Abordagem neuropsicológica das alterações na atenção e memória no sindroma de Burnout

O sindroma de Burnout, quadro psicofisio-patológico tem sido objecto de investigação intensiva, desde o artigo de Freudenberger (1974) intitulado "Staff Burnout", com dois objectivos: compreendê-lo melhor, através de meios de diagnóstico, e criar técnicas de intervenção terapêutica. Na realidade, desde essa altura, foram efectuados e publicados um número avultado de trabalhos de investigação, nos campos do diagnóstico e caracterização do Burnout, e da sua resolução terapêutica. O pensamento dominante, nessa altura e ainda hoje, é de tendência analítica e/ou psico-social. Este quadro, espoletado por uma sucessão de episódios emocionalmente negativos em contexto ocupacional em indivíduos com provável predisposição genética e sujeitos a situações de pressão laboral, dos mais diversos tipos (podendo ir do “simples” stress por acumulação de tarefas até às situações de mobbing), tem efeitos frequentemente dramáticos ao nível da dinâmica biopsico- social, nos seus mais diversos aspectos. Estes estendem-se, quase sempre, muito para lá das problemáticas laborais, prejudicando, de forma mais ou menos grave, as interacções sociais com particular impacto ao nível da dinâmica familiar. Por outro lado, o Burnout propicia o aparecimento de patologias diversas, já que toda a estrutura psiconeuro-endocrino-imunulógica estará posta em causa, potenciando situações de fragilidade sistémica. No entanto, há aspectos correlacionáveis com este quadro disfuncional que têm sido muito pouco abordados – alterações cognitivo-operativas ou neuropsicológicas. Aliás os trabalhos que sobre eles incidem são em número muito reduzido. Assim após termos registado queixas, acentuadas, ao nível da capacidade de concentração e da memória em pessoas com burnout observadas na clínica hospitalar e privada, decidimos investigar estas situações, usando uma metodologia clínica de tipo qualitativo, e constatámos que, na realidade, as queixas eram pertinentes. Posto isto, achámos que a situação deveria ser aprofundada e partimos para um trabalho mais sistematizado, este, com o objectivo de caracterizar melhor o tipo de disfunções atencionais e mnésicas. Para isso, após uma selecção prévia, a partir de um grupo de 192 enfermeiros que responderam à Escala de Maslach, avaliámos uma amostra de risco constituída por 40 enfermeiros e enfermeiras, de Instituições Psiquiátricas da Grande Lisboa, trabalhando em urgência e enfermaria, que comparámos com uma amostra de igual número de enfermeiros, desenvolvendo a sua actividade na consulta externa ou em ambientes mais protegidos de stress ocupacional continuo. Para o efeito, e após uma anamnese cuidada, aplicámos provas de atenção e memória, sensíveis a qualquer tipo de compromisso encefálico seja ele funcional ou patológico. Para a componente atenção/concentração e a componente vísuo-grafo-espacial usámos a prova de Toulouse-Piéron, assim como as séries de dígitos ou digit span, para a vertente audio-verbal. A dinâmica mnésica foi avaliada através da prova de memória associativa (Escala de Memória de Wechsler) para testar a variante áudio-verbal, e a reprodução de figuras (Escala de Memória de Wechlser). Os resultados, após uma dupla análise clínica e estatística, comprovaram globalmente as hipóteses, indicando uma correlação significativa entre o grau de Burnout e os défices neuropsicológicos detectados: alteração da atenção/concentração e dismnésia, de natureza limitativa face às exigências quotidianas dos indivíduos. Finalmente, com base na revisão da literatura e os resultados deste estudo, foi esquematizado um Modelo Neuropsicológico do sindroma de Burnout, que nos parece espelhar as relações entre este quadro clínico, as alterações cognitivooperativas encontradas e as principais estruturas encefálicas, que julgamos, implicadas em toda a dinâmica do processo disfuncional.

