Isthmin-1 (ISM1), a novel adipokine that reflects abdominal adipose tissue distribution in individuals with obesity.

BACKGROUND: The assessment of obesity-related health risks has traditionally relied on the Body Mass Index and waist circumference, but their limitations have propelled the need for a more comprehensive approach. The differentiation between visceral (VIS) and subcutaneous (SC) fat provides a finer-grained understanding of these risks, yet practical assessment methods are lacking. We hypothesized that combining the SC-VIS fat ratio with non-invasive biomarkers could create a valuable tool for obesity-related risk assessment. METHODS AND RESULTS: A clinical study of 125 individuals with obesity revealed significant differences in abdominal fat distribution measured by CT-scan among genders and distinct models of obesity, including visceral, subcutaneous, and the SC/VIS ratio. Stratification based on these models highlighted various metabolic changes. The SC/VIS ratio emerged as an excellent metric to differentiate metabolic status. Gene expression analysis identified candidate biomarkers, with ISM1 showing promise. Subsequent validation demonstrated a correlation between ISM1 levels in SC and plasma, reinforcing its potential as a non-invasive biomarker for fat distribution. Serum adipokine levels also correlated with the SC/VIS ratio. The Receiver Operating Characteristic analysis revealed ISM1's efficacy in discriminating individuals with favorable metabolic profiles based on adipose tissue distribution. Correlation analysis also suggested that ISM1 was involved in glucose regulation pathways. CONCLUSION: The study's results support the hypothesis that the SC-VIS fat ratio and its derived non-invasive biomarkers can comprehensively assess obesity-related health risks. ISM1 could predict abdominal fat partitioning and be a potential biomarker for evaluating obesity-related health risks.

Evaluation of Cardiovascular Risk Factors after Hepatitis C Virus Eradication with Direct-Acting Antivirals in a Cohort of Treatment-Naïve Patients without History of Cardiovascular Disease.

BACKGROUND: Hepatitis C virus (HCV) produces changes at multiple levels in host metabolism, especially in lipid profile and cardio-metabolic risk. It is unclear how HCV eradication by direct-acting antivirals (DAAs) modifies those changes. OBJECTIVE: To evaluate the impact of DAA treatment on different risk factors associated with cardiovascular disease. METHODS: Prospective study with two-year follow-up. All patients treated with DAAs in the Liver Clinic of a tertiary hospital were included. Patients co-infected with HBV or HIV, with other causes of liver disease, on lipid-lowering treatment, pregnant, or with previous HCV treatment were excluded. The results were analyzed using linear mixed models. RESULTS: 167 patients (53% female, 9.6% cirrhosis) were included. Low plasma lipid levels were observed before initiating HCV eradication. During the first year after treatment with DAA, we observed a sustained increase in cholesterol, triglycerides, HDL cholesterol (only in men), and LDL-cholesterol levels. An ameliorated glycemic control was also observed with a decrease in fasting insulin and reduced HOMA. Iron metabolism and coagulation function also improved with lower levels of serum ferritin and prothrombin activity; these biochemical changes resulted in a new diagnosis of hypercholesterolaemia in 17.4% of patients, requiring initiation of statins in 15%. Two non-fatal cardiovascular events were observed during the first 2 years of follow-up. CONCLUSIONS: DAA treatments returned plasma lipids to the normal range without increasing either the occurrence of cardiovascular events or the consumption of lipid-lowering medication beyond what is normal in a sex- and age-matched population.

Randomized Clinical Trial: Effects of ß-Hydroxy-ß-Methylbutyrate (HMB)-Enriched vs. HMB-Free Oral Nutritional Supplementation in Malnourished Cirrhotic Patients.

