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Physical Examination - Top 30 Publications

Association of body mass index with clinical outcomes for in-hospital cardiac arrest adult patients following extracorporeal cardiopulmonary resuscitation.

Obesity might be associated with disturbance of cannulation in situation of extracorporeal cardiopulmonary resuscitation (ECPR). However, limited data are available on obesity in the setting of ECPR. Therefore, we investigated the association between body mass index (BMI) and clinical outcome in patients underwent ECPR.

Modeling the shape and composition of the human body using dual energy X-ray absorptiometry images.

There is growing evidence that body shape and regional body composition are strong indicators of metabolic health. The purpose of this study was to develop statistical models that accurately describe holistic body shape, thickness, and leanness. We hypothesized that there are unique body shape features that are predictive of mortality beyond standard clinical measures. We developed algorithms to process whole-body dual-energy X-ray absorptiometry (DXA) scans into body thickness and leanness images. We performed statistical appearance modeling (SAM) and principal component analysis (PCA) to efficiently encode the variance of body shape, leanness, and thickness across sample of 400 older Americans from the Health ABC study. The sample included 200 cases and 200 controls based on 6-year mortality status, matched on sex, race and BMI. The final model contained 52 points outlining the torso, upper arms, thighs, and bony landmarks. Correlation analyses were performed on the PCA parameters to identify body shape features that vary across groups and with metabolic risk. Stepwise logistic regression was performed to identify sex and race, and predict mortality risk as a function of body shape parameters. These parameters are novel body composition features that uniquely identify body phenotypes of different groups and predict mortality risk. Three parameters from a SAM of body leanness and thickness accurately identified sex (training AUC = 0.99) and six accurately identified race (training AUC = 0.91) in the sample dataset. Three parameters from a SAM of only body thickness predicted mortality (training AUC = 0.66, validation AUC = 0.62). Further study is warranted to identify specific shape/composition features that predict other health outcomes.

Initial systemic inflammatory state perturbs exercise training adaptations in elite Taekwondo athletes.

This study examined ten-week TKD-specific training effects on aerobic capacity, body composition, hormone responses and hematological parameters in elite TKD athletes with varied initial inflammatory states.

Perirenal fat thickness measured with computed tomography is a reliable estimate of perirenal fat mass.

Deposition of perirenal adipose tissue has been associated with adverse renal and cardiovascular events. We compared various methods to measure perirenal adipose tissue using computerized tomography (CT)-scan and performed correlations with anthropometric measures associated with renal and cardiovascular events. Voluntary overweight and obese subjects undergoing a CT-scan for diagnostic purposes were included in the study. Perirenal adipose tissue volume, adipose tissue area of the renal sinus and perirenal fat thickness were manually measured bilaterally. The intra- and inter-observer coefficient correlations and the correlation between the diverse measures of renal adipose tissue, subcutaneous (SC-)fat and anthropometrics measures were analyzed using Pearson's correlation tests. The forty included patients (24 men, 16 women) had a mean age of 57.6 ± 18.1 years and a mean body mass index of 28.9 ± 2.9 kg/m2. Despite comparable waist circumference, women had a greater SC-fat thickness compared to men, and therefore a smaller amount of visceral fat, as well as smaller perirenal fat volumes. Perirenal fat thickness was better correlated with perirenal fat volume than adipose area of the renal sinus (p <0.02). The adipose area of the renal sinus did not correlate with any anthropometric measures. In women, perirenal fat volume and thickness showed a negative correlation with SC-fat thickness and no correlation with waist circumference. In men, perirenal fat volume and thickness showed a positive correlation with waist circumference and no correlation with subcutaneous fat thickness. In conclusion, perirenal fat thickness measured with CT-scan at the level of the renal veins is a simple and reliable estimate of perirenal fat volume, that correlated negatively with SC-fat in women and positively with waist circumference in men. The adipose area of the renal sinus did not correlate with any anthropometric measure.

The Sheep Grimace Scale as an indicator of post-operative distress and pain in laboratory sheep.

