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Traumatic brain injury (TBI) is a temporary or permanent damage to the cerebral functions caused by external force on the skull. TBI is one of the most common causes of death worldwide and has significant socioeconomic and health consequences. This article examines classification, clinical pictures and adequate emergency treatment with diagnostics, surgical therapy and prognosis.
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Lesões Encefálicas Traumáticas , Serviços Médicos de Emergência , Humanos , Lesões Encefálicas Traumáticas/terapia , Tratamento de Emergência/métodosRESUMO
INTRODUCTION: Germany is one of the few countries with a medical specialty of psychosomatic medicine and psychotherapy and many treatment resources of this kind. OBJECTIVE: This observational study describes the psychosomatic treatment programs as well as a large sample of day-hospital and inpatients in great detail using structured diagnostic interviews. METHODS: Mental disorders were diagnosed according to ICD-10 and DSM-IV by means of Mini-DIPS and SCID-II. In addition to the case records, a modified version of the CSSRI was employed to collect demographic data and service use. The PHQ-D was used to assess depression, anxiety, and somatization. RESULTS: 2,094 patients from 19 departments participated in the study after giving informed consent. The sample consisted of a high proportion of "complex patients" with high comorbidity of mental and somatic diseases, severe psychopathology, and considerable social and occupational dysfunction including more than 50 days of sick leave per year in half of the sample. The most frequent diagnoses were depression, somatoform and anxiety disorders, eating disorders, personality disorders, and somato-psychic conditions. CONCLUSIONS: Inpatient and day-hospital treatment in German university departments of psychosomatic medicine and psychotherapy is an intensive multimodal treatment for complex patients with high comorbidity and social as well as occupational dysfunction.
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Pacientes Internados , Medicina Psicossomática , Humanos , Transtornos Psicofisiológicos/epidemiologia , Transtornos Psicofisiológicos/terapia , Psicoterapia , Hospitais , Alemanha/epidemiologiaRESUMO
Quantum graphs are ideally suited to studying the spectral statistics of chaotic systems. Depending on the boundary conditions at the vertices, there are Neumann and Dirichlet graphs. The latter ones correspond to totally disassembled graphs with a spectrum being the superposition of the spectra of the individual bonds. According to the interlacing theorem, Neumann and Dirichlet eigenvalues on average alternate as a function of the wave number, with the consequence that the Neumann spectral statistics deviate from random matrix predictions. There is, e.g., a strict upper bound for the spacing of neighboring Neumann eigenvalues given by the number of bonds (in units of the mean level spacing). Here, we present analytic expressions for level spacing distribution and number variance for ensemble averaged spectra of Dirichlet graphs in dependence of the bond number, and compare them with numerical results. For a number of small Neumann graphs, numerical results for the same quantities are shown, and their deviations from random matrix predictions are discussed.
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We employ electric circuit networks to study topological states of matter in non-Hermitian systems enriched by parity-time symmetry PT and chiral symmetry anti-PT (APT). The topological structure manifests itself in the complex admittance bands which yields excellent measurability and signal to noise ratio. We analyze the impact of PT-symmetric gain and loss on localized edge and defect states in a non-Hermitian Su-Schrieffer-Heeger (SSH) circuit. We realize all three symmetry phases of the system, including the APT-symmetric regime that occurs at large gain and loss. We measure the admittance spectrum and eigenstates for arbitrary boundary conditions, which allows us to resolve not only topological edge states, but also a novel PT-symmetric Z_{2} invariant of the bulk. We discover the distinct properties of topological edge states and defect states in the phase diagram. In the regime that is not PT symmetric, the topological defect state disappears and only reemerges when APT symmetry is reached, while the topological edge states always prevail and only experience a shift in eigenvalue. Our findings unveil a future route for topological defect engineering and tuning in non-Hermitian systems of arbitrary dimension.
