Dopamine-related deficit in reward learning after catecholamine depletion in unmedicated, remitted subjects with bulimia nervosa

Disturbances in reward processing have been implicated in bulimia nervosa (BN). Abnormalities in processing reward-related stimuli might be linked to dysfunctions of the catecholaminergic neurotransmitter system, but findings have been inconclusive. A powerful way to investigate the relationship between catecholaminergic function and behavior is to examine behavioral changes in response to experimental catecholamine depletion (CD). The purpose of this study was to uncover putative catecholaminergic dysfunction in remitted subjects with BN who performed a reinforcement-learning task after CD. CD was achieved by oral alpha-methyl-para-tyrosine (AMPT) in 19 unmedicated female subjects with remitted BN (rBN) and 28 demographically matched healthy female controls (HC). Sham depletion administered identical capsules containing diphenhydramine. The study design consisted of a randomized, double-blind, placebo-controlled crossover, single-site experimental trial. The main outcome measures were reward learning in a probabilistic reward task analyzed using signal-detection theory. Secondary outcome measures included self-report assessments, including the Eating Disorder Examination-Questionnaire. Relative to healthy controls, rBN subjects were characterized by blunted reward learning in the AMPT-but not in placebo-condition. Highlighting the specificity of these findings, groups did not differ in their ability to perceptually distinguish between stimuli. Increased CD-induced anhedonic (but not eating disorder) symptoms were associated with a reduced response bias toward a more frequently rewarded stimulus. In conclusion, under CD, rBN subjects showed reduced reward learning compared with healthy control subjects. These deficits uncover disturbance of the central reward processing systems in rBN related to altered brain catecholamine levels, which might reflect a trait-like deficit increasing vulnerability to BN.

[Prosthetic rehabilitation of a traumatic occlusion due to bulimia nervosa. Case report]

Because of the typical localisation of erosions in anorectic/bulimic patients, the dentist is frequently the first medical person to discern this general illness (anorexia and bulimia nervosa). From the dental viewpoint, the aim should be to preserve sound dental tissue and to prevent further toothwear. A restorative treatment is to be carried out only after causal therapy and after resolving the basic disease. By means of this procedure a good long-term prognosis can be expected. Considering the patient's young age, dentistry should be preservative using the adhesive technique. This case report documents the systematic procedure of the functional and esthetic rehabilitation of an eroded dentition and shows factors essential to the treatment.

Behavioral responses to catecholamine depletion in unmedicated, remitted subjects with bulimia nervosa and healthy subjects

BACKGROUND: Bulimia nervosa (BN) has been associated with dysregulation of the central catecholaminergic system. An instructive way to investigate the relationship between catecholaminergic function and psychiatric disorder has involved behavioral responses to experimental catecholamine depletion (CD). The purpose of this study was to examine a possible catecholaminergic dysfunction in the pathogenesis of bulimia nervosa. METHODS: CD was achieved by oral administration of alpha-methyl-para-tyrosine (AMPT) in 18 remitted female subjects with BN (rBN) and 31 healthy female control subjects. The study design consisted of a randomized, double blind, placebo-controlled crossover, single-site experimental trial. The main outcome measures were bulimic symptoms assessed by the Eating Disorder Examination-Questionnaire. Measures were assessed before and 26, 30, 54, 78, 102 hours after the first AMPT or placebo administration. RESULTS: In the experimental environment (controlled environment with a low level of food cues) rBN subjects had a greater increase in eating disorder symptoms during CD compared with healthy control subjects (condition × diagnosis interaction, p < .05). In the experimental environment, rBN subjects experienced fewer bulimic symptoms than in the natural environment (uncontrolled environment concerning food cues) 36 hours after the first AMPT intake (environment × diagnosis interaction, p < .05). Serum prolactin levels increased significantly, and to a comparable degree across groups, after AMPT administration. CONCLUSIONS: This study suggests that rBN is associated with vulnerability for developing eating disorder symptoms in response to reduced catecholamine neurotransmission after CD. The findings support the notion of catecholaminergic dysfunction as a possible trait abnormality in BN.