The EU Directive 2010/63/EU changed the requirements regarding the use of laboratory animals and raised important issues related to assessing the severity of all procedures undertaken on laboratory animals. However, quantifiable parameters to assess severity are rare, and improved assessment strategies need to be developed. Hence, a Sheep Grimace Scale (SGS) was herein established by observing and interpreting sheep facial expressions as a consequence of pain and distress following unilateral tibia osteotomy. The animals were clinically investigated and scored five days before surgery and at 1, 3, 7, 10, 14 and 17 days afterwards. Additionally, cortisol levels in the saliva of the sheep were determined at the respective time points. For the SGS, video recording was performed, and pictures of the sheep were randomized and scored by blinded observers. Osteotomy in sheep resulted in an increased clinical severity score from days 1 to 17 post-surgery and elevated salivary cortisol levels one day post-surgery. An analysis of facial expressions revealed a significantly increased SGS on the day of surgery until day 3 post-surgery; this elevated level was sustained until day 17. Clinical severity and SGS scores correlated positively with a Pearson´s correlation coefficient of 0.47. Further investigations regarding the applicability of the SGS revealed a high inter-observer reliability with an intraclass correlation coefficient of 0.92 and an accuracy of 68.2%. In conclusion, the SGS represents a valuable approach for severity assessment that may help support and refine a widely used welfare assessment for sheep during experimental procedures, thereby meeting legislation requirements and minimizing the occurrence of unrecognized distress in animal experimentation.

Children's weight changes according to maternal perception of the child's weight and health: A prospective cohort of Peruvian children.

The aim of the study was to estimate the association between maternal perception of their child's health status and (mis)classification of their child's actual weight with future weight change. We present cross-sectional and longitudinal analyses from the Peruvian younger cohort of the Young Lives Study. For cross-sectional analysis, the exposure was maternal perception of child health status (better, same or worse); the outcome was underestimation or overestimation of the child's actual weight. Mothers were asked about their perception of their child's weight (same, lighter or heavier than other children). Actual weight status was defined with IOTF BMI cut-off points. For longitudinal analysis, the exposure was (mis)classification of the child's actual weight; the outcome was the standardized mean difference between follow-up and baseline BMI. A Generalized Linear Model with Poisson family and log-link was used to report the prevalence ratio (PR) and 95% confidence intervals (95% CI) for cross-sectional analyses. A Linear Regression Model was used to report the longitudinal analysis as coefficient estimates (β) and 95% CI. Normal weight children who were perceived as more healthy than other children were more likely to have their weight overestimated (PR = 2.06); conversely, those who were perceived as less healthy than other children were more likely to have their weight underestimated (PR = 2.17). Mean follow-up time was 2.6 (SD: 0.3) years. Overall, underweight children whose weight was overestimated were more likely to gain BMI (β = 0.44); whilst overweight children whose weight was considered to be the same of their peers (β = -0.55), and those considered to be lighter than other children (β = -0.87), lost BMI. Maternal perception of the child's health status seems to influence both overestimation and underestimation of the child's actual weight status. Such weight (mis)perception may influence future BMI.

A large-scale analysis of sex differences in facial expressions.

There exists a stereotype that women are more expressive than men; however, research has almost exclusively focused on a single facial behavior, smiling. A large-scale study examines whether women are consistently more expressive than men or whether the effects are dependent on the emotion expressed. Studies of gender differences in expressivity have been somewhat restricted to data collected in lab settings or which required labor-intensive manual coding. In the present study, we analyze gender differences in facial behaviors as over 2,000 viewers watch a set of video advertisements in their home environments. The facial responses were recorded using participants' own webcams. Using a new automated facial coding technology we coded facial activity. We find that women are not universally more expressive across all facial actions. Nor are they more expressive in all positive valence actions and less expressive in all negative valence actions. It appears that generally women express actions more frequently than men, and in particular express more positive valence actions. However, expressiveness is not greater in women for all negative valence actions and is dependent on the discrete emotional state.

Validation of enhanced kinect sensor based motion capturing for gait assessment.

Optical motion capturing systems are expensive and require substantial dedicated space to be set up. On the other hand, they provide unsurpassed accuracy and reliability. In many situations however flexibility is required and the motion capturing system can only temporarily be placed. The Microsoft Kinect v2 sensor is comparatively cheap and with respect to gait analysis promising results have been published. We here present a motion capturing system that is easy to set up, flexible with respect to the sensor locations and delivers high accuracy in gait parameters comparable to a gold standard motion capturing system (VICON). Further, we demonstrate that sensor setups which track the person only from one-side are less accurate and should be replaced by two-sided setups. With respect to commonly analyzed gait parameters, especially step width, our system shows higher agreement with the VICON system than previous reports.

Prevalence of varicocoele and its association with body mass index among 39,559 rural men in eastern China: a population-based cross-sectional study.

