This pilot study examines whether abdominoplasty leads to permanent weight loss and the potential neurocrine factors involved. 21 patients who underwent abdominoplasty were reviewed. 90.5% reported weight loss, with 47.6% maintaining loss over 1 year. The greatest predictor of long-term loss was pre-op weight between 140-210 lbs. Patients cited increased satiety as the main reason for loss. Satiety levels correlated with short vs long-term loss. A future study is proposed to test gut hormone levels before and after surgery to examine their association with reported satiety and weight loss.
Obesity is a life-long progressive, life threatening condition marked by the excess accumulation of body fat, which can significantly reduce life expectancy. When weight reaches extreme levels, it is called MORBID OBESITY and is a chronic condition with numerous medical, psychological and social consequences.
For more information visit - https://www.radiancehospitals.org/medical-treatment/bariatric-surgery
Obesity is a life-long progressive, life threatening condition marked by the excess accumulation of body fat, which can significantly reduce life expectancy. When weight reaches extreme levels, it is called MORBID OBESITY and is a chronic condition with numerous medical, psychological and social consequences.
For more information visit - https://www.radiancehospitals.org/medical-treatment/bariatric-surgery
BARIATRIC SURGERY IN TREATMENT OF MORBIDLY OBESE PATIENTSweightlossindia
Only surgery has proven effective over the long term
for most patients with clinically severe obesity.”
- NIH Consensus Conference Statement, 1991
Surgery for the treatment of clinically severe obesity
is endorsed by:
The National Institutes of Health
The American Medical Association
The National Institute of Diabetes and Digestive
and Kidney Diseases
American Association of Family Practitioners
From Fat to Fit - How to Jump - Start Your Metabolism and Get Amazing Weight ...MontanaDevis
Weight loss is one of the hottest topics ever. Everyone seems to be trying to lose weight nowadays. Most diet programs are about weight loss and body weight is often used as an indicator of fitness progress. But, this is an incorrect approach.
Your ultimate goal should always be to lose fat and reducing excess body fat is what you should be concerned about. Weight loss and Fat loss is NOT the same thing! Many people confuse the two terms, often believing that they mean the same, when in fact weight loss and fat loss are very different from one another.
Rivision surgery after laparoscopic sleeve gastrectomyIbrahim Abunohaiah
Revision Surgery After Laparoscopic Sleeve Gastrectomy
Introduction to bariatric surgery
When to Revise a Weight Loss Surgery?
Options for redo surgery.
Laparoscopic Roux-en-Y gastric Bypass.
permanent weight reduction from abdominoplasty
see http://www.plasticsurgery.org/news-and-resources/many-women-have-long-term-weight-loss-after-tummy-tuck-reports-plastic-and-reconstructive-surgery.html
BARIATRIC SURGERY IN TREATMENT OF MORBIDLY OBESE PATIENTSweightlossindia
Only surgery has proven effective over the long term
for most patients with clinically severe obesity.”
- NIH Consensus Conference Statement, 1991
Surgery for the treatment of clinically severe obesity
is endorsed by:
The National Institutes of Health
The American Medical Association
The National Institute of Diabetes and Digestive
and Kidney Diseases
American Association of Family Practitioners
From Fat to Fit - How to Jump - Start Your Metabolism and Get Amazing Weight ...MontanaDevis
Weight loss is one of the hottest topics ever. Everyone seems to be trying to lose weight nowadays. Most diet programs are about weight loss and body weight is often used as an indicator of fitness progress. But, this is an incorrect approach.
Your ultimate goal should always be to lose fat and reducing excess body fat is what you should be concerned about. Weight loss and Fat loss is NOT the same thing! Many people confuse the two terms, often believing that they mean the same, when in fact weight loss and fat loss are very different from one another.
Rivision surgery after laparoscopic sleeve gastrectomyIbrahim Abunohaiah
Revision Surgery After Laparoscopic Sleeve Gastrectomy
Introduction to bariatric surgery
When to Revise a Weight Loss Surgery?
Options for redo surgery.