The Role of BDNF, Leptin and Catecholamines in Reward Learning in Bulimia Nervosa

Background: A relationship between bulimia nervosa (BN) and reward-related behavior is supported by several lines of evidence. The dopaminergic dysfunctions in the processing of reward-related stimuli have been shown to be modulated by the neurotrophin brain derived neurotrophic factor (BDNF) and the hormone leptin. Methods: Using a randomized, double-blind, placebo-controlled, crossover design, a reward learning task was applied to study the behavior of 20 female subjects with remitted BN (rBN) and 27 female healthy controls under placebo and catecholamine depletion with alpha-methyl-para-tyrosine (AMPT). The plasma levels of BDNF and leptin were measured twice during the placebo and the AMPT condition, immediately before and 1 h after a standardized breakfast. Results: AMPT-induced differences in plasma BDNF levels were positively correlated with the AMPT-induced differences in reward learning in the whole sample (p = 0.05). Across conditions, plasma BDNF levels were higher in rBN subjects compared to controls (diagnosis effect; p = 0.001). Plasma BDNF and leptin levels were higher in the morning before compared to after a standardized breakfast across groups and conditions (time effect; p < 0.0001). The plasma leptin levels were higher under catecholamine depletion compared to placebo in the whole sample (treatment effect; p = 0.0004). Conclusions: This study reports on preliminary findings that suggest a catecholamine-dependent association of plasma BDNF and reward learning in subjects with rBN and controls. A role of leptin in reward learning is not supported by this study. However, leptin levels were sensitive to a depletion of catecholamine stores in both rBN and controls.

Safe refeeding management of anorexia nervosa inpatients: an evidence-based protocol.

OBJECTIVE Anorexia nervosa is associated with several serious medical complications related to malnutrition, severe weight loss, and low levels of micronutrients. The refeeding phase of these high-risk patients bears a further threat to health and potentially fatal complications. The objective of this study was to examine complications due to refeeding of patients with anorexia nervosa, as well as their mortality rate after the implementation of guidelines from the European Society of Clinical Nutrition and Metabolism. METHODS We analyzed retrospective, observational data of a consecutive, unselected anorexia nervosa cohort during a 5-y period. The sample consisted of 65 inpatients, 14 were admitted more than once within the study period, resulting in 86 analyzed cases. RESULTS Minor complications associated with refeeding during the first 10 d (replenishing phase) were recorded in nine cases (10.5%), four with transient pretibial edemas and three with organ dysfunction. In two cases, a severe hypokalemia occurred. During the observational phase of 30 d, 16 minor complications occurred in 14 cases (16.3%). Six infectious and 10 non-infectious complications occurred. None of the patients with anorexia nervosa died within a follow-up period of 3 mo. CONCLUSIONS Our data demonstrate that the seriousness and rate of complications during the replenishment phase in this high-risk population can be kept to a minimum. The findings indicate that evidence-based refeeding regimens, such as our guidelines are able to reduce complications and prevent mortality. Despite anorexia nervosa, our sample were affected by serious comorbidities, no case met the full diagnostic criteria for refeeding syndrome.

The prevalence of bulimia nervosa and bulimic behaviors among university students in Texas

This cross-sectional study examined by questionnaire the prevalence of bulimia nervosa and bulimic behaviors in a sample of 1175 undergraduate students enrolled in two state-supported universities in Texas. In one university, the student population was predominantly white; in the other, it was predominantly black. Fifty-nine percent of the respondents were female and 41% were male. Information regarding age, sex, ethnicity, college major, college year, marital status, housing arrangements, religion, socioeconomic status, height, weight, dieting behaviors, and family history of alcoholism, drug abuse, and depression was collected. Bulimia status was assessed using the Revised Bulimia Test (BULIT-R), which is based on the DSM-III-R criteria for bulimia nervosa. Only 1.3% of the females and 0.4% of the males were classified as having bulimia nervosa. The prevalence of bulimic behaviors was considerably higher; 6.4% of the females and 3.6% of the males were classified as having bulimic behaviors. Univariate analysis showed the following factors to be significantly associated with bulimic behaviors: female gender, single marital status, high BMI, a family history of alcoholism, drug abuse, or depression, and certain dieting behaviors. In the present study, ethnicity did not prove to be a significant factor associated with bulimia nervosa or bulimic behaviors. Multivariate analysis showed that, in comparison to normal/underweight individuals, the odds of having bulimic behaviors for severely overweight subjects were 2.23 (95% CI: 1.43, 3.50). Students who were dieting at the time of the study were 3.22 times (95% CI: 2.05, 5.06) as likely to have bulimic behaviors as were students who had never dieted. This study concludes there is a need to distinguish between bulimia nervosa and bulimic behaviors when estimating prevalence of a population. ^