ß-Hydroxy-ß-methylbutyrate (HMB) supplementation increases muscle and strength mass in some muscle-wasting disorders. Malnutrition and sarcopenia are often present in liver cirrhosis. We aimed to investigate the effects of oral HMB supplementation on changes in body composition and liver status in patients with cirrhosis and malnutrition. In a randomized, controlled, double-blind trial, 43 individuals were randomized to receive twice a day and for 12 weeks an oral nutritional supplement (ONS) enriched with 1.5 g of calcium HMB per bottle or another supplement with similar composition devoid of HMB. Inclusion criteria were liver cirrhosis with at least one previous decompensation and clinical malnutrition. Liver function, plasma biochemistry analyses, and physical condition assessment were carried out at baseline, then after six and 12 weeks of supplementation. A total of 34 patients completed the clinical trial. An improvement in liver function and an increase in fat mass index were observed in both groups. None of the two ONS changed the fat-free mass. However, we observed an upward trend in handgrip strength and a downward trend in minimal hepatic encephalopathy in the HMB group. At the end of the trial and regardless of the supplement administered, fat mass content increased with no change in fat-free mass, while liver function scores and nutritional analytic markers also improved.

Amino Acid Profile in Malnourished Patients with Liver Cirrhosis and Its Modification with Oral Nutritional Supplements: Implications on Minimal Hepatic Encephalopathy.

Low plasma levels of branched chain amino acids (BCAA) in liver cirrhosis are associated with hepatic encephalopathy (HE). We aimed to identify a metabolic signature of minimal hepatic encephalopathy (MHE) in malnourished cirrhotic patients and evaluate its modification with oral nutritional supplements (ONS) enriched with ß-Hydroxy-ß-methylbutyrate (HMB), a derivative of the BCAA leucine. Post hoc analysis was conducted on a double-blind placebo-controlled trial of 43 individuals with cirrhosis and malnutrition, who were randomized to receive, for 12 weeks, oral supplementation twice a day with either 220 mL of Ensure® Plus Advance (HMB group, n = 22) or with 220 mL of Ensure® Plus High Protein (HP group, n = 21). MHE evaluation was by psychometric hepatic encephalopathy score (PHES). Compared to the HP group, an HMB-specific treatment effect led to a larger increase in Val, Leu, Phe, Trp and BCAA fasting plasma levels. Both treatments increased Fischer's ratio and urea without an increase in Gln or ammonia fasting plasma levels. MHE was associated with a reduced total plasma amino acid concentration, a reduced BCAA and Fischer´s ratio, and an increased Gln/Glu ratio. HMB-enriched ONS increased Fischer´s ratio without varying Gln or ammonia plasma levels in liver cirrhosis and malnutrition, a protective amino acid profile that can help prevent MHE.

Evaluation of liver function tests in the paediatric patient.

INTRODUCTION: Although changes in liver function tests can be non-specific in numerous clinical conditions, they can be the first sign of a potentially serious disease in an asymptomatic patient. MATERIAL AND METHODS: Retrospective cohort study, performed by reviewing the records of children of a reference hospital central laboratory with alanine aminotransferase enzyme (ALT) elevation during a 6-month aleatory period. RESULTS: 572 blood tests with serum ALT elevation corresponding to 403 patients have been assessed during the period studied. 98 patients were excluded for presenting abnormal liver test before the study period of comorbidity that could produce ALT elevation. The remaining 305 patients, 22.6% were diagnosed with a medical condition during the first blood test that explained the ALT elevation, although only 33.3% of them were followed up until verifying their normalisation. Final study sample consists of 236 patients with abnormal liver test without apparent liver disease. Adequate follow-up was found only in 29% of them. From this group, 9 patients (13%) were diagnosed with liver disease. The rest of the samples were not properly monitored. In patients with higher serum ALT levels, follow-up was early and more appropriate. CONCLUSIONS: In our area, most children without apparent liver disease are no properly monitored. Therefore, an opportunity to diagnosis and treat a potential liver disease was lost in a great number of children. All children with unexplained hypertransaminasaemia must be studied.

