Search Results (73)

Background/Objectives: Hyperlipidemia is a major risk factor for cardiovascular disease and atherosclerosis. Polyphenols found in polyphenol-rich extra virgin olive oil (EVOO) have been shown to possess strong antioxidant, anti-inflammatory, and cardioprotective properties. The present study aimed to assess the effects of two types of EVOO with different polyphenol content and dosages on the lipid profile of hyperlipidemic patients. Methods: In this single-blind, randomized clinical trial, 50 hyperlipidemic patients were randomized to receive either a higher-dose, lower-phenolic EVOO (414 mg/kg phenols, 20 g/day) or a lower-dose, higher-phenolic EVOO (1021 mg/kg phenols, 8 g/day), for a period of 4 weeks. These doses were selected to ensure equivalent daily polyphenol intake in both groups (~8.3 mg of total phenols/day), based on chemical analysis performed using NMR spectroscopy. The volumes used (8–20 g/day) reflect typical daily EVOO intake and were well tolerated by participants. A group of 20 healthy individuals, separated into two groups, also received the two types of EVOO, respectively, for the same duration. Primary endpoints included blood levels of total blood cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides, lipoprotein-a (Lpa), and apolipoproteins A1 and B. Measurements were performed at baseline and at the end of the 4-week intervention. Linear mixed models were performed for the data analysis. Results: The higher-phenolic, lower-dose EVOO group showed a more favorable change in total blood cholesterol (p = 0.045) compared to the lower-phenolic, higher-dose group. EVOO intake was associated with a significant increase in HDL (p < 0.001) and reduction in Lp(a) (p = 0.040) among hyperlipidemic patients in comparison to healthy individuals. Conclusions: EVOO consumption significantly improved the lipid profile of hyperlipidemic patients. Higher-phenolic EVOO at lower dosages appears to be more effective in improving the lipid profile than lower-phenolic EVOO in higher dosages. Full article

Background/Objectives: Randomized studies of patients with unprotected left main coronary artery (ULMCA) disease involve highly selected populations. Therefore, we sought to investigate the 60-month event-free survival of consecutive patients undergoing ULMCA percutaneous coronary intervention (PCI) and determine the best risk score system and independent predictors of event-free survival. Methods: All patients who underwent ULMCA PCI at our center between 1 January 2007 and 31 December 2014 were included. The primary endpoint was the time to cardiac death, target lesion myocardial infarction, or target lesion revascularization (whichever came first) with a follow-up of 60 months. Results: A total of 513 patients (mean age 68 ± 12 years, 64% male, 157 elective, 356 acute) underwent ULMCA PCI. The 60-month incidence of events was 16.8% and 38.0% in elective and acute patients, respectively. There were significantly more events in the acute group during the first 6.5 months. Of the risk scores, the ACEF (AUC = 0.786) and SYNTAX II (AUC = 0.716) scores had the best predictive power in elective and acute patients, respectively. The SYNTAX score proved to be the least predictive in both groups (AUC = 0.638 and 0.614 in the elective and acute groups, respectively). Left ventricular function (hazard ratio (HR) for +10% 0.53 [95% CI, 0.38–0.75] and 0.81 [95% CI, 0.71–0.92] in elective and acute patients, respectively) and, in acute patients, access site (femoral vs. radial HR 1.76 [95% CI, 1.11–2.80]), hyperlipidemia (HR 0.58 [95% CI, 0.39–0.86]), and renal function (HR for +10 mL/min/1.73 m² higher GFR: 0.87 [95% CI, 0.78–0.97]) were independent predictors of event-free survival. Conclusions: Acute ULMCA PCI patients have worse prognosis than elective patients, having more events during the first 6.5 months. Besides anatomical complexity, clinical and procedural parameters determine the prognosis. Full article