Teatro, exilio y crítica periférica

La intención del presente trabajo es abordar la práctica teatral de las compañías itinerantes española en el extremo sur del país durante el período de la guerra civil y el exilio. Leer desde allí, es decir, desde el evento teatral marginal, periférico, perdido en el territorio austral, lejos del escenario en cuestión, las determinaciones de producción y tratamiento que bien podrían considerarse, en un nivel macro, como generales a las prácticas artísticas de la centralidad. Intentar explicar la lógica de producción del teatro en el contexto de la violencia política, donde el control y la censura se esgrimen como los instrumentos eficaces para la homogeneización del discurso artístico en función de los intereses del Estado pero, desde el detalle y casi la anécdota del ejercicio teatral absolutamente periférico, no sólo para el teatro español sino también, para el propio teatro argentino, en un borde territorial absolutamente ignoto para la hegemonía del poder español tanto como para el de la Nación argentina.

Teatro, exilio y crítica periférica

La intención del presente trabajo es abordar la práctica teatral de las compañías itinerantes española en el extremo sur del país durante el período de la guerra civil y el exilio. Leer desde allí, es decir, desde el evento teatral marginal, periférico, perdido en el territorio austral, lejos del escenario en cuestión, las determinaciones de producción y tratamiento que bien podrían considerarse, en un nivel macro, como generales a las prácticas artísticas de la centralidad. Intentar explicar la lógica de producción del teatro en el contexto de la violencia política, donde el control y la censura se esgrimen como los instrumentos eficaces para la homogeneización del discurso artístico en función de los intereses del Estado pero, desde el detalle y casi la anécdota del ejercicio teatral absolutamente periférico, no sólo para el teatro español sino también, para el propio teatro argentino, en un borde territorial absolutamente ignoto para la hegemonía del poder español tanto como para el de la Nación argentina.

Teatro, exilio y crítica periférica

La intención del presente trabajo es abordar la práctica teatral de las compañías itinerantes española en el extremo sur del país durante el período de la guerra civil y el exilio. Leer desde allí, es decir, desde el evento teatral marginal, periférico, perdido en el territorio austral, lejos del escenario en cuestión, las determinaciones de producción y tratamiento que bien podrían considerarse, en un nivel macro, como generales a las prácticas artísticas de la centralidad. Intentar explicar la lógica de producción del teatro en el contexto de la violencia política, donde el control y la censura se esgrimen como los instrumentos eficaces para la homogeneización del discurso artístico en función de los intereses del Estado pero, desde el detalle y casi la anécdota del ejercicio teatral absolutamente periférico, no sólo para el teatro español sino también, para el propio teatro argentino, en un borde territorial absolutamente ignoto para la hegemonía del poder español tanto como para el de la Nación argentina.

Sensibilização ao látex em pacientes com mielomeningocele na urologia do HC-FMUSP: prevalência e fatores associados

