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In ecological contexts, it is conventionally expected that increased food availability would boost consumption, particularly when animals prioritize maximizing their food intake. This paper challenges this conventional wisdom by conducting an in-depth game-theoretic analysis of a basic foraging model, in which animals must choose between intensive food searching as producers or moderate searching while relying on group members as scroungers. Our study reveals that, under certain circumstances, increasing food availability can amplify the inclination to scrounge to such an extent that it leads to a reduction in animals' food consumption compared to scenarios with limited food availability. We further illustrate a similar phenomenon in a model capturing free-riding dynamics among workers in a company. We demonstrate that, under certain reward mechanisms, enhancing workers' production capacities can inadvertently trigger a surge in free-riding behavior, leading to both diminished group productivity and reduced individual payoffs. Our findings provide intriguing insights into the complex relationships between individual and group performances, as well as the intricate mechanisms underlying the emergence of free-riding behavior in competitive environments.
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Conducta Alimentaria , Conducta Social , AnimalesRESUMEN
Gigantism is prevalent in animals, but it has never reached more extreme levels than in aquatic mammals such as whales, dolphins, and porpoises. A new study by Silva et al. has uncovered five genes underlying this gigantism, a phenotype with important connections to aging and cancer suppression in long-lived animals.
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Neoplasias , Ballenas , Animales , Ballenas/genética , Neoplasias/genética , Océanos y MaresRESUMEN
Species' phenotypic characteristics often remain unchanged over long stretches of geological time. Stabilizing selection-in which fitness is highest for intermediate phenotypes and lowest for the extremes-has been widely invoked as responsible for this pattern. At the community level, such stabilizing selection acting individually on co-occurring species is expected to produce a rugged fitness landscape on which different species occupy distinct fitness peaks. However, even with an explosion of microevolutionary field studies over the past four decades, evidence for persistent stabilizing selection driving long-term stasis is lacking. Nonetheless, biologists continue to invoke stabilizing selection as a major factor explaining macroevolutionary patterns. Here, by directly measuring natural selection in the wild, we identified a complex community-wide fitness surface in which four Anolis lizard species each occupy a distinct fitness peak close to their mean phenotype. The presence of local fitness optima within species, and fitness valleys between species, presents a barrier to adaptive evolutionary change and acts to maintain species differences through time. However, instead of continuously operating stabilizing selection, we found that species were maintained on these peaks by the combination of many independent periods among which selection fluctuated in form, strength, direction, or existence and in which stabilizing selection rarely occurred. Our results suggest that lack of substantial phenotypic evolutionary change through time may be the result of selection, but not persistent stabilizing selection as classically envisioned.
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Evolución Biológica , Selección Genética , Fenotipo , Ambiente , BiotaRESUMEN
Smart adhesives that can be applied and removed on demand play an important role in modern life and manufacturing. However, current smart adhesives made of elastomers suffer from the long-standing challenges of the adhesion paradox (rapid decrease in adhesion strength on rough surfaces despite adhesive molecular interactions) and the switchability conflict (trade-off between adhesion strength and easy detachment). Here, we report the use of shape-memory polymers (SMPs) to overcome the adhesion paradox and switchability conflict on rough surfaces. Utilizing the rubbery-glassy phase transition in SMPs, we demonstrate, through mechanical testing and mechanics modeling, that the conformal contact in the rubbery state followed by the shape-locking effect in the glassy state results in the so-called rubber-to-glass (R2G) adhesion (defined as making contact in the rubbery state to a certain indentation depth followed by detachment in the glassy state), with extraordinary adhesion strength (>1 MPa) proportional to the true surface area of a rough surface, overcoming the classic adhesion paradox. Furthermore, upon transitioning back to the rubbery state, the SMP adhesives can detach easily due to the shape-memory effect, leading to a simultaneous improvement in adhesion switchability (up to 103, defined as the ratio of the SMP R2G adhesion to its rubbery-state adhesion) as the surface roughness increases. The working principle and the mechanics model of R2G adhesion provide guidelines for developing stronger and more switchable adhesives adaptable to rough surfaces, thereby enhancing the capabilities of smart adhesives, and impacting various fields such as adhesive grippers and climbing robots.