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In this pilot study, we explored the immune phenotype of patients with severe obesity and comorbid depressive symptoms compared to non-depressed patients with obesity and normal-weight controls. Immune cell subsets were analysed by flow cytometry and depressive symptoms assessed using the Patient Health Questionnaire (PHQ-9). Cell frequencies were correlated with depressive symptom scores and waist-to-hip ratio (WHR). Patients with obesity and comorbid depression showed significantly lower numbers of circulating cytotoxic natural killer cells, dendritic cells and CD8+ effector memory T cells, compared to normal-weight controls. Regulatory T cells and CD4+ central memory T cells were increased compared to non-depressed patients with obesity and compared to normal-weight controls, respectively. Frequencies of cytotoxic natural killer cells and CD4+ central memory T cells significantly correlated with PHQ-9 scores, but not with WHR. Reduced numbers of dendritic cells were observed in both patient groups with obesity and correlated with PHQ-9 scores and WHR. These findings provide evidence for an altered immune composition in comorbid obesity and depression, supporting a pathobiological overlap between the two disorders.
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Linfócitos T CD4-Positivos/imunologia , Linfócitos T CD8-Positivos/imunologia , Células Dendríticas/imunologia , Depressão/imunologia , Memória Imunológica , Obesidade Mórbida/imunologia , Adulto , Linfócitos T CD4-Positivos/patologia , Linfócitos T CD8-Positivos/patologia , Células Dendríticas/patologia , Depressão/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/patologia , Projetos Piloto , Inquéritos e QuestionáriosRESUMO
BACKGROUND: The number of elderly patients diagnosed with esophageal cancer rises. Current information about outcomes in elderly patients undergoing thoracoscopic Ivor Lewis esophagectomy is limited. The objective of this study was to evaluate the influence of age on short-and mid-term outcomes after thoracoscopic Ivor Lewis esophagectomy. METHODS: A retrospective review of 188 patients with esophageal cancer undergoing thoracoscopic Ivor Lewis esophagectomy between August 2014 and July 2019 was performed. Patients were divided into patients aged > 75 years (elderly group (EG), n = 37) and patients ≤ 75 years (younger group (YG), n = 151) and matched using propensity-score matching. Baseline characteristics, length of hospital stay, mortality and major postoperative complications (Clavien-Dindo ≥ grade III) were compared. RESULTS: After matching 74 patients remained (n = 37 in each group). Postoperatively, no significant differences in major and overall complications, intra-hospital and 30-day mortality, disease-free or overall survival up to 3 years after surgery were noted. The incidence of pulmonary complications (65% vs. 38%) and pneumonia (54% vs. 30%) was significantly higher and the median hospital length of stay (12 vs. 14 days) significantly longer in the EG versus YG. CONCLUSION: Thoracoscopic Ivor Lewis esophagectomies resulted in acceptable postoperative major morbidity and mortality without compromising 3-years overall and disease-free survival in elderly compared to younger patients with esophageal cancer. However, the incidence of postoperative pulmonary complications was higher in patients aged over 75 years.
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Neoplasias Esofágicas , Esofagectomia , Idoso , Intervalo Livre de Doença , Neoplasias Esofágicas/cirurgia , Humanos , Pontuação de Propensão , Estudos RetrospectivosRESUMO
In this web-based field study, we compared the diagnostic accuracy and clinical utility of 10 selected mental disorders between the ICD-11 Clinical Descriptions and Diagnostic Guidelines (CDDG) and the ICD-10 CDDG using vignettes in a sample of 928 health professionals from all WHO regions. On average, the ICD-11 CDDG displayed significantly higher diagnostic accuracy (71.9% for ICD-11, 53.2% for ICD-10), higher ease of use, better goodness of fit, higher clarity, and lower time required for diagnosis compared to the ICD-10 CDDG. The advantages of the ICD-11 CDDG were largely limited to new diagnoses in ICD-11. After limiting analyses to diagnoses existing in ICD-11 and ICD-10, the ICD-11 CDDG were only superior in ease of use. The ICD-11 CDDG were not inferior in diagnostic accuracy or clinical utility compared to the ICD-10 CDDG for any of the vignettes. Diagnostic accuracy was consistent across WHO regions and independent of participants' clinical experience. There were no differences between medical doctors and psychologists in diagnostic accuracy, but members of other health professions had greater difficulties in determining correct diagnoses based on the ICD-11 CDDG. In sum, there were no differences in diagnostic accuracy for diagnoses existing in ICD-10 and ICD-11, but the introduction of new diagnoses in ICD-11 has improved the diagnostic classification of some clinical presentations. The favourable clinical utility ratings of the ICD-11 CDDG give reason to expect a positive evaluation by health professionals in the implementation phase of ICD-11. Yet, training in ICD-11 is needed to further enhance the diagnostic accuracy.
