RESUMO
DNA methylation could provide a link between environmental, genetic factors and weight control and can modify gene expression pattern. This study aimed to identify genes, which are differentially expressed and methylated depending on adiposity state by evaluating normal weight women and obese women before and after bariatric surgery (BS). We enrolled 24 normal weight (BMI: 22.5 ± 1.6 kg/m2) and 24 obese women (BMI: 43.3 ± 5.7 kg/m2) submitted to BS. Genome-wide methylation analysis was conducted using Infinium Human Methylation 450 BeadChip (threshold for significant CpG sites based on delta methylation level with a minimum value of 5%, a false discovery rate correction (FDR) of q < 0.05 was applied). Expression levels were measured using HumanHT-12v4 Expression BeadChip (cutoff of p ≤ 0.05 and fold change ≥2.0 was used to detect differentially expressed probes). The integrative analysis of both array data identified four genes (i.e. TPP2, PSMG6, ARL6IP1 and FAM49B) with higher methylation and lower expression level in pre-surgery women compared to normal weight women: and two genes (i.e. ZFP36L1 and USP32) that were differentially methylated after BS. These methylation changes were in promoter region and gene body. All genes are related to MAPK cascade, NIK/NF-kappaB signaling, cellular response to insulin stimulus, proteolysis and others. Integrating analysis of DNA methylation and gene expression evidenced that there is a set of genes relevant to obesity that changed after BS. A gene ontology analysis showed that these genes were enriched in biological functions related to adipogenesis, orexigenic, oxidative stress and insulin metabolism pathways. Also, our results suggest that although methylation plays a role in gene silencing, the majority of effects were not correlated.
Assuntos
Adiposidade/genética , Cirurgia Bariátrica , Metilação de DNA , Obesidade/genética , Transcriptoma , Proteínas Adaptadoras de Transdução de Sinal/genética , Proteínas Adaptadoras de Transdução de Sinal/metabolismo , Adulto , Aminopeptidases/genética , Aminopeptidases/metabolismo , Fator 1 de Resposta a Butirato/genética , Fator 1 de Resposta a Butirato/metabolismo , Dipeptidil Peptidases e Tripeptidil Peptidases/genética , Dipeptidil Peptidases e Tripeptidil Peptidases/metabolismo , Feminino , Humanos , Peptídeos e Proteínas de Sinalização Intracelular/genética , Peptídeos e Proteínas de Sinalização Intracelular/metabolismo , Proteínas de Membrana/genética , Proteínas de Membrana/metabolismo , Redes e Vias Metabólicas , Pessoa de Meia-Idade , Proteínas Mitocondriais/genética , Proteínas Mitocondriais/metabolismo , Obesidade/metabolismo , Obesidade/cirurgia , Período Pós-Operatório , Período Pré-Operatório , Serina Endopeptidases/genética , Serina Endopeptidases/metabolismo , Ubiquitina Tiolesterase/genética , Ubiquitina Tiolesterase/metabolismoRESUMO
BACKGROUND/OBJECTIVES: Obesity has been associated with gene methylation regulation. Recent studies have shown that epigenetic signature plays a role in metabolic homeostasis after Roux-en Y gastric bypass (RYGB). To conduct a genome-wide epigenetic analysis in peripheral blood to investigate whether epigenetic changes following RYGB stem from weight loss or the surgical procedure per se. SUBJECTS/METHODS: By means of the Infinium Human Methylation 450 BeadChip array, global methylation was analyzed in blood of 24 severely obese women before and 6 months after RYGB and in 24 normal-weight women (controls). RESULTS: In blood cells, nine DMCpG sites showed low methylation levels before surgery, methylation levels increased after RYGB and neared the levels measured in the controls. Additionally, 44 CpG sites associated with the Wnt and p53 signaling pathways were always differently methylated in the severely obese patients as compared to the controls and were not influenced by RYGB. Finally, 1638 CpG sites related to inflammation, angiogenesis, and apoptosis presented distinct methylation in the post-surgery patients as compared to the controls. CONCLUSION: Bariatric surgery per se acts on CpGs related to inflammation, angiogenesis, and endothelin-signaling. However, the gene cluster associated with obesity remains unchanged, suggesting that weight loss 6 months after RYGB surgery cannot promote this effect.
Assuntos
Metilação de DNA , Epigênese Genética , Derivação Gástrica , Adulto , Peso Corporal/genética , Ilhas de CpG/genética , Feminino , Humanos , Masculino , Obesidade/genética , Obesidade/cirurgia , Fenótipo , Fatores de TempoRESUMO
INTRODUCTION: The waste management of a hospital center affects people both those who receive health care and the environment that receives them. The impact on the environment of the task of peri-operative care has not yet been properly studied. It is known that of the 105 tons of garbage monthly from the health center understudy go to the landfills of the municipality. However, there are different elements, such as low-density plastics (LDP), which can be recycled. OBJECTIVE: implement a clean low-density plastics recycling program in the central Operating Room of the UC-Christus Clinical Hospital. METHODOLOGY: In this report, a prospective longitudinal study was conducted with a sample for convenience, in which an intervention was scheduled in series repeated over time from 2017 to 2018. Residents of anesthesia, anesthesiologists, nurses, nurse technicians, and hospital support personnel participated. RESULTS: In total 200 employees participated. During the pilot phase, 30 kg of plastics were quantified, later increasing to 100 kg of LDP in the subsequent phases. It began with the transfer phase to other pavilions within the healthcare center and to other centers in the metropolitan region. Finally, an alternative was started with the municipalities. CONCLUSIONS: It was possible to quantify the amount of clean LPD for recycling. It was possible to involve the collaborators of the institution. This is the first program reported that involves an intervention for LPD.
