ACP1 y la asociación entre obesidad y diabetes tipo 2. Un estudio confirmatorio / ACP1 AND THE ASSOCIATION BETWEEN OBESITY AND TYPE 2 DIABETES . A CONFIRMATION STUDY

En un estudio previo sobre sujetos con enfermedades cardiovasculares (ECV) hemos observado que en los pacientes obesos con genotipo *B/*B en el gen ACP1, la proporción de pacientes con diabetes mellitus tipo 2 (DM2) es significativamente menor en comparación con pacientes con otros genotipos en el gen ACP1. En este trabajo hemos llevado a cabo un nuevo estudio en sujetos con DM2 sin ECV y en sujetos no diabéticos sin ECV. Hemos estudiado 277 sujetos con DM2 sin ECV y 137 sujetos sanos sin DM2 y sin ECV. Se obtuvo el consentimiento informado de estos sujetos para participar en el estudio que fue aprobado por el Departamento institucional respectivo. El genotipo presente en el gen ACP1 se determinó por análisis de ADN. Las pruebas estadísticas fueron realizadas con el programa SPSS. El genotipo *B/*B que está asociado con la mayor concentración de isoforma F ejerce un efecto protector sobre la susceptibilidad a la DM2 en sujetos obesos. Se observa una correlación negativa entre la concentración de la isoforma F y el índice de probabilidades para la susceptibilidad a la DT2 en sujetos obesos. La presente observación confirma la asociación previamente observada en sujetos con ECV haciendo improbable la posibilidad de un mero artefacto casual de muestreo. La expresión de las isoformas de ACP1 en el tejido adiposo a través de una acción sobre la proteína de unión a los lípidos de los adipocitos y el metabolismo de los lípidos puede ejercer un papel importante en la susceptibilidad a la DM2 en sujetos obesos.

In a previous study on subjects with cardiovascular diseases (CVD) we have observed that in obese patients with ACP1*B/*B genotype the proportion of those with type 2 diabetes (T2D) is significantly lower as compared to other ACP1 genotypes. We have now carried a new study in subjects with T2D without CVD and in non diabetic subjects without CVD. We have studied 277 subjects with T2D without CVD and 137 healthy subjects without T2D and without CVD. Iinformed consent was obtained from these subjects to participate to the study that was approved by the Council of Department. ACP1 genotype was determined by DNA analysis. Statistical tests were carried out by SPSS programs. ACP1*B/*B genotype which is associated with the highest concentration of F isoform exerts a protective effect on susceptibility to T2D in obese subjects. A negative correlation is observed between F isoform concentration and odds ratio for susceptibility to T2D in obese subjects The present observation confirms the association previously observed in subjects with CVD making unlikely the possibility of a mere sampling chance artifact. The expression of ACP1 isoforms in adipose tissue trough an action on adipocytes lipid binding protein and lipid metabolism may exert an important role in the susceptibility to T2D in obese subjects

Implementing apportionment strategy to identify costs in a multidisciplinary clinic / Implantação de estratégia de rateio para identificação do custo em clínica multidisciplinar

ABSTRACT Objective To present the implementation of an apportionment strategy proportional to the productive areas of a multidisciplinary clinic, defining the minimum values to be passed monthly to health professionals who work there. Methods A study of the clinic structure was carried out, in which the area of occupation of each service was defined. Later the cost was prorated, allocating a value to each room, proportional to the space occupied. Results The apportionment implementation allowed the clinic managers to visualize the cost of each room, providing a value base for formation of a minimum amount necessary to be passed monthly to each professional, as a form of payment for rent of using their facilities. Conclusion The risk of financial loss of the clinic was minimized due to variation of its productivity, as well as the conditions of transference at the time of hiring by professionals were clear, promoting greater confidence and safety in contract relations.

RESUMO Objetivo Apresentar a implantação de uma estratégia de rateio proporcional às áreas produtivas de uma clínica multidisciplinar, definindo valores mínimos a serem repassados mensalmente aos profissionais de saúde que as ocupam. Métodos Estudo da estrutura da clínica, no qual foi definida, em metros quadrados, a área de ocupação de cada serviço. Em seguida, o custo foi rateado, alocando um valor a cada sala, proporcional ao espaço ocupado. Resultados A implantação do rateio possibilitou aos gestores da clínica estudada visualizar o custo de cada sala, fornecendo uma base de valor para formação de um valor mínimo necessário a ser repassado mensalmente para cada profissional, como forma de pagamento pelo aluguel de utilização de suas instalações. Conclusão Minimizou-se o risco de prejuízo da clínica pela variação de sua produtividade, bem como ficaram claras as condições de repasse no momento de contratação do aluguel pelos profissionais, promovendo maior confiança e segurança na relação contratual.