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Millions of RNA sequencing samples have been deposited into public databases, providing a rich resource for biological research. These datasets encompass tens of thousands of experiments and offer comprehensive insights into human cellular regulation. However, a major challenge is how to integrate these experiments that acquired at different conditions. We propose a new statistical tool based on beta-binomial distributions that can construct robust gene co-regulation network (CoRegNet) across tens of thousands of experiments. Our analysis of over 12 000 experiments involving human tissues and cells shows that CoRegNet significantly outperforms existing gene co-expression-based methods. Although the majority of the genes are linearly co-regulated, we did discover an interesting set of genes that are non-linearly co-regulated; half of the time they change in the same direction and the other half they change in the opposite direction. Additionally, we identified a set of gene pairs that follows the Simpson's paradox. By utilizing public domain data, CoRegNet offers a powerful approach for identifying functionally related gene pairs, thereby revealing new biological insights.
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Redes Reguladoras de Genes , Modelos Estadísticos , Humanos , RNA-Seq , Análisis de Secuencia de ARN/métodos , Perfilación de la Expresión Génica/métodosRESUMEN
SignificanceBacteriophages, the most widespread reproducing biological entity on Earth, employ two strategies of virus-host interaction: lysis of the host cell and lysogeny whereby the virus genome integrates into the host genome and propagates vertically with it. We present a population model that reveals an effect known as Parrondo's paradox in game theory: Alternating between lysis and lysogeny is a winning strategy for a bacteriophage, even when each strategy individually is at a disadvantage compared with a competing bacteriophage. Thus, evolution of bacteriophages appears to optimize the ratio between the lysis and lysogeny propensities rather than the phage burst size in any individual phase. This phenomenon is likely to be relevant for understanding evolution of other host-parasites systems.
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Bacteriófagos , Lisogenia , Bacteriófagos/genética , Teoría del Juego , Genoma ViralRESUMEN
Experiments often find that net primary productivity (NPP) increases with species richness when native species are considered. However, relationships may be altered by exotic (non-native) species, which are hypothesized to reduce richness but increase productivity (i.e., 'invasion-diversity-productivity paradox'). We compared richness-NPP relationships using a comparison of exotic versus native-dominated sites across the central USA, and two experiments under common environments. Aboveground NPP was measured using peak biomass clipping in all three studies, and belowground NPP was measured in one study with root ingrowth cores using root-free soil. In all studies, there was a significantly positive relationship between NPP and richness across native species-dominated sites and plots, but no relationship across exotic-dominated ones. These results indicate that relationships between NPP and richness depend on whether native or exotic species are dominant, and that exotic species are 'breaking the rules', altering richness-productivity and richness-C stock relationships after invasion.
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Biodiversidad , Especies Introducidas , Biomasa , Suelo , EcosistemaRESUMEN
BACKGROUND: The association between common neuroradiological markers of multiple sclerosis (MS) and clinical disability is weak. Given that the disability in patients with MS may depend on the underlying structural connectivity of the brain, our study aimed to examine the association between white matter tracts affected by MS and the patients' disability using a new tract density index (TDI). METHOD: This study included 53 patients diagnosed with MS, examined between 2019 and 2020. Manual lesion segmentation was performed on fluid-attenuated inversion recovery (FLAIR) images, and the density of white matter tracts encompassing the lesion (i.e., TDI) was calculated. Correlation analysis was employed to assess the association between TDI and disability. Additionally, the relationship between disability, TDI, and lesion-derived network metrics was examined by computing a partial correlation network. RESULTS: The TDI significantly correlated with the expanded disability status scale (EDSS) (r = 0.30, p = 0.03). Furthermore, the patient's disability is linked solely through TDI to lesion-derived network metrics -a key metric that 'bridges' the gap between the brain lesion and disability. CONCLUSIONS: In this study, MS lesions encompassing regions with high white matter tract density were associated and linked with severe physical disability. These findings indicate that TDI may be an outcome predictor that may connect radiologic findings to clinical practice.
