RESUMO
Background: The German healthcare sector is in the process of being disrupted by digitization. Universities are asked to reflect on the consequences and develop strategies to prepare their medical students for a digitalized health care sector. The current state of research does not systematically record the associated activities of individual medical faculties in Germany. Objective: This study was designed to survey the status-quo of how German medical faculties view the digitization progress and to what extend digital capability building is already integrated into the curricula. Methods: A questionnaire with three focus areas was developed: Firstly, the general view of the medical faculties on digitization; secondly, concrete measures to prepare students for digital change and thirdly, the overarching organizational and regulatory conditions. The data was collected through short, questionnaire-based telephone interviews among those responsible for the curriculum at their faculty. The datasets collected were anonymized and statistically evaluated. Results: 30 interviews were conducted. The majority of faculty representatives agreed that digitization will change the role of physicians (87% agreement). Changes caused by individual digitization trends were however viewed to be less likely, e.g., whether medical expertise will become less important due to digital assistance systems (20% agreement), whether physician positions will be replaced by robots and algorithms (7% agreement), or whether hierarchies in hospitals will flatten (13% agreement). Digitization was seen to be of major importance for medical studies (93% agreement). Associated content should be given a higher priority in the curriculum (87% agreement). Two-thirds of faculty representatives believed that overarching institutions such as politics and medical associations ought to have more concrete plans for implementing the digital transformation and that innovations should be implemented in practice faster. Conclusion: While most faculty representatives attach great importance to the digitization of the health care system for university education, various questions about structural teaching measures to prepare students for the digital change show that there is no uniform education of medical students for a digitized health care system. We were also able to show that most faculty representatives are dissatisfied with the regulatory and organizational conditions of digitization in the medical sector.
Assuntos
Educação de Graduação em Medicina , Docentes de Medicina , Currículo , Alemanha , Setor de Assistência à Saúde , Humanos , Inquéritos e QuestionáriosRESUMO
The chemokine chemerin exists as C-terminally processed isoforms whose biological functions are mostly unknown. A highly active human chemerin variant (huChem-157) was protective in experimental hepatocellular carcinoma (HCC) models. Hepatic stellate cells (HSCs) are central mediators of hepatic fibrogenesis and carcinogenesis and express the chemerin receptors chemokine-like receptor 1 (CMKLR1) and G protein-coupled receptor 1 (GPR1). Here we aimed to analyse the effect of chemerin isoforms on the viability, proliferation and secretome of the human HSC cell line LX-2. Therefore, huChem-157, 156 and 155 were over-expressed in LX-2 cells, which have low endogenous chemerin levels. HuChem-157 produced in LX-2 cells activated CMKLR1 and GPR1, and huChem-156 modestly induced GPR1 signaling. HuChem-155 is an inactive chemerin variant. Chemerin isoforms had no effect on cell viability and proliferation. Cellular expression of the fibrotic proteins galectin-3 and alpha-smooth muscle actin was not regulated by any chemerin isoform. HuChem-156 increased IL-6, IL-8 and galectin-3 in cell media. HuChem-157 was ineffective, and accordingly, did not enhance levels of these proteins in media of primary human hepatic stellate cells when added exogenously. These analyses provide evidence that huChem-156 is the biologic active chemerin variant in hepatic stellate cells and acts as a pro-inflammatory factor.