Postprandial dysmetabolism, which refers to the impaired regulation of glucose and lipid levels after meals, is recognized as an independent risk factor for cardiovascular diseases (CVDs). Diets rich in polyphenols have demonstrated potential in improving postprandial hyperglycemia and hyperlipidemia. This study investigates the effects of olive leaf polyphenols on postprandial metabolic outcomes following a high-fat and high-carbohydrate meal. A total of 36 healthy adults participated in a three-arm randomized crossover trial. They ingested either a biscuit made from olive leaf powder (OLB), olive leaf tea (OLT), or a placebo meal (CTRL) to assess the impact of olive leaf polyphenols on postprandial glycemia, lipid levels, platelet aggregation factor (PAF), and plasma antioxidant status (TAC). Although no statistically significant differences were observed in the primary biomarkers, including glucose and lipid profiles, a delayed insulin response was noted in the interventions involving olive leaf. These findings suggest that while acute olive leaf supplementation did not significantly alter postprandial glycemia or lipidemia, it may subtly influence insulin kinetics. Further research is needed to explore the long-term effects of olive leaf polyphenols on metabolic health, especially in populations at risk for CVDs. Full article

Background and Objectives: Bell’s palsy, characterized by acute idiopathic facial nerve paralysis, exhibits variable recovery outcomes influenced by treatment timing, modality, and patient comorbidities. This study aimed to compare the effectiveness of corticosteroid-based treatment (Ear, Nose, and Throat [ENT]), nerve blocks/physical therapy (Pain Medicine), and acupuncture/herbal medicine (Traditional Korean Medicine [KM]) and identify predictors of recovery and recurrence. This retrospective cohort study leverages South Korea’s pluralistic healthcare system, where patients choose specialties, to provide novel insights into departmental treatment outcomes. Materials and Methods: We analyzed 600 patients treated within 72 h of Bell’s palsy onset (2010–2024) at Wonkwang University Hospital, South Korea, using propensity score matching (PSM) (1:1:1) for age, sex, comorbidities, and initial House–Brackmann (HB) grade. The primary outcome was complete recovery (HB grade I) at 6 months; secondary outcomes included recovery time, recurrence, complications, and patient satisfaction. Multivariate logistic regression identified predictors. Results: The ENT group achieved the highest complete recovery rate (87.5%, phi = 0.18) versus Pain Medicine (74.0%) and KM (69.5%) (p < 0.001), with the shortest recovery time (4 weeks, Cohen’s d = 0.65 vs. KM). Synkinesis was lowest in the ENT group (6.0%). ENT treatment (OR: 1.75; 95% CI: 1.29–2.37) and early corticosteroid application (OR: 1.95; 95% CI: 1.42–2.68) predicted recovery. Hypertension (OR: 4.40), hyperlipidemia (OR: 8.20), and diabetes (OR: 1.40) increased recurrence risk. Subgroup analyses showed that ENT treatment was most effective for severe cases (HB grade IV: 90% recovery vs. 65% in KM, p < 0.01). Conclusions: Corticosteroid-based treatment (ENT) yielded superior recovery outcomes. Comorbidity management is critical for recurrence prevention. Early ENT referral and integrated care models are recommended to optimize outcomes in diverse healthcare settings. Full article

Background/Objectives: Gypenosides (Gps) are the main active compounds of Gynostemma and show promise in managing diabetes; nevertheless, the mechanism by which Gps exert anti-diabetic effects is still not fully understood. The aim of this study is to clarify the molecular mechanisms of Gps in ameliorating glucose dysregulation. Methods: Qualitative and quantitative analyses on the chemical components of Gps were performed, respectively. Type 2 diabetes mellitus mouse models were established, and the mice were subsequently treated with Gps at doses of 200, 100, or 50 mg/kg for 4 weeks. Biochemical markers were measured. Histopathological assessments of hepatic and colonic tissues were conducted. The compositions of the intestinal microbiota, short-chain fatty acids (SCFAs), and bile acids (BAs) in fecal samples were analyzed. Western blotting was applied to examine the activation of relevant signaling pathways. Results: Gps have potent regulatory effects on metabolic homeostasis by improving glucose and lipid profiles and alleviating hepatic tissue damage. Treatment with Gps significantly reduced serum levels of lipopolysaccharides and key pro-inflammatory cytokines (interleukin-6 and tumor necrosis factor-α). Moreover, Gps enhanced the integrity of the gut barrier by upregulating the level of tight junction proteins (ZO-1 and occludin). Microbiota profiling revealed that Gps markedly increased microbial diversity and richness, decreased the ratio of Firmicutes/Bacteroidetes, and elevated Bacteroidia abundance from the phylum to the genus level. Targeted metabolomics further demonstrated that Gps modulated gut microbial metabolites by promoting SCFA production and reshaping BA profiles. Specifically, Gps elevated the primary-to-secondary BA ratio while reducing the 12α-hydroxylated to non-12α-hydroxylated BA ratio. Mechanistically, Western blotting demonstrated that Gps triggered the hepatic PI3K/AKT pathway and the intestinal BA/FXR/FGF15 axis, suggesting the coordinated regulation of metabolic and gut–liver axis signaling pathways. Conclusions: Gps significantly ameliorate hyperglycemia and hyperlipidemia through a multifaceted mechanism involving gut microbiota modulation, the restoration of intestinal barrier function, and the regulation of microbial metabolites such as SCFAs and BAs. These findings offer novel insights into their mechanism of action via the gut–liver axis. Full article