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Esclerosis Múltiple , Sustancia Blanca , Humanos , Sustancia Blanca/diagnóstico por imagen , Sustancia Blanca/patología , Femenino , Masculino , Esclerosis Múltiple/patología , Esclerosis Múltiple/diagnóstico por imagen , Adulto , Persona de Mediana Edad , Imagen por Resonancia Magnética/métodos , Evaluación de la Discapacidad , Imagen de Difusión Tensora/métodos , Encéfalo/patología , Encéfalo/diagnóstico por imagen , Personas con DiscapacidadRESUMEN
The presence of alien species represents a major cause of habitat degradation and biodiversity loss worldwide, constituting a critical environmental challenge of our time. Despite sometimes experiencing reduced propagule pressure, leading to a reduced genetic diversity and an increased chance of inbreeding depression, alien invaders are often able to thrive in the habitats of introduction, giving rise to the so-called "genetic paradox" of biological invasions. The adaptation of alien species to the new habitats is therefore a complex aspect of biological invasions, encompassing genetic, epigenetic, and ecological processes. Albeit numerous studies and reviews investigated the mechanistic foundation of the invaders' success, and aimed to solve the genetic paradox, still remains a crucial oversight regarding the temporal context in which adaptation takes place. Given the profound knowledge and management implications, this neglected aspect of invasion biology should receive more attention when examining invaders' ability to thrive in the habitats of introduction. Here, we discuss the adaptation mechanisms exhibited by alien species with the purpose of highlighting the timing of their occurrence during the invasion process. We analyze each stage of the invasion separately, providing evidence that adaptation mechanisms play a role in all of them. However, these mechanisms vary across the different stages of invasion, and are also influenced by other factors, such as the transport speed, the reproduction type of the invader, and the presence of human interventions. Finally, we provide insights into the implications for management, and identify knowledge gaps, suggesting avenues for future research that can shed light on species adaptability. This, in turn, will contribute to a more comprehensive understanding of biological invasions.
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Adaptación Fisiológica , Ecosistema , Especies Introducidas , Biodiversidad , AnimalesRESUMEN
BACKGROUND: Obesity paradox has been reported in patients with cardiovascular disease, showing an inverse association between obesity as defined by BMI (in kg/m2) and prognosis. Nutritional status is associated with systemic inflammatory response and affects cardiovascular disease outcomes. OBJECTIVES: This study sought to examine the influence of obesity and malnutrition on the prognosis of patients with acute coronary syndrome (ACS). METHODS: This study included consecutive patients diagnosed with ACS and underwent coronary angiogram between January 2009 and February 2023. At baseline, patients were categorized according to their BMI as follows: underweight (<18), normal weight (18-24.9), overweight (25.0-29.9), and obese (>30.0). We assessed the nutritional status by Prognostic Nutritional Index (PNI). Malnutrition was defined as a PNI value of <38. RESULTS: Of the 21,651 patients with ACS, 582 (2.7%) deaths from any cause were observed over 28.7 months. Compared with the patient's state of normal weight, overweight, and obesity were associated with decreased risk of all-cause mortality. Malnutrition was independently associated with poor survival (hazards ratio: 2.64; 95% CI: 2.24, 3.12; P < 0.001). In malnourished patients, overweight and obesity showed a 39% and 72% reduction in the incidence of all-cause mortality, respectively. However, in nourished patients, no significant reduction in the incidence of all-cause mortality was observed (all P > 0.05). CONCLUSIONS: Obesity paradox appears to occur in patients with ACS. Malnutrition may be a significant independent risk factor for prognosis in patients with ACS. The obesity paradox is influenced by the status of malnutrition.