Evaluación del seguimiento de niños con hallazgo de hipertransaminasemia / Evaluation of liver function tests in the paediatric patient

Introducción: Las alteraciones del perfil hepático constituyen un hecho inespecífico propio de numerosas condiciones clínicas. Sin embargo, puede implicar la primera manifestación de una patología potencialmente grave en un paciente asintomático.Material y métodos: Estudio observacional retrospectivo que incluye todas las analíticas sanguíneas con elevación de alanino aminotransferasa (ALT) en pacientes pediátricos solicitadas en un sector sanitario en un período de 6meses.Resultados: Se registraron 572 analíticas correspondientes a 403 pacientes. Se excluyeron 98 pacientes con hipertransaminasemia ya conocida o comorbilidad. De los 305 restantes, el 22,6% se diagnosticaron de patología asociada a hipertransaminasemia, y de estos, se comprobó normalización en el 33,3%. De los 236 pacientes con hipertransaminasemia sin justificar se realizó un seguimiento en el 29%, encontrando patología hepática en 9pacientes (13% del grupo). En el resto de la muestra no se comprobó analíticamente la evolución de las transaminasas ni la presencia de posible patología hepática. Los pacientes con cifras más elevadas se controlan mejor y antes que los que presentan cifras más bajas.Conclusiones: En nuestra área, la mayoría de los niños sin enfermedad hepática aparente con hallazgo de ALT elevada no son adecuadamente controlados. Esto hace que se pierda una oportunidad única de diagnosticar y tratar precozmente una enfermedad hepática potencial en un gran número de niños. Todo niño con hipertransaminasemia inexplicada debe ser estudiado. (AU)

Introduction: Although changes in liver function tests can be non-specific in numerous clinical conditions, they can be the first sign of a potentially serious disease in an asymptomatic patient.Material and methods: Retrospective cohort study, performed by reviewing the records of children of a reference hospital central laboratory with alanine aminorransferase enzyme (ALT) elevation during a 6 month aleatory period.Results: 572 blood tests with serum ALT elevation corresponding to 403 patients had been assessed during the period studied. 98 patients were excluded for presenting abnormal liver test before the study period of comorbidity that could produce ALT elevation. The remaining 305 patients, 22.6% were diagnosed with a medical condition during the first blood test that explained the ALT elevation, although only 33.3% of them were followed up until verifying their normalization. Final study sample consists of 236 patients with abnormal liver test without apparent liver disease. Adequate follow-up was found only in 29% of them. From this group, 9 patients (13%) were diagnosed with liver disease. The rest of the sample were not properly monitored. In patients with higher serum ALT levels, follow-up was early and more appropiate.Conclusions: In our area, most children without apparent liver disease are no properly monitored. Therefore, an opportunity to diagnosis and treat a potential liver disease was lost in a great number of children. All children with unexplainedhypertransaminasaemia must be studied. (AU)

Comportamiento clínico, endoscópico e histológico del cáncer gástrico diagnosticado en el Hospital "Dr. Mario Muñoz Monroy" / Histological, endoscopic and clinical behavior of gastric cancer diagnosed in the Hospital "Dr. Mario Muñoz Monroy"

RESUMEN Introducción: en los últimos años, se aprecia a nivel global un aumento del cáncer gástrico. La mayoría de los tumores gástricos primarios son malignos. En Matanzas, existe un incremento de esta patología. Objetivo: determinar el comportamiento clínico, endoscópico e histológico del cáncer gástrico diagnosticado. Materiales y métodos: se realizó un estudio observacional, descriptivo y prospectivo en el Departamento de Gastroenterología del Hospital "Dr. Mario Muñoz Monroy", de la ciudad de Matanzas, en el período de enero del 2017 a octubre del 2019. El universo fue 25 pacientes que presentaron cáncer gástrico por diagnóstico endoscópico e histológico. Resultados: el grupo de edad más afectado correspondió a los pacientes entre 61 y 70 años, (44 %). El sexo masculino predominó en un 68 %. Los factores de riesgo de mayor incidencia, fueron la dieta inadecuada y el hábito de fumar. Las manifestaciones clínicas más relevantes fueron: epigastralgia, plenitud gástrica y pérdida de peso. La variedad hística que predominó fue el adenocarcinoma difuso y la localización el antro. Conclusiones: el cáncer gástrico constituye un problema de salud que, al actuar sobre los factores de riesgo se puede disminuir su incidencia; con un diagnóstico precoz se logrará disminuir la mortalidad (AU).