INTRODUÇÃO: A alergia ao látex é um importante problema de saúde pública, especialmente em grupos de risco que têm contato frequente com este potente alérgeno. Este estudo estimou a prevalência e os fatores de risco para sensibilização ao látex em pacientes com mielomeningocele (MMC) submetidos a procedimentos cirúrgicos urológicos no HC-FMUSP. MÉTODOS: Foram selecionados pacientes com MMC submetidos a pelo menos uma cirurgia urológica, entre 2009 e 2014.Todos foram entrevistados e seus prontuários revisados. Uma amostra de sangue permitiu que a IgE específica ao látex, a K82, e seus recombinantes fossem investigados pelo método lmmunoCAP100 (kUa/L -1). A associação entre a exposição e o desfecho foi avaliada por meio de regressão logística de Poisson, Quiquadrado ou o teste exato de Fischer, para variáveis categóricas. O teste t de Student foi utilizado para comparar variáveis contínuas (nível de significância de 5%). Foram calculados a razão de prevalência (RP) e o intervalo de confiança de 95%. RESULTADOS: Foram identificados Duzentos e doze pacientes (51% do sexo masculino, 20,4 ± 6,4 anos de idade), 68 foram submetidos a pelo menos um procedimento urológico e 51 aceitaram participar (87,9%). Vinte e nove pacientes foram considerados não-sensibilizados (IgE específica para o látex :: a 0,7 kUa/L) e 22 sensibilizados ao látex com IgE > 0,7 kUa/L. Quando comparados os dois grupos, o sensibilizado apresentou um número de procedimentos cirúrgicos maior (11,6 ± 5,9 vs 7,2 ± 5,6) e dentre eles 48,3% apresentaram alguma alergia anterior contra 27,6% no grupo não sensibilizado. A sensibilização ao látex foi independentemente associada com alergia a produtos de látex (p = 0,014) e com o número de cirurgias anteriores (p = 0,032). A alergia ao látex tinha uma razão de prevalência de 2,87 (95% Cl: 1,24 a 6,65) ajustado para o número de cirurgias. Para cada procedimento cirúrgico, ajustado à alergia a produtos que contém látex, aumentou o risco para sensibilização em 4% (PR = 1,04; 95% CI: 1,00-1,09). CONCLUSÕES: A história de alergia ao látex e o número de cirurgias foram fatores de risco independentes para sensibilização ao látex

Estudo de efeitos da polarização eletrostática periférica no Tokamak TCABR

Efeitos da polarização eletrostática de eletrodos na periferia de tokamaks têm sido investigados em pequenos tokamaks e mesmo em alguns tokamaks de grande porte. Em geral as experiências são realizadas em condições em que bifurcação do campo elétrico radial é obtida, processo este identificado como modo H de polarização. No Tokamak TCABR, as experiências indicam que o confinamento aumenta para tensões aplicadas até +300 volts, atingindo um máximo de duas vezes o tempo de confinamento do modo L, mas sem bifurcação. Indícios de bifurcação foram notados com +400 V de polarização, mas a descarga termina devido à excitação da atividade MHD, ainda sob investigação. No presente trabalho, a pesquisa é aprofundada com a utilização de uma sonda de Langmuir com 18 pinos dispostos em duas fileiras sob a forma de um ancinho (rake probe) o que permite a medição da temperatura, densidade e flutuação de potencial ao longo do raio menor na periferia do Tokamak. A resolução temporal desse sistema é de cerca de 0,5 ms, para a temperatura, e 5 microssegundos para densidade e potencial flutuante do plasma. Outra sonda eletrostática com 5-pinos na mesma posição radial, mas em diferentes posições poloidal e toroidal foi usada para medições de turbulência e transporte de partículas. Os efeitos da polarização foram investigados e indicam que os níveis de turbulência e transporte começam a diminuir entre +150 e +200 V e para +300 V chegam a atingir uma quase supressão. Nesse mesmo intervalo de tensão a densidade começa a aumentar e para +300 V chega a ser um fator de aproximadamente 2. Quanto ao perfil de temperatura a variação é pouco significativa, mas as incertezas das medidas são maiores. Esses dados são compatíveis com a criação de uma barreira de transporte na região entre o eletrodo em r = 17 cm e o limitador em a = 18 cm. Além disso, o campo elétrico radial mostra forte cisalhamento nessa região. Tomando o início da subida do potencial flutuante como origem de uma escala de tempo, o atraso temporal do início da subida da densidade de elétrons e o atraso do início do decréscimo do transporte de partículas foram medidos. Os resultados são 50 microssegundos para a densidade de elétrons e 60 microssegundos para o transporte de partículas. A questão dos limiares de potência é discutida no texto. Os dados desta experiência indicam que o campo elétrico radial desempenha o papel principal para a melhoria do confinamento.