Studies of epithelial response to streptozotocin-induced hyperglycemia

A hiperglicemia é a principal característica da diabetes mellitus (DM), uma das causas de morte que mais cresce em Portugal, e cujas complicações a longo prazo são mais debilitantes e mais sobrecarregam os sistemas de saúde. No entanto, os mecanismos subjacentes à resposta fisiológica de alguns tecidos à hiperglicemia não estão completamente esclarecidos. Este estudo teve como objetivo avaliar de que forma o tempo de exposição à hiperglicemia afeta dois tecidos epiteliais, o endotélio e as glândulas salivares, que são frequentemente associados a complicações da DM, utilizando um modelo animal. Adicionalmente, procurou-se encontrar novos biomarcadores para avaliar a suscetibilidade a complicações orais em diabéticos, analisando as modificações pós-traducionais (PTMs) da família de proteínas mais representativa na saliva humana: proteínas ricas em prolina (PRPs). A disfunção vascular está na origem de várias complicações da diabetes. Neste sentido, observou-se uma progressiva disfunção endotelial com o aumento do tempo de exposição à hiperglicemia, que resulta do aumento de danos no endotélio e da diminuição da capacidade de mobilização de células progenitoras. Simultaneamente, o aumento observado na atividade da via de ativação do sistema de complemento mediada por lectinas (MBL), sugere um envolvimento do sistema de imunidade inata na patogénese da disfunção vascular. Outra complicação comum da DM é o desenvolvimento de doenças orais, nomeadamente as relacionadas com a redução da secreção salivar. Na análise às glândulas submandibulares, observou-se uma resposta inicial à hiperglicemia com fortes variações na expressão de proteínas, mas a longo prazo, estas variações foram atenuadas, sugerindo um mecanismo de adaptação à hiperglicemia crónica. Adicionalmente, as proteínas relacionadas com a secreção, como as anexinas, apresentaram-se sobre-expressas, enquanto as calicreinas e proteínas metabólicas estavam sub-expressas. Estas variações sugerem que, apesar de uma diminuição da capacidade de regeneração, as células tentam superar a perda de tecido por meio do aumento da secreção, embora sem êxito. O comprometimento funcional das glândulas salivares tem consequências na composição e funções da saliva. Analisando as PTMs das PRPs salivares humanas, observou-se um aumento da frequência de péptidos com ciclização de resíduos N-terminais de glutamina a piroglutamato, o que confere uma resistência à atividade proteolítica que, por sua vez, se encontra aumentada em diabéticos. Assim, a presença de péptidos com N-piroglutamato poderá ser um potencial biomarcador da suscetibilidade a complicações orais em diabéticos.

Toxicogenomics of natural and anthropogenic effectors in eleutheroembryos

The introduction of chemicals into the environment by human activities may represent a serious risk to environmental and human health. Environmental risk assessment requires the use of efficient and sensitive tools to determine the impact of contaminants on the ecosystems. The use of zebrafish for the toxicity assessment of pharmaceuticals, drugs, and pollutants, is becoming well accepted due to zebrafish unique advantages for the screening of compounds for hazard identification. The aim of the present work is to apply toxicogenomic approaches to identify novel biomarkers and uncovered potential modes of action of classic and emergent contaminants able to disrupt endocrine systems, such as the Retinoic Acid Receptor, Retinoid X Receptor and the Aryl Hydrocarbon Receptor. This study relies on different nuclear and cytosolic protein receptors and other conditional (ligand- or stress- activated) transcriptional factors that are intimately involved in the regulation of defensome genes and in mechanisms of chemical toxicity. The transcriptomic effects of organic compounds, endogenous compounds, and nanoparticles were analysed during the early stages of zebrafish development. Studying the gene expression profiles of exposed and unexposed organisms to pollutants using microarrays allowed the identification of specific gene markers and to establish a "genetic code" for the tested compounds. Changes in gene expression were observed at toxicant concentrations that did not cause morphological effects. Even at low toxicant concentrations, the observed changes in transcript levels were robust for some target genes. Microarray responses of selected genes were further complemented by the real time quantitative polymerase chain reaction (qRT-PCR) methodology. The combination of bio-informatic, toxicological analyses of differential gene expression profiles, and biochemical and phenotypic responses across the treatments allowed the identification of uncovered potential mechanisms of action. In addition, this work provides an integrated set of tools that can be used to aid management-decision making by improving the predictive capability to measure environmental stress of contaminants in freshwater ecosystems. This study also illustrates the potential of zebrafish embryos for the systematic, large-scale analysis of chemical effects on developing vertebrates.