ABSTRACT Introduction: an increase of gastric cancer is appreciated in the world in the last years. Most of the primary gastric tumors are malignant. There is an increase of this disease also in Matanzas. Objective: to determine the histological, endoscopic and clinical behavior of the diagnosed gastric cancer. Materials and methods: a prospective, descriptive and observational study was carried out in the Department of Gastroenterology of the Hospital "Mario Munoz Monroy, of Matanzas, in the period from January 2017 to October 2019. The universe were 25 patients presenting gastric cancer by histologic and endoscopic diagnosis. Results: The most affected age group was the one of patients among 61 and 70 years old (44 %). Male sex predominated in 68 %. The risk factors having higher incidence were an inadequate diet and smoking. The more relevant clinical manifestation were epigastralgia, gastric fullness and weight loss. The predominating tissue variety was the diffuse adenocarcinoma and antrum location. Conclusions: gastric cancer is a health problem the incidence of which could be reduced when acting on its risk factors; with a precocious diagnosis mortality will be reduced (AU).

Serum protein profile analysis in lysosomal storage disorders patients.

INTRODUCTION: Serum protein electrophoresis (SPE) is a well-established technique to identify alterations in plasma protein profiles, caused by diseases as multiple myeloma (MM). In addition, it could be a cost-effective technique to discover new plasma biomarkers. Relation between MM and lysosomal storage diseases (LSDs) as Gaucher disease has been set out but, it has not been evaluated on other LSDs nor the utility of the SPE as first step on LSDs biomarkers discovery projects. MATERIALS AND METHODS: Stored plasma samples at diagnosis from several LSDs patients underwent analysis. Quality control was checked prior to the SPE was analyzed by capillary electrophoresis. The analysis for monoclonal spikes and the differences between each fraction on patients' samples vs the control data previously published, were evaluated. Furthermore, immunoprotein quantification and free light chains ratio were done by nephelometry and turbidimetry. RESULTS: Seventy-five samples of LSD patients at diagnosis, were assessed. The frequency of the MGUS on LSDs patients was not higher than in general population whereas one lysosomal acid lipase deficiency infant showed increased IgA and kappa deviation. Regarding to the usefulness of SPE in biomarkers discovery, statistically significant differences were observed on SPE fractions between LSDs and healthy population. DISCUSSION: The evaluation of SPE fractions can be a useful tool to understand pathophysiologic aspects in LDSs and, to simplify new marker discovery projects. In some of them, the MGUS appearance is a risk factor for the MM development despite its frequency is not increased on the studied LSDs at diagnosis.

PTRF acts as an adipokine contributing to adipocyte dysfunctionality and ectopic lipid deposition

Adipose tissue (AT) expands under obesogenic conditions. Yet, when the growth exceeds a certain limit, AT becomes dysfunctional and surplus lipids start depositing ectopically. Polymerase I and transcription release factor (PTRF) has been proposed as a mechanism leading to a dysfunctional AT by decreasing the adipogenic potential of human adipocyte precursors. However, whether or not PTRF can be secreted by the adipocytes into the bloodstream is not yet known. For this work, PTRF presence was investigated in plasma. We also produced a recombinant PTRF (rPTRF) and examined its impact on the functional interactions between the adipocyte and the hepatocyte in vitro. We demonstrated that PTRF can be found in human plasma, and is at least in part, carried by exosomes. In vitro treatment with rPTRF increased the hypertrophy and senescence of 3T3-L1 adipocytes. In turn, those rPTRF-treated adipocytes increased lipid accumulation in hepatocytes. Lastly, we found a positive correlation between circulating PTRF and the concentration of PTRF in the visceral fat depot. All these findings point toward the presence of an enlarged and dysfunctional visceral adipose tissue which secretes PTRF. This circulating PTRF behaves as an adipokine and may partially contribute to the well-known detrimental effects of visceral fat accumulation

PTRF acts as an adipokine contributing to adipocyte dysfunctionality and ectopic lipid deposition.