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Síndrome Coronario Agudo , Desnutrición , Obesidad , Humanos , Síndrome Coronario Agudo/complicaciones , Síndrome Coronario Agudo/mortalidad , Masculino , Femenino , Desnutrición/complicaciones , Obesidad/complicaciones , Persona de Mediana Edad , Anciano , Índice de Masa Corporal , Estado Nutricional , Pronóstico , Factores de Riesgo , Evaluación Nutricional , Paradoja de la ObesidadRESUMEN
BACKGROUND: Peer victimization predicts the development of mental health symptoms in the transition to adolescence, but it is unclear whether and how parents and school environments can buffer this link. METHODS: We analyzed two-year longitudinal data from the Adolescent Brain Cognitive Development (ABCD) study, involving a diverse sample of 11 844 children across the United States (average at baseline = 9.91 years; standard deviation = 0.63; range = 8.92-11.08; complete case sample = 8385). Longitudinal associations between peer victimization and two-year changes in mental health symptoms of major depression disorder (MDD), separation anxiety (SA), prodromal psychosis (PP), and attention-deficit/hyperactivity disorder (ADHD) were examined including a wide range of covariates. Mixed linear models were used to test for the moderating effects of parental warmth and prosocial school environment. RESULTS: 20% of children experienced peer victimization. Higher exposure to peer victimization was associated with increases in MDD, SA, and ADHD symptoms. Parental warmth was associated with decreases in MDD symptoms but did not robustly buffer the link between peer victimization and mental health symptoms. Prosocial school environment predicted decreases in PP symptoms and buffered the link between peer victimization and MDD symptoms but amplified the link between peer victimization and SA and ADHD symptoms. CONCLUSIONS: Peer victimization is associated with increases in mental health symptoms during the transition to adolescence. Parental warmth and prosocial school environments might not be enough to counter the negative consequences of peer victimization on all mental health outcomes.
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OBJECTIVE: We studied cis-women with uterine cancer presenting to the two Public Hospitals in Queens, New York from 2006 to 2015 to examine the relationship between nativity (birthplace) and survival. METHODS: A retrospective review of tumor registries identified women diagnosed with uterine cancer between January 1, 2006, and December 31, 2015. Data from 259 women were available for this analysis. RESULTS: Most women were born outside the United States (US) (76% versus 24%). The majority of US-born women were black (68%). Seventy-seven women (30%) were born in Latin America, 76 in the Caribbean Islands (29%) and 44 in Asia/South Asia (17%). Most women presented with stage I/II disease (70%) and endometrioid/mucinous histology (68%) with no significant differences observed among nativity groups. Kaplan-Meier estimated survival curves stratified by birthplace demonstrated significant differences in survival distributions among the groups using the log-rank test (P < 0.0001). The most favorable survival curves were observed among all foreign-born women, whereas the least favorable survival was demonstrated in US-born women. Time to death was analyzed using the Cox proportional hazards model. Adjusting for age of diagnosis, insurance status, stage, and treatment modality, Latin American and Asia/South Asia birthplace was significantly associated with increased survival time. CONCLUSION: An immigrant health paradox was defined for foreign-born Latin American and Asian/South Asian women presenting to the two Public Hospitals of Queens, New York, as women born in these geographic regions were less likely to die at any given time compared to those born in the United States.
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Emigrantes e Inmigrantes , Neoplasias Uterinas , Humanos , Femenino , Estados Unidos , New York/epidemiología , Estudios Retrospectivos , Hospitales PúblicosRESUMEN
BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading cause of chronic liver disease and 10%-20% occurs in lean individuals. There is little data in the literature regarding outcomes in an ethnically-diverse patient populations with MASLD. Thus, we aim to investigate the natural history and ethnic disparities of MASLD patients in a diverse population, and stratified by body mass index categories. METHODS: We conducted a retrospective multicenter study on patients with MASLD at the Banner Health System from 2012 to 2022. Main outcomes included mortality and incidence of cirrhosis, cardiovascular disease, diabetes mellitus (DM), liver-related events (LREs), and cancer. We used competing risk and Cox proportional hazard regression analysis for outcome modelling. RESULTS: A total of 51 452 (cross-sectional cohort) and 37 027 (longitudinal cohort) patients were identified with 9.6% lean. The cohort was 63.33% European ancestry, 27.96% Hispanic ancestry, 3.45% African ancestry, and 2.31% Native American/Alaskan ancestry. Median follow-up was 45.8 months. After adjusting for confounders, compared to European individuals, Hispanic and Native American/Alaskan patients had higher prevalence of cirrhosis and DM, and individuals of Hispanic, African, and Native American/Alaskan ancestry had higher mortality and incidence of LREs and DM. Lean patients had higher mortality and incidence of LREs compared with non-lean patients. CONCLUSION: Native American/Alaskan, Hispanic, and African patients had higher mortality and incidence of LREs and DM compared with European patients. Further studies to explore the underlying disparities and intervention to prevent LREs in lean patients, particularly several ethnic groups, may improve clinical outcomes.
