Introduction: Overweight was defined as a BMI ≥23 kg/m2 but <25 kg/m2 for both genders (based on the World Health Organization Asia Pacific Guidelines) with or without Abdominal Obesity (AO). Generalized Obesity (GO) was defined as a BMI ≥ 25 kg/m2 for both genders (based on the World Health Organization Asia Pacific Guidelines) with or without AO. Ghrelin is synthesized as a pre-prohormone, in the epithelial cells lining the fundus of the stomach, with smaller amounts produced in the placenta, kidney, pituitary and hypothalamus. Ghrelin is an appetite-stimulating hormone that increases growth hormone secretion and food intake in humans. Furthermore, ghrelin regulates several physiological processes, including glucose metabolism, insulin secretion, gastric emptying, cell proliferation, learning and memory, stress and anxiety. Material and Methods: All the obese patients attending outpatient department (OPD) of Medicine. Subjects willing to participate and written informed consent was obtained from each participant before study. Subjects were screened for selection criteria. Baseline evaluation included recording of demographic details, BMI, medical history, general and systemic examination and laboratory investigations, which included complete haemogram, hepatic and renal function tests and routine urine analysis. The eligible patients were enrolled as randomization. Metformin was given at a daily dose of 1.0 gm BD for 3 months. Follow- up visits were scheduled at the end of every month for 3 months for assessment, including measurement of weight and general and systemic examination. Results: Total 141 diabetic patients selected, 89 were male (63.12%) while 52 were female patients (36.87%). There was no statistically significant difference (0.231). The mean of Ghrelin (pg/ml) is 311.42±29.53 at baseline (pg/ml) and after 3rd month 279.43±19.34 (pg/ml). Serum Ghrelin within same group showed significant decreased over a period of 3 months (p< 0.013). The mean of Total Cholesterol level was 215.97±11.05 mg/dl at baseline, 172.52±10.38 mg/dl after 3rd month. Triglycerides levels within same group showed significant reduction over a period of 3 months (p< 0.05). The mean of HDL Cholesterol level was 39.13±3.89 mg/dl at baseline, 43.10±4.33 mg/dl after 3rd month. Conclusion: Based on the above description of the effect of metformin in modulating AMPK and involving the IR regulation, as well as the pharmacological property of rosiglitazone as one of the compounds of thiazolidinedione, acting as a selective agonist of PPAR-γ, such combination may significantly promote the synthesis and secretion of adiponectin contributing to increasing level of adiponectin and improving insulin sensitivity.

Background:  Adiponectin is an adipose-derived hormone with a variety of beneficial biological functions on glucose and lipid metabolism. Adiponectin levels are inversely correlated with visceral obesity; therefore, high levels of adiponectin are negative correlated with obesity whereas low adiponectin levels exhibit a positive correlation. Serum levels of adiponectin are associated with metabolic syndrome and therefore metabolic syndrome development may be associated with obesity, adipose tissue content and hormonal levels. Metformin, a biguanide class of oral hypoglycemic agents, is the first line drug for the treatment of type 2 diabetes mellitus. Material and Methods: This is a Prospective and randomized study was conducted in obese patients attending the outpatient department of Medicine in Index Medical College and Hospital over a period of 2 years over a period of 2 Years. Subjects were screened for selection criteria. Baseline evaluation included recording of demographic details, BMI, medical history, general and systemic examination and laboratory investigations, which included complete haemogram, hepatic and renal function tests and routine urine analysis. The eligible patients were enrolled as randomization. Metformin was given at a daily dose of 1.0 gm BD for 3 months (Tab. Glycomet SR, USV Pharmaceutical Limited). RESULTS: In our study, maximum number of patients were in the age group of 51-60 years and least number of patients were ≤40 years of age. Mean age of patients were 53.43±5.34 years. The mean of Adiponectin (ng/ml) is 12.01±2.35 at baseline (ng/ml) and after 3rd month 23.88±2.09 (ng/ml). Serum Adiponectin levels within same group showed significant increased over a period of 3 months (p< 0.017). The mean fasting blood glucose level at baseline was 96.54 mg/dl with SD of 8.53 mg/dl and after 3 months 71.62±7.35 mg/dl. These was statistically significant difference in mean Fasting Blood Glucose level at baseline versus after 3 months (p=0.025). The mean of HbA1c as 5.91±0.14% at baseline, 4.32±0.17 after 3rd month. HbA1c levels within same group showed significant reduction over a period of 3 months (p< 0.0001). Conclusion: Metformin remains equivocal as a primary treatment for obesity and as a weight loss agent. It may serve as an adjunct therapy for those patients who are at high risk for metabolic complications or are experiencing other sequelae of obesity. Its mechanistic effects on central hypothalamic signaling, incretin secretion and alteration of the gut microbiome establish attractive areas of research in identifying new targets for obesity treatment.