Occurrence and fate of estrogens and antibiotics in the environment evaluated by low-cost analytical methodologies

Endocrine disruptors and pharmaceuticals are considered to be concerning environmental contaminants. During the last two decades, studies dealing with the occurrence and fate of these emerging contaminants in the aquatic environment have raised attention and its number is constantly increasing. The presence of these contaminants in the environment is particularly important since they are known to induce adverse effects in the ecosystems even at extremely low concentrations. Estrogens and antibiotics, in particular, are identified as capable of induce endocrine disruption and contribute for the appearance of multi-resistant bacteria, respectively. A better assessment and understanding of the real impact of these contaminants in the aquatic environment implies the evaluation of their occurrence and fate, which is the main aim of this Thesis. Two estrogens (17-estradiol and 17-ethinylestradiol) and an antibiotic (sulfamethoxazole) were the contaminants under study and their occurrence in surface and waste waters was assessed by the implementation of enzyme linked immunosorbent assays (ELISAs). The assays were optimized in order to accomplish two important aspects: to analyze complex water samples, giving special attention to matrix effects, and to increase the sensitivity. Since the levels of these contaminants in the environment are extremely low, a pre-concentration methodology was also object of study in this Thesis. Dispersive liquid-liquid microextraction (DLLME) was developed for the preconcentration of E2 and EE2, subsequently quantified by either highperformance liquid chromatography (HPLC) and the previously optimized ELISAs. Moreover, the use of anthropogenic markers, i.e. indicators of human presence or activity, has been discussed as a tool to track the origin and type of contamination. An ELISA for the quantification of caffeine, as an anthropogenic marker, was also developed in order to assess the occurrence of human domestic pollution in Portuguese surface waters. Finally, photodegradation is considered to be one of the most important pathways contributing for the mitigation of pollutants’ presence in the aquatic environment. Both direct and indirect photodegradation of E2 and EE2 were evaluated. Since the presence of humic substances (HS) is known to have a noticeable influence on the photodegradation of pollutants and in order to mimic the real aquatic environment, special attention was given to the influence of the presence and concentration of different fractions of HS on the photodegradation of both hormones.

Caracterização endócrina da PTH-L e calcitonina no transporte de cálcio e na secreção de bicarbonato no intestino da dourada (Sparus auratus)

Dissertação de Mestrado, Biologia Marinha, Faculdade de Ciências do Mar e do Ambiente, Universidade do Algarve, 2009

Análise e caracterização da expressão e papel funcional dos potenciais genes da família 2 GPCRs no protostómio Caenorhabditis elegans

Dissertação de Mestrado, Biotecnologia, Faculdade de Engenharia de Recursos Naturais, Universidade do Algarve, 2009

Evolution of the extracellular matrix in deuterostomes and the influence of calcitropic hormones

Tese de dout., Biologia (Biologia Molecular), Faculdade de Ciências e Tecnologia, Univ. do Algarve, 2010

A proteomic study of the effects of nutrient restriction in utero on postnatal metabolism