Adipose tissue (AT) expands under obesogenic conditions. Yet, when the growth exceeds a certain limit, AT becomes dysfunctional and surplus lipids start depositing ectopically. Polymerase I and transcription release factor (PTRF) has been proposed as a mechanism leading to a dysfunctional AT by decreasing the adipogenic potential of human adipocyte precursors. However, whether or not PTRF can be secreted by the adipocytes into the bloodstream is not yet known. For this work, PTRF presence was investigated in plasma. We also produced a recombinant PTRF (rPTRF) and examined its impact on the functional interactions between the adipocyte and the hepatocyte in vitro. We demonstrated that PTRF can be found in human plasma, and is at least in part, carried by exosomes. In vitro treatment with rPTRF increased the hypertrophy and senescence of 3T3-L1 adipocytes. In turn, those rPTRF-treated adipocytes increased lipid accumulation in hepatocytes. Lastly, we found a positive correlation between circulating PTRF and the concentration of PTRF in the visceral fat depot. All these findings point toward the presence of an enlarged and dysfunctional visceral adipose tissue which secretes PTRF. This circulating PTRF behaves as an adipokine and may partially contribute to the well-known detrimental effects of visceral fat accumulation.

Knockdown of PTRF ameliorates adipocyte differentiation and functionality of human mesenchymal stem cells.

Healthy expansion of human adipose tissue requires mesenchymal stem cells (hMSC) able to proliferate and differentiate into mature adipocytes. Hence, characterization of those factors that coordinate hMSC-to-adipocyte transition is of paramount importance to modulate the adipose tissue expansion. It has been previously reported that the adipogenic program of hMSC can be disrupted by upregulating caveolar proteins, and polymerase I and transcript release factor (PTRF) is an integral component of caveolae, highly expressed in adipose tissue. Here, we hypothesized that the role of PTRF in adipocyte functionality might stem from an effect on hMSC. To test this hypothesis, we isolated hMSC from the subcutaneous fat depot. We found an upregulated expression of the PTRF associated with decreased adipogenic potential of hMSC, likely due to the existence of senescent adipocyte precursors. Employing short hairpin RNA-based constructs to stably reduce PTRF, we were able to restore insulin sensitivity and reduced basal lipolysis and leptin levels in human adipocytes with high levels of PTRF. Additionally, we pinpointed the detrimental effect caused by PTRF on the adipose tissue to the existence of senescent adipocyte precursors unable to proliferate and differentiate into adipocytes. This study provides evidence that impaired adipocyte functionality can be corrected, at least partially, by PTRF downregulation and warrants further in vivo research in patients with dysfunctional adipose tissue to prevent metabolic complications.

Age-Related Changes in the Processing of Emotional Faces in a Dual-Task Paradigm.

UNLABELLED: Background/ Study Context: Age-related changes appear to affect the ability to identify emotional facial expressions in dual-task conditions (i.e., while simultaneously performing a second visual task). The level of interference generated by the secondary task depends on the phase of emotional processing affected by the interference and the nature of the secondary task. The aim of the present study was to investigate the effect of these variables on age-related changes in the processing of emotional faces. METHODS: The identification of emotional facial expressions (EFEs) was assessed in a dual-task paradigm using the following variables: (a) the phase during which interference was applied (encoding vs. retrieval phase); and (b) the nature of the interfering stimulus (visuospatial vs. verbal). The sample population consisted of 24 healthy aged adults (mean age = 75.38) and 40 younger adults (mean age = 26.90). The accuracy of EFE identification was calculated for all experimental conditions. RESULTS: Consistent with our hypothesis, the performance of the older group was poorer than that of the younger group in all experimental conditions. Dual-task performance was poorer when the interference occurred during the encoding phase of emotional face processing and when both tasks were of the same nature (i.e., when the experimental condition was more demanding in terms of attention). CONCLUSIONS: These results provide empirical evidence of age-related deficits in the identification of emotional facial expressions, which may be partially explained by the impairment of cognitive resources specific to this task. These findings may account for the difficulties experienced by the elderly during social interactions that require the concomitant processing of emotional and environmental information.

Skilful communication: Emotional facial expressions recognition in very old adults.