Assuntos
Quimiocinas/metabolismo , Células Estreladas do Fígado/metabolismo , Actinas/metabolismo , Linhagem Celular , Proliferação de Células , Células Cultivadas , Quimiocinas/genética , Galectina 3/metabolismo , Humanos , Isoformas de Proteínas/genética , Isoformas de Proteínas/metabolismo , Receptores de Quimiocinas/metabolismo , Receptores Acoplados a Proteínas G/metabolismoRESUMO
Tubulin alpha 8 (TUBA8) is highly abundant in murine liver tumors suggesting a role in hepatocellular carcinoma (HCC). Non-alcoholic steatohepatitis (NASH) is a risk factor for HCC. In mice that are fed with a methionine-choline deficient diet for two weeks to induce advanced murine NASH, we do see increased hepatic levels of TUBA8 protein. In animals given a high-fat diet for 14 weeks or an atherogenic diet for 12 weeks, hepatic TUBA8 is unchanged. TUBA8 is highly expressed in human hepatic stellate cells (HSC) and co-localizes with the HSC marker desmin in the murine liver. Inflammatory (TNF, LPS, IL-6) and profibrotic mediators (TGF-beta) do not regulate TUBA8 in HepG2 cells, primary HSC and the HSC cell line LX-2, when stimulated for 24 h. Agonists of the farnesoid X receptor and peroxisome proliferator activated receptor gamma, which are nuclear receptors involved in NASH and HCC pathophysiology, have no effect on TUBA8 in HepG2 and LX-2 cells. In human HCC tissues of 18 patients TUBA8 is significantly upregulated when compared to the corresponding non-tumorous tissues. Compared to non-transformed hepatocytes, TUBA8 protein is strongly expressed in transformed cells. Thus, TUBA8 is a marker of HSC whose cell number is increased in NASH, while higher levels in HCC may be related to induction of TUBA8 in parenchymal cells.
Assuntos
Transformação Celular Neoplásica/metabolismo , Células Estreladas do Fígado/metabolismo , Neoplasias Hepáticas/metabolismo , Hepatopatia Gordurosa não Alcoólica/metabolismo , Tubulina (Proteína)/metabolismo , Idoso , Idoso de 80 Anos ou mais , Animais , Linhagem Celular Tumoral , Colina/efeitos adversos , Dieta Hiperlipídica/efeitos adversos , Modelos Animais de Doenças , Células Hep G2 , Humanos , Masculino , Metionina/efeitos adversos , Camundongos , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/induzido quimicamente , Células RAW 264.7 , Regulação para CimaRESUMO
BACKGROUND: Chemerin is associated with insulin resistance and is expressed in the liver. Nonalcoholic fatty liver disease (NAFLD) is related to impaired insulin sensitivity, but studies evaluating hepatic and serum chemerin in NAFLD resulted in discordant data. MATERIALS AND METHODS: Chemerin mRNA was determined in the liver tissue obtained from 33 controls and 76 NAFLD patients. Chemerin serum levels were measured in a different cohort of patients with ultrasound-diagnosed NAFLD and the respective controls. Hepatic stellate cells and hepatocytes were exposed to selected metabolites and nuclear receptor agonists to study the regulation of chemerin. Effect of recombinant chemerin on hepatocyte released proteins was analysed. RESULTS: Hepatic chemerin expression was not related to BMI, gender, type 2 diabetes and hypertension. Chemerin mRNA did not correlate with steatosis and was negatively associated with inflammation, fibrosis and nonalcoholic steatohepatitis (NASH) score. Patients with NASH had lower chemerin mRNA compared to those with borderline NASH and controls. Factors with a role in NASH mostly did not regulate chemerin in the liver cells. Of note, liver X receptor agonist reduced chemerin protein. Serum chemerin was not changed in NAFLD. Levels positively correlated with age, waist-to-hip ratio, systolic blood pressure, serum FGF21 and lipocalin 2, and negatively with transferrin saturation. Chemerin induced FGF21 in supernatants of primary human hepatocytes. Hepcidin, a major regulator of iron homoeostasis and lipocalin 2, were not regulated by chemerin. CONCLUSION: Chemerin mRNA is reduced in the liver of NASH patients, and liver X receptor seems to have a role herein.