Background: Osteoporosis is a significant public health concern, especially in postmenopausal women. This study aims to investigate the risk factors of osteoporosis among postmenopausal women review.  Material & Methods: A cross-sectional study enrolled 100 postmenopausal women aged 51 to 78 years. Data were collected on demographic characteristics, health history, and lifestyle factors. Bone Mineral Density (BMD) tests were conducted to diagnose osteoporosis. Statistical analysis included calculation of Odds Ratios (ORs), 95% Confidence Intervals (CIs), and p-values to evaluate the association between osteoporosis and various risk factors.  Results: The overall incidence of osteoporosis was 40%. Age-specific incidence showed a progressive increase with age: 20% in ages 51-60, 50% in ages 61-70, and 70% in ages 71-78. Significant risk factors included age (OR: 3.8, 95% CI: 2.0-7.1), low BMI (<18.5, OR: 4.5, 95% CI: 2.5-8.0), positive family history (OR: 3.3, 95% CI: 1.8-6.0), low calcium intake (p<0.001), and vitamin D deficiency (OR: 3.5, 95% CI: 1.9-6.3). Low physical activity and current smoking status were also associated with increased risk. Hormone Replacement Therapy (HRT) usage was associated with a 30% lower incidence (p<0.05). Socioeconomic status showed a significant correlation, with lower status linked to higher incidence (p<0.01).  Conclusion: The study highlights increased risk of osteoporosis in postmenopausal women driven by multiple risk factors. These findings emphasize the need for targeted interventions focusing on modifiable risk factors to manage and prevent osteoporosis in this population.

Background: Pulmonary autograft dilatation after Ross operation often necessitates reoperation. To understand autograft remodeling, a biomechanical understanding of human autografts after exposure to systemic pressure is required. We previously developed an ex vivo human pulmonary autograft finite element (FE) model to predict wall stress after exposure to systemic pressure. However, autograft material properties vary significantly among individuals. Our study aim was to quantify range of wall stress changes in a human autograft after Ross operation prior to remodeling based upon normal variation in human autograft mechanical properties.

Methods: A normal human autograft FE model was loaded to pulmonary and systemic arterial pressures. Stress-strain data of normal human autografts (n=24) were incorporated into an Ogden hyper-elastic model to describe autograft mechanical behavior. Autograft wall stresses at pulmonary vs. systemic pressures were examined. Autograft volume-based stress analysis was performed, based on percentage of autograft element volume exceeding 1 standard deviation (SD) above group mean stress at systemic systole.

Results: Mean first principal wall stresses (FPS) at systole of systemic versus pulmonary pressures were 129.29±17.47kPa versus 24.42±3.85kPa (p<0.001) at the annulus, 187.53±20.06kPa versus 35.98±2.15kPa at sinuses (p<0.001), and 268.68±23.40kPa versus 50.15±5.90kPa (p<0.001) at sinotubuluar junction (STJ). The percentage of autograft element volume that exceeded one SD above the group mean was 14.3±5.6% for FPS and 12.6±10.1% for second principal stresses.

Conclusion: We quantified normal human autograft biomechanical responses to systemic pressure based on patient-specific material properties. Regions of peak stresses were observed in autograft sinuses and STJ regions, which corresponded clinically to locations of autograft dilation. Our results provide valuable information on predicting variations in patient-specific ex vivo FE models when population-based material properties are used in settings where patient-specific properties are unknown.

How to cite: Wisneski, A. D., Wang, Z., Xuan, Y., Guccione, J. M., Ge, L., & Tseng, E. E. (2019). Range of Pulmonary Autograft Responses to Systemic Pressure Immediately After Ross Procedure. The Journal of heart valve disease, 28(1), 22–31.