OBJECTIVES: The main objective of this study was to assess the changes associated with ageing in the ability to identify emotional facial expressions and to what extent such age-related changes depend on the intensity with which each basic emotion is manifested. METHODS: A randomised controlled trial carried out on 107 subjects who performed a six alternative forced-choice emotional expressions identification task. The stimuli consisted of 270 virtual emotional faces expressing the six basic emotions (happiness, sadness, surprise, fear, anger and disgust) at three different levels of intensity (low, pronounced and maximum). The virtual faces were generated by facial surface changes, as described in the Facial Action Coding System (FACS). RESULTS: A progressive age-related decline in the ability to identify emotional facial expressions was detected. The ability to recognise the intensity of expressions was one of the most strongly impaired variables associated with age, although the valence of emotion was also poorly identified, particularly in terms of recognising negative emotions. CONCLUSIONS: Nurses should be mindful of how ageing affects communication with older patients. In this study, very old adults displayed more difficulties in identifying emotional facial expressions, especially low intensity expressions and those associated with difficult emotions like disgust or fear.

Malposición de catéter venoso central con resultado de hidrotórax en lactante tras cirugía cardiaca. A propósito de un caso / Hydrothorax in an infant induced by central venous catheter malposition after cardiac surgery. A case report

La perforación vascular con resultado de hidrotórax es una complicación poco frecuente de la colocación de un catéter venoso central. Debe sospecharse en aquellos pacientes con catéter venoso central en vena subclavia o yugular interna y derrame pleural con insuficiencia respiratoria y/o inestabilidad hemodinámica. Las pruebas radiológicas junto con una correcta interpretación de los resultados analíticos son clave para la realización de un diagnóstico rápido que evite complicaciones futuras. Se presenta el caso clínico de una lactante de un mes y 10 días que ingresa en unidad de cuidados intensivos tras cirugía cardiaca. Al ingreso en esta unidad se mantiene ventilación mecánica y catéter venoso central en vena yugular derecha, cuya correcta posición había sido comprobada mediante radiografía de tórax. A las 5-6 horas posteriores, se constata oliguria con hipotensión y aumento del débito por drenaje pleural, sospechando insuficiencia cardiaca. Dada la no mejoría clínica tras el tratamiento con fármacos vasoactivos, se realiza drenaje torácico para descartar quilotórax. Los resultados obtenidos tras el análisis del líquido pleural en el laboratorio de bioquímica clínica hacen sospechar de una posible contaminación con suero glucosalino, por lo que rápidamente es advertido al clínico solicitante. Ante esta situación se decide realizar una radiografía de tórax con contraste yodado, donde se evidencia extravasación del contenido de la vía central a cavidad pleural, con resultado de hidrotórax, procediendo a la retirada inmediata de dicha vía. La evolución posterior fue favorable y no hubo nuevas complicaciones (AU)

Hydrothorax as a result of vascular perforation is a rare complication of central venous catheter (CVC) and should be suspected in patients with subclavian or internal jugular vein catheterism as well as pleural effusion with respiratory failure and/or hemodynamic instability. A proper interpretation of the analytical results, in addition to radiological findings, is crucial for an early diagnosis that may avoid future complications. In this article we present a clinical case of an infant, aged one month and 10 days, who was admitted to the ICU after a cardiac surgery. Once in the ICU, mechanical ventilation and right jugular vein catheterism are maintained; the proper CVC placement had been previously verified by chest X-ray. After 5-6 hours the patient began to suffer from oliguria with hypotension and increased debt by pleural drainage, suspecting heart failure. There was no clinical improvement after treatment with vasoactive drugs so chest drainage was performed to discard chylotorax. The clinical biochemistry laboratory conducted a pleural fluid analysis. The results suggested contamination with glucosaline solution. Such results were reported to the applicant physician. According to the clinical situation a chest X-ray with iodinated contrast was performed evidencing an extravasation of the content of the CVC to pleural cavity, resulting in hydrothorax. The CVC was immediately removed. The subsequent evolution was favorable and there were no further complications (AU)

Emotional processing in patients with mild cognitive impairment: the influence of the valence and intensity of emotional stimuli: the valence and intensity of emotional stimuli influence emotional processing in patients with mild cognitive impairment.