Laparoscopic Roux-en-Y gastric Bypass.
permanent weight reduction from abdominoplasty
see http://www.plasticsurgery.org/news-and-resources/many-women-have-long-term-weight-loss-after-tummy-tuck-reports-plastic-and-reconstructive-surgery.html
This presentation was delivered at Puri on 10th january 2015
on the occasion of annual Rotary District Conference along with IMA Puri. It highlights on metabolic syndrome and its surgical solution.
This is a presentation Dr. beck and Dr. Eakin give at the bariatric information sessions at Jordan Valley Medical Center, in Salt Lake City, Utah. It provides strategies fro medical weight loss, an it discusses the pros and cons of common bariatric operations.
Does being overweight or obese have a negative affect on your life? Learn how weight loss surgery can help you improve your health, feel better, and get your life back! Join us for a review of surgical options, including discussion about lifestyle changes to keep you on track with a healthy weight after weight loss surgery.
Vancomycin mixed with calcium sulphate beads provide a 2-3 week sustained local high antibiotic release elution profile which may impede the formation of a recurrent calpular contracture in conjunction with capsulotomy open and or capsulectomy as well as implant change.
Case presentation of severe papillomatosis of the larynx in non sexually active male teenager and discussion of biopsy finding of severe dysplasia and possible formation of laryngeal cancer
Role for Turbinectomy In the Crowded Nasal Airway, Is Empty Nose Syndrome A R...Rex Moulton-Barrett
Does Empty Nose Syndrome Occur following turninectomy in patients with a crowded nasal airway? Hoe successful is turbinectomy in relieving nasal obstruction and chronis sinus headaches
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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Hot Selling Organic intermediates
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Long Term Weight Loss Following Abdominoplasty: Neurocrine Factors
1. Permanent Weight Reduction after Abdominoplasty:
Neurocrine Factors,
A Pilot Study
Rex Moulton-Barrett, MD & Jennifer Fuller, B.A.
Plastic & Reconstructive Surgery
Alameda and Brentwood, Ca
2. The Role for Abdominoplasty ?
Just because you can, does not mean you should ?
4. Questions
• Does abdominoplasty lead to long-term weight loss ?
• Which group of patient’s benefit most ?
• What are the cause(s) of weight loss after surgery ?
5. Obesity Epidemic
• BMI: Body Mass Index: weight kg/(height m) 2
• <1/3 of U.S.
19-25
Normal
• 1/3 of U.S.
25-30
Overweight
• 1/3 of U.S.
BMI 30-40
BMI
Obese
BMI
• The prevalence of obesity has more than doubled since
1980
• 3% of U.S.
BMI> 40
Morbid-Super Obese
6. Treatment of Obesity
3 main methods of treatment:
•
Life Style Modification
– Moderately effective but difficult to monitor and sustain
•
Pharmacological Therapy
– Few effective treatments exist
•
Surgical Treatment
– Significant and permanent weight loss
– Insurance criteria morbid obesity (BMI ≥40)
7. Life Style Modification
• Convert to ‘ negative energy gap ’
• Increased energy expenditure:
reduce non-active time: car, chair, sofa
increased exercise time
increased energy lost during exercise
• Diet: high protein
low carbohydrate
low sugar
‘+ ketogenic diets’ reduce appetite
( Am J of Clin Nutrition, 2008: 87(1), 44-55 )
avoid exercise before meals: 20 minute run =
20oz
ie avoid post exercise ‘calorie rewards’
8. Current Weight Reduction Drugs
( 1% of 59 billion dollars spent to loose fat in USA / yr )
1997:fen-phen (fenfluramine-phentermine) &
Redux (dexfenfluramine) removed from market
% body weight lost
% pts lost at least
minus placebo
5% body weight
a.c.t. placebo ‘/x’
• FDA Approved
– Meridia: Sibutramine
– Xenical: Orllstat
4.3
2.9
55/27
54/33
9.0
4.6
3.4
67/19
53/21
47/23
• New drugs pending approval
– Qnexa
– Contrave
– Lorcaserin
9. Mechanism of Action
• Meredia: Monoamine RI (serotonin & noradrenaline)
(Abbott) may
BP, HR: not to use if hypertensive
unlike fenfluramine does not elevate serum serotonin
controls binge eating
• Qnexa:
(Vivus)
Phentermine & Topiramate
56 week course: 37 lb loss: BP, glucose, cholesterol
may be useful in type 2 DM
Phentermine: hypothalamic norepinephrine release
high dose: potential for dependence
Topiramate: ( Topamax ), anti-epileptic,
anti-migraine,
bipolar/binge eating
11. Abdominoplasty Work-Up
• Obese versus abdominal laxity or symptomatic pannus ?