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Pessoal de Saúde/estatística & dados numéricos , Pesquisa sobre Serviços de Saúde/estatística & dados numéricos , Classificação Internacional de Doenças/normas , Transtornos Mentais/diagnóstico , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Physical activity (PA) plays a role in the course of anorexia nervosa (AN). OBJECTIVE: To assess the association between PA, nutritional status and psychological parameters in patients with AN. METHOD: Using a wearable activity monitor, PA was assessed in 60 female AN inpatients, by step count and time spent in 4 metabolic equivalent (MET)-intensity levels: sedentary behaviour, light, moderate and vigorous PA. In addition, BMI, psychological (patient-reported outcome questionnaires) and nutritional parameters (body fat, energy and macronutrient intake) were assessed. RESULTS: The study population spent little time in vigorous PA. BMI on admission and discharge was higher when more time was spent in sedentary behaviour, and lower with more time spent in light PA. Relationships between PA and patient-reported outcomes were weak and limited to an association between vigorous PA and compulsiveness. Low fat mass was associated with more time spent in light PA, while subjects with higher step counts showed less intake of energy, carbohydrates and fat. CONCLUSION: The relationship between inadequate food intake and increased PA in patients with AN requires further investigation.
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Anorexia Nervosa/psicologia , Anorexia Nervosa/terapia , Exercício Físico , Estado Nutricional , Adolescente , Adulto , Feminino , Monitores de Aptidão Física , Humanos , Fatores de Risco , Comportamento Sedentário , Adulto JovemRESUMO
Unwanted drug interactions are responsible for a high rate of hospitalization. The rate of unwanted interactions increases with the number of drugs taken. Drug interactions occur on pharmacodynamic and pharmacokinetic levels. They can be caused by an emergency treatment and can be the cause of a necessary emergency treatment. To avoid unwanted drug interactions, electronic databases and smartphone apps could be helpful.
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Interações Medicamentosas , Medicina de Emergência , Gerenciamento de Dados , HumanosRESUMO
We propose an electric circuit array with topologically protected unidirectional voltage modes at its boundary. Instead of external bias fields or Floquet engineering, we employ negative impedance converters with current inversion (INICs) to accomplish a nonreciprocal, time-reversal symmetry-broken electronic network we call a topolectrical Chern circuit (TCC). The TCC features an admittance bulk gap fully tunable via the resistors used in the INICs, along with a chiral voltage boundary mode reminiscent of the Berry flux monopole present in the admittance band structure. The active circuit elements in the TCC can be calibrated to compensate for dissipative loss.
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BACKGROUND: During the last years healthcare personnel is more often faced with different degrees of violence and aggression while doing their jobs. However, systematic data with respect to offender profiles, reasons, frequency and types of violence in emergency medicine in Germany has not been systematically analyzed. AIM: The aim of this article is to overview the data of present German studies. RESULTS: Only a few German studies could be included. Data suggest that violence in emergency medicine is an underreported but ubiquitous, persistent problem. 90% of the participants in the surveyed rescue staff and 75% of the participants in the surveyed emergency departments had experienced occasional verbal or physical violence within the last months before survey started. Most participants felt poorly prepared to react on aggressive situations. There is a need for appropriate training in de-escalation skills and self defence. Moreover a constant presence of security services was demanded to reduce violence in emergency departments.