UNLABELLED: We studied the ability of individuals with mild cognitive impairment (MCI) to process emotional facial expressions (EFEs). To date, no systematic study has addressed how variation in intensity affects recognition of the different type of EFEs in such subjects. DESIGN: Two groups of 50 elderly subjects, 50 healthy individuals and 50 with MCI, completed a task that involved identifying 180 EFEs prepared using virtual models. Two features of the EFEs were contemplated, their valence (operationalized in six basic emotions) and five levels of intensity. RESULTS: At all levels of intensity, elderly individuals with MCI were significantly worse at identifying each EFE than healthy subjects. Some emotions were easier to identify than others, with happiness proving to be the easiest to identify and disgust the hardest, and intensity influenced the identification of the EFEs (the stronger the intensity, the greater the number of correct identifications). Overall, elderly individuals with MCI had a poorer capacity to process EFEs, suggesting that cognitive ability modulates the processing of emotions, where features of such stimuli also seem to play a prominent role (e.g., valence and intensity). Thus, the neurological substrates involved in emotional processing appear to be affected by MCI.

The FAT expandability (FATe) Project: Biomarkers to determine the limit of expansion and the complications of obesity.

BACKGROUND: Obesity is an excessive accumulation of fat frequently, but not always, associated with health problems, mainly type 2 diabetes and cardiovascular disease. During a positive energy balance, as caused by excessive intake or sedentary lifestyle, subcutaneous adipose tissue expands and accumulates lipids as triglycerides. However, the amount of adipose tissue per se is unlikely to be the factor linking obesity and metabolic complications. The expandability hypothesis states that, if this positive energy balance is prolonged, a point is eventually reached where subcutaneous adipose tissue can not further expand and energy surplus no longer can be safely stored. Once the limit on storage capacity has been exceeded, the dietary lipids start spilling and accumulate ectopically in other organs (omentum, liver, muscle, pancreas) forming lipid byproducts toxic to cells. METHODS/DESIGN: FATe is a multidisciplinary clinical project aimed to fill gaps that still exist in the expandability hypothesis. Imaging techniques (CT-scan), metabolomics, and transcriptomics will be used to identify the factors that set the limit expansion of subcutaneous adipose tissue in a cohort of caucasian individuals with varying degrees of adiposity. Subsequently, a set of biomarkers that inform the individual limits of expandability will be developed using computational and mathematical modeling. A different validation cohort will be used to minimize the risk of false positive rates and increase biomarkers' predictive performance. DISCUSSION: The work proposed here will render a clinically useful screening method to predict which obese individuals will develop metabolic derangements, specially diabetes and cardiovascular disease. This study will also provide mechanistic evidence that promoting subcutaneous fat expansion might be a suitable therapy to reduce metabolic complications associated with positive energy balance characteristic of Westernized societies.

Estado prostodóncico y salud bucal en pacientes que solicitaron reparaciones protésicas / Prosthodontics State and Oral Health in Patients that Requested Denture Repairs

Introducción: la salud bucodental es un componente de la salud general, por esto un mejoramiento de la salud oral puede influir positivamente en la calidad de vida. Objetivo: determinar el estado prostodóncico y aspectos de salud bucal, en los pacientes que solicitaron reparaciones protésicas. Método: se realizó un estudio transversal en pacientes que solicitaron reparaciones protésicas, en la Clínica Estomatológica Manuel Angulo Farrán, del municipio Holguín, desde febrero a diciembre de 2011. La muestra de 1 772 pacientes con prótesis removibles entre los 1 802 pacientes atendidos. Se realizó interrogatorio y examen clínico. Se utilizó el cálculo porcentual y el test de diferencia de proporciones. Los resultados se presentaron en tablas de distribución de frecuencia. Resultados: el mayor número de pacientes que solicitaron reparaciones pertenecían al sexo femenino (60,8 %) y al grupo de edad de 51 a 60 años (29,4 %). El tipo de prótesis que más se reparó, fue la parcial superior (59,8 %), el objeto de reparación más común fue la fractura completa (32,6 %). La frecuencia y métodos incorrectos de higiene bucal se evidenciaron en el 95,1 % y el 85,3 % de las prótesis se consideraron no aceptables. La estomatitis subprótesis fue la más frecuente de las alteraciones orales (71,4 %). Conclusiones: la mayoría de los pacientes acudieron a reparar prótesis consideradas no aceptables, presentaban hábitos de higiene incorrectos y lesiones en los tejidos bucales.