• First consultation: attempt weight reduction if >200lbs
• Charge about 25% more if over 200lbs
• ‘3 S plan’: South Beach Diet, Sugarless house, Stationary
bike with 45 minute 3x week TV contract after meals
• + Meridia if unsuccessful > 4 weeks & binge eating ?
12. Abdominoplasty Technique
•
•
•
•
•
•
•
•
•
Low incision 4 cm above the anterior labial commissure
Aggressive midline Rectus Abdominus plication
Jack knife sitting / Trendelenburg position closure
Closure: interrupted Scarpa’s fascia
running dermal barbed 3.0 V -Lock Suture
skin glue and 1 inch Steri-Strips
Lateral flank liposuction for contour
5 day pain pump & overnight in surgery center
Rented surgical bed at home for 2-4 weeks
Prolonged paper taping for 6 months when clothed
3 S’s starting 6 weeks post-op
13.
14. Methods
•
Retrospective case review: chart & structured
interview
•
same surgeon and one post-graduate student
•
n= 21 patients post-abdominoplasty
• Follow up to > 1 year: 2007-2009
15. Methods
Data collected included:
• Age, sex, and height
• Previous bariatric surgery ?
• Weight prior to abdominoplasty
• Changes in satiety
• Minimum weight and time attained
• Patient’s beliefs about cause of wt
loss
• Time when weight regained
• Weight at 1 year post-surgery
• Current Weight
• Complications of surgery
• Patient satisfaction with surgical
results
• Changes in diet & exercise after
surgery
• Weight of pannus resected
16. Results: Patient Population
5/21 patients previously underwent bariatric
surgery
Range
Mean
Age
21-61 years
45 years
Height
5’0” – 6’0”
5’5”
Pre-op Weight
105-245 lbs
167.5 lbs
Pannus Weight
1.8 – 12.5 lbs
5.74 lbs
17. Results: BMI’s
My patients BMI mean: 27.66, lowest 18, highest 33.5
My patients
BMI
US population
• 21 %
Normal
33 %
• 50 %
Overweight
33 %
• 29 %
Obese
33 %
• None
Morbid Obesity
3%
18. Results: Patient Weight loss
• 90.5 % reported weight loss
• 47.6% maintained weight loss > 1 yr after surgery
19. Results: Patient Weight Loss
Percent of Mean
Patients
Pre-op
Weight
(lbs)
Mean
Maximum
Weight
loss (lbs)
Mean Time
of Max
Weight Loss
(months)
Mean Time of
Weight Regain
(months)
Short term
weight loss
only (<1 year)
n=9
42.9
161.8
8.7
2.3
7.1
Long term
weight loss
(> 1 year)
n=10
47.6
170.4
16.4
3.7
___
9.5
175.5
___
___
___
No Weight loss
n=2
20. Results: Patient Weight loss
Weight loss as a function of Pannus Weight:
Weight of
Pannus
No. of
Patients
Pre-op
Weight
Maximum
weight loss
% with long-term
weight loss
(> 1 year)
≤ 4 lbs
7
144.9
5.3
33 %
> 4 lbs
14
178.7
14.7
54 %
21. Results: Patient Weight Loss
• The greatest predictor of weight loss: pre-operative weight
Pre-op Weight
(lbs)
No. of
Patients
Mean
Weight of
Pannus
(lbs)
Mean
Maximum
Weight
Loss (lbs)
Mean Time
Max Weight
Loss reached
(months)
No. Patients
with long
term weight
loss (>1year)
< 140 lbs
4
2.5
1.8
1.4
0
140 ≥ to < 210
14
5.6
15
3.5
9 (64.3%)
≥ 210
3
9.2
8.6
2.2
1 (33.3%)
22. Pre-operative weight associated with
long term weight loss
WEIGHT
(LBS)
LONG TERM
WEIGHT LOSS
( >/= 4lbs & >1 YR )
< 140 & ≥ 210
1
6
≥ 140 to 210
9
5
p<0.0005
NO LONG TERM
WEIGHT LOSS
( < 4lbs & > 1 YR )
23. Pre-operative BMI associated With
long term weight loss
BMI
LONG TERM
WEIGHT LOSS
( >/= 4lbs & >1 YR )
<24.5 & ≥ 33.5
1
8
