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1.
J Mech Behav Biomed Mater ; 150: 106298, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38096609

RESUMO

Skeletal muscle is a hierarchical structure composed of multiple organizational scales. A major challenge in the biomechanical evaluation of muscle relates to the difficulty in evaluating the experimental mechanical properties at the different organizational levels of the same tissue. Indeed, the ability to integrate mechanical properties evaluated at various levels will allow for improved assessment of the entire tissue, leading to a better understanding of how changes at each level evolve over time and/or impact tissue function, especially in the case of muscle diseases. Therefore, the purpose of this study was to analyze a genetically engineered mouse model (Klf10 KO: Krüppel-Like Factor 10 knockout) with known skeletal muscle defects to compare the mechanical properties with wild-type (WT) controls at the three main muscle scales: the macroscopic (whole muscle), microscopic (fiber) and submicron (myofibril) levels. Passive mechanical tests (ramp, relaxation) were performed on two types of skeletal muscle (soleus and extensor digitorum longus (EDL)). Results of the present study revealed muscle-type specific behaviors in both genotypes only at the microscopic scale. Interestingly, loss of Klf10 expression resulted in increased passive properties in the soleus but decreased passive properties in the EDL compared to WT controls. At the submicron scale, no changes were observed between WT and Klf10 KO myofibrils for either muscle; these results demonstrate that the passive property differences observed at the microscopic scale (fiber) are not caused by sarcomere intrinsic alterations but instead must originate outside the sarcomeres, likely in the collagen-based extracellular matrix. The macroscopic scale revealed similar passive mechanical properties between WT and Klf10 KO hindlimb muscles. The present study has allowed for a better understanding of the role of Klf10 on the passive mechanical properties of skeletal muscle and has provided reference data to the literature which could be used by the community for muscle multiscale modeling.


Assuntos
Colágeno , Músculo Esquelético , Animais , Camundongos , Colágeno/metabolismo , Matriz Extracelular/metabolismo , Músculo Esquelético/fisiologia
2.
Front Physiol ; 14: 1242177, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-38274042

RESUMO

Sarcomere lengths are non-uniform on all structural levels of mammalian skeletal muscle. These non-uniformities have been associated with a variety of mechanical properties, including residual force enhancement and depression, creep, increased force capacity, and extension of the plateau of the force-length relationship. However, the nature of sarcomere length non-uniformities has not been explored systematically. The purpose of this study was to determine the properties of sarcomere length non-uniformities in active and passive muscle. Single myofibrils of rabbit psoas (n = 20; with 412 individual sarcomeres) were subjected to three activation/deactivation cycles and individual sarcomere lengths were measured at 4 passive and 3 active points during the activation/deactivation cycles. The myofibrils were divided into three groups based on their initial average sarcomere lengths: short, intermediate, and long average sarcomere lengths of 2.7, 3.2, and 3.6 µm. The primary results were that sarcomere length non-uniformities did not occur randomly but were governed by some structural and/or contractile properties of the sarcomeres and that sarcomere length non-uniformities increased when myofibrils went from the passive to the active state. We propose that the mechanisms that govern the systematic sarcomere lengths non-uniformities observed in active and passive myofibrils may be associated with the variable number of contractile proteins and the variable number and the adjustable stiffness of titin filaments in individual sarcomeres.

