Emma Steenbergen

OBJECTIVE: Plasma lipoprotein levels are determined by the balance between lipoprotein production and clearance. Recently, angiopoietin-like protein 4 (ANGPTL4) was uncovered as a novel endocrine factor that potently raises plasma triglyceride levels by inhibiting triglyceride clearance. However, very little is known about ANGPTL4 in human. Here we set out to identify physiological determinants of plasma ANGPTL4 levels in humans, focusing on the effect of energy restriction and plasma FFAs. METHODS AND RESULTS: We developed an ELISA for quantitative measurement of ANGPTL4 in human plasma. Using this assay we found major variations in baseline plasma ANGPTL4 levels between individuals. Within an individual, plasma ANGPTL4 levels remain stable throughout the day but increase significantly in response to long-term fasting, chronic caloric restriction, and endurance exercise. Intralipid injection as well as treatment with a beta-adrenergic agonist, both of which lead to elevated plasma FFA levels, increased plasma ANGPTL4 levels compared to control treatment. Fatty acids markedly induced ANGPTL4 gene expression in rat hepatoma FAO cells, human primary myocytes, and mouse intestinal MSIE cells. CONCLUSIONS: In conclusion, our results show that plasma ANGPTL4 levels are increased by fasting, caloric restriction, and exercise, which is likely mediated by elevated plasma FFAs.

Introduction: Physical therapy (PT) is recommended after stroke, but relationship between its dose and recovery during acute hospitalization remains unclear. This study aimed to assess whether PT volume and frequency are associated with meaningful improvement in functional mobility at hospital discharge. Review of Literature: Studies of early rehabilitation, especially in critical care settings, show that short, frequent mobilization can enhance independence in the months after stroke. While long-term effects are well documented, more research is needed on early recovery in the first one to two weeks of hospitalization, as it influences access and decisions about post-discharge rehabilitation. Subjects: Adults admitted to a stroke center over ten months, excluding those with late admissions, pre-existing functional impairments, palliative care needs, or those independent post-stoke. Methods: Retrospective analysis of medical records. The primary outcome was a ≥4 points improvement on the Functional Status Score for the Intensive Care Unit (FSS-ICU) from hospital admission to discharge, defined as a meaningful change. Multivariable logistic regressions identified factors independently associated with this improvement. Results: 331 patients were included, with a median age of 51 (44-63) years and 240 (72.5%) males. FSS-ICU improved from 19 (11-26) to 26 (17-33). 201 patients achieved a meaningful improvement in functional mobility. This group received 4 (3-7) PT sessions and 115 (71-204.5) PT minutes, while the group that did not meaningfully improve (n = 130) received 3 (2-4) PT sessions and 88 (59.5-136) PT minutes (p < 0.001 and p = 0.001, respectively). After adjusting for other variables, the number of PT sessions (p = 0.01) and PT minutes (0.037) were independently associated with meaningful improvement. Conclusion: Increased PT frequency and minutes may enhance short-term recovery in patients with stroke. These findings contribute to the limited evidence on PT provision and outcomes during acute hospitalization