Introduction: an oral health improvement can influence positively in the quality of life because buccal health is a general health component. Objective: to determine the prosthodontics state and buccal health aspects in the patients that requested denture repairs. Method: a descriptive and cross-sectional study in patients requesting denture repairs at “Manuel Angulo" dental clinic from February to December 2011 was done. The sample comprised 1 772 patients with dentures among 1 802 patients. Interview and clinical examination were performed. Percentage calculation and difference of proportions test were used and the results were showed in simple frequency distribution charts. Results: the greatest number of patients requiring repairs was of female sex representing 60.8 % as well as the age group between 51 to 60 (29.4 %). Upper partial denture was the most fixed one, being the complete fracture the most common repaired object (32.6 %). The frequency and the improper way of oral hygiene were seen in 95.1 % of patients and 85.3 % of them were considered unacceptable. Denture stomatitis was the most frequent alterations detected in the buccal mucous (71.4 %). Conclusions: the majority of patients with repaired dentures that considered it unacceptable had poor hygiene habits and injury in oral tissues.

Estado prostodóncico y salud bucal en pacientes que solicitaron reparaciones protésicas / Prosthodontics State and Oral Health in Patients that Requested Denture Repairs

Introducción: la salud bucodental es un componente de la salud general, por esto un mejoramiento de la salud oral puede influir positivamente en la calidad de vida.Objetivo: determinar el estado prostodóncico y aspectos de salud bucal, en los pacientes que solicitaron reparaciones protésicas.Método: se realizó un estudio transversal en pacientes que solicitaron reparaciones protésicas, en la Clínica Estomatológica Manuel Angulo Farrán, del municipio Holguín, desde febrero a diciembre de 2011. La muestra de 1 772 pacientes con prótesis removibles entre los 1 802 pacientes atendidos. Se realizó interrogatorio y examen clínico. Se utilizó el cálculo porcentual y el test de diferencia de proporciones. Los resultados se presentaron en tablas de distribución de frecuencia.Resultados: el mayor número de pacientes que solicitaron reparaciones pertenecían al sexo femenino (60,8 por cientot) y al grupo de edad de 51 a 60 años (29,4 por ciento). El tipo de prótesis que más se reparó, fue la parcial superior (59,8 por ciento), el objeto de reparación más común fue la fractura completa (32,6 por ciento). La frecuencia y métodos incorrectos de higiene bucal se evidenciaron en el 95,1 por ciento y el 85,3 por ciento de las prótesis se consideraron no aceptables. La estomatitis subprótesis fue la más frecuente de las alteraciones orales (71,4 por ciento).Conclusiones: la mayoría de los pacientes acudieron a reparar prótesis consideradas no aceptables, presentaban hábitos de higiene incorrectos y lesiones en los tejidos bucales.(AU)

Introduction: an oral health improvement can influence positively in the quality of life because buccal health is a general health component.Objective: to determine the prosthodontics state and buccal health aspects in the patients that requested denture repairs.Method: a descriptive and cross-sectional study in patients requesting denture repairs at Manuel Angulo dental clinic from February to December 2011 was done. The sample comprised 1 772 patients with dentures among 1 802 patients. Interview and clinical examination were performed. Percentage calculation and difference of proportions test were used and the results were showed in simple frequency distribution charts.Results: the greatest number of patients requiring repairs was of female sex representing 60.8 percent as well as the age group between 51 to 60 (29.4 percent). Upper partial denture was the most fixed one, being the complete fracture the most common repaired object (32.6 percent). The frequency and the improper way of oral hygiene were seen in 95.1 percent of patients and 85.3 percent of them were considered unacceptable. Denture stomatitis was the most frequent alterations detected in the buccal mucous (71.4 percent).Conclusions: the majority of patients with repaired dentures that considered it unacceptable had poor hygiene habits and injury in oral tissues(AU)