3.
Int J Obes (Lond) ; 45(11): 2464-2470, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34404907

RESUMO

OBJECTIVES: Food intake in obesity has been found to be reward-based and less contingent on homeostatic needs. Accordingly, previous studies investigating neural processing of food cues observed aberrant processing in reward- and control-related brain regions in obesity. To further investigate the relation between homeostasis and food intake, this study investigated the influence of glucose metabolism on the neuronal response during the regulation of food craving in participants with obesity. METHODS: Twenty-five normal-weight and 25 women with obesity were examined on two occasions after receiving either water or glucose directly into the stomach using a nasogastric tube. Participants were blinded to the type of infusion and were required to refrain from eating for 16 h before each visit. An event-related fMRI paradigm was used to investigate the effect of intestinal glucose load on the neuronal response during the regulation of food craving. RESULTS: A 2 × 2 mixed-model ANOVA revealed that craving regulation was associated with increased activation in fronto-parietal regions in participants with obesity when compared to healthy controls. However, this effect was observed independently from homeostatic satiety. A regression analysis revealed that the reduction of food craving was related to increased activation in the lingual gyrus in individuals with obesity following the infusion of water. CONCLUSIONS: In participants with obesity, the neuronal response during the regulation of food craving is associated with increased neural cognitive top-down control and increased visual food processing. Since this observation was independent from satiety status, our results indicate a reduced influence of homeostasis on neural processing during food craving in obesity. This study was registered on clinicaltrials.org: NCT03075371.


Assuntos
Fissura/fisiologia , Homeostase/fisiologia , Obesidade/complicações , Adulto , Análise de Variância , Encéfalo/diagnóstico por imagem , Encéfalo/fisiologia , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Imageamento por Ressonância Magnética/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Obesidade/diagnóstico por imagem , Obesidade/psicologia
4.
Osteoarthritis Cartilage ; 29(6): 870-881, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33798706

RESUMO

OBJECTIVE: Increased levels of pro-inflammatory cytokines are associated with the release of degradative enzymes leading to osteoarthritis (OA) development. Although physical exercise (PE) is generally recognized as beneficial for OA symptoms, excessive training workload and eccentric muscular exercise have increased OA risk. Here, we investigated the effects of excessive exercise workload and exercise type on systemic inflammation and knee joint OA. METHODS: Mice were divided into five groups: sedentary (SED), uphill training (TRU), downhill training (TRD), excessive uphill training (ETU), and excessive downhill training (ETD) for an 8-week training intervention protocol. RESULTS: ETD group had increased pro-inflammatory cytokines in serum, vastus lateralis (VL), and vastus medialis (VM) muscles, while ETU group mice had increased cytokine levels in the VL and VM. Total knee joint OARSI score were more significant in ETD group compared to SED and TRU groups. They were also more meaningful for the medial tibial plateau of ETD group compared to SED group. MMP-3 and cleaved Caspase-3 were higher in the ETD group than the SED and TRU group, while Adamts-5 was higher in the ETD group than the SED group. TRU group had increased PRG-4 levels compared to ETU and ETD group. ETD group had decreased total bone volume, trabecular bone volume, and cortical thickness compared to SED group. CONCLUSION: Excessive downhill training induced a chronic pro-inflammatory state in mice and was associated with early signs of cartilage and bone degeneration that are clinical indicators of knee OA.


Assuntos
Osteoartrite do Joelho/etiologia , Condicionamento Físico Animal/efeitos adversos , Idade de Início , Animais , Camundongos , Camundongos Endogâmicos C57BL , Distribuição Aleatória
5.
Int J Ment Health Syst ; 13: 69, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31719843

RESUMO

BACKGROUND: Over a course of 10 weeks the psychosomatic-psychotherapeutic evening clinic at the University of Heidelberg offers an intensive and multimodal 3-h treatment program on three evenings a week. The clinic aims at accommodating patients who on the one hand do not fit the criteria of partial or full-time inpatient therapy, but on the other hand requires a more intensified therapy dose than the usual German outpatient settings can cater for. In the presented monocentric, qualitative study, we wanted to examine this treatment concept with regard to the patients' specific concerns, expectations, and individual experiences. By contrasting differences in intensity of outpatient and inpatient treatment, we aimed to identify those characteristics of the evening clinic setting that were perceived as especially helpful. METHOD: Each of the 25 patients was interviewed twice, using semi-structured interviews. The interviews took place before (T0) and after (T1) the 10-week treatment interval. A qualitative content analysis of the transcribed interviews was performed using the software "MaxQDA". RESULTS: We identified a total of 1609 separate codes and grouped them into 33 topics and 5 overarching categories. Here, we found some aspects independent of the therapeutic setting, and others concerning the patients' specific expectations and experiences resulting from the particularities of the evening clinic as an outpatient setting including certain inpatient characteristics. This included the possibility of patients continuing to work and being able to fulfil social obligations, i.e. childcare or caring for relatives, while at the same time undergoing intensive psychotherapeutic treatment. CONCLUSIONS: Our results show that the evening clinic concept is particularly suitable for patients with mental and psychosomatic disorders who require intensified multimodal therapy while continuing to meet their obligations in their private and working lives. However, in comparison to other therapeutic methods, this concept generated greater stress and time challenges. Patients should therefore have a reasonably good standard of functioning in everyday life and sufficient coping resources. This is especially important for patients who continue working in their jobs while undergoing treatment. So far, there is a lack of quantitative data which would be needed to evaluate the effectiveness of this novel setting.

