Impaired white adipose tissue fatty acid metabolism in mice fed a high-fat diet worsened by arsenic exposure, primarily affecting retroperitoneal adipose tissue.

Fatty acid (FA) metabolism dysfunction of white adipose tissue (WAT) underlies obesity and insulin resistance in response to high calorie intake and/or endocrine-disrupting chemicals (EDCs), among other factors. Arsenic is an EDC that has been associated with metabolic syndrome and diabetes. However, the combined effect of a high-fat diet (HFD) and arsenic exposure on WAT FA metabolism has been little studied. FA metabolism was evaluated in visceral (epididymal and retroperitoneal) and subcutaneous WAT of C57BL/6 male mice fed control or HFD (12 and 40% kcal fat, respectively) for 16 weeks together with an environmentally relevant chronic arsenic exposure through drinking water (100 µg/L) during the second half of the study. In mice fed HFD, arsenic potentiated the increase of serum markers of selective insulin resistance in WAT and fatty acid re-esterification and the decrease of the lipolysis index. Retroperitoneal was the WAT most affected, where the combination of arsenic and HFD in contrast to HFD, generated higher adipose weight, larger adipocytes, increased triglyceride content, and decreased fasting stimulated lipolysis evidenced by lower phosphorylation of HSL and perilipin. At the transcriptional level, arsenic in mice fed either diet downregulated genes involved in fatty acid uptake (LPL, CD36), oxidation (PPARα, CPT1), lipolysis (ADRß3) and glycerol transport (AQP7 and AQP9). Additionally, arsenic potentiated hyperinsulinemia induced by HFD, despite a slight increase in weight gain and food efficiency. Thus, the second hit of arsenic in sensitized mice by HFD worsens fatty acid metabolism impairment in WAT, mainly retroperitoneal, along with an exacerbated insulin resistance phenotype.

Value of pre-licensure interprofessional education on post-licensure interprofessional collaboration: Perceptions and experiences of practicing professionals.

Interprofessional education (IPE) allows students in health professional programs to practice providing collaborative patient care before graduating. Understanding the perceptions and experiences of health care professionals' IPE received prior to entering the workforce is key for improving IPE programs. This study investigated participants' post-licensure interprofessional collaboration (IPC) experiences, how IPE helped prepare them for IPC post-licensure, their perceptions of the IPE they received as students, and their suggestions for improving IPE. This qualitative descriptive study included 20 healthcare workers from seven professions who graduated from two of three co-located post-secondary educational institutions. Data were collected using semi-structured interviews, which were audiotaped and transcribed verbatim. Inductive thematic analysis revealed five themes and six sub-themes: (a) Quality of care; (b) Role clarification; (c) Interpersonal skills (sub-themes: communication and self-confidence); (d) Co-location; and (e) Need for IPE improvements (sub-themes: additional IPE exposures, shadowing experiences, mandatory IPE, and informal peer learning). These findings appear to reinforce the perception that pre-licensure IPE may support the development of skills for IPC among practicing health professionals.

Is insulin resistance tissue-dependent and substrate-specific? The role of white adipose tissue and skeletal muscle.

Insulin resistance (IR) refers to a reduction in the ability of insulin to exert its metabolic effects in organs such as adipose tissue (AT) and skeletal muscle (SM), leading to chronic diseases such as type 2 diabetes, hepatic steatosis, and cardiovascular diseases. Obesity is the main cause of IR, however not all subjects with obesity develop clinical insulin resistance, and not all clinically insulin-resistant people have obesity. Recent evidence implies that IR onset is tissue-dependent (AT or SM) and/or substrate-specific (glucometabolic or lipometabolic). Therefore, the aims of the present review are 1) to describe the glucometabolic and lipometabolic activities of insulin in AT and SM in the maintenance of whole-body metabolic homeostasis, 2) to discuss the pathophysiology of substrate-specific IR in AT and SM, and 3) to highlight novel validated tests to assess tissue and substrate-specific IR that are easy to perform in clinical practice. In AT, glucometabolic IR reduces glucose availability for glycerol and fatty acid synthesis, thus decreasing the esterification and synthesis of signaling bioactive lipids. Lipometabolic IR in AT impairs the antilipolytic effect of insulin and lipogenesis, leading to an increase in circulating FFAs and generating lipotoxicity in peripheral tissues. In SM, glucometabolic IR reduces glucose uptake, whereas lipometabolic IR impairs mitochondrial lipid oxidation, increasing oxidative stress and inflammation, all of which lead to metabolic inflexibility. Understanding tissue-dependent and substrate-specific IR is of paramount importance for early detection before clinical manifestations and for the development of more specific treatments or direct interventions to prevent chronic life-threatening diseases.