Varicocoele is a common cause of male infertility. We undertook a population-based cross-sectional study to evaluate the prevalence of varicocoele among rural men in eastern China and its association with body mass index. A total of 39,559 rural men in six counties in Beijing, Guangdong and Shandong provinces were recruited from 2011 to 2012. The presence and severity of varicocoele were measured by physical examinations. Univariate and multivariate logistic regression models were constructed to assess the association between varicocoele and body mass index after adjusting for possible confounders. Varicocoele was diagnosed in 1911 of 39,559 participants with an overall prevalence of 4.83%. The prevalence of varicocoele was highest in underweight (6.29%) and lowest in obese patients (3.71%, p < 0.05). The prevalence also decreased as body mass index increased in all three varicocoele grades. In multivariate logistic regression analysis after adjusting for region, age, height, occupation, cigarette smoking and alcohol consumption, body mass index was still inversely and independently associated with varicocoele (p < 0.001). Compared with normal weight men, underweight men (OR = 1.34; 95% CI, 1.10-1.63) were more likely to have varicocoele, whereas overweight men (OR = 0.88; 95% CI, 0.79-0.99) and obese men (OR = 0.75; 95% CI, 0.58-0.97) were less likely to have varicocoele. This study revealed that the prevalence of varicocoele was 4.83% among rural men in eastern China; body mass index was inversely and independently associated with the presence of varicocoele. Future efforts should be made to validate the risk factors for varicocoele and strengthen the prevention and treatment of varicocoele, especially in underweight men.

Severe Asymptomatic Hypertension: Evaluation and Treatment.

Hypertension affects one-third of Americans and is a significant modifiable risk factor for cardiovascular disease, stroke, renal disease, and death. Severe asymptomatic hypertension is defined as severely elevated blood pressure (180 mm Hg or more systolic, or 110 mm Hg or more diastolic) without symptoms of acute target organ injury. The short-term risks of acute target organ injury and major adverse cardiovascular events are low in this population, whereas hypertensive emergencies manifest as acute target organ injury requiring immediate hospitalization. Individuals with severe asymptomatic hypertension often have preexisting poorly controlled hypertension and usually can be managed in the outpatient setting. Immediate diagnostic testing rarely alters short-term management, and blood pressure control is best achieved with initiation or adjustment of antihypertensive therapy. Aggressive lowering of blood pressure should be avoided, and the use of parenteral medications is not indicated. Current recommendations are to gradually reduce blood pressure over several days to weeks. Patients with escalating blood pressure, manifestation of acute target organ injury, or lack of compliance with treatment should be considered for hospital admission.

Premature Ventricular Contraction Coupling Interval Variability Destabilizes Cardiac Neuronal and Electrophysiological Control: Insights From Simultaneous Cardioneural Mapping.

Variability in premature ventricular contraction (PVC) coupling interval (CI) increases the risk of cardiomyopathy and sudden death. The autonomic nervous system regulates cardiac electrical and mechanical indices, and its dysregulation plays an important role in cardiac disease pathogenesis. The impact of PVCs on the intrinsic cardiac nervous system, a neural network on the heart, remains unknown. The objective was to determine the effect of PVCs and CI on intrinsic cardiac nervous system function in generating cardiac neuronal and electric instability using a novel cardioneural mapping approach.

Azithromycin Causes a Novel Proarrhythmic Syndrome.

The widely used macrolide antibiotic azithromycin increases risk of cardiovascular and sudden cardiac death, although the underlying mechanisms are unclear. Case reports, including the one we document here, demonstrate that azithromycin can cause rapid, polymorphic ventricular tachycardia in the absence of QT prolongation, indicating a novel proarrhythmic syndrome. We investigated the electrophysiological effects of azithromycin in vivo and in vitro using mice, cardiomyocytes, and human ion channels heterologously expressed in human embryonic kidney (HEK 293) and Chinese hamster ovary (CHO) cells.

Association of Preference-Based Health-Related Quality of Life with Weight Loss in Obese Adults.

The obesity epidemic is linked to substantial health care resource use, reduction in workforce and home productivity, and poor health-related quality of life (HRQOL). Changes in body mass index (BMI) are associated with improvements in HRQOL; the nature of this relationship, however, has not been reliably described.

Cost-Effectiveness Analysis of a Skin Awareness Intervention for Early Detection of Skin Cancer Targeting Men Older Than 50 Years.

To assess the cost-effectiveness of an educational intervention encouraging self-skin examinations for early detection of skin cancers among men older than 50 years.

Association between length of residence and overweight among adult immigrants in Portugal: A nationwide cross-sectional study.

Despite the importance of immigrant population in Portugal few studies have analyzed the patterns of overweight/obesity in this subpopulation. The aims of this study are: (i) describe and compare the prevalence of overweight between immigrants and natives in Portugal; (ii) analyze the association between length of residence and overweight among adult immigrants in Portugal.