6.
BMC Med Educ ; 19(1): 353, 2019 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-31521146

RESUMO

BACKGROUND: Peer-assisted learning (PAL) is a common teaching and learning method in medical education worldwide. In the setting of skills laboratories (skills labs), student tutors are often employed as an equivalent alternative to faculty teachers. However, to the best of our knowledge, there is a lack of qualitative studies which explore the reasons for the personal commitment of student tutors. The aim of our study was to examine how undergraduate students experienced and evaluated their roles as skills lab student tutors, what their motivation was, and whether social and cognitive congruence played a role in their teaching experiences. METHODS: We conducted in-depth, semi-structured interviews with student tutors who were currently teaching in a skills lab. After the interviews had been transcribed verbatim, two independent investigators performed a qualitative content analysis according to Mayring. RESULTS: In total, we conducted nine interviews with student tutors. Our results revealed that all student tutors showed great enthusiasm and motivation for their jobs as peer teachers. One of the main motivating factors for student tutors to teach in a skills lab was the possibility to simultaneously share and improve their knowledge and expertise. In general, the participants of our study had high aspirations for their teaching. They found it particularly important to be empathetic with the student learners. At the same time, they thought they would personally benefit from their teaching activities and develop a certain expertise as student tutors. CONCLUSIONS: With the present study we are able to gain some insight into what motivates student tutors to teach in a skills lab and what kind of experiences they have. Our results provide an important input for the future training of highly qualified student tutors.


Assuntos
Educação de Graduação em Medicina/normas , Docentes de Medicina , Motivação , Estudantes de Medicina , Currículo , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Influência dos Pares , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa , Ensino
7.
Sci Rep ; 9(1): 5975, 2019 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-30967560

RESUMO

A correction to this article has been published and is linked from the HTML and PDF versions of this paper. The error has been fixed in the paper.

8.
Osteoarthritis Cartilage ; 27(4): 687-693, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30641135

RESUMO

OBJECTIVE: The aim of this study was to document the natural history of development and long-term progression of osteoarthritis (OA) in the feline knee after minimally invasive anterior cruciate ligament (ACL) transection. DESIGN: ACL transections of the left knee joint of 14 skeletally mature cats were performed. Radiographic scores, tibiofemoral and patellofemoral joint space and anterior tibial translation were assessed before, immediately and every 3 months after ACL transection (longest follow-up: 93 months). RESULTS: After 26 months, all ACL transected knees had developed definite OA. The earliest changes were observed on the tibia plateau starting as early as 2 months after ACL transection, and at 12 months signs of OA were present in more than 80% of cats in the medial and in almost 80% of cats in the lateral compartment. In the first 24 months, medial tibiofemoral joint space decreased by 0.88 mm (95% confidence interval [-0.55;-1.21] mm) and lateral tibiofemoral joint space by 0.55 mm ([-0.26;-0.85] mm). In the same interval, the joint space in the patellofemoral joint increased by 0.98 mm ([0.59; 1.37] mm). Throughout the entire observation period, the anterior tibial translation was on average 5.3 mm greater than in the contralateral knee ([4.5; 6.0]mm). CONCLUSIONS: Immediate changes in anterior tibial translation during an anterior drawer test clearly showed joint instability that persisted throughout the lifetime of the animals. Degenerative changes were observed on radiographs within 4 months of the injury only in the transected but not the contralateral limb suggesting the role of mechanical instability for the development and progression of knee OA.