≥ 24.5 to <33.5
9
3
p<0.0023
NO LONG TERM
WEIGHT LOSS
( < 4lbs & > 1 YR )
24. Results: Weight Loss & Satiety
No
change
in
appetite
(%)
Sense of satiety
only after
eating (%)
Lack of
appetite at
all times (%)
Unpleasant
abdominal
sensation
2 (22.2)
4 (44.4)
3 (33.3)
2 (22.2)
Long-term
weight loss
(>1 year)
n=10
1 (10)
4 (40)
5 (50)
1 (10)
No weight
loss
n=2
2 (100)
0 (0)
0 (0)
0 (0)
All Patients
n=21
5 (23.8)
8 (38.1)
8 (38.1)
3 (14.3)
Short-term
weight loss
only (<1year)
n=9
25. Reason(s) for Weight Loss
•
Most frequent reason sited for weight loss: increased sense of satiety
•
84.2 % experienced an increase in satiety
– 1/2 report satiety throughout the day, 1/2 report satiety only after eating
•
90% of long-term weight loss patients: reported increased satiety
•
Mean duration of sense of satiety 7.3 months
26. Conclusions
• The greatest predictor of long-term weight
loss was pre-operative weight then BMI
• 64.3% of patients weighing between 140
and 210 lbs had long term weight loss
• Only 14.3 % of patients outside this range
had long-term weight loss
27. Conclusions
• The key factor in patient weight loss is
an increase in satiety
• Short-term weight loss patients began
to regain their weight at 7.1 months,
about the same time when their
satiety dissipated
29. The Hypothalamus
• One of the Hypothalamic Nuclei is called
the Arcuate Nucleus (ARC)
• ARC incomplete blood-brain barrier
• Allows CNS entry of peripheral peptides
and proteins
30. The ARC
• ARC contains two major populations of
neurotransmitter releasng neurons :
• stimulate feeding:
– agouti-related peptide (AgRP) & neuropeptide Y (NPY)
• inhibit feeding:
– Cocaine & amphetamine regulated transcript (CART) &
proopiomelanocortin (POMC),
– POMC cleaves into α -MSH.
Neural/ endocrine
signals
↑ Feeding
2 nd order
neurons
ARC
Hypothalamus
α-MSH
↓ Feeding
31. The ARC
∀ α -MSH acts as a ligand at the melanocortin - 4
receptor ( MC4 )
• Defects of this receptor: implicated in up to 46% of all
monogenetic childhood onset obesity in
humans
∀ α -MSH inhibits the receptor to AgRP: inhibiting
appeptite
• AgRP inhibits the MC4 receptor: stimulating
appetite
32. The Brainstem
Appetite signals:
A. from circulating hormones via the area
postrema: incomplete blood-brain
barrier
B. neural signals from the vagus nerve
C. Bidirectional connections with
hypothalamus
33. The Vagus Nerve
• Afferent signals: mechanical & chemical
• Cell bodies of afferent neurons in the Nodose Ganglia
• Projects into brainstem to interface with hypothalamus
34. The Vagus Nerve Continued
• The stretch receptor stimulation
dependent on gastric volume
• May suppress meal size independent of content
• Effect is abolished by subdiaphragmatic vagotomy
• Gastric distension is insufficient to account for all
aspects of satiety
35. The Vagus Nerve
• Contains receptors for a number of gut
hormones
• Vagotomy abolishes appetite-modifying
action of
many gut hormones: CCK, PYY, GLP-1
• Vagus nerve is thought to be a major
sight of gut hormone signaling
36. A Very Quick Overview of Appetite
Regulating Hormones
37. Appetite-regulating hormones:
• Ghrelin, released from the stomach, is the only known appetite
stimulant, acting via hypothalamic expression of NPY and AgRP.