INTRODUCCIÓN: El manejo de los desechos de un centro hospitalario afecta a las personas tanto a los que reciben atención de salud como también al medioambiente que recibe éstos. El impacto en el ambiente del quehacer de la atención perioperatoria aún no ha sido estudiado apropiadamente. Se sabe que 105 toneladas de basura mensuales del centro asistencial en estudio van a los vertederos de la municipalidad. Sin embargo, existen distintos elementos, como los plásticos de baja densidad (PBD), limpios los cuales pueden ser reciclados. OBJETIVO: Implementar de un programa de reciclaje de plásticos de baja de densidad limpios en el Servicio de Pabellón Central del Hospital Clínico UC-Christus. MATERIAL Y MÉTODOS: En este reporte se realizó un estudio prospectivo longitudinal con una muestra por conveniencia, en la cual se programó una intervención en series repetidas en el tiempo durante 2017 al 2018. Participaron residentes de anestesia, anestesiólogos, enfermeras, TENS, personal de apoyo del hospital entre otros. RESULTADOS: En total 200 colaboradores participaron. Durante la fase piloto se cuantificó 30 kg de plásticos, posteriormente, se incrementó a 100 kg de PBD en las fases posteriores. Se comenzó con la fase de transferencia hacia otros pabellones dentro del centro asistencial y hacia otros centros de la Región Metropolitana. Finalmente, se comenzó a buscar alternativa con las municipalidades. CONCLUSIONES: Se logró cuantificar la cantidad de PBD limpios para reciclar. Se logró involucrar a los colaboradores de la institución. Este es el primer programa reportado que involucra una intervención para el PBD.
Assuntos
Humanos , Salas Cirúrgicas , Plásticos , Reciclagem , Anestesiologia/instrumentação , Estudos Prospectivos , Estudos Longitudinais , Planejamento em SaúdeRESUMO
Irisin is assumed to be a relevant link between muscle and weight maintenance as well as to mediate exercise benefits on health. The aim of this study was to assess the possible associations between irisin levels and glucose homeostasis in obese subjects with metabolic syndrome (MetS) following an energy-restricted treatment. Ninety-six adults with excessive body weight and MetS features underwent a hypocaloric dietary pattern for 8 weeks, within the RESMENA randomized controlled trial (www.clinicaltrials.gov; NCT01087086). After the intervention, dietary restriction significantly reduced body weight and evidenced a dietary-induced decrease in circulating levels of irisin in parallel with improvements on glucose homeostasis markers. Interestingly, participants with higher irisin values at baseline (above the median) showed a greater reduction on glucose (P=0.022) and insulin (P=0.021) concentrations as well as on the homeostasis model assessment index (P=0.008) and triglycerides (P=0.006) after the dietary intervention, compared with those presenting low-irisin baseline values (below the median). Interestingly, a positive correlation between irisin and carbohydrate intake was found at the end of the experimental period. In conclusion, irisin appears to be involved in glucose metabolism regulation after a dietary-induced weight loss.
RESUMO
To determine whether peer-reviewed consensus statements have changed clinical practice, we surveyed acromegaly care in specialist centers across the globe, and determined the degree of adherence to published consensus guidelines on acromegaly management. Sixty-five acromegaly experts who participated in the 7th Acromegaly Consensus Workshop in March 2009 responded. Results indicated that the most common referring sources for acromegaly patients were other endocrinologists (in 26% of centers), neurosurgeons (25%) and primary care physicians (21%). In sixty-nine percent of patients, biochemical diagnoses were made by evaluating results of a combination of growth hormone (GH) nadir/basal GH and elevated insulin like growth factor-I (IGF-I) levels. In both Europe and the USA, neurosurgery was the treatment of choice for GH-secreting microadenomas and for macroadenomas with compromised visual function. The most widely used criteria for neurosurgical outcome assessment were combined measurements of IGF-I and GH levels after oral glucose tolerance test (OGTT) 3 months after surgery. Ninety-eight percent of respondents stated that primary treatment with somatostatin receptor ligands (SRLs) was indicated at least sometime during the management of acromegaly patients. In nearly all centers (96%), the use of pegvisomant monotherapy was restricted to patients who had failed to achieve biochemical control with SRL therapy. The observation that most centers followed consensus statement recommendations encourages the future utility of these workshops aimed to create uniform management standards for acromegaly.
Assuntos
Acromegalia/terapia , Endocrinologia/métodos , Endocrinologia/tendências , Prática Profissional/tendências , Acromegalia/epidemiologia , Austrália/epidemiologia , Brasil/epidemiologia , Canadá/epidemiologia , China/epidemiologia , Coleta de Dados , Europa (Continente)/epidemiologia , Humanos , Internacionalidade , Neurocirurgia/métodos , Neurocirurgia/estatística & dados numéricos , Nova Zelândia/epidemiologia , Médicos de Atenção Primária , Período Pós-Operatório , Prática Profissional/estatística & dados numéricos , Resultado do Tratamento , Estados Unidos/epidemiologiaRESUMO
The clinical case of a 23 days old male newborn with prenatal ultrasonographic diagnosis of choledochal cyst is described and discussed. The diagnosis was first suspected in the 23rd gestation week and confirmed in the 35th. The advantages of prenatal ultrasonographic diagnosis and early surgical management in patients with choledochal cyst are emphasized.