Assuntos
Lesões do Ligamento Cruzado Anterior/complicações , Cartilagem Articular/patologia , Osteoartrite do Joelho/etiologia , Amplitude de Movimento Articular/fisiologia , Animais , Lesões do Ligamento Cruzado Anterior/diagnóstico , Fenômenos Biomecânicos , Gatos , Modelos Animais de Doenças , Progressão da Doença , Feminino , Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/fisiopatologia , Prognóstico , Radiografia
9.
J Biomech ; 83: 65-75, 2019 01 23.
Artigo em Inglês | MEDLINE | ID: mdl-30501912

RESUMO

Site-specific and depth-dependent properties of cartilage were implemented within a finite element (FE) model to determine if compositional or structural changes in the tissue could explain site-specific alterations of chondrocyte deformations due to cartilage loading in rabbit knee joints 3 days after a partial meniscectomy (PM). Depth-dependent proteoglycan (PG) content, collagen content and collagen orientation in the cartilage extracellular matrix (ECM), and PG content in the pericellular matrix (PCM) were assessed with microscopic and spectroscopic methods. Patellar, femoral groove and samples from both the lateral and medial compartments of the femoral condyle and tibial plateau were extracted from healthy controls and from the partial meniscectomy group. For both groups and each knee joint site, axisymmetric FE models with measured properties were generated. Experimental cartilage loading was applied in the simulations and chondrocyte volumes were compared to the experimental values. ECM and PCM PG loss occurred within the superficial cartilage layer in the PM group at all locations, except in the lateral tibial plateau. Collagen content and orientation were not significantly altered due to the PM. The FE simulations predicted similar chondrocyte volume changes and group differences as obtained experimentally. Loss of PCM fixed charge density (FCD) decreased cell volume loss, as observed in the medial femur and medial tibia, whereas loss of ECM FCD increased cell volume loss, as seen in the patella, femoral groove and lateral femur. The model outcome, cell volume change, was also sensitive to applied tissue geometry, collagen fibril orientation and loading conditions.


Assuntos
Cartilagem Articular/citologia , Condrócitos/citologia , Análise de Elementos Finitos , Articulação do Joelho/citologia , Articulação do Joelho/cirurgia , Fenômenos Mecânicos , Meniscectomia , Animais , Tamanho Celular , Colágeno/metabolismo , Matriz Extracelular/metabolismo , Proteoglicanas/metabolismo , Coelhos
10.
Sci Rep ; 8(1): 14150, 2018 09 20.
Artigo em Inglês | MEDLINE | ID: mdl-30237492

RESUMO

Menisci in the knee joint are thought to provide stability, increased contact area, decreased contact pressures, and offer protection to the underlying articular cartilage and bone during joint loading. Meniscal loss or injury is typically accompanied by degenerative changes in the knee, leading to an increased risk for osteoarthritis in animals including humans. However, the detailed mechanisms underlying joint degeneration and the development of osteoarthritis remain largely unknown, and the acute effects of meniscal loss have not been studied systematically. We developed a microscopy-based system to study microscale joint mechanics in living mice loaded by controlled muscular contractions. Here, we show how meniscal loss is associated with rapid chondrocyte death (necrosis) in articular cartilage within hours of injury, and how intact menisci protect chondrocytes in vivo in the presence of intense muscle-based joint loading and/or injury to the articular cartilage. Our findings suggest that loading the knee after meniscal loss is associated with extensive cell death in intact and injured knees, and that early treatment interventions should be aimed at preventing chondrocyte death.