– Ghrelin levels rise preprandially in humans
– Administration of exogenous ghrelin leads to increased food intake and
weight gain
38. Appetite-regulating Hormones:
• In contrast, a growing number of peptide hormones have been found to
produce satiety and decrease food intake.
Vagus
Nerve
Pancreatic
Polypeptide (PP)
Amylin
Insulin
Peptide YY (PYY)
Cholecystokinin (CCK)
Adiponectin
Leptin
Oxyntomodulin (OXM)
Apolipoprotein A-IV (apo A-IV)
Vasoactive Intestinal
Polypeptide (VIP)
Glucagon-like peptide-1
(GLP-1)
Bombesin
40. Another Important Satiety
Regulator: Leptin
• Leptin, is released from adipose tissue,
mammary glands, ovarian follicles, placenta,
skeletal muscle, and the P cell and chief cells of
the stomach
• 25% of circulating leptin is derived from the
stomach
• Leptin levels positively correlate with body fat:
higher circulating leptins with greater BMI
• Leptin mediates central regulation of energy
homeostasis via receptors in the ARC and
peripherally via the vagus nerve
41. Leptin Studies
• after binding in the hypothalamus receptor:
• leptin inhibits NPY and AgRP and
stimulates POMC and CART
• decreasing appetite & increasing energy expenditure
(Cowley M, et al; Leptin activates anorexigenic POMC neurons through a neural network in the arcuate nucleus. 2001)
• mice with mutation of the Leptin receptor are profoundly obese.
(Farooqi I, et al; Clinical and molecular genetic spectrum of congenital deficiency of the leptin receptor. 2007)
Ob /Ob mouse
42. Appetite-regulating hormones:
• Starvation:
: ghrelin,
: PYY-3-36, insulin, leptin
• Post-prandial satiety:
: ghrelin,
: PYY-3-36, insulin, leptin
• Receptor mutations: CCK, OXM, insulin, PYY, leptin & bombesin
: food intake and obesity
• Receptor antagonist or antisera for CCK, OXM, apo A-IV, PYY, and GLP-1
: food intake
• Jejuno-ileal bypass surgery or vertical-banded gastroplasty
: GLP-1, PYY & PP levels
• Roux-en-Y :
: 77% reduction in serum ghrelin
• 2 clinical studies from U London:
a. s/cut injections CCK: Med students ate 25% less curry
b. s/cut Modulin: 17 % less food intake & 26 % increased energy expenditure
: 1 pound / wk. weight loss
43. Future Study
• Patients are tested before abdominoplasty and
incrementally after for levels of specific gut hormones
• Is there an association between hormone expression
levels, reported satiety, and patient weight loss?
44. Methods
• 15 patients to participate in our study
• Prior to surgery: age, weight, height, gynecological history, previous
bariatric surgeries, and exercise regimens
• Fasting blood draw: Prior to & 1, 3, 6, and 12 months after surgery
• At surgery weight of the pannus will be recorded
45. Methods
• Blood plasma specimens will be shipped to Inter Science Institute on
dry ice then assayed for PYY, GLP-1, PP, CCK, leptin, bombesin, and
ghrelin
• At 0, 1, 3, 6, and 12 months post-abdominoplasty, document:
– Ranking on a 0-3 scale of:
» Appetite at rest
» Postprandial satiety
» Unpleasant abdominal feeling associated with poor appetite
» Amount of food consumed during a meal