Background: Neurosurgical interventions are often indicated for patients with subcortical, supratentorial intracerebral hemorrhage (ICH); however, the optimal treatment modality is controversial. Whether minimally invasive surgery (MIS) may be superior to conventional craniotomy (CC) or decompressive craniectomy (DC) in real-world clinical practice is unknown. Methods: This was a retrospective cohort study of hospitalization data from the 2016–22 Nationwide Readmissions Database. International Classification of Diseases—10th edition (ICD-10) codes were used to identify patients with primary supratentorial subcortical ICH who underwent neurosurgical treatment. Patients with ICH in other brain compartments (other than intraventricular hemorrhage) were excluded. Coprimary outcomes were routine discharge to home without rehabilitation needs (excellent outcome) and in-hospital mortality. Outcomes were compared between MIS versus CC and MIS versus DC, with multivariable adjustments for patient demographics and comorbidities. Results: A total of 3829 patients were identified; 418 underwent MIS (10.9%), 2167 (56.6%) underwent CC, and 1244 (32.5%) underwent DC. Compared to CC patients, MIS patients were less likely female (p = 0.004) but otherwise had similar patient characteristics; compared to DC patients, MIS patients were older, less likely female, more likely to have mental status abnormalities, more likely to have underlying dementia, less likely to undergo external ventricular drainage, more likely to have vascular risk factors (hypertension, hyperlipidemia, diabetes), and less likely to have underlying coagulopathy (all p < 0.05). After multivariable adjustments, MIS patients had higher odds of excellent outcomes compared to CC (OR 1.99 [95%CI 1.06–3.30], p = 0.039), and similar odds compared to DC (OR 1.10 [95%CI 0.66–1.86], p = 0.73). In terms of in-hospital mortality, MIS had lower odds compared to DC (OR 0.63 [95%CI 0.41–0.96], p = 0.032) and similar odds compared to CC (OR 0.81 [95%CI 0.56–1.18], p = 0.26). Conclusions: For patients with subcortical, supratentorial ICH requiring surgical evacuation, MIS was associated with higherhigher rates of excellent outcomes compared to CC and lower rates of in-hospital mortality compared to DC. However, since key variables such as hematoma size and symptom severity were not available, residual confounding could not be excluded, and results should be interpreted cautiously. Dedicated prospective or randomized studies are needed to confirm these findings. Full article

Background/Objectives: Hyperlipidemia (HLP) encompasses a spectrum of poorly understood lipid metabolism disorders that are frequently overlooked or misdiagnosed, potentially leading to multiple complications. While the gut microbiota has been implicated in HLP pathogenesis, the causal relationships and molecular mechanisms remain elusive. This study aimed to investigate the therapeutic mechanisms of Monascus-fermented ginseng (MFG) on HLP through gut microbiota modulation and explore treatment potential via fecal microbiota transplantation (FMT). Methods: The MFG-modulated gut microbiota was transplanted into HLP mice. Systemic evaluations, including serum biochemical parameter detection, histopathological section analysis, 16S rRNA sequencing, and fecal metabolomics, were conducted to assess therapeutic efficacy and identify associated metabolic pathways. Results: FMT significantly improved lipid profiles, reduced body weight, and attenuated hepatic lipid accumulation in HLP mice. Mechanistically, it enhanced cholesterol excretion and fatty acid β-oxidation while suppressing lipogenic regulators, concurrently promoting primary-to-secondary bile acid conversion. Gut microbiota analysis revealed that the MFG intervention effectively normalized the Firmicutes/Bacteroidetes ratio and enriched beneficial microbiota. Conclusions: These findings demonstrate FMT’s therapeutic value in HLP management and provide new perspectives on utilizing fermented herbal medicines for metabolic disorders via gut microbiota reprogramming. Full article