Assuntos
Cartilagem Articular/fisiologia , Condrócitos/fisiologia , Articulação do Joelho/fisiologia , Menisco/fisiologia , Contração Muscular/fisiologia , Animais , Camundongos , Suporte de Carga
11.
Bone Joint Res ; 7(4): 274-281, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29922445

RESUMO

OBJECTIVES: Metabolic syndrome and low-grade systemic inflammation are associated with knee osteoarthritis (OA), but the relationships between these factors and OA in other synovial joints are unclear. The aim of this study was to determine if a high-fat/high-sucrose (HFS) diet results in OA-like joint damage in the shoulders, knees, and hips of rats after induction of obesity, and to identify potential joint-specific risks for OA-like changes. METHODS: A total of 16 male Sprague-Dawley rats were allocated to either the diet-induced obesity group (DIO, 40% fat, 45% sucrose, n = 9) or a chow control diet (n = 7) for 12 weeks. At sacrifice, histological assessments of the shoulder, hip, and knee joints were performed. Serum inflammatory mediators and body composition were also evaluated. The total Mankin score for each animal was assessed by adding together the individual Modified Mankin scores across all three joints. Linear regression modelling was conducted to evaluate predictive relationships between serum mediators and total joint damage. RESULTS: The HFS diet, in the absence of trauma, resulted in increased joint damage in the shoulder and knee joints of rats. Hip joint damage, however, was not significantly affected by DIO, consistent with findings in human studies. The total Mankin score was increased in DIO animals compared with the chow group, and was associated with percentage of body fat. Positive significant predictive relationships for total Mankin score were found between body fat and two serum mediators (interleukin 1 alpha (IL-1α) and vascular endothelial growth factor (VEGF)). CONCLUSION: Systemic inflammatory alterations from DIO in this model system may result in a higher risk for development of knee, shoulder, and multi-joint damage with a HFS diet.Cite this article: K. H. Collins, D. A. Hart, R. A. Seerattan, R. A. Reimer, W. Herzog. High-fat/high-sucrose diet-induced obesity results in joint-specific development of osteoarthritis-like degeneration in a rat model. Bone Joint Res 2018;7:274-281. DOI: 10.1302/2046-3758.74.BJR-2017-0201.R2.

12.
Am J Physiol Cell Physiol ; 315(3): C310-C318, 2018 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-29768046

RESUMO

The aim of this study was to determine the role of titin in preventing the development of sarcomere length nonuniformities following activation and after active and passive stretch by determining the effect of partial titin degradation on sarcomere length nonuniformities and force in passive and active myofibrils. Selective partial titin degradation was performed using a low dose of trypsin. Myofibrils were set at a sarcomere length of 2.4 µm and then passively stretched to sarcomere lengths of 3.4 and 4.4 µm. In the active condition, myofibrils were set at a sarcomere length of 2.8 µm, activated, and actively stretched by 1 µm/sarcomere. The extent of sarcomere length nonuniformities was calculated for each sarcomere as the absolute difference between sarcomere length and the mean sarcomere length of the myofibril. Our main finding is that partial titin degradation does not increase sarcomere length nonuniformities after passive stretch and activation compared with when titin is intact but increases the extent of sarcomere length nonuniformities after active stretch. Furthermore, when titin was partially degraded, active and passive stresses were substantially reduced. These results suggest that titin plays a crucial role in actively stretched myofibrils and is likely involved in active and passive force production.


Assuntos
Conectina/metabolismo , Proteínas Musculares/metabolismo , Miofibrilas/metabolismo , Sarcômeros/metabolismo , Sarcômeros/fisiologia , Animais , Feminino , Fenômenos Mecânicos , Contração Muscular/fisiologia , Coelhos
13.
J Neuroeng Rehabil ; 15(1): 16, 2018 03 07.
Artigo em Inglês | MEDLINE | ID: mdl-29514702

RESUMO

In Fig. 3a of the original manuscript [1], the passive force at the beginning of the force-time history (approximately from 0 to 1 s) of each of the black and orange traces was interchanged in the coloring process. This was an error in the artwork preparation, not the original data. The corrected figure is shown below.