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Serviços Médicos de Emergência/estatística & dados numéricos , Violência , Agressão , Serviço Hospitalar de Emergência/estatística & dados numéricos , Alemanha/epidemiologia , Pessoal de Saúde , Humanos , IncidênciaRESUMO
The German Society for Psychiatry, Psychosomatics and Psychotherapy (DGPPN,) conducted a comprehensive field study (principal investigator WG) funded by the German Federal Ministry of Health in cooperation with 4 other German medical societies in the field of mental health (DGPM, DGPPR, DeGFS, DGfS) * to support WHO's development of the ICD-11 (Chapters 6 and 17). The objective of the web-based field study was to compare ICD-10 and ICD-11 (beta draft) for selected mental disorders, regarding consistency, accuracy and assessment of utility. The first study (TP1) focused on the diagnostic classification and the second (TP2) on assignment of diagnostic codes.In TP1, clinicians used either the ICD-10 Clinical Descriptions and Diagnostic Guidelines (CDDG) version or a draft version of the ICD-11 CDDG to evaluate 10 case vignettes in a randomized study implemented through the WHO GCPN **. As hypothesized, consistency was in favor of the ICD-11 (p = .02; n = 319 expert participants) though there was some variability across the different diagnostic categories. In addition, time for diagnosis was shorter (p = .01) and clinicians' judgment of utility (ease of use; goodness of fit) was better for ICD-11 (p = .047 and p < .001 respectively).TP2 focused on consistency of diagnostic code assignment for 25 short case descriptions (including explicit diagnosis and additional clinical information) using both ICD-10 and ICD-11 in a randomized web-based field study which was run on the WHO ICD-FiT *** platform. Based on 531 code assignments by120 expert clinicians, consistency for ICD-11 was significantly lower compared to ICD-10 (71 % vs. 82 %, p < .001) contrary to study hypothesis, and time required was significantly higher for ICD-11 (p < .001). Nevertheless, utility assessments were in favor of ICD-11 (p < .005).In summary, in TP1, given vignettes with more complex clinical descriptions more similar to clinical cases, ICD-11 showed advantages in the consistency of correct diagnoses among clinicians, time required to reach a diagnosis, and clinicians' ratings of clinical utility. These results provide evidence for quality improvement of the diagnostic process due to the revision of the more complete diagnostic guidelines for ICD-11. In the coding task of TP2, coding by clinicians using the ICD-10 was more consistent and faster than coding using the ICD-11. This may be a result of the greater complexity for coding use of the ICD-11 (e. g., due to 'post-coordination'), as well as greater familiarity with the ICD-10 system (which German clinicians currently use) and lack of practice with the new ICD-11 codes and tools. In spite of this, users assessed the ICD-11 system as more useful than the ICD-10, in part also because of ICD-11's more systematic and comprehensive coding tools. In addition, time needed for coding improved with practice, indicating need for intense education and training initiatives when ICD-11 is adopted and implemented into clinical practice.
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Classificação Internacional de Doenças/tendências , Internet , Transtornos Mentais/classificação , Humanos , Transtornos Mentais/diagnóstico , Transtornos Mentais/psicologia , Psiquiatria/normasRESUMO
While physical hyperactivity represents a frequent symptom of anorexia nervosa and may have a deleterious impact on the course of the disease, the underlying mechanisms are poorly understood. Since several food intake-regulatory hormones affect physical activity, the aim of the study was to investigate the association of physical activity with novel candidate hormones (kisspeptin, ghrelin, oxyntomodulin, orexin-A, FGF-21, R-spondin-1) possibly involved in patients with anorexia nervosa. Associations with psychometric parameters and body composition were also assessed. We included 38 female anorexia nervosa inpatients (body mass index, BMI, mean ± SD: 14.8 ± 1.7 kg/m2). Physical activity was evaluated using portable armband devices, body composition by bioelectrical impedance analysis. Blood withdrawal (hormones measured by ELISA) and psychometric assessment of depressiveness (PHQ-9), anxiety (GAD-7), perceived stress (PSQ-20) and disordered eating (EDI-2) were performed at the same time. Patients displayed a broad spectrum of physical activity (2479-26,047 steps/day) which showed a negative correlation with kisspeptin (r = -0.41, p = 0.01) and a positive association with ghrelin (r = 0.42, p = 0.01). The negative correlation with oxyntomodulin (r = -0.37, p = 0.03) was lost after consideration of potential confounders by regression analysis. No correlations were observed between physical activity and orexin-A, FGF-21 and R-spondin-1 (p > 0.05). Kisspeptin was positively correlated with BMI and body fat mass and negatively associated with the interpersonal distrust subscale of the EDI-2 (p < 0.01). Depressiveness, anxiety, and perceived stress did not correlate with kisspeptin or any other of the investigated hormones (p > 0.05). In conclusion, kisspeptin is inversely and ghrelin positively associated with physical activity as measured by daily step counts in anorexia nervosa patients suggesting an implication of these peptide hormones in the regulation of physical activity in anorexia nervosa.
