Weight gain decreases elevated plasma ghrelin concentrations of patients with anorexia nervosa.

OBJECTIVE: Ghrelin is a new gastric hormone that has been identified as an endogenous ligand for the growth hormone (GH) secretagogue receptor subtype 1a (GHS-R1a). Ghrelin administration however not only stimulates GH secretion but also induces adiposity in rodents by increasing food intake and decreasing fat utilization. We hypothesized that impaired ghrelin secretion in anorexia nervosa may be involved in the pathogenesis of this eating disorder. To examine this hypothesis and to further investigate the role for ghrelin in regulating energy homeostasis, we analyzed circulating ghrelin levels in patients with anorexia nervosa and examined possible correlations with clinical parameters before and after weight gain. METHODS: Plasma ghrelin levels were measured in overnight fasting plasma samples from 36 female patients with anorexia nervosa (age: 25.0+/-1.2 years, BMI: 15.2+/-0.2 kg/m(2)) before and after weight gain following psychotherapeutic treatment intervention in a psychosomatic institution. Plasma ghrelin levels were also measured in fasting plasma samples from 24 age-matched female controls (31+/-1.4 years, BMI: 22.9+/-0.45 kg/m(2)). For quantification of ghrelin levels a commercially available radioimmunoassay (Phoenix Pharmaceuticals, USA) was used. RESULTS: Fasting plasma ghrelin levels in anorectic patients were significantly higher (1057+/-95 pg/ml) than in normal age-matched female controls (514+/-63 pg/ml n=24, P=0.02). Therapeutic intervention in a psychosomatic institution caused an BMI increase of 14% (P<0.001) leading to a significant decrease in circulating ghrelin levels of 25%, (P=0.001). A significant negative correlation between Deltaghrelin and DeltaBMI was observed (correlation coefficient: -0.47, P=0.005, n=36). CONCLUSION: We show for the first time that fasting plasma levels of the novel appetite-modulating hormone ghrelin are elevated in anorexia nervosa and return to normal levels after partial weight recovery. These observations suggest the possible existence of ghrelin resistance in cachectic states such as caused by eating disorders. Future studies are necessary to investigate putative mechanisms of ghrelin resistance such as a possible impairment of intracellular ghrelin receptor signaling in pathophysiological states presenting with cachexia.

Comparison of American medical dictionaries.

Although American medical dictionaries are a valuable part of any medical library collection, the attributes of each of the four major dictionaries are often unknown and the reference material contained in each unused. The medical librarian should be aware of the differences and values of each dictionary and try to have at least one edition of each available to library users in order to maintain an adequate reference collection.

Determination of continuing medical education needs of clinicians from a literature search study, Part I. The study.

Continuing medical education is an area of current concern to health sciences librarians. A comprehensive study of literature searches requested by physicians and by fourth-year medical students serving their five-week preceptorship with a rural physician was conducted: (1) to determine if there is any pattern to the requests received so that areas of study for continuing medical education can be ascertained; and (2) to determine whether there is any appreciable difference in nature and complexity between those searches requested by clinicians and those requested by medical student preceptees. Literature search requests were examined in terms of individual MeSH subjects, subcategories, and categories for each subject covered in every search. This analysis has demonstrated that assessing the clinical problems of practicing physicians may be one method of determining needed continuing medical education topics.

Determination of continuing medical education needs of clinicians from a literature search study. Part II. Questionnaire results.

Part II of this study of the needs of clinicians for continuing medical education (CME) examines the results of a questionnaire sent of Oklahoma physicians to determine if they would request formal CME courses in the same subject areas in which they had previously requested in formation from librarians. The degree of correlation between literature search requests and responses to the questionnaire confirms that the analysis of library information requests may be one approach to determining CME needs.