14.
J Psychosom Res ; 105: 72-79, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29332637

RESUMO

OBJECTIVE: Different forms of psychotherapeutic treatments have been proven effective in irritable bowel syndrome (IBS), but disorder-oriented and integrative concepts are still rare. Therefore, we implemented and evaluated an integrative group therapeutic concept within an interdisciplinary tertiary care clinic for functional gastrointestinal disorders (FGIDs). AIMS: present our integrative group concept, assess feasibility issues, and evaluate efficacy. METHODS: A pilot-RCT with a randomized controlled wait-listed group design was conducted. The treatment concept was a disorder-oriented multicomponent group therapy (12 90-min weekly sessions) integrating interactive psychoeducation, gut-directed hypnotherapy, and open group phases. All patients received enhanced medical care and completed a short online diary as an active wait-listed control condition. INCLUSION CRITERIA: refractory IBS diagnosed as somatoform autonomic dysfunction of the lower gastrointestinal tract (SAD). PRIMARY OUTCOME: IBS symptom severity (IBS-SSS). RESULTS: Of 294 patients, 220 had IBS (ROME III), 144 were diagnosed as SAD (ICD-10), 51 were eligible regarding inclusion/exclusion criteria, and 30 consented to participate (group intervention: n=16, wait-listed control condition: n=14). Only 1 patient dropped out. Intention-to-treat-analysis with repeated-measures mixed ANOVA showed that the group intervention was not significantly superior to the wait-listed control condition. Nevertheless, the calculated effect size for the between-group difference in IBS-SSS at the end of treatment (post) was moderate (d=0.539). CONCLUSION: Our disorder-oriented integrative group intervention for IBS proved to be acceptable and feasible in an interdisciplinary tertiary care setting. There is promise in this intervention, but a larger RCT may be needed to investigate efficacy.


Assuntos
Hipnose/métodos , Medicina Integrativa/métodos , Síndrome do Intestino Irritável/terapia , Psicoterapia de Grupo/métodos , Transtornos Somatoformes/terapia , Adulto , Terapia Combinada , Estudos de Viabilidade , Feminino , Humanos , Síndrome do Intestino Irritável/psicologia , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto/métodos , Projetos Piloto , Transtornos Somatoformes/psicologia , Resultado do Tratamento , Listas de Espera
15.
Psychother Res ; 28(6): 873-886, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-27808005

RESUMO

OBJECTIVE: Patients' processing of psychotherapy between sessions ("inter-session process" (ISP)) has been repeatedly shown to be related to outcome. The aim of this study was to compare ISP characteristics of cognitive-behavioral vs. psychodynamic psychotherapy in the treatment of anorexia nervosa (AN) and their relation to outcome. METHODS: Data of 106 patients participating in a randomized-controlled trial who received either 40 sessions of enhanced cognitive-behavioral therapy (CBT-E) or focal psychodynamic therapy (FPT) were analyzed. The ISP was measured with the Inter-session Experience Questionnaire (IEQ). Three outcome classes were distinguished: full recovery, partial recovery, and still fulfilling all AN criteria. RESULTS: Patients receiving CBT-E reported more on "applying therapy" in the initial and the final treatment phase compared to FPT patients. In terms of process-outcome relations, higher levels of "recreating the therapeutic dialogue between sessions," "recreating the therapeutic dialogue with negative emotions" as well as "applying therapy with negative emotions" in the final phase of treatment predicted negative outcome in FPT, whereas overall higher levels of negative emotions predicted negative outcome in CBT-E. CONCLUSIONS: In outpatient treatment in AN, the processing of therapy as measured by the IEQ showed surprisingly few differences between CBT-E and FPT. However, different ISP patterns were predictive of outcome, pointing to different mechanisms of change.