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Anorexia Nervosa/sangue , Grelina/sangue , Hipercinese/diagnóstico , Kisspeptinas/sangue , Atividade Motora , Agitação Psicomotora/diagnóstico , Magreza/etiologia , Actigrafia , Adiposidade , Adolescente , Adulto , Amenorreia/etiologia , Anorexia Nervosa/fisiopatologia , Anorexia Nervosa/psicologia , Ansiedade/etiologia , Índice de Massa Corporal , Feminino , Alemanha , Humanos , Hipercinese/etiologia , Pessoa de Meia-Idade , Agitação Psicomotora/etiologia , Índice de Gravidade de Doença , Adulto JovemRESUMO
OBJECTIVES: There is a high degree of misallocated medical care for patients with somatoform disorders and patients with concomitant mental diseases. This complex of problems could be reduced remarkably by integrating psychosomatic departments into hospitals with maximum medical care. Admitting a few big psychosomatic specialist clinics into the calculation basis decreased the Day-Mix Index (DMI). The massive reduction of the calculated costs per day leads to a gap in funding resulting in a loss of the necessary personnel requirements - at least in university psychosomatic departments. The objective of this article is therefore to empirically verify the reference numbers of personnel resources calculated on the basis of the new German lump-sum reimbursement system in psychiatry and psychosomatics (PEPP). METHODS: The minute values of the reference numbers of Heuft (1999) are contrasted with the minute values of the PEPP reimbursement system in the years 2013 and 2014, as calculated by the Institute for Payment Systems in Hospitals (InEK). RESULTS: The minute values derived from the PEPP data show a remarkable convergence with the minute values of Heuft's reference numbers (1999). CONCLUSIONS: A pure pricing system like the PEPP reimbursement system as designed so far threatens empirically verifiable and qualified personnel requirements of psychosomatic departments. In order to ensure the necessary therapy dosage and display it in minute values according to the valid OPS procedure codes, the minimum limit of the reference numbers is mandatory to maintain the substance of psychosomatic care. Based on the present calculation, a base rate of at least 285 e has to be politically demanded. Future developments in personnel costs have to be refinanced at 100 %.
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Necessidades e Demandas de Serviços de Saúde/economia , Transtornos Mentais/economia , Transtornos Mentais/terapia , Psiquiatria/economia , Transtornos Psicofisiológicos/economia , Transtornos Psicofisiológicos/terapia , Medicina Psicossomática/economia , Psicoterapia/economia , Comorbidade , Redução de Custos/economia , Estudos Transversais , Prestação Integrada de Cuidados de Saúde , Pesquisa Empírica , Alemanha , Alocação de Recursos para a Atenção à Saúde/economia , Humanos , Transtornos Mentais/epidemiologia , Modelos Econômicos , Sistema de Pagamento Prospectivo/economia , Transtornos Psicofisiológicos/epidemiologia , Escalas de Valor Relativo , Recursos HumanosRESUMO
Links between premorbid physical activity (PA) and disease onset/course in patients with anorexia nervosa (AN) remain unclear. The aim was to assess self-reported PA as a predictor of change in percent median BMI (%mBMI) and length of hospital stay (LOS). Five PA domains were assessed via semi-structured interview in adolescents with AN at hospitalization: premorbid PA in school grades 1-6 (PA1-6); PA before AN onset (PA-pre) and after AN onset (PA-post); new, pathological motivation for PA (PA-new); and high intensity PA (PA-high). Eating disorder psychopathology was measured via the Eating Disorder Examination Questionnaire (EDE-Q), and current PA (steps/day) with accelerometry. PA1-6 was also assessed in healthy controls (HCs). Using stepwise backward regression models, predictors of %mBMI change and LOS were examined. Compared with 22 HCs (age = 14.7 ± 1.3 years, %mBMI = 102.4 ± 12.1), 25 patients with AN (age = 15.1 ± 1.7 years, %mBMI = 74.8 ± 6.0) reported significantly higher PA1-6 (median, AN = 115 [interquartile range IQR = 75;200] min vs. HC = 68 [IQR = 29;105] min; p = 0.017). PA-post was 244 ± 323% higher than PA-pre. PA1-6 was directly associated with PA-pre (p = 0.001) but not with PA-post (p = 0.179) or change in PA-pre to PA-post (p = 0.735). Lower %mBMI gain was predicted by lower baseline %mBMI (p = 0.001) and more PA-high (p = 0.004; r2 = 0.604). Longer LOS was predicted by higher PA-pre (p = 0.003, r2 = 0.368). Self-reported PA may identify a subgroup of youth with AN at risk of less weight gain and prolonged LOS during inpatient treatment for AN.