Heart valve disease (HVD) can be significantly influenced by systemic autoimmune diseases, which may exacerbate or modify the progression of valve pathologies. This article reviews the interplay between systemic autoimmune diseases and heart valve disease, including mechanisms, diagnostic challenges, and therapeutic approaches. We discuss the impact of autoimmune conditions such as rheumatoid arthritis, systemic lupus erythematosus, and scleroderma on heart valve function, and highlight recent advances in understanding and managing these complex interactions.

MicroRNAs (miRNAs) are small non-coding RNAs that play critical roles in the regulation of gene expression. In the context of heart valve development and disease, miRNAs have emerged as important regulators of cellular processes, including differentiation, proliferation, and apoptosis. This review explores the roles of various miRNAs in heart valve development and pathology, examining their mechanisms of action, potential as diagnostic biomarkers, and therapeutic targets. We summarize recent findings and discuss future directions for research in this evolving field.

Obesity has emerged as a significant risk factor for cardiovascular diseases, including heart valve diseases (HVD). This review explores the impact of obesity on the progression of heart valve diseases, including mechanisms linking obesity with valve pathology, clinical implications, and management strategies. We discuss how obesity influences the development and progression of various types of heart valve diseases, including aortic stenosis, mitral regurgitation, and tricuspid valve disorders. The review also highlights current research findings and future directions for managing obesity-related heart valve disease.

Atrial fibrillation (AF) and heart valve disease (HVD) frequently co-occur, creating complex clinical scenarios that challenge diagnosis and management. This review explores the interplay between AF and HVD, examining their pathophysiological connections, diagnostic approaches, and treatment strategies. We discuss how the presence of one condition can exacerbate the other and highlight current research findings on managing these dual diagnoses.

Extracellular matrix (ECM) remodeling is a fundamental process in the pathogenesis of heart valve diseases. This review examines the role of ECM remodeling in valve disease progression, highlighting the molecular mechanisms, key regulatory factors, and clinical implications. We discuss how alterations in ECM composition and structure contribute to the development and progression of various heart valve diseases, including aortic stenosis, mitral regurgitation, and tricuspid valve disorders. The review also explores potential therapeutic strategies targeting ECM remodeling to mitigate valve disease progression.

Radiation therapy, commonly used in the treatment of various malignancies, has been associated with long-term cardiovascular complications, including heart valve dysfunction. This longitudinal study investigates the effects of radiation therapy on heart valve function over an extended period. We analyze changes in valve function, mechanisms of radiation-induced damage, and implications for patient management. The findings underscore the importance of monitoring heart valve health in patients with a history of radiation therapy and provide insights into potential preventive and therapeutic strategies.

Wearable technology is transforming the field of cardiovascular health by providing real-time monitoring and data collection for various conditions, including heart valve disease. This research article explores the application of wearable devices in tracking the progression of heart valve disease, evaluating their effectiveness, and discussing their potential to improve patient outcomes. We review current technologies, their integration into clinical practice, and future directions for research in wearable health monitoring.

Reoperative valve surgery is a challenging procedure with varied outcomes based on numerous factors. This study examines the outcomes of reoperative valve surgery, identifies key risk factors and predictors of adverse events, and provides insights into improving patient outcomes. By analyzing clinical data from multiple centers, we aim to enhance understanding of reoperative valve surgery and inform strategies to optimize patient care.

Heart valve disease is increasingly recognized as a condition with significant immunological underpinnings. This research article explores the role of inflammation and fibrosis in the pathogenesis of heart valve disease. We review the mechanisms by which immune responses contribute to valve dysfunction, the progression from inflammation to fibrosis, and the potential for targeted immunological therapies. Insights from recent studies and clinical trials are discussed to highlight the impact of these mechanisms on disease management and patient outcomes.

Transcatheter mitral valve repair (TMVR) has revolutionized the treatment of mitral valve disease, offering a less invasive alternative to surgical repair. This article reviews current trends in TMVR, including recent advancements in technology and procedural techniques. It also explores future directions in the field, emphasizing emerging technologies and potential areas for research. By synthesizing recent studies and clinical trials, this review aims to provide a comprehensive overview of TMVR's progress and future prospects.