Assuntos
Anorexia Nervosa/terapia , Terapia Cognitivo-Comportamental/métodos , Avaliação de Processos e Resultados em Cuidados de Saúde , Psicoterapia Psicodinâmica/métodos , Adulto , Feminino , Humanos
16.
BMC Med Educ ; 17(1): 111, 2017 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-28693486

RESUMO

BACKGROUND: Particularly at the beginning of their studies, international medical students face a number of language-related, social and intercultural challenges. Thus, they perform poorer than their local counterparts in written and oral examinations as well as in Objective Structured Clinical Examinations (OSCEs) in the fields of internal medicine and surgery. It is still unknown how international students perform in an OSCE in the field of psychosocial medicine compared to their local fellow students. METHODS: All students (N = 1033) taking the OSCE in the field of psychosocial medicine and an accompanying written examination in their eighth or ninth semester between 2012 and 2015 were included in the analysis. The OSCE consisted of four different stations, in which students had to perform and manage a patient encounter with simulated patients suffering from 1) post-traumatic stress disorder, 2) schizophrenia, 3) borderline personality disorder and 4) either suicidal tendency or dementia. Students were evaluated by trained lecturers using global checklists assessing specific professional domains, namely building a relationship with the patient, conversational skills, anamnesis, as well as psychopathological findings and decision-making. RESULTS: International medical students scored significantly poorer than their local peers (p < .001; η2 = .042). Within the specific professional domains assessed, they showed poorer scores, with differences in conversational skills showing the highest effect (p < .001; η2 = .053). No differences emerged within the multiple-choice examination (p = .127). CONCLUSION: International students showed poorer results in clinical-practical exams in the field of psychosocial medicine, with conversational skills yielding the poorest scores. However, regarding factual and practical knowledge examined via a multiple-choice test, no differences emerged between international and local students. These findings have decisive implications for relationship building in the doctor-patient relationship.


Assuntos
Competência Clínica , Barreiras de Comunicação , Avaliação Educacional , Médicos Graduados Estrangeiros , Idioma , Exame Físico , Relações Médico-Paciente , Transtorno Bipolar/diagnóstico , Lista de Checagem , Tomada de Decisão Clínica , Demência/diagnóstico , Feminino , Médicos Graduados Estrangeiros/normas , Humanos , Masculino , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Ideação Suicida , Análise e Desempenho de Tarefas
17.
Opt Lett ; 42(2): 203-206, 2017 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-28081076

RESUMO

We report a photothermal modulation of Mie scattering (PMMS) method that enables concurrent spatial and spectral discrimination of individual micron-sized particles. This approach provides a direct measurement of the "fingerprint" infrared absorption spectrum with the spatial resolution of visible light. Trace quantities (tens of picograms) of material were deposited onto an infrared-transparent substrate and simultaneously illuminated by a wavelength-tunable intensity-modulated quantum cascade pump laser and a continuous-wave 532 nm probe laser. Absorption of the pump laser by the particles results in direct modulation of the scatter field of the probe laser. The probe light scattered from the interrogated region is imaged onto a visible camera, enabling simultaneous probing of spatially-separated individual particles. By tuning the wavelength of the pump laser, the IR absorption spectrum is obtained. Using this approach, we measured the infrared absorption spectra of individual 3 µm PMMA and silica spheres. Experimental PMMS signal amplitudes agree with modeling using an extended version of the Mie scattering theory for particles on substrates, enabling the prediction of the PMMS signal magnitude based on the material and substrate properties.