Leptin and adiponectin synthesis and secretion in mature 3T3-L1 adipocytes are differentially down-regulated by arsenic and palmitic acid exposure throughout different stages of adipogenesis.

AIMS: Arsenic is a risk factor for type 2 diabetes and cardiovascular disease. However, little is known about arsenic effects over adipocyte endocrine functionality, particularly for leptin and adiponectin, and about its interaction with dietary components, which are the main environmental regulators of adipose tissue functionality. The aim of this work was to evaluate leptin and adiponectin in mature 3T3-L1 adipocytes exposed to palmitate (simulating excess fat intake), arsenite, or both throughout two different stages of adipogenesis. MATERIAL AND METHODS: 3T3-L1 adipocytes were exposed starting from the beginning of its differentiation process during 11 d or once adipocytes were mature for 72 h. Adipokines secretion was evaluated by ELISA, intracellular protein levels and secreted adiponectin multimers by Western blot and mRNA abundance by qPCR. KEY FINDINGS: Leptin and adiponectin secretion decreased by arsenite alone or in combination with palmitate due to reduced gene and protein expression of both adipokines. However, leptin was impaired more at the transcriptional level, whereas affections to adiponectin were more relevant at the intracellular protein amount level with changes in the multimers proportion. The gene expression of several of their transcription factors was altered. Additionally, the magnitude of the effects depends on the adipocyte cell stage at which exposure began; adiponectin was more affected when exposure started from differentiation and leptin once adipocytes were mature. SIGNIFICANCE: These results in an in vivo model could be translated into less satiety and reduced insulin sensitivity.

Artificial Intelligence-Based Clinical Decision Support Systems Using Advanced Medical Imaging and Radiomics.

Artificial intelligence (AI) is poised to make a veritable impact in medicine. Clinical decision support (CDS) is an important area where AI can augment the clinician's capability to collect, understand and make inferences on an overwhelming volume of patient data to reach the optimal clinical decision. Advancements in medical image analysis, such as Radiomics, and data computation, such as machine learning, have expanded our understanding of disease processes and their management. In this article, we review the most relevant concepts of AI as applicable to advanced imaging-based clinical decision support systems.

Partnering for Patti: Shaping future healthcare teams through simulation-enhanced interprofessional education.

BACKGROUND: Simulation-enhanced interprofessional education (sim-IPE) is a growing component of undergraduate health curricula, preparing learners for the practice environment and, in doing so, redefining practice culture. The Canadian Interprofessional Health Collaborative (CIHC) has established a national competency framework of integrative competency domains focused on fostering core skills, attitudes, and values in an effort to evolve interprofessional collaboration (IPC). This framework serves as the foundational underpinning for IPE within all health professions. Partnering for Patti is a sim-IPE experience collaboratively developed by faculty from Bachelor of Nursing and Respiratory Therapy programs within two Atlantic institutions leveled for third-year nursing and respiratory therapy students. This event provides an opportunity for participants to enhance their knowledge of the six CIHC IPE domains, and improve their understanding of and appreciation for IPC. Within this context learners must work together, and rely on the expertise of both professional groups to critically think through and improve a declining client scenario. Once complete, debriefing and reflective journaling help participants solidify learning and deduce new frames of understanding. It has been hypothesized that this event enhances student knowledge of CIHC IPE domains, and creates a deeper appreciation for, and understanding of IPC. The primary objective of this research was to determine if participants' understanding of CIHC IPE domains improved, and if perceptions of their own and the other profession were reframed as a result of this innovation. METHODS: This article describes the educators' approach in setting up and delivering this learning experience and the results of this event through students' perceptions. This cross-sectional study used a descriptive mixed-methods design. Two data collection tools were used to explore changes in participants' perceptions and event feedback. RESULTS: Data analysis found that the majority of participants identified value in this IPE learning experience. Qualitative and quantitative findings suggest participants developed a deepened appreciation for IPC and an improved understanding of the CIHC IPE competency domains. DISCUSSION: The evaluative findings of this study support the value of Partnering for Patti as a novel IPE learning experience. Although it is unclear to what degree objectives were met, findings strongly support continued integration of this learning experience.