Obesity is a growing public health challenge across the globe. It is associated with increased morbidity and mortality. Cardiovascular disease (CVD) is the leading cause of mortality for people with obesity. Current strategies to reduce CVD are largely focused on addressing traditional risk factors such as dyslipidemia, type 2 diabetes (T2D) and hypertension. Although this approach is proven to reduce CVD, substantial residual risk remains for people with obesity. This necessitates a better understanding of the etiology of CVD in people with obesity and alternate therapeutic approaches. Reducing inflammation may be one such strategy. A wealth of animal and human data indicates that obesity is associated with adipose tissue and systemic inflammation. Inflammation is a known contributor to CVD in humans and can be successfully targeted to reduce CVD. Here we will review the etiology and pathogenesis of inflammation in obesity associated metabolic disease as well as CVD. We will review to what extent these associations are causal based on human genetic studies and pharmacological studies. The available data suggests that anti-inflammatory treatments can be used to reduce CVD, but off-target effects such as increased infection have precluded its broad therapeutic application to date. The role of anti-inflammatory therapies in improving glycaemia and metabolic parameters is less established. A number of clinical trials are currently ongoing which are evaluating anti-inflammatory agents to lower CVD. These studies will further clarify whether anti-inflammatory agents can safely reduce CVD.

Purpose: The purpose of this study was to assess the safety and efficacy of using particles only in the embolization of the hemorrhoidal arteries for the management of hemorrhoids. Subjects and Methods: This is a retrospective study for patients treated between March 2015 and December 2018. We treated 33 patients, 13 men and 20 women with a mean age of 37 years (range: 18–70 years), in which 11 patients had Grade II hemorrhoids and 22 had Grade III hemorrhoids. Technical and clinical successes together with procedural complications were assessed. Results: The technical success rate was 100%. No minor or major complications have been reported. No cases of anorectal ischemia, anal incontinence, hemorrhoidal thrombosis, or complications related to femoral arterial puncture have occurred. Follow-up was at 3 months and 12 months postembolization. Clinical success was observed in 32 patients (96.9%) with improvement by at least 2 points of the French bleeding score at 3 months postembolization. Conclusion: The use of particles alone in the embolization of hemorrhoidal arteries whether from the superior rectal artery and/or from the middle and inferior rectal arteries can offer a safe and effective treatment option.

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Mendelian randomization (MR) suggests post-prandial hyperinsulinemia (unadjusted for plasma glucose) increases body mass index (BMI) but its impact on cardiometabolic disease (CMD), a leading cause for mortality and morbidity in people with obesity is not established. Fat distribution i.e. increased centripetal and/or reduced femoro-gluteal adiposity is causally associated with and better predicts CMD than BMI. We therefore undertook bi-directional MR to assess the effect of corrected insulin response (CIR, insulin 30 minutes after a glucose challenge adjusted for plasma glucose) on BMI, waist-to-hip ratio (WHR), leg fat, type 2 diabetes (T2D), triglyceride (TG), high-density lipoprotein (HDL), liver fat, hypertension and CAD in people of European descent. Inverse variance weighted MR suggests a potential causal association between increased CIR and increased BMI (b= 0.048±0.02, p=0.03), increased leg fat (b=0.029±0.012, p=0.01), reduced T2D (b=-0.73±0.15, p=6×10-7, OR 0.48 (0.36-0.64), reduced TG (b=-0.07±0.02, p=0.003) and increased HDL (b=0.04±0.01, p=0.006) with some evidence of horizontal pleiotropy. CIR had neutral effects on WHR (b=0.009±0.02, p=0.69), liver fat (b=-0.08±0.04, p=0.06), hypertension (b=-0.001±0.004, p=0.7, odds ratio (OR) (95% confidence interval (CI)) OR 1.00 (0.99-1.01) and coronary artery disease (b=-0.002±0.002, p=0.48, OR 0.99 (0.81-1.21). T2D decreased CIR (b-0.22±0.04, p=1.3×10-7), with no evidence that BMI, TG, HDL, liver fat, hypertension and CAD modulate CIR. In conclusion, we did not find evidence that increased CIR increases CMD. It might increase BMI with favorable fat distribution, reduce T2D and improve lipids.

Background: Poor adherence in pediatric oncology leads to significant morbidity and mortality. Currently used medication reminder aids have shown little to no benefit in improving adherence. Phone applications (apps) have demonstrated improved adherence in recent studies involving the adult and pediatric patients. At this time, no pediatric oncology center is recommending a particular phone app. Objective: The objective of this study was to determine the proportion of parents of pediatric oncology patients interested in using a phone app for medication reminders and desired features. Methods: In this single-center observational trial, 45 questionnaires were completed by parents accompanying their child at a pediatric oncology center. See Supplemental Digital Content 1 (http://links.lww.com/JPHO/A327) for a copy of the questionnaire. Participants had a child on active cancer treatment and were able to read and write English. Primary outcomes included a number of parents currently using a phone app, the number of parents interested in using a phone app, main reasons for not using a phone app and desired phone app features. Results: Overall, 95.6% of parents had never used a phone app to aid in medication adherence. Over 85% of these parents were highly interested in using a phone app, but most were not aware of available phone apps to use (57.1%). Desired features included: refill notifications, tracking doses administered, personalizable medication schedule, free of charge, no advertisements, ability to input special instructions, use on multiple devices, unique alarms, tracking child’s results, and privacy protection. Conclusions: A majority of parents at an outpatient pediatric oncology clinic were interested in using a phone app to assist in medication adherence but were unaware of an available phone app. An ideal criteria list was created with 10 desired features to evaluate available phone apps that may be recommended for this population. Further studies are needed to evaluate if phone apps recommended by this tool improve adherence.

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Purpose The aim of this study was to assess the safety and effectiveness of percutaneous vulvoperineal varices sclerotherapy using 2% polidocanol foam under fluoroscopic guidance. Subjects and Methods This is a retrospective review of prospectively collected data of 70 patients treated between June 2020 and November 2021, with a mean age of 31 years (range: 24–42 years). All patients were not pregnant with residual vulvoperineal varices after embolization of their refluxing tributaries of the ovarian vein and/or internal iliac veins presenting with vulvoperineal heaviness/pain with or without lower limb varicosities. Technical and clinical successes together with procedural complications were assessed. Results The technical success rate was 100%. No minor or major complications have been reported. Follow-up was at 1 week, 2 weeks, 6 months, and 12 months post sclerotherapy. Clinical success was observed in all patients with improvement in their symptoms. Conclusion Direct fluoroscopic-guided sclerotherapy for vulvoperineal varices offers a safe and effective treatment option with the ability of visualization and embolization of the pelvic leak points to avoid recurrence.