It is widely recognized that protein restriction in utero may cause metabolic and endocrine adaptations, which may be of benefit to the neonate on a short-term basis but may cause adverse long-term conditions such as obesity, Type 2 diabetes, metabolic syndrome, hypertension and cardiovascular diseases. Adequate foetal and early post natal nutrient and energy supply is therefore essential for adult animal health, performance and life span. In this project it was investigated the progressive adaptations of the hepatic proteome in male mink offspring exposed to either a low protein (FL) or an adequate protein (FA) diet in utero fed either on a low protein (LP) or on an adequate (AP) diet from weaning until sexual maturity. Specifically, the aim was to determine the metabolic adaptations at selected phases of the animal’s first annual cycle and establish the metabolic priorities occurring during those phases. The three different morphological stages studied during the first year of development included, end of bone growth at 4 months of age, maximal fat accretion at 6 months of age and sexual maturity at 12 months of age. A reference proteome of mink liver coming from these different animal groups were generated using 2D electrophoresis coupled to MALDI-TOF analysis and the way in which dietary treatment affect their proteome was established. Approximately 330 proteins were detected in the mink liver proteome. A total of 27 comparisons were carried out between all different animal groups which resulted in 20 differentially expressed proteins. An extensive survey was conducted towards the characterization of these proteins including their subcellular localization, the biological processes in which they are involved and their molecular functions. This characterization allowed the identification of proteins in various processes including the glycolysis and fatty acid metabolism. The detailed analysis of the different dietary treatment animal groups was indicative of differences in metabolism and also to changes associated with development in mink.

Effects of active pharmaceutical ingredients in mussel mytilus galloprovincialis

More than 3000 types of active pharmaceutical ingredients (APIs) are applied in Human and veterinary medicine practice. These compounds are considered an emergent class of environmental contaminants with the ability to cause damage and unexpected effects to aquatic organisms, namely in species of high commercial value. APIs are ubiquitous in the environment being frequently detected in influents and effluents of waste water treatment plants (WWTPs), surface waters and more distressingly in the public tap water in concentrations ranging from ng to μg.L-1. Considering these premises, the present thesis focused on APIs detection in the Arade river water, the impact of summer period in APIs’ concentration alterations applying the passive sampler device, POCIS (polar organic compound integrative sampler), as well as, the assessment of the effects caused by non-steroidal anti-inflammatory drugs (NSAID) ibuprofen (IBU) and diclofenac (DCF) and antidepressant selective serotonin reuptake inhibitor (SSRI) fluoxetine as single and mixture exposures along with a classical contaminant copper (Cu) on a non-target species, mussel Mytilus galloprovincialis. For this purpose, a multibiomarker approach was applied namely including biomarkers of oxidative stress (antioxidant enzymes activities of superoxide dismutase – SOD, catalase – CAT, glutathione reductase – GR and Phase II glutathione-S-transferase), damage - lipid peroxidation (LPO), neurotoxic effects (through the activity of acetylcholinesterase enzyme - AChE) and endocrine disruption (through vitellogenin-like proteins measurement applying the indirect method of alkali-labile phosphate - ALP) after exposure of mussel species’ to selected APIs at environmental relevant concentrations. The main results highlighted the occurrence of 19 APIs in the river Arade from several distinct therapeutic classes. Stimulant caffeine, antiasthmatic theophylline, NSAID ibuprofen and analgesic paracetamol presented the highest concentrations. Summer impact was inconclusive due to each API transient concentration in each month. The multibiomarker results revealed distinct responses towards each selected API (as single exposure or as mixtures) that were tissue and time dependent. Several multistressor interactions were proposed for each biomarker. The results also revealed APIs potential to induce oxidative stress, LPO, neurotoxicity and endocrine disruption even at extremely low concentrations on a species extremely vulnerable to APIs presence highlighting the urgency on the development of methodologies able to prevent its entrance in the aquatic environment.