The association between self-rated health and different anthropometric and body composition measures in the Chinese population.

To analyze the strength of association between self-rated health and six anthropometric and body composition measures to explore the best indicator.

Ethnic differences in association of high body mass index with early onset of Type 1 diabetes - Arab ethnicity as case study.

The "accelerator hypothesis" predicts early onset of Type 1 diabetes (T1D) in heavier children. Studies testing direction of correlation between body mass index (BMI) and age at onset of T1D in different continental populations have reported differing results-inverse, direct, and neutral. Evaluating the correlation in diverse ethnic populations is required to generalize the accelerator hypothesis.

Event-related potentials to changes in facial expression in two-phase transitions.

The purpose of the study was to compare event-related potentials (ERPs) to different transitions between emotional and neutral facial expressions. The stimuli contained a single transition between two different images of the same face, giving a strong impression of changing expression though apparent motion whilst eliminating change in irrelevant stimulus variables such as image contrast or identity. Stimuli were calibrated for intensity, valence and perceived emotion category and only trials where the target emotion was correctly identified were included. In the first experiment, a magnification change (zoom) was a control condition. Transitions from neutral to angry expressions produced a more negative N1 with longer peak latency, and more positive P2 than did an increase in magnification. Critically, response to neutral following angry, relative to neutral following magnified, showed a generally more negative ERP with a delayed N1 peak and reduced P2 amplitude. In the second experiment, comparison of neutral-happy and neutral-frightened transitions showed significantly different ERPs to emotional expression change. Responses to the reversed direction of a transition (happy-neutral and frightened-neutral) were much reduced. Unlike the comparison of angry-neutral with magnified-neutral, there were minimal differences in the responses to neutral following happy and neutral following frightened. The results demonstrate in a young adult sample the directionality of responses to facial expression dynamics, and suggest a separation of neural mechanisms for detecting expression changes and magnification changes.

Mechanisms, Pathophysiology, and Management of Obesity.

Mechanisms, Pathophysiology, and Management of Obesity.

Interpreting Incidentally Identified Variants in Genes Associated With Catecholaminergic Polymorphic Ventricular Tachycardia in a Large Cohort of Clinical Whole-Exome Genetic Test Referrals.

The rapid expansion of genetic testing has led to increased utilization of clinical whole-exome sequencing (WES). Clinicians and genetic researchers are being faced with assessing risk of disease vulnerability from incidentally identified genetic variants which is typified by variants found in genes associated with sudden death-predisposing catecholaminergic polymorphic ventricular tachycardia (CPVT). We sought to determine whether incidentally identified variants in genes associated with CPVT from WES clinical testing represent disease-associated biomarkers.

Obesity is positively associated with arachidonic acid-derived 5- and 11-hydroxyeicosatetraenoic acid (HETE).

Oxylipids are oxygenated polyunsaturated fatty acid (PUFA) metabolites that are responsible for the onset and resolution of the inflammatory response. Enzymatic oxygenation through the lipoxygenase (LOX) or cytochrome P450 (CYP) pathways can form oxylipids that have either proinflammatory or proresolving functions depending on the type of PUFA substrate and degree of metabolism. The objective of this study was to determine how PUFA substrates and their corresponding oxylipids are associated with obesity.

Knocking down amygdalar PTP1B in diet-induced obese rats improves insulin signaling/action, decreases adiposity and may alter anxiety behavior.

Protein tyrosine phosphatase 1B (PTP1B) has been extensively implicated in the regulation of body weight, food intake, and energy expenditure. The role of PTP1B appears to be cell and brain region dependent.

Persistent weight loss with a non-invasive novel medical device to change eating behaviour in obese individuals with high-risk cardiovascular risk profile.