Background and Objectives: Oral isotretinoin has revolutionized the treatment of severe acne vulgaris. Isotretinoin is associated with multiple adverse effects, one of which is dyslipidemia (DLP). Materials and Methods: This single-center prospective study recruited 498 patients who were eligible for isotretinoin for severe acne. Risk factors for hyperlipidemia and serum lipids were assessed at baseline. Patients received daily doses ranging from 0.25 to 1 mg/kg of their body weight, and their fasting serum lipids were checked regularly until they reached a cumulative dose of 120–150 mg/kg. Our primary objective is to investigate dyslipidemia incidence and predictors, while the secondary objective is to assess the impact of dose reduction on lipid panels. Results: Our sample was primarily female (n = 380, 76.3%), with a normal Body Mass Index (23.2 ± 4.0) and a mean age of 20.7 (±4.1) years. About 72.5% had a family history of acne, 17.1% a family history of dyslipidemia. Around 17.3% reported tobacco use. A total of 57 (11.4%) patients on isotretinoin developed DLP. Smoking was independently associated with a higher risk of dyslipidemia (OR 1.97, 95% CI [1.01, 3.82], p = 0.046). The mean onset of DLP was at 3.23 (±2.13) months. A total of 52 patients out of the 57 had a dose reduction of 10 mg (n = 5) or 20 mg (n = 47). A dose reduction of 50% was found to significantly improve triglyceride levels. Conclusions: More than 1 out of 10 patients on isotretinoin developed DLP. Tobacco use was significantly associated with developing DLP. Dose reduction significantly impacted a decrease in triglyceride levels. Full article

Background: Wound dehiscence is a common complication in metastatic spinal tumor surgery, but its risk factors remain unclear. Methods: This retrospective, multicenter study included patients who underwent surgical treatment for metastatic spinal tumors between 2020 and 2022. Data on patient demographics, primary tumor type, comorbidities, laboratory values, surgical details, and the use of radiation therapy, chemotherapy, and steroids were collected. Univariate and multivariate analyses were performed to identify the risk factors associated with wound dehiscence, and survival analysis was conducted based on wound dehiscence. Results: Among the 277 patients included, 32 (11.6%) experienced wound dehiscence, with an average time to onset of 37.1 ± 24.3 days. Of these patients, 11 patients with wound infections required revision surgery under general anesthesia, whereas 21 patients underwent localized revision surgery. Univariate analysis identified diabetes (p = 0.002), hyperlipidemia (p = 0.026), surgical length (p = 0.008), and preoperative chemotherapy within 30 days before surgery (p = 0.007) as significant risk factors. On multivariate analysis, independent predictors included diabetes (OR: 4.02, 95% CI: 1.66–9.72, p = 0.002), surgical length (OR: 1.25, 95% CI: 1.02–1.52, p = 0.029), and preoperative chemotherapy within 30 days (OR: 3.75, 95% CI: 1.55–9.10, p = 0.003). Preoperative and postoperative radiation therapy did not significantly influence wound dehiscence. Additionally, there was no significant association between wound dehiscence and 90-day mortality or overall survival. Conclusions: This study highlights diabetes, surgical length, and preoperative chemotherapy within 30 days as significant predictors of wound dehiscence following metastatic spinal tumor surgery. Full article

Background: The Mediterranean diet (MD) has been shown to have cardioprotective effects, as demonstrated in adults, but data on hyperlipidemic children are scanty. This study assessed the impact of MD adherence, evaluated with the updated KIDMED score, on the lipid profiles of pediatric patients affected by primary hyperlipidemias. Methods: This retrospective study included data on 157 children (mean age: 10.01 ± 3.54 years) dating from 2016 to 2020. Dietary adherence and lipid levels were assessed at baseline (T₀) and after 6 months (T₁) of dietary counseling. Adherence was categorized using the KIDMED score: ≥8 (optimal), 4–7 (improvement needed), and ≤3 (very low). Results: KIDMED scores improved for 65% of patients, with adherence classes increasing for 33.8%. Significant reductions in LDL-C and non-HDL-C (p < 0.0001) levels were associated with even a one-point score increase, beyond which no additional benefits were observed. Conclusions: MD adherence, as measured using the updated KIDMED score, significantly improved the lipid profiles of children with dyslipidemia. These findings will support the performance of early dietary interventions to reduce cardiovascular risk factors. Full article

