Sources of hepatic glycogen synthesis following a milk-containing breakfast meal in healthy subjects.

During feeding, dietary galactose is a potential source of hepatic glycogen synthesis; but its contribution has not been measured to date. In the presence of deuterated water ((2)H(2)O), uridine diphosphate (UDP)-glucose derived from galactose is not enriched, whereas the remainder derived from glucose-6-phosphate (G6P) is enriched in position 2 to the same level as body water, assuming complete G6P-fructose-6-phosphate (F6P) exchange. Hence, the difference between UDP-glucose position 2 and body water enrichments reflects the contribution of galactose to glycogen synthesis relative to all other sources. In study 1, G6P-F6P exchange in 6 healthy subjects was quantified by supplementing a milk-containing breakfast meal with 10 g of [U-(2)H(7)]glucose and quantifying the depletion of position 2 enrichment in urinary menthol glucuronide. In study 2, another 6 subjects ingested (2)H(2)O and acetaminophen followed by an identical breakfast meal with 10 g of [1-(13)C]glucose to resolve direct/indirect pathways and galactose contributions to glycogen synthesis. Metabolite enrichments were determined by (2)H and (13)C nuclear magnetic resonance. In study 1, G6P-F6P exchange approached completion; therefore, the difference between position 2 and body water enrichments in study 2 (0.20% ± 0.03% vs 0.27% ± 0.03%, P < .005) was attributed to galactose glycogenesis. Dietary galactose contributed 19% ± 3% to glycogen synthesis. Of the remainder, 58% ± 5% was derived from the direct pathway and 22% ± 4% via the indirect pathway. The contribution of galactose to hepatic glycogen synthesis was resolved from that of direct and indirect pathways using a combination of (2)H(2)O and [1-(13)C]glucose tracers.

O ensino da psicoterapia de orientação sistêmico-integrativa no Instituto da Família de Porto Alegre / The teaching of systemic-integrative psychotherapy in the Instituto da Família de Porto Alegre

Neste trabalho, os autores apresentam o trabalho realizado no Instituto da Família de Porto Alegre (INFAPA). Essa é uma instituição privada que se dedica ao ensino da psicoterapia e de outras intervenções terapêuticas, além de oferecer regularmente Cursos de Formação em Terapia sistêmico-inte-grativa Familiar, Individual e de Casal, Terapias Cognitivo-Comportamentais, Arteterapia e EMDR (Rapid Eye Mouvement Desensetization). É apresentado um breve relato da história da terapia de família sistêmica, que se encontra com a história do instituto, sendo ele um dos pioneiros no País e o primeiro no estado na formação de terapeutas de família. O INFAPA ministra o Curso de Especialização em Terapia Individual, Familiar e de Casal - Abordagem sistêmico-integrativa, que se fundamenta principalmente no referencial sistêmico, em suas múltiplas abordagens: estrutural, estratégica, comunicacional, simbólico-experiencial, trigeracional, construtivista, construcionista social e narrativista. É realizada uma apresentação detalhada de como se dá a formação desses profissionais, que, além de seminários teóricos, também passam por estágios supervisionados. Dá-se especial ênfase ao trabalho realizado no preparo da pessoa do terapeuta como profissional que aprende com suas dificuldades relacionais. Por fim, os autores revelam novos projetos para o ano de 2013 e expõem o comportamento científico de seus profissionais, que são formadores de conhecimento na área em apreço.(AU)

In this article the authors sketch the work carried out at the INFAPA (Instituto da Familia de Porto Alegre - Porto Alegre Institute of the Family), a private institution dedicated to the teaching of psychotherapy and other therapeutic interventions, in addition to regularly offering courses on Systemic-Integrative Therapy for family, individual, and couple; Cognitive-Behavioral Therapy; Art-Therapy; and Eye Movement Desensitization and Reprocessing (EMDR). A brief account on the history of systemic family therapy is presented, intertwining with the history of the Institute, one of the pioneering groups in the country and the first within its state in the training of family therapists. The INFAPA provides the Specialization Course in Individual, Family and Couple Systemic-Integrative Psychotherapy, based above all on the systemic referential in its various approaches: structural, strategic, communicational, symbolic-experiential, tri-generational, constructivist, social constructionist and narrativist. The article includes a detailed presentation of this training, which comprises, in addition to theoretical seminars, supervised apprenticeships. An especial emphasis is placed on the work with the therapist's person as a professional learning from his or her relational difficulties. Finally, they reveal new projects for 2013 and expose the scientific behavior of their professionals who are knowledge builders in this area.(AU)

Clinical practice in Crohn's disease in bordering regions of two countries: different medical options, distinct surgical events.

UNLABELLED: Contemplating the multifactorial nature of Crohn's disease (CD), the purpose of this study was to compare two neighbouring CD populations from different nations and examine how clinical characteristics of patients can influence therapeutic strategies and consequently different surgical events in routine clinical practice. Cross-sectional study based on data of an on-line registry of patients with CD in northern Portugal and Galicia. Of the 1238 patients, all with five or more years of disease, 568 (46%) were male and 670 (54%) female. The Portuguese and Galician populations were similar regarding Montreal categories, age at diagnosis, and years of follow-up. Galician B2 patients were associated with immunosuppression (OR 3.6; CI 2.2-6.1) and biologic treatment (OR 1.8; CI 1.0-3.1). In both populations ileocolonic disease was associated with immunosuppression and biologic treatment and the penetrating group was linked to immunosuppression. In the north of Portugal 47% and 16% of patients, and in Galicia 63% and 33%, were treated with immunosuppressants and biologic treatment, respectively. In the north of Portugal 44% of patients classified as stricturing behavior were operated without immunomodulation, in contrast to 12% in Galicia. In the latter it was possible to maintain 16% of B2 patients and 40% of B3 patients without surgery with adequate immunosuppression and/or biologic treatment. The delta of surgeries in B2 patients was 8% and in B3 26%. CONCLUSIONS: Stratifying patients according to the Montreal classification identified similar clinical patterns in disparate geographic populations, and revealed that differing medical therapeutic practices may influence the occurrence of surgical events.

Simple measurement of gluconeogenesis by direct 2H NMR analysis of menthol glucuronide enrichment from 2H2O.

The contribution of gluconeogenesis to fasting glucose production was determined by a simple measurement of urinary menthol glucuronide (MG) 2H enrichment from 2H2O. Following ingestion of 2H2O (0.5% body water) during an overnight fast and a pharmacological dose (400 mg) of a commercial peppermint oil preparation the next morning, 364 micromol MG was quantitatively recovered from a 2-h urine collection by ether extraction and a 125 micromol portion was directly analyzed by 2H NMR. The glucuronide 2H-signals were fully resolved and their relative intensities matched those of the monoacetone glucose derivative. The pharmacokinetics and yields of urinary MG after ingestion of 400 mg peppermint oil as either gelatin or enteric-coated capsules 1 h before breakfast were quantified in five healthy subjects. Gelatin capsules yielded 197 +/- 81 micromol of MG from the initial 2-h urine collection while enteric-coated capsules gave 238 +/- 84 micromol MG from the 2- to 4-h urine collection.