidade preditiva à triagem do desfecho. Métodos: Estudo epidemiológico, populacional, transversal, realizado com 210 pessoas idosas. Os indicadores antropométricos analisados foram: índice de massa corporal, circunferência da cintura, circunferência abdominal, índice de adiposidade corporal, dobra cutânea tricipital, relação cintura/quadril, relação cintura/altura e índice de conicidade. O diagnóstico de hipertensão arterial foi autorreferido. Resultados: Observou-se que os indicadores de adiposidade aumentaram a probabilidade à hipertensão. Além disso, as pessoas idosas hipertensas, de ambos os sexos, apresentaram maiores escores nos indicadores de adiposidade quando comparadas às não hipertensas (p < 0,05). Para os homens, o indicador mais sensível ao desfecho foi o índice de conicidade (81,82%; ponto de corte: 1,30) e o mais específico foi o índice de massa corporal (69,77%; ponto de corte: 25,05 kg/m2). Nas mulheres, o indicador mais sensível ao desfecho foi o índice de adiposidade corporal (86,08%; ponto de corte: 31,03%) e o mais específico foi a circunferência abdominal (82,82%; ponto de corte: 98,70 cm). Conclusão: Em ambos os sexos, os indicadores de adiposidade mostraram-se positivamente associados à hipertensão; os participantes hipertensos apresentaram valores mais elevados nos escores dos indicadores. Ademais, identificou-se para os sexos, feminino e masculino, que os indicadores com melhor capacidade de rastrear a hipertensão, foram, respectivamente, o índice de adiposidade corporal e índice de conicidade. Enquanto a circunferência abdominal e o índice de massa corporal mostraram maior capacidade de rastrear, respectivamente, as mulheres e os homens não hipertensos.

La pérdida de peso y la oxidación del tejido adiposo (grasa) en el fitness / Perda de peso e oxidação do tecido adiposo (gordura) em forma / Weight loss and adipose (fat) tissue oxidation in fitness

RESUMEN Introducción: El fitness está orientado a mejorar la condición física y la salud general, donde el control y la pérdida de peso son orientaciones básicas para perfeccionar el equilibrio corporal, potenciando la resistencia aeróbica. Saber el nivel de conocimientos de los especialistas nacionales delimitará los alcances y limitaciones a desarrollar en un futuro programa de intervención. Objetivo: Validar el nivel de conocimientos de un grupo de especialistas nacionales sobre la pérdida de peso mediante la oxidación del tejido adiposo (grasa) en fitness. Materiales y métodos: La investigación es descriptiva-explicativa con reforzamiento correlacional, seleccionado bajo un muestreo intencional no probabilístico a 32 especialistas nacionales del fitness a través de dos criterios de inclusión, para lo cual calificarán ocho indicadores teóricos que servirán de base metodológica para diseñar a futuro, un modelo sostenible de entrenamiento fitness. Resultados: La individualización, las alternativas complementarias y el método anaeróbico obtuvieron los menores puntajes promedios (1.81 puntos, 2.31 puntos y 2.53 puntos respectivamente) en su nivel de importancia, mientras que la asequibilidad y la sostenibilidad un nivel medio (3.19 puntos; 3.34 puntos) y los indicadores control sistemático, nivel de importancia y el método aeróbico los de mejor puntaje respectivamente (4.13 puntos, 4.56 puntos y 4.75 puntos). Los indicadores analizados evidencian diferentes niveles de importancia. Conclusiones: Se recomienda realizar una capacitación a los profesionales nacionales del fitness sobre los reales niveles de importancia que reviste cada indicador, enfatizando en la integración de cada componente de entrenamiento, incluyendo los principios estudiados, el entrenamiento anaeróbico como complemento al proceso de intervención aeróbico y las alternativas complementarias.

RESUMO Introdução: O condicionamento físico visa melhorar a condição física e a saúde em geral, onde o controle de peso e a perda de peso são orientações básicas para aperfeiçoar o equilíbrio corporal, melhorando a resistência aeróbica. O conhecimento do nível de conhecimento dos especialistas nacionais delimitará o escopo e as limitações a serem desenvolvidas em um futuro programa de intervenção. Objetivo: Validar o nível de conhecimento de um grupo de especialistas nacionais em perda de peso através da oxidação do tecido adiposo (gordura) em condição física. Materiais e métodos: A pesquisa é descritiva-explicativa com reforço correlacional, selecionada sob uma amostragem intencional não-probabilística de 32 especialistas nacionais em fitness através de dois critérios de inclusão, para os quais eles qualificarão oito indicadores teóricos que servirão como base metodológica para projetar um modelo sustentável de treinamento de fitness no futuro. Resultados: Individualização, alternativas complementares e o método anaeróbico obtiveram as notas médias mais baixas (1,81 pontos, 2,31 pontos e 2,53 pontos, respectivamente) em seu nível de importância, enquanto que a acessibilidade e sustentabilidade obtiveram um nível médio (3,19 pontos; 3,34 pontos) e os indicadores controle sistemático, nível de importância e o método aeróbico obtiveram as melhores notas, respectivamente (4,13 pontos, 4,56 pontos e 4,75 pontos). Os indicadores analisados evidenciam diferentes níveis de importância. Conclusões: Recomenda-se a realização de treinamento para profissionais de fitness nacionais sobre os níveis reais de importância de cada indicador, enfatizando a integração de cada componente de treinamento, incluindo os princípios estudados, o treinamento anaeróbico como complemento ao processo de intervenção aeróbica e alternativas complementares.

ABSTRACT Introduction: Fitness is aimed at improving physical condition and general health, where weight control and loss are basic guidelines to improve body balance, enhancing aerobic resistance. To be informed about the level of knowledge of the national specialists will delimit the scope and limitations to be developed in a future intervention program. Objective: To validate the level of knowledge of a group of national specialists on weight loss through the oxidation of adipose tissue (fat) in fitness. Materials and methods: The research is descriptive-explanatory with correlational reinforcement, selected under an intentional non-probabilistic sampling of 32 national fitness specialists through two inclusion criteria, for which they will qualify eight theoretical indicators that will serve as a methodological basis to design a future, a sustainable model of fitness training. Results: The individualization, the complementary alternatives and the anaerobic method obtained the lowest average scores (1.81 points, 2.31 points and 2.53 points respectively) in their level of importance, while affordability and sustainability a medium level (3.19 points; 3.34 points) and the indicators systematic control, level of importance and the aerobic method the ones with the best score respectively (4.13 points, 4.56 points and 4.75 points). The indicators analyzed show different levels of importance. Conclusions: It is recommended to train national fitness professionals on the real levels of importance of each indicator, emphasizing the integration of each training component, including the principles studied, anaerobic training as a complement to the aerobic intervention process and complementary alternatives.