Pancreatic lipase serves as a primary trigger for hyperlipidemia and is also a crucial target in the inhibition of hypercholesterolemia. By synthesizing anti-hypercholesterolemic drugs such as atorvastatin, which are used to treat hypercholesterolemia, there were some side effects associated with the long-term use of statins. Based on this idea, in the present study, we identified peptides that inhibited PL by virtual screening and in vitro activity assays. In addition, to delve into the underlying mechanisms, we undertook a dual investigative approach involving both molecular docking analyses and molecular dynamics simulations. The results showed that peptides RK7, KQ7, and TL9, all with molecular weights of <1000 Da and a high proportion of hydrophobic amino acids, inhibited PL well. Molecular docking and molecular dynamics showed that peptides RK7, KQ7, and TL9 bound to important amino acid residues of PL, such as Pro and Leu, through hydrogen bonding, hydrophobic interactions, salt bridges, and π-π stacking to occupy the substrate-binding site, which inhibited PL and identified them as potential PL inhibitors. In vitro tests showed that the IC₅₀ of RK7 and KQ7 on PL were 0.690 mg/mL and 0.593 mg/mL, respectively, and the inhibitory effects of RK7 and KQ7 on PL were significantly enhanced after simulated gastrointestinal digestion. Our results suggested that peptides RK7 and KQ7 from yak milk cheese can be identified as a novel class of potential PL inhibitors. Full article

Background: Chest pain is one of the most common reasons for emergency department (ED) visits. Patients presenting with inconclusive symptoms complicate the diagnostic process and add to the burden upon the ED. This study aimed to determine factors possibly influencing ED decisions on hospitalization versus discharge for patients with the diagnosis of chest pain. Methods: In the cohort study including 400 patients admitted to the emergency unit with a working diagnosis of chest pain, data on demographics, medical history, symptoms, lab results, and risk scores were collected from the medical records of patients admitted to the ED with a working diagnosis of chest pain. To reduce potential bias, the analysis was restricted to 330 patients who were referred to the ED by a primary care provider or clinic for chest pain. Results: Of 330 patients admitted to the ED, 58.5% were discharged, and 41.5% were hospitalized. Hospitalized patients were significantly older, with a median age of 70 versus 57 years for those discharged (p < 0.001). A higher proportion of hospitalizations occurred during the late-night shift. Significant predictors of hospitalization included hyperlipidemia (OR 3.246), diaphoresis (OR 8.525), dyspnea (OR 2.897), and hypertension (OR 1.959). Nursing home residents had a lower risk of hospitalization (OR 0.381). The area under the ROC curve for this model was 0.801 (95% CI: 0.753–0.848), indicating the predictive accuracy of the model in estimating the probability of admission. The HEART (history, ECG, age, risk factors, and troponin level) score was more effective than the TIMI (Thrombolysis in Myocardial Infarction) score in predicting the need for hospitalization, with an area under the curve (AUC) of 0.807 compared to 0.742 for TIMI. Conclusions: The HEART score in comparison with TIMI score proved especially valuable for quick risk assessment for hospitalization. The model that included hyperlipidemia, diaphoresis, dyspnea, and hypertension was the most predictive for the risk of hospitalization. Further research with larger populations is needed to validate these findings. Full article

