Many countries have seen a two-wave pattern in reported cases of coronavirus disease-19 during the 2020 pandemic, with a first wave during spring followed by the current second wave in late summer and autumn. Empirical data show that the characteristics of the effects of the virus do vary between the two periods. Differences in age range and severity of the disease have been reported, although the comparative characteristics of the two waves still remain largely unknown. Those characteristics are compared in this study using data from two equal periods of 3 and a half months. The first period, between 15th March and 30th June, corresponding to the entire first wave, and the second, between 1st July and 15th October, corresponding to part of the second wave, still present at the time of writing this article. Two hundred and four patients were hospitalized during the first period, and 264 during the second period. Patients in the second wave were younger and the duration of hospitalization and case fatality rate were lower than those in the first wave. In the second wave, there were more children, and pregnant and post-partum women. The most frequent signs and symptoms in both waves were fever, dyspnea, pneumonia, and cough, and the most relevant comorbidities were cardiovascular diseases, type 2 diabetes mellitus, and chronic neurological diseases. Patients from the second wave more frequently presented renal and gastrointestinal symptoms, were more often treated with non-invasive mechanical ventilation and corticoids, and less often with invasive mechanical ventilation, conventional oxygen therapy and anticoagulants. Several differences in mortality risk factors were also observed. These results might help to understand the characteristics of the second wave and the behaviour and danger of SARS-CoV-2 in the Mediterranean area and in Western Europe. Further studies are needed to confirm our findings.

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Objective. The retinol-binding protein 4 (RBP4) has been linked to the insulin resistance state in obesity and type 2 diabetes in animal studies. Data in humans are controversial and their relationship with organ damage in diabetic patients is lacking. We studied the association of plasma RBP4 with organ complications in type 2 diabetic patients.Setting. Sant Joan University Hospital, Reus, Spain.Subjects. 165 nonsmoker type 2 diabetic subjects according to American Diabetes Association criteria, aged 36-79 years, without proteinuria or severely decreased glomerular filtration rates (MDRD-GFR <30 mL min )1 1.73 m )2 ), were included in the study.Main outcome measure. Plasma RBP4 concentrations were the primary outcome variable. Statistics were performed in relation to clinical and subclinical arteriosclerosis, renal function parameters and biochemical data.Results. Plasma RBP4 concentrations were positively correlated with serum creatinine levels (r = 0.322, P < 0.001) and inversely correlated with MDRD-GFR (r = )0.468, P = 0.009). Patients with moderately renal dysfunction (MDRD-GFR <60 mL min )11.73 m )2 ) had higher plasma RBP4 concentrations than those with normal to mildly decreased GFR (55.3 ± 24.6 vs. 40.8 ± 15.4, P < 0.001). Patients in the top quartile of RBP4 concentrations had an increased adjusted odds ratio for moderately renal dysfunction compared with lower quartiles (4.68; 95% CI: 1.52-14.36, P = 0.007). The presence of microalbuminuria was not associated with RBP4. Plasma RBP4 concentrations were higher in those subjects with previous clinical arteriosclerosis than in event-free subjects (48.8 ± 24.2 vs. 40.6 ± 13.9, P = 0.045). The presence of retinopathy or polyneuropathy did not differ across RBP4 quartiles.Conclusions. Plasma RBP4 concentration might be a biomarker of nephropathy and cardiovascular disease in type 2 diabetic subjects.

The aim of this study was to evaluate the impact of adipocyte fatty acid binding protein 4 (FABP4) on the lipid profile in type 2 diabetic subjects. Plasma levels of FABP4 and adiponectin and an extensive lipid profile were analyzed in 169 type 2 diabetic subjects and 105 controls. Type 2 diabetic subjects were categorized according the presence of atherogenic dyslipidemia. Univariate statistical analyses, partial correlation tests, and binary logistic regression models were applied. In type 2 diabetic subjects, FABP4 was positively correlated with plasma triglycerides (P 5 0.007), apolipoprotein C-III (apoC-III) (P 5 0.009), and all the components of triglyceride-rich lipoproteins, including VLDL triglycerides (P 5 0.002), VLDL-cholesterol (P 5 0.001), and VLDL apoB (P 5 0.001). FABP4 was inversely correlated with apoA-I (P 5 0.038), HDL-cholesterol (P 5 0.002), and HDL apoA-I (P 5 0.010) in type 2 diabetic subjects. These correlations are not significantly affected by age, gender, body mass index, adiponectin, insulin, or any pharmacological treatment. The associations are even stronger when the FABP4/adiponectin ratio is considered. None of these associations were observed in controls. High FABP4 and low adiponectin levels are independent predictors of atherogenic dyslipidemia. In conclusion, FABP4 plasma concentrations hold strong potential for development as a clinical biomarker for atherogenic dyslipidemia, independent of obesity and insulin resistance, in type 2 diabetic subjects.-Cabré, A., I. Lázaro, J. Girona, J. M. Manzanares, F. Marimón, N. Plana, M. Heras, and L. Masana. Plasma fatty acid binding protein 4 is associated with atherogenic dyslipidemia in diabetes. J. Lipid Res.