Assessment of the mineralogenic toxicity of aquatic pollutants

In ecotoxicology a major focus is in the aquatic environment, not only because it presents a great economic value to man but it is an ecosystem widely affected by the growing anthropogenic pollution. Most of the studies performed relate to adverse effects in development, reproductive or endocrine disruption but little is known about the possible effects in bone formation and skeletal development. In this study, we set out to evaluate the effects of 8 aquatic pollutants on the skeletal development using an in vivo system, the zebrafish larvae aged 20 days post-fertilization, through chronic exposure. Several endpoints were considered such as the cumulative mortality, total length, occurrence of skeletal deformities and marker gene expression. We were able to establish LD50 values for some pollutants, like 3-methylcholanthrene, lindane, diclofenac, cobalt and vanadate and found that the total length was not affected by any of the pollutants tested. Cobalt was the most harmful chemical to affect hatching time, severely affecting the ability of the zebrafish embryos to hatch and overall the number of deformities increased upon exposure to tested chemicals but no patterns of deformities were identified. We also propose that 3-methylcholanthrene has an osteogenic effect, affecting osteoblast and osteoclast function and that op levels can act as a mediator of 3-methylcholanthrene toxic stress to the osteoblast. In turn we found naphthalene to probably have a chondrogenic effect. Our results provided new insights into the potential osteotoxicity of environmental pollutants. Future studies should aim at confirming these preliminary data and at determining mechanisms of osteotoxicity.

Desenvolvimento de um sistema multidimensional para classificação e gestão de informação em saúde: aplicabilidade à informação clínica

Introdução: A profusão de informação na área médica cria problemas de gestão, sendo necessários métodos sistematizados para armazenamento e recuperação. Quando a informação se insere no contexto do processo clínico, os métodos devem integrar terminologias biomédicas controladas e igualmente devem integrar as características desejáveis dirigidas à estrutura, conteúdo e resultados clínicos. O objectivo deste artigo é testar a aplicabilidade e capacidade de recuperação, de um sistema multidimensional desenvolvido para classificação e gestão de informação em saúde. Métodos: A partir das questões recebidas em seis anos (Serviço de Informação de Medicamentos, Serviços Farmacêuticos, Hospitais da Universidade de Coimbra), seleccionaram-se 300 questões sobre informação clínica, por método aleatório informatizado. Caracterizou-se e avaliou-se a aplicabilidade pela quantidade classificada e pela necessidade de alterações ao sistema que é constituído por várias dimensões independentes e que englobam conceitos por vezes hierarquizados. A recuperação das questões foi testada pesquisando informação numa dimensão ou cruzamento de dimensões. Resultados: Todas as questões foram classificadas: 53% são casos clínicos com incidência nas doenças geniturinárias; doenças metabólicas, nutricionais e endócrinas; neoplasias; infecções e doenças do sistema nervoso. Em 81%, o objecto é o medicamento, sobretudo anti-infecciosos e anti-neoplásicos. As áreas de terapêutica e segurança foram as mais solicitadas, incidindo principalmente sobre os assuntos: utilização, reacções adversas, identificação de medicamentos e tecnologia farmacêutica. Na aplicabilidade, foi necessário adicionar alguns conceitos e modificar alguns grupos hierárquicos que não modificaram a estrutura base, nem colidiram com as características desejáveis. As limitações prenderam-se com os sistemas de classificação externos integrados. A pesquisa na dimensão assunto, do conceito administração de medicamentos, recuperou 19 questões. O cruzamento de duas dimensões: anti-infecciosos (externa) e teratogenicidade (assunto), recuperou três questões. Nos dois exemplos recupera-se informação a partir de qualquer um dos níveis da hierarquia, do mais geral ao mais específico e mesmo a partir de dimensões externas. Conclusões: A utilização do sistema nesta amostra demonstrou aplicabilidade na classificação e arquivo de informação clínica, capacidade de recuperação e flexibilidade, sofrendo alterações sem interferir com as características desejáveis. Esta ferramenta permite a recuperação da evidência que interessa orientada para o doente. Introduction: The large amount of information in the medical area creates management problems, being necessary systematic methods for filing and retrieval. With information on the context of clinical records, methods must integrate controlled biomedical terminologies and desirable characteristics oriented to the structure, content and clinical results. The objective is to test the applicability and capacity for retrieval of a multidimensional system developed for classification and management of health information. Methods: Three hundred questions were randomly selected, by computerized method, from the questions received in six years (Medicine Information Service, Pharmaceutical Department, Coimbra University Hospitals). They were characterized and applicability evaluated by classified amount and need to alter the system, which is composed of various independent dimensions, incorporating concepts sometimes hierarchical. Questions retrieval was tested searching information in a dimension or between dimensions. Results: All questions were classified: 53% are clinical cases with illnesses incidence in the genitourinary system; metabolic, nutritional and endocrine disease; cancer; infections and nervous system. In 81%, the object is a drug, mostly anti-infectious and anti-neoplastic agents. The therapeutic and safety areas had been the most requested, regarding the subjects: use, adverse reactions, drug identification and pharmaceutical technology. As to applicability, it was necessary to add some concepts and modify same hierarchical groups, that didn’t modify the basic structure, nor had collided with the desirable characteristics. The limitations were related with the incorporated external classification systems. The search in the subject dimension of the concept drug administration retrieved 19 questions. The search between two dimensions: antiinfectious (external) and teratogenicity (subject) retrieved three questions. In the two examples, it was possible to retrieve information from any one of the levels of the hierarchy, from the most general to the most specific and even from external dimensions. Conclusions: The use of the system in this sample showed its applicability in clinical information classification and filing, retrieval capacity and flexibility, supporting modifications without interfering with desirable characteristics. This tool allows retrieval of patient-oriented evidence that matters.