18.
Mol Psychiatry ; 22(2): 192-201, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27184124

RESUMO

The maintenance of normal body weight is disrupted in patients with anorexia nervosa (AN) for prolonged periods of time. Prior to the onset of AN, premorbid body mass index (BMI) spans the entire range from underweight to obese. After recovery, patients have reduced rates of overweight and obesity. As such, loci involved in body weight regulation may also be relevant for AN and vice versa. Our primary analysis comprised a cross-trait analysis of the 1000 single-nucleotide polymorphisms (SNPs) with the lowest P-values in a genome-wide association meta-analysis (GWAMA) of AN (GCAN) for evidence of association in the largest published GWAMA for BMI (GIANT). Subsequently we performed sex-stratified analyses for these 1000 SNPs. Functional ex vivo studies on four genes ensued. Lastly, a look-up of GWAMA-derived BMI-related loci was performed in the AN GWAMA. We detected significant associations (P-values <5 × 10-5, Bonferroni-corrected P<0.05) for nine SNP alleles at three independent loci. Interestingly, all AN susceptibility alleles were consistently associated with increased BMI. None of the genes (chr. 10: CTBP2, chr. 19: CCNE1, chr. 2: CARF and NBEAL1; the latter is a region with high linkage disequilibrium) nearest to these SNPs has previously been associated with AN or obesity. Sex-stratified analyses revealed that the strongest BMI signal originated predominantly from females (chr. 10 rs1561589; Poverall: 2.47 × 10-06/Pfemales: 3.45 × 10-07/Pmales: 0.043). Functional ex vivo studies in mice revealed reduced hypothalamic expression of Ctbp2 and Nbeal1 after fasting. Hypothalamic expression of Ctbp2 was increased in diet-induced obese (DIO) mice as compared with age-matched lean controls. We observed no evidence for associations for the look-up of BMI-related loci in the AN GWAMA. A cross-trait analysis of AN and BMI loci revealed variants at three chromosomal loci with potential joint impact. The chromosome 10 locus is particularly promising given that the association with obesity was primarily driven by females. In addition, the detected altered hypothalamic expression patterns of Ctbp2 and Nbeal1 as a result of fasting and DIO implicate these genes in weight regulation.


Assuntos
Anorexia Nervosa/genética , Alelos , Índice de Massa Corporal , Peso Corporal/genética , Bases de Dados Genéticas , Feminino , Frequência do Gene/genética , Loci Gênicos , Predisposição Genética para Doença/genética , Variação Genética , Estudo de Associação Genômica Ampla , Humanos , Desequilíbrio de Ligação/genética , Masculino , Obesidade/genética , Polimorfismo de Nucleotídeo Único/genética , Fatores de Risco
20.
J Biomech ; 49(16): 4057-4064, 2016 12 08.
Artigo em Inglês | MEDLINE | ID: mdl-27825604

RESUMO

We determined the biomechanical responses of chondrocytes to indentation at specific locations within the superficial zone of cartilage (i.e. patellar, femoral groove, femoral condylar and tibial plateau sites) taken from female New Zealand white rabbits three days after a partial meniscectomy in the lateral compartment of a knee joint. Confocal laser scanning microscopy combined with a custom indentation system was utilized to image chondrocyte responses at sites taken from ten contralateral and experimental knee joints. Cell volume, height, width and depth changes, global, local axial and transverse strains and Young׳s moduli were determined. Histological assessment was performed and proteoglycan content from the superficial zone of each site was determined. Relative to contralateral group cells, patellar, femoral groove and lateral femoral condyle cells in the experimental group underwent greater volume decreases (p < 0.05), due to smaller lateral expansions (with greater decreases in cell height only for the lateral femoral condyle cells; p < 0.05) whereas medial femoral and medial tibial plateau cells underwent smaller volume decreases (p < 0.05), due to less deformation in cell height (p < 0.05). Proteoglycan content was reduced in the patellar (p > 0.05), femoral groove, medial femoral condyle and medial tibial plateau experimental sites (p < 0.05). The findings suggest: (i) cell biomechanical responses to cartilage loading in the rabbit knee joint can become altered as early as 3 days after a partial meniscectomy, (ii) are site-specific, and (iii) occur before alterations in tissue mechanics or changes detectable with histology.


Assuntos
Condrócitos/citologia , Articulação do Joelho/citologia , Fenômenos Mecânicos , Menisco/cirurgia , Animais , Tamanho Celular , Condrócitos/metabolismo , Feminino , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/fisiologia , Proteoglicanas/metabolismo , Coelhos
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