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Anorexia Nervosa , Exercício Físico , Pacientes Internados , Tempo de Internação , Autorrelato , Humanos , Anorexia Nervosa/terapia , Anorexia Nervosa/psicologia , Adolescente , Projetos Piloto , Feminino , Tempo de Internação/estatística & dados numéricos , Pacientes Internados/estatística & dados numéricos , Masculino , Resultado do Tratamento , Índice de Massa Corporal , HospitalizaçãoRESUMO
Light-matter superposition states obtained via strong coupling play a decisive role in quantum information processing, but the deleterious effects of material dissipation and environment-induced decoherence inevitably destroy coherent light-matter polaritons over time. Here, we propose the use of coherent perfect absorption under near-field driving to prepare and protect the polaritonic states of a single quantum emitter interacting with a plasmonic nanocavity at room temperature. Our scheme of quantum nanoplasmonic coherent perfect absorption leverages an inherent frequency specificity to selectively initialize the coupled system in a chosen plasmon-emitter dressed state, while the coherent, unidirectional and non-perturbing near-field energy transfer from a proximal plasmonic waveguide can in principle render the dressed state robust against dynamic dissipation under ambient conditions. Our study establishes a previously unexplored paradigm for quantum state preparation and coherence preservation in plasmonic cavity quantum electrodynamics, offering compelling prospects for elevating quantum nanophotonic technologies to ambient temperatures.
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Background/Objectives: In patients diagnosed with uncomplicated acute appendicitis (UAA), the absence of calcified deposits or stones, called appendicoliths, often leads to consideration of non-operative treatment (NOT), despite the notable treatment failure rate associated with this approach. Previous research has indirectly estimated the prevalence of appendicoliths to range between 15% and 38% retrospectively by CT scan, intraoperative palpation, and pathology report, thereby potentially missing certain concrements. Our hypothesis proposes that this reported prevalence significantly underestimates the occurrence of appendicoliths, which could explain the high failure rate of 29% of patients with appendicitis observed with NOT. Methods: In our prospective study, conducted with a cohort of 56 adult patients diagnosed with acute appendicitis (AA), we employed intraoperative extracorporeal incisions of the vermiform appendix, in addition to standard diagnostic methods. Results: Our findings revealed 50% more appendicoliths by intraoperative incision (n = 36, p < 0.001) compared to preoperative imaging (n = 24). Appendicoliths were present in 71.4% (n = 40, p < 0.001) of AA patients. Conclusions: These results suggest that conventional diagnostic procedures plausibly underestimate the actual prevalence of appendicoliths, potentially elucidating the frequent treatment failures observed in NOT approaches applied to patients with UAA.