Cardiovascular disease (CVD) and ischemic stroke (IS) are the primary causes of mortality worldwide. Hypercholesterolemia has been recognized as an independent risk factor for CVD and IS. Numerous clinical trials have unequivocally demonstrated that reducing levels of low-density lipoprotein cholesterol (LDL-C) significantly mitigates the risk of both cardiac and cerebral vascular events, thereby enhancing patient prognosis. Consequently, LDL-C reduction remains a pivotal therapeutic strategy for CVD and IS. However, despite intensive statin therapy, a significant proportion of high-risk hypercholesterolemic patients fail to achieve sufficient reductions in LDL-C levels. In response to this challenge, an inhibitor targeting proprotein convertase subtilisin-kexin type 9 (PCSK9) has been developed as a therapeutic intervention for hyperlipidemia. Numerous randomized controlled trials (RCTs) have conclusively demonstrated that the combination of PCSK9 inhibitors and statins significantly enhances prognosis not only in patients with CVD, but also in those afflicted with symptomatic intracranial artery stenosis (sICAS). PCSK9 inhibitors significantly reduce LDL-C levels by binding to the PCSK9 molecule and preventing its interaction with LDLRs. This prevents degradation of the receptor and increases uptake of LDL-C, thereby decreasing its concentration in blood. Besides significantly reducing LDL-C levels, PCSK9 inhibitors also demonstrate anti-inflammatory and anti-atherosclerotic properties while promoting plaque stabilization and inhibiting platelet aggregation and thrombosis. This article aims to provide a comprehensive review based on the relevant literature regarding the evolving understanding of pleiotropic effects associated with PCSK9 inhibitors, particularly focusing on their impact on the cardiovascular system and central nervous system. Full article

Background: Studies of pharmacists’ clinical programs have demonstrated improvements in controlling chronic diseases. However, significantly less data are available regarding pharmacist impact in a value-based Patient-Centered Medical Home (PCMH). The present study assessed a population health initiative to incorporate pharmacists for the management of type 2 diabetes (T2D), hypertension, and hyperlipidemia in a PCMH. Methods: This was a single-center retrospective cohort study of patients with T2D and baseline glycated hemoglobin (HbA1c) greater than 9%. Patients were excluded if they received care from an endocrinology provider or were lost to follow-up during the observation window of 1 January 2023 through 31 July 2023. Patients were analyzed in two cohorts: (1) patients who received any outpatient care from a clinical pharmacist (pharmacist cohort) and (2) patients who did not receive any outpatient care from a clinical pharmacist (usual care cohort). The primary outcome was the proportion of patients achieving an HbA1c of less than 8%. Secondary outcomes included blood pressure control and receipt of guideline-directed statin therapy. Results: Ninety-one patients were identified, twenty-nine in the pharmacist cohort and sixty-two in the usual care cohort. The overall population was older (mean age ~66 years), 59% female, and racially diverse (<50% Caucasian). HbA1c less than 8% was achieved in 34% of patients in the pharmacist cohort and 29% of patients in the usual care cohort (p = 0.001). A blood pressure goal of less than 140/90 mmHg was achieved more frequently in the pharmacist cohort (90% vs. 61%, p = 0.006), but guideline-directed statin therapy was similar between groups (90% vs. 79%, p = 0.215). Conclusions: Pharmacists can play an integral role within a PCMH to improve value-based measures for HbA1c and blood pressure control. Further research is needed to assess the impact of pharmacist care on statin use and economic outcomes. Full article

In the parent, gestational diabetes mellitus (GDM) causes both hyperglycemia and hyperlipidemia. Despite excess lipid availability, infants exposed to GDM are at risk for essential long-chain polyunsaturated fatty acid (LCPUFA) deficiency. Isotope studies have confirmed less LCPUFA transfer from the parent to the fetus, but how diabetic fuels impact placental fatty acid (FA) uptake and lipid droplet partitioning is not well-understood. We evaluated the effects of high glucose conditions, high lipid conditions, and their combination on trophoblast growth, viability, mitochondrial bioenergetics, BODIPY-labeled fatty acid (FA) uptake, and lipid droplet dynamics. The addition of four carbons or one double bond to FA acyl chains dramatically affected the uptake in both BeWo and primary isolated cytotrophoblasts (CTBs). The uptake was further impacted by media exposure. The combination-exposed trophoblasts had more mitochondrial protein (p = 0.01), but impaired maximal and spare respiratory capacities (p < 0.001 and p < 0.0001), as well as lower viability (p = 0.004), due to apoptosis. The combination-exposed trophoblasts had unimpaired uptake of BODIPY C12 but had significantly less whole-cell and lipid droplet uptake of BODIPY C16, with an altered lipid droplet count, area, and subcellular localization, whereas these differences were not seen with individual high glucose or lipid exposure. These findings bring us closer to understanding how GDM perturbs active FA transport to increase the risk of adverse outcomes from placental and neonatal lipid accumulation alongside LCPUFA deficiency. Full article