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Disparidades en el Estado de Salud , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Índice de Masa Corporal , Enfermedades Cardiovasculares/mortalidad , Enfermedades Cardiovasculares/etnología , Estudios Transversales , Diabetes Mellitus/etnología , Diabetes Mellitus/mortalidad , Etnicidad/estadística & datos numéricos , Incidencia , Cirrosis Hepática/mortalidad , Cirrosis Hepática/etnología , Estudios Longitudinales , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Estados Unidos/epidemiología , Indio Americano o Nativo de Alaska , Negro o Afroamericano , Blanco , Hispánicos o LatinosRESUMEN
AIMS: This study aimed to explore whether the obesity paradox exists in overall and specific cancers and to investigate the role of systemic inflammation in the obesity paradox. METHODS: The Cox proportional hazard model was used to explore the relationship between body mass index (BMI) and all-cause mortality. The mediated effect was used to investigate the proportion of systemic inflammation mediating the relationship between BMI and cancer survival risk. RESULTS: The survival probability showed a step-like increase with an increase in BMI regardless of pathological stage. Approximately 10.8%-24.0% of the overall association between BMI and all-cause mortality in cancer was mediated by inflammation. In the internal validation, we found evidence of the obesity paradox in all body composition obtained using BIA, with inflammation remaining an important mediating factor. Furthermore, we also validated the existence of the obesity paradox of cancer in NHANES. Systemic inflammation remains an important factor in mediating the association between BMI and prognosis in cancer patients. CONCLUSIONS: The obesity paradox is prevalent in most cancers, except for hepatic biliary cancer and breast cancer. Inflammation may be one of the true features of the obesity paradox in cancer.
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Neoplasias , Obesidad , Humanos , Obesidad/epidemiología , Obesidad/complicaciones , Paradoja de la Obesidad , Encuestas Nutricionales , Estudios de Cohortes , Inflamación/complicaciones , Neoplasias/epidemiología , Neoplasias/complicaciones , Factores de RiesgoRESUMEN
INTRODUCTION: Obesity is increasingly prevalent both nationwide and in the emergency general surgery (EGS) population. While previous studies have shown that obesity may be protective against mortality following EGS procedures, the association between body mass index (BMI) and postoperative outcomes, as well as intraoperative decision-making, remains understudied. METHODS: The National Surgical Quality Improvement Program 2015-2019 database was used to identify all adult patients undergoing an open abdominal or abdominal wall procedure for EGS conditions. Our outcomes included 30-d postoperative mortality, composite 30-d morbidity, delayed fascial closure, reoperation, operative time, and hospital length of stay (LOS). Multivariable logistic regression models were used to explore the association between BMI and each outcome of interest while adjusting for patient demographics, comorbidities, laboratory tests, preoperative and intraoperative variables. RESULTS: We identified 78,578 patients, of which 3121 (4%) were categorized as underweight, 23,661 (30.1%) as normal weight, 22,072 (28.1%) as overweight, 14,287 (18.2%) with class I obesity, 7370 (9.4%) with class II obesity, and 8067 (10.3%) with class III obesity. Class III obesity was identified as a risk factor for 30-d postoperative morbidity (adjusted odds ratio 1.14, 95% CI, 1.03-1.26, P < 0.01). An increase in obesity class was also associated with a stepwise increase in the risk of undergoing delayed fascial closure, experiencing a prolonged operative time, and having an extended LOS. CONCLUSIONS: Obesity class was associated with an increase in delayed fascial closure, longer operative time, higher reoperation rates, and extended hospital LOS. Further studies are needed to explore how a patient's BMI impacts intraoperative factors, influences surgical decision-making, and contributes to hospital costs.