In evidence-based weight-loss programs weight regain is common after an initial weight reduction. Eating slowly significantly lowers meal energy intake and hunger ratings. Despite this knowledge, obese individuals do not implement this behaviour. We, thus tested the hypothesis of changing eating behaviour with an intra-oral medical device leading to constant weight reduction in overweight and obesity. Six obese patients (6 men, age 56 ± 14, BMI 29 ± 2 kg / m2) with increased CVRF profile were included in this prospective study. All patients had been treated for obesity during the last 10 years in a single centre and had at least 3 frustrate evidence-based diets. Patients received a novel non-invasive intra-oral medical device to slow eating time. Further advice included not to count calories, to avoid any other form of diet, to take their time with their meals, and to eat whatever they liked. This device was used only during meals for the first 4 to 8 weeks for a total of 88 [20-160] hours. Follow-up period was 23 [15-38] months. During this period, patients lost 11% [5-20%] (p<0.001) of their initial weight. At 12 months, all patients had lost >5%, and 67% (4/6) achieved a >10% bodyweight loss. In the course of the study, altered eating patterns were observed. There were no complications with the medical device. Of note, all patients continued to lose weight after the initial intervention period (p<0.001) and none of them had weight regain. With this medical device, overweight and obese patients with a history of previously frustrating attempts to lose weight achieved a significant and sustained weight loss over two years. These results warrant the ongoing prospective randomised controlled trial to prove concept and mechanism of action.

Visceral adipose tissue but not subcutaneous adipose tissue is associated with urine and serum metabolites.

Obesity is a complex multifactorial phenotype that influences several metabolic pathways. Yet, few studies have examined the relations of different body fat compartments to urinary and serum metabolites. Anthropometric phenotypes (visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), the ratio between VAT and SAT (VSR), body mass index (BMI), waist circumference (WC)) and urinary and serum metabolite concentrations measured by nuclear magnetic resonance spectroscopy were measured in a population-based sample of 228 healthy adults. Multivariable linear and logistic regression models, corrected for multiple testing using the false discovery rate, were used to associate anthropometric phenotypes with metabolites. We adjusted for potential confounding variables: age, sex, smoking, physical activity, menopausal status, estimated glomerular filtration rate (eGFR), urinary glucose, and fasting status. In a fully adjusted logistic regression model dichotomized for the absence or presence of quantifiable metabolite amounts, VAT, BMI and WC were inversely related to urinary choline (ß = -0.18, p = 2.73*10-3), glycolic acid (ß = -0.20, 0.02), and guanidinoacetic acid (ß = -0.12, p = 0.04), and positively related to ethanolamine (ß = 0.18, p = 0.02) and dimethylamine (ß = 0.32, p = 0.02). BMI and WC were additionally inversely related to urinary glutamine and lactic acid. Moreover, WC was inversely associated with the detection of serine. VAT, but none of the other anthropometric parameters, was related to serum essential amino acids, such as valine, isoleucine, and phenylalanine among men. Compared to other adiposity measures, VAT demonstrated the strongest and most significant relations to urinary and serum metabolites. The distinct relations of VAT, SAT, VSR, BMI, and WC to metabolites emphasize the importance of accurately differentiating between body fat compartments when evaluating the potential role of metabolic regulation in the development of obesity-related diseases, such as insulin resistance, type 2 diabetes, and cardiovascular disease.

Reference values of brachial-ankle pulse wave velocity according to age and blood pressure in a central Asia population.

Brachial-ankle pulse wave velocity (baPWV), a direct measure of aortic stiffness, has increasingly become an important assessment for cardiovascular risk. The present study established the reference and normal values of baPWV in a Central Asia population in Xinjiang, China.

The effects of body mass index on spirometry tests among adults in Xi'an, China.

Obese people have higher risk of respiratory symptoms. The relationship between obesity and lung function varies with age, race, and geographical region. The objective of this study is to examine the effects of body mass index on spirometric tests among adults in Xi'an city.This is a cross-sectional study. Pulmonary function testing was conducted on participants recruited from Xi'an, China between July and August 2012. Force expiratory volume in first second (FEV1), force vital capacity (FVC), FEV1/FVC, peak expiratory flow (PEF), and forced expiratory flow at 25-75% (FEF25-75) were measured by portable Spirometer. Lung function was analyzed according to Chinese standard of general obesity.A total of 770 subjects were analyzed in this study, of whom 299 were males and 471 were females. FVC% (P = .037) decreased significantly in obese subjects than in nonobese subjects. FVC% (P = .02) declined significantly in overweight subjects than in normal subjects. For smoker, FEV1% (P = .03) and FVC% (P = .02) were lower notably in overweight subjects than in normal subjects. FEV1% (P = .0008), FVC% (P = .0004), and PEF% (P < .0001) were higher significantly in normal subjects than in underweight subjects.FVC notably decreased in obese people, not FEV1, FEV1/FVC, PEF, and FEF25-75. FEV1, FVC, and PEF were higher significantly in normal subjects than in underweight subjects. FVC is affected by BMI in diphasic change.

Mechanisms, Pathophysiology, and Management of Obesity.

Mechanisms, Pathophysiology, and Management of Obesity.

Mechanisms, Pathophysiology, and Management of Obesity.