Assuntos
Quimiocinas/genética , Peptídeos e Proteínas de Sinalização Intercelular/genética , Fígado/metabolismo , Hepatopatia Gordurosa não Alcoólica/genética , RNA Mensageiro/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Estudos de Casos e Controles , Linhagem Celular , Células Cultivadas , Quimiocinas/sangue , Quimiocinas/farmacologia , Comorbidade , Citocinas/metabolismo , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Fatores de Crescimento de Fibroblastos/metabolismo , Células Hep G2 , Células Estreladas do Fígado/efeitos dos fármacos , Células Estreladas do Fígado/metabolismo , Hepatócitos/efeitos dos fármacos , Hepatócitos/metabolismo , Hepcidinas/metabolismo , Humanos , Hidrocarbonetos Fluorados/farmacologia , Hipertensão/epidemiologia , Hipoglicemiantes/farmacologia , Técnicas In Vitro , Resistência à Insulina , Peptídeos e Proteínas de Sinalização Intercelular/sangue , Peptídeos e Proteínas de Sinalização Intercelular/farmacologia , Leptina/metabolismo , Lipocalina-2/metabolismo , Receptores X do Fígado/agonistas , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/sangue , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Reação em Cadeia da Polimerase em Tempo Real , Receptores Citoplasmáticos e Nucleares/agonistas , Proteínas Recombinantes/farmacologia , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Rosiglitazona , Índice de Gravidade de Doença , Sulfonamidas/farmacologia , Tiazolidinedionas/farmacologia , Relação Cintura-Quadril , Adulto JovemRESUMO
The chemokine-like receptor 1 (CMKLR1) ligands resolvin E1 and chemerin are known to modulate inflammatory response. The progression of non-alcoholic fatty liver disease (NAFLD) to non-alcoholic steatohepatitis (NASH) is associated with inflammation. Here it was analyzed whether hepatic CMKLR1 expression is related to histological features of NASH. Therefore, CMKLR1 mRNA was quantified in liver tissue of 33 patients without NAFLD, 47 patients with borderline NASH and 38 patients with NASH. Hepatic CMKLR1 mRNA was not associated with gender and body mass index (BMI) in the controls and the whole study group. CMKLR1 expression was similar in controls and in patients with borderline NASH and NASH. In male patients weak positive correlations with inflammation, fibrosis and NASH score were identified. In females CMKLR1 was not associated with features of NAFLD. Liver CMKLR1 mRNA tended to be higher in type 2 diabetes patients of both genders and in hypercholesterolemic women. In summary, this study shows that hepatic CMKLR1 mRNA is weakly associated with features of NASH in male patients only.
Assuntos
Hepatopatia Gordurosa não Alcoólica/genética , RNA Mensageiro/genética , Receptores de Quimiocinas/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Diabetes Mellitus Tipo 2/genética , Progressão da Doença , Feminino , Humanos , Fígado/metabolismo , Fígado/patologia , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Adulto JovemRESUMO
Colloid-based chemical synthesis methods of bimetallic alloy nanoparticles (NPs) provide good monodispersity, yet generally show a strong variation of the resulting mean particle size with alloy composition. This severely compromises accurate correlation between composition of alloy particles and their size-dependent properties. To address this issue, a general CO adsorption-assisted capping ligand-free solvothermal synthesis method is reported which provides homogeneous bimetallic NPs with almost perfectly constant particle size over an unusually wide compositional range. Using Pt-Ni alloy NPs as an example, we show that variation of the reaction temperature between 160 and 240 °C allows for precise control of the resulting alloy particle bulk composition between 15 and 70 atomic % Ni, coupled with a constant mean particle size of â¼4 nm. The size-confining and Ni content-controlling role of CO during the nucleation and growth processes are investigated and discussed. Data suggest that size-dependent CO surface chemisorption and reversible Ni-carbonyl formation are key factors for the achievement of a constant particle size and temperature-controlled Ni content. To demonstrate the usefulness of the independent control of size and composition, size-deconvoluted relations between composition and electrocatalytic properties are established. Refining earlier reports, we uncover intrinsic monotonic relations between catalytic activity and initial Ni content, as expected from theoretical considerations.