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The actions of the major human leg muscles are well established; however, the functions of these muscle actions during steady running remain unclear. Here, leg structures and mechanisms are considered in terms of their functions in meeting the task of a vehicle acting as an effective machine, supporting body weight during translation with low mechanical work demand and in supplying mechanical work economically. Legs are modelled as a sequence of linkages that predict muscle actions and reveal the varying muscle functions within the integrated leg. Work avoidance is achieved with isometric muscles and linkages that promote a sliding of the hip over the ground contact, resulting in an approximately horizontal path of the centre of mass. Economical work supply requires, for muscle with constrained power, shortening over the entire stance duration; this function is achieved by the hamstrings without disrupting the linkages resulting in work avoidance. In late stance, the two functions occur through coactivation of antagonistic muscles, providing one answer to Lombard's paradox. Quadriceps and hamstring tensions result in opposing moments about both hip and knee joints, but by doing so perform the independent yet complementary roles of work avoidance during translating weight support and economical work supply.
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Pierna , Músculo Esquelético , Carrera , Humanos , Carrera/fisiología , Músculo Esquelético/fisiología , Pierna/fisiología , Fenómenos BiomecánicosRESUMEN
BACKGROUND AND AIM: The study aims to determine the prognostic impact of obesity, sarcopenic obesity, and dynapenic obesity in patients with chronic liver disease. METHODS: This retrospective observational study enrolled patients with chronic hepatitis (n = 746) and liver cirrhosis (n = 434) without hepatocellular carcinoma at entry. The patients were evaluated for sarcopenia and obesity between April 2016 and April 2022. Obesity was defined as a body mass index of ≥ 25 kg/m2. Sarcopenic obesity was defined as low skeletal muscle mass (pre-sarcopenia) with obesity and dynapenic obesity was defined as low muscle strength (dynapenia) with obesity. The effects of obesity on survival were evaluated retrospectively. RESULTS: The mean observation period was 2.5 years. Obesity, sarcopenic obesity, and dynapenic obesity were found in 271 (45.5%), 17 (2.9%), and 21 (3.5%) men, and 261 (44.7%), 59 (10.1%), and 53 (9.1%) women, respectively. A multivariate Cox proportional hazards model revealed that Child-Pugh class, dynapenia (hazard ratio [HR] 3.89), elderly (≥ 65 years old) (HR 2.11), and obesity (HR 0.58) were independently associated with overall survival (OS). However, neither sarcopenic nor dynapenic obesity were associated with OS. In patients with cirrhosis, the OS of the obese group was significantly higher than that of the non-obese group. The effect of obesity on OS was significant in elderly patients, but not in younger patients. CONCLUSIONS: Sarcopenic and dynapenic obesity seem unrelated to the prognosis of patients with chronic liver disease. Obesity has a positive effect on the prognosis of elderly patients with cirrhosis.
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Cirrosis Hepática , Obesidad , Sarcopenia , Humanos , Cirrosis Hepática/complicaciones , Cirrosis Hepática/mortalidad , Masculino , Femenino , Pronóstico , Obesidad/complicaciones , Sarcopenia/etiología , Sarcopenia/complicaciones , Estudios Retrospectivos , Persona de Mediana Edad , Anciano , Fuerza Muscular , Factores de Edad , Modelos de Riesgos Proporcionales , Hepatitis Crónica/complicaciones , Índice de Masa Corporal , Adulto , Tasa de SupervivenciaRESUMEN
BACKGROUND: Patients with diabetes mellitus (DM) caused by obesity have increased in recent years. The impact of obesity on long-term outcomes in patients undergoing percutaneous coronary intervention (PCI) with or without DM remains unclear. METHODS: We retrospectively analysed data from 1918 patients who underwent PCI. Patients were categorized into four groups based on body mass index (BMI, normal weight: BMI < 25 kg/m2; overweight and obese: BMI ≥ 25 kg/m2) and DM status (presence or absence). The primary endpoint was the occurrence of major adverse cardiac and cerebrovascular events (MACCE; defined as all-cause death, myocardial infarction, stroke, and unplanned repeat revascularization). RESULTS: During a median follow-up of 7.0 years, no significant differences in MACCE, myocardial infarction, or stroke were observed among the four groups. Overweight and obese individuals exhibited lower all-cause mortality rates compared with normal-weight patients (without DM: hazard ratio [HR]: 0.54, 95% confidence interval [CI]: 0.37 to 0.78; with DM: HR: 0.57, 95% CI: 0.38 to 0.86). In non-diabetic patients, the overweight and obese group demonstrated a higher risk of unplanned repeat revascularization than the normal-weight group (HR:1.23, 95% CI:1.03 to 1.46). After multivariable adjustment, overweight and obesity were not significantly associated with MACCE, all-cause death, myocardial infarction, stroke, or unplanned repeat revascularization in patients with and without diabetes undergoing PCI. CONCLUSION: Overweight and obesity did not demonstrate a significant protective effect on long-term outcomes in patients with and without diabetes undergoing PCI.