The Rabbit Model of Femoral Bone Defects: Steps to Overcome Potential Pitfalls.

Aims: To identify the potential pitfalls and indicate procedures to prevent them, during the evaluation of biomaterials for orthopaedic and craniofacial research in the New Zealand White (NZW) rabbit animal model of femoral bone defects. Place and Duration of Study: Laboratory for Research of the Musculoskeletal System, School of Medicine, University of Athens, between June 2014 and July 2015. Materials and Methods: Pre-emptive analgesia (carprofen 2.2 mg/kg sc), chemoprophylaxis (enrofloxacin 10 mg/kg sc) and anaesthesia (ketamine/xylazine 30/5 mg/kg im) were administered to NZW rabbits (body weight 3.3±0.2 kg, mean ± SD) for the aseptic surgical creation of drilled bone defects of 6 mm diameter (“critical size defect”) in the external femoral condyle of the left limb. All rabbits recovered without post-surgical complications from the first postoperative day. Results and Discussion: Although the research group consisted of Veterinarians and Orthopaedic Surgeons with experience in this model, they were challenged with potential pitfalls which were overcome step by step. Among them is the precise localization of the defect to be drilled. Intra-operative palpation of the external femoral condyle assists in determining the site, and post-operative X-ray evaluation confirms it. Additionally the correct width and depth of the bone defect are important to adhere to, which was achieved by using a 5.5 mm diameter bone drill and observing its depth marks. Another challenge is to have the specific amount of biomaterial implanted confined to the defect. Its potential distribution in the femoral shaft, diffusion in the metaphysial trabecular bone or excessive covering of the bone surface, are also pitfalls to be avoided. Conclusions: The increased use of this animal model in the evaluation of biomaterials in orthopaedic and craniofacial research requires knowledge, skills, surgical accuracy and attention to a sequence of steps, in order to achieve homogenous results and high repeatability of the implantation technique. With the fulfillment of these conditions, the extraction of valid scientific results and reduction of the number of animals used are possible.

HBV Infection in Italian and Non-Italian Patients in Northern Italy.

Aims: The introduction of HBV vaccination in Italy has reduced the incidence and prevalence of HBV infection. However, increasing immigration from countries in which HBV is endemic has led to a wave of new HBsAg-positive subjects and their clinical impact needs evaluation. We compared the serological, clinical and epidemiological data relating to Italian and non-Italian subjects referred to a hospital in Northern Italy. Study Design: We retrospectively analysed the laboratory and clinical records of 488 subjects, including 107 (21.9%) non-Italians, in order to find data concerning clinical diagnoses, possible routes of infection, anti-HCV and anti-HDV antibodies. Results: The differences in gender distribution and mean age between the non-Italian and Italian patients were statistically significant (p<.001). There were no significant differences in the prevalence of anti-HCV (2.9% vs 4.9%, p=.86) or anti-HDV (4.7% vs 5.0%, p=.89) co-infection, or the presence of HBeAg in chronic infection. There were no differences in the rates of acute (3.3% vs 5.1%; p=.68) or chronic infections (96.7% vs 94.9%; p=.68) infections, but there were statistically significant differences (p<.001) in the rates of prevalent (54.5% vs 85.3%) and incident cases (45.5% vs 14.7%). The differences in the rates of asymptomatic (70.6% vs 34.9%) and symptomatic patients (29.4% vs 65.1%) were also statistically significant (p<.001). The only significant differences in terms of risk factors related to transfusions (0% vs 6.8%; p=.04), and vertical/perinatal transmission (44.1% vs 6.8%; p<.001). Conclusion: The non-Italian HBsAg-positive subjects were mainly women and younger than their Italian counterparts, and had a recent diagnosis. They were predominantly asymptomatic and probably considered themselves healthy and fit to emigrate. Perinatal transmission among non-Italians is still an important risk factor that reflects the epidemiological situation of their countries of origin.