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Background: Fatty acid–binding protein 4 (FABP4) has been linked to metabolic syndrome development, diabetes, and arteriosclerosis, but the role of FABP4 in target organ damage has not been assessed. We evaluated whether plasma FABP4 is associated with renal dysfunction in type 2 diabetic patients. Methods: In 263 individuals (161 type 2 diabetic patients and 102 healthy nondiabetic controls), we analyzed the correlation between FABP4 and creatinine or glomerular filtration index (MDRD-GFR) regarding the presence or absence of microalbuminuria. Patients with severe chronic kidney disease (MDRD-GFR &lt;30 mL/min/1.73 m2) or albuminuria were not included. Results: FABP4 concentrations were higher in diabetic patients with MDRD-GFR &lt;60 mL/min/1.73 m2 (P &lt;0.001). We observed a significant, direct correlation between FABP4 and creatinine (r = 0.446, P &lt;0.001) and an inverse correlation between FABP4 and MDRD-GFR (r = −0.511, P &lt;0.001) in type 2 diabetic patients, but not in nondiabetic individuals. These correlations were sustained when only those patients without microalbuminuria were analyzed (r = 0.414, P &lt;0.001 and r = −0.510, P &lt;0.001, respectively). Type 2 diabetic patients with FABP4 in the highest tertile compared with those in the lower tertiles had increased adjusted odds ratios for moderate renal dysfunction [7.5 (95%CI 1.8–30.7), P = 0.005 and 15.3 (3.1–76.4), P = 0.001; respectively], independent of microalbuminuria. Conclusions: High FABP4 plasma concentrations are associated with high plasma creatinine and low MDRD-GFR in patients with type 2 diabetes even in the absence of microalbuminuria or clinically relevant alterations of creatinine and MDRD-GFR values. FABP4 concentrations should be taken into consideration as an early marker of kidney damage in patients with type 2 diabetes.

The aim of this study is to determine if circulating fatty acid-binding protein 4 (FABP4) plasma levels are a possible marker of metabolic risk in SLE patients. Circulating levels of adipose FABP4 are associated with adiposity, insulin resistance (IR), metabolic syndrome, diabetes and cardiovascular diseases. Patients affected by systemic lupus erythematosus (SLE) show an accelerated atherosclerosis that cannot be entirely explained by traditional cardiovascular risk factors. Sixty consecutive patients with SLE and 34 non-SLE age-matched controls were recruited for the study. Total plasma lipids and circulating FABP4 were determined. Subclinical atherosclerosis was evaluated by measuring carotid intimae-media thickness (c-IMT) by sonography, and the distribution of lipoprotein subclasses was analysed by nuclear magnetic resonance (NMR) spectroscopy. In the SLE group, FABP4 was associated with IR, atherogenic dyslipidaemia, as measured by NMR, and the presence of subclinical atherosclerosis. In multivariate analyses FABP4 was associated with increased c-IMT independent of the inflammatory state of the patient. In sum, circulating FABP4 is involved in the metabolic disturbances of SLE affecting lipid metabolism and IR, and it could be a biomarker of atherosclerosis in this population.

Computational fluid dynamics was used to simulate the flow of blood within an inferior vena cava (IVC) geometry model that was reconstructed from computed tomography images obtained from a real patient. The main novelty of the present work is that we simulated the implantation of 4 different filter models in this realistic IVC geometry. We considered different blood flow rates in the range between V =20 and V =80 cm /s, and all simulations were performed with both the Newtonian and a non-Newtonian model for the blood viscosity. We compared the hemodynamics performance of the different filter models, and we paid a special attention to the total drag force, F , exerted by the blood flow on the filter surface. This force is the sum of 2 contributions: the viscous skin friction force, which was found to be roughly proportional to the filter surface area, and the pressure force, which depended on the particular filter geometry design. The F force is relevant because it must be balanced by the total force exerted by the filter hooks/struts on the IVC wall at the attachment locations. For the highest V value investigated, the variation in F among filters was from 116 to 308 dyne. We also showed how the present results can be extrapolated to obtain good estimates of the drag forces if the blood viscosity levels change, ie, if the patient with a filter implanted is treated with anticoagulant therapy.