Étude sur l’endocytose du récepteur de l’insuline : rôle du noeud de signalisation ATIC / PTPLAD1

La cellule utilise des nœuds d’interactions protéiques relativement stables, conservés et souvent constitués d’adaptateurs moléculaires pour gérer des signaux reçus (synthèse, sécrétion, traffic, métabolisme, division), des problèmes de sécurité et de niveaux d’énergie. Nos résultats montrent que la cellule utilise aussi des nœuds relativement petits et dynamiques où des informations propres concernant des voies métaboliques apparemment indépendantes sont évaluées. Ces informations y sont intégrées localement et une décision y est prise pour action immédiate. Cette idée est supportée par notre étude sur le récepteur de l’insuline (RI). Ce récepteur transmembranaire à activité tyrosine kinase reconnaît un signal externe (insuline circulante) et engage la signalisation de l’insuline, les réponses métaboliques et le contrôle du glucose circulant. Le RI est aussi impliqué dans l’internalisation de l’insuline et sa dégradation dans les endosomes (clairance). Il régule donc indirectement la sécrétion de l’insuline par les cellules du pancréas endocrine. La signification pathophysiologique de l’endocytose du RI ainsi que les bases moléculaires d’une telle coordination sont peu connues. Nous avons construit un réseau d’interactions du RI (IRGEN) à partir d’un protéome de fractions Golgi-endosomales (G/E) hépatiques. Nous démontrons une forte hétérogénéité fonctionnelle autour du RI avec la présence des protéines ATIC, PTPLAD1, AMPKα et ANXA2. ANXA2 est une protéine impliquée dans la biogénèse et le transport endosomal. Nos résultats identifient un site de SUMOylation régulé par l’insuline dans sa région N-terminale. ATIC est une enzyme de la voie de synthèse des purines de novo dont le substrat AICAR est un activateur de l’AMPKα. Des analyses biochimiques in vitro et in vivo nous montrent que ATIC favorise la tyrosine phosphorylation du RI par opposition fonctionnelle à PTPLAD1. Une délétion partielle d’ATIC stimule l’activation de l’AMPK dont la sous-unité AMPKα2 apparaît déterminante pour le trafic du RI. Nous démontrons que ATIC, PTPLAD1, AMPKα, AICAR et ANXA2 contrôlent l’endocytose du RI à travers le cytosquelette d’actine et le réseau de microtubules. Nous ressortons un nœud de signalisation (ATIC, PTPLAD1, AMPKα) capable de détecter les niveaux d’activation du RI, d’énergie cellulaires (rapports AMP/ATP) et aussi d’agir sur la signalisation et l’endocytose du RI. Cette proximité moléculaire expliquerait le débat sur le mécanisme primaire du diabète de type 2 (DT2), notamment entre la sensibilité à l’insuline et sa clairance. Nous avons calculé un enrichissement de 61% de variants communs du DT2 parmi les protéines fonctionnellement proches du RI incluant RI, ATIC, AMPKα, KIF5A et GLUT2. Cet enrichissement suggère que l’hétérogénéité génétique révélée par les consortiums sur études génomiques (GWAS) converge vers des mécanismes peu étudiés de biologie cellulaire.