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The orexigenic peptide ghrelin and the anorexigenic peptide nesfatin-1 are expressed by the same endocrine cell of the rat stomach, the X/A-like cell. However, data in humans are lacking, especially under conditions of obesity. We collected gastric tissue of obese patients undergoing sleeve gastrectomy and investigated the expression of nesfatin-1 and ghrelin in the gastric oxyntic mucosa by immunofluorescence. Nesfatin-1 immunoreactivity was detected in the human oxyntic mucosa in cells with an endocrine phenotype. A major portion of nesfatin-1 immunoreactive cells (78 %) co-localized with ghrelin indicating the occurrence in human X/A-like cells. In patients with very high body mass index (BMI 55-65 kg/m(2)), the number of nesfatin-1 immunoreactive cells/low-power field was significantly higher than in obese patients with lower BMI (40-50 kg/m(2), 118 ± 10 vs. 82 ± 11, p < 0.05). On the other hand, the number of ghrelin immunoreactive cells was significantly reduced in obese patients with higher compared to lower BMI (96 ± 12 vs. 204 ± 21, p < 0.01). Also the ghrelin-acylating enzyme ghrelin-O-acyltransferase decreased with increasing BMI. In conclusion, nesfatin-1 immunoreactivity is also co-localized with ghrelin in human gastric X/A-like cells giving rise to a dual role of this cell type with differential effects on stimulation and inhibition of appetite dependent on the peptide released. The expression of these two peptides is differentially regulated under obese conditions with an increase of nesfatin-1 and a decrease of ghrelin immunoreactivity with rising BMI pointing towards an adaptive change of expression that may counteract further body weight increase.
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Proteínas de Ligação ao Cálcio/metabolismo , Proteínas de Ligação a DNA/metabolismo , Mucosa Gástrica/metabolismo , Grelina/metabolismo , Proteínas do Tecido Nervoso/metabolismo , Obesidade Mórbida/metabolismo , Aciltransferases/metabolismo , Adaptação Fisiológica , Adulto , Idoso , Western Blotting , Índice de Massa Corporal , Feminino , Mucosa Gástrica/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Nucleobindinas , Obesidade Mórbida/patologia , Obesidade Mórbida/cirurgiaRESUMO
PURPOSE OF REVIEW: The recently identified myokine, irisin has raised great expectations as a potential target in the conservative treatment of obesity. This review focuses on studies exploring the effects of irisin in humans. RECENT FINDINGS: Peroxisome proliferator-activated receptor γ coactivator-1 α expression in skeletal muscles is induced by exercise followed by expression of the membrane protein fibronectin type III domain containing 5. After cleavage from fibronectin type III domain containing 5, irisin is secreted into blood increasing thermogenesis by browning of subcutaneous white/beige adipose tissue. Although clear-cut data have been reported in rodents, the thermogenic effect of irisin in humans remains controversial. The initially reported exercise-dependent increase of irisin in humans could not be confirmed in most studies. However, a robust finding in human studies is the association of irisin with BMI. SUMMARY: The discovery of irisin provides more insight into exercise-induced browning of adipose tissue, and therefore leads to a better understanding of mechanisms underlying body weight regulation and further down the road possibly may lead to treatment strategies of diseases with greatly altered body weight such as obesity or anorexia nervosa.
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Tecido Adiposo/metabolismo , Fibronectinas/sangue , Obesidade/sangue , Animais , Índice de Massa Corporal , Metabolismo Energético , Exercício Físico/fisiologia , Fatores de Crescimento de Fibroblastos/metabolismo , Homeostase , Humanos , Músculo Esquelético/metabolismo , Peptídeos Natriuréticos/metabolismo , PPAR gama/metabolismo , Termogênese/fisiologiaRESUMO
Biomass is widely identified as a promising, renewable replacement for fossil feedstocks in the production of energy, fuels, and chemicals. However, the sustainable supply of biomass is limited. Economic and ecological criteria support prioritization of biomass as a carbon source for organic chemicals; however, utilization for energy currently dominates. Therefore, to optimize the use of available biomass feedstock, biorefining development must focus on high carbon efficiencies and enabling the conversion of all biomass fractions, including lignin and fermentation-derived CO2. Additionally, novel technological platforms should allow the incorporation of nontraditional, currently underutilized carbon feedstocks (e.g. manure) into biorefining processes. To this end, funneling of waste feedstocks to a single product (e.g. methane) and subsequent conversion to chemicals is a promising approach.