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Enfermedad de la Arteria Coronaria , Diabetes Mellitus , Infarto del Miocardio , Intervención Coronaria Percutánea , Accidente Cerebrovascular , Humanos , Sobrepeso , Estudios Retrospectivos , Índice de Masa Corporal , Intervención Coronaria Percutánea/efectos adversos , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiología , Infarto del Miocardio/etiología , Obesidad/complicaciones , Obesidad/diagnóstico , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/complicaciones , Resultado del Tratamiento , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/terapia , Enfermedad de la Arteria Coronaria/complicacionesRESUMEN
BACKGROUND: Recent studies have demonstrated an obesity paradox, where obese patients with cardiovascular disease have a better outcome compared to those with normal weight. However, the effect of obesity and body mass index (BMI) on the outcome of patients with cardiac resynchronization therapy (CRT) devices remains unclear. The current study aims to investigate this relationship using all available published data. METHODS: We systematically reviewed studies from Medline and EMBASE databases from inception to January 2024. Eligible studies must investigate the association between BMI status and all-cause mortality in individuals with CRT devices. Relative risk (RR) or hazard ratio (HR) and 95% CIs were retrieved from each study and combined using the generic inverse variance method. RESULTS: A total of 12 cohort studies were included in the meta-analysis. Pooled analysis showed that overweight and obesity patients had lower all-cause mortality compared to those with normal body weight with the pooled risk ratios (RR) for overweight of 0.77 (95% CI 0.69-0.87, I2 47%) and for obesity of 0.81 (95% CI 0.67-0.97, I2 59%). Conversely, the underweight exhibited higher all-cause mortality than the group with normal weight, with a pooled RR of 1.37 (95% CI 1.14-1.64, I2 0%). Additionally, higher BMI as continuous data was associated with decreased all-cause mortality, with a pooled HR of 0.94 (95% CI 0.89-0.98, I2 72%). CONCLUSIONS: The pooled analyses observed an obesity paradox in patients with CRT, where overweight and obesity were associated with reduced all-cause mortality, while underweight individuals exhibited higher all-cause mortality. Further research is necessary to investigate the underlying mechanisms and their implications for clinical practice.
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Effort expenditure not only prospectively discounts the reward associated with it but also retrospectively adds the subjective value of reward, which is known as the effort paradox. This study aimed to resolve the effort paradox during reward evaluation through the critical lens of neural dynamics and its potential moderators. In total, 40 participants completed an effort-reward task wherein they exerted varying physical efforts to obtain an opportunity to win monetary rewards by active or passive decision-making. We found that after-effects of physical effort expenditure during reward evaluation unfolded as an effort paradox over time, manifesting itself as an effort discounting effect during the reward positivity (RewP) period but as an effort enhancement effect during the late positive potential (LPP) interval. Then, we found a dynamic balance between the discounting effect and the enhancement effect such that the more effort discounted the RewP at the early stage, the more effort increased the LPP at the late stage. Moreover, we observed that the effort-reward relationship was modulated by perceived control such that it increased the reward sensitivity effect and decreased the effort discounting effect. Together, our findings provide new insights into the neural mechanisms underlying the after-effects of physical effort exertion during reward evaluation.