Role of plasmodium translationally repressed gene products in malaria transmission

Tese de doutoramento, Ciências Biomédicas (Microbiologia e Parasitologia), Universidade de Lisboa, Faculdade de Medicina, 2015

Circulating pancreatic polypeptide concentrations predict visceral and liver fat content

CONTEXT AND OBJECTIVE: No current biomarker can reliably predict visceral and liver fat content, both of which are risk factors for cardiovascular disease. Vagal tone has been suggested to influence regional fat deposition. Pancreatic polypeptide (PP) is secreted from the endocrine pancreas under vagal control. We investigated the utility of PP in predicting visceral and liver fat. PATIENTS AND METHODS: Fasting plasma PP concentrations were measured in 104 overweight and obese subjects (46 men and 58 women). In the same subjects, total and regional adipose tissue, including total visceral adipose tissue (VAT) and total subcutaneous adipose tissue (TSAT), were measured using whole-body magnetic resonance imaging. Intrahepatocellular lipid content (IHCL) was quantified by proton magnetic resonance spectroscopy. RESULTS: Fasting plasma PP concentrations positively and significantly correlated with both VAT (r = 0.57, P < .001) and IHCL (r = 0.51, P < .001), but not with TSAT (r = 0.02, P = .88). Fasting PP concentrations independently predicted VAT after controlling for age and sex. Fasting PP concentrations independently predicted IHCL after controlling for age, sex, body mass index (BMI), waist-to-hip ratio, homeostatic model assessment 2-insulin resistance, (HOMA2-IR) and serum concentrations of triglyceride (TG), total cholesterol (TC), and alanine aminotransferase (ALT). Fasting PP concentrations were associated with serum ALT, TG, TC, low- and high-density lipoprotein cholesterol, and blood pressure (P < .05). These associations were mediated by IHCL and/or VAT. Fasting PP and HOMA2-IR were independently significantly associated with hepatic steatosis (P < .01). CONCLUSIONS: Pancreatic polypeptide is a novel predictor of visceral and liver fat content, and thus a potential biomarker for cardiovascular risk stratification and targeted treatment of patients with ectopic fat deposition.

HES1 in immunity and cancer

Hairy and enhancer of split homolog-1 (HES1) is a part of an extensive family of basic helix-loop-helix (bHLH) proteins and plays a crucial role in the control and regulation of cell cycle, proliferation, cell differentiation, survival and apoptosis in neuronal, endocrine, T-lymphocyte progenitors as well as various cancers. HES1 is a transcription factor which is regulated by the NOTCH, Hedgehog and Wnt signalling pathways. Aberrant expression of these pathways is a common feature of cancerous cells. There appears to be a fine and complicated crosstalk at the molecular level between the various signalling pathways and HES1, which contributes to its effects on the immune response and cancers such as leukaemia. Several mechanisms have been proposed, including an enhanced invasiveness and metastasis by inducing epithelial mesenchymal transition (EMT), in addition to its strict requirement for tumour cell survival. In this review, we summarize the current biology and molecular mechanisms as well as its use as a clinical target in cancer therapeutics.