Gestational diabetes treatment medscape,medical errors florida ceu indomavel,s oliver meir,type 2 diabetes levels of prevention - Review

Diabetes is on the rise in Australia and the rest of the world and has reached epidemic proportions.
Feeling tired and lethargic, always feeling hungry, having cuts that heal slowly, skin infections, blurred vision, gradual weight gain, mood swings, headaches and dizziness.
You are more chance of  becoming diabetic if you have a family history of diabetes or if you are over 55 years of age – as the risk increases as we age.
There are so many benefits to strength training: increased muscle strength and power, increased muscle size and endurance, reduction in body fat, increased bone mineral density, increased metabolic rate, lower blood pressure, increased sense of well being and self esteem… do I need to keep going?
Strength training programs should be designed by qualified trainers (and supervised where possible) and  and be reviewed regularly so that weights are gradually increased. If you think you know someone who might be at risk of type 2 diabetes, their GP is the best place to start.
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The Role of Placental Exosomes in Gestational Diabetes MellitusCarlos Salomon1, 2, Luis Sobrevia1, Keith Ashman2, Sebastian E. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising.
Clipping is a handy way to collect and organize the most important slides from a presentation. Our body is constantly fighting with the harmful free radicals with the help of antioxidants. While this task is also done well by the body, it sometimes results in inflammation that affects several internal organs, especially the pancreas. According to November 2010 issue of the Diabetes, Obesity and Metabolism journal; an indirect confirmation points out that diabetes is an inferior inflammatory ailment.
Turmeric is a rich source of an ingredient named curcumin that is a great anti-inflammatory as well as antioxidant substance! All recent studies have reported that curcumin is capable of fighting against diabetes, obesity, and high cholesterol level. The findings of this study were published in the journal ISRN Pharmacology, which revealed that the ingredient is capable of triggering a biochemical procedure wherein the flavonoids contained in curcumin and the aforementioned extracts inhibit the uptake of glucose by attaching themselves to the glucose carriers for alleviating the amount of glucose to be transported. Frankly speaking, no study or research has been performed, which recommends a specific dose of turmeric for reducing the high blood sugar levels. Although this prescription can be a good suggestion to begin, it is not recommended to start following this prescription without consulting your own doctor. You are also at risk if you are over 45 years of age and are overweight or have high blood pressure or you are over 35 years of age and are from an Aboriginal or Torres Strait Islander, or Pacific Island, Indian subcontinent or Chinese cultural background. Particularly for people with diabetes, strength training and increased muscle mass means more uptake of insulin into the muscle, (and therefore less glucose floating around in the bloodstream causing trouble.) Exercise increases the amount of insulin receptors released and an increase in muscle cells from strength training means more opportunities for insulin to bind to those receptors and move glucose from the blood into the cells.
Contrary to the popular belief that exercise should be light, research shows that type 2 diabetics, with no other contraindications, will experience the most benefit from moderate to hard weight training sessions.
An increase in the incidence of gestational diabetes mellitus: Northern California, 1991-2000.
The genetics of gestational diabetes mellitus: evidence for relationship with type 2 diabetes mellitus.
Gestational diabetes reduces adenosine transport in human placental microvascular endothelium, an effect reversed by insulin.
Morphologic and proteomic characterization of exosomes released by cultured extravillous trophoblast cells.
Specific isolation of placenta-derived exosomes from the circulation of pregnant women and their immunoregulatory consequences.
Human trophoblast-derived exosomal fibronectin induces pro-inflammatory IL-1beta production by macrophages. Human villous trophoblasts express and secrete placenta-specific microRNAs into maternal circulation via exosomes.
Application of systems biology principles to protein biomarker discovery: Urinary exosomal proteome in renal transplantation. Proteomic identification of exosomal LRG1: a potential urinary biomarker for detecting NSCLC. Mast cell- and dendritic cell-derived exosomes display a specific lipid composition and an unusual membrane organization.
Analysis of antigen presenting cell derived exosomes, based on immuno-magnetic isolation and flow cytometry. Exosome: from internal vesicle of the multivesicular body to intercellular signaling device. Comparison of ultracentrifugation, density gradient separation, and immunoaffinity capture methods for isolating human colon cancer cell line LIM1863-derived exosomes. Isolation and characterization of exosomes from cell culture supernatants and biological fluids. Membrane vesicle release in bacteria, eukaryotes, and archaea: a conserved yet underappreciated aspect of microbial life.
Microvesicles derived from human umbilical cord mesenchymal stem cells stimulated by hypoxia promote angiogenesis both in vitro and in vivo.
Placenta-derived soluble MHC class I chain-related molecules down-regulate NKG2D receptor on peripheral blood mononuclear cells during human pregnancy: a possible novel immune escape mechanism for fetal survival.
Review: Differential placental macrovascular and microvascular endothelial dysfunction in gestational diabetes.
Plasma kisspeptin levels in pregnancies with diabetes and hypertensive disease as a potential marker of placental dysfunction and adverse perinatal outcome. In this daily battle, the free radicals are defeated well, if the antioxidants are present in good quantities.
When this organ is affected, the production of insulin is either nil, too less, or incompatible to the cells for carrying glucose to the blood stream. In order to fight with this inflammation, here comes the most widely used Indian spice, turmeric, with a scientific proof! The several clinical studies have proved that the anti-inflammatory property of this active ingredient aids in reducing the levels of inflammatory enzymes that are stimulated at the time of glucose absorption.
So, this study revealed the good effects of the turmeric’s anti-oxidant, anti-diabetic, anti-obese, and lipid-lowering properties. After examining the impact of 6gm dose of turmeric on the insulin levels, plasma glucose, and the glycemic index in almost 14 fit people, the study found that the intake of turmeric did not affected the glucose level, but helped in increasing the level of insulin.
However, there are doctors who usually prescribe 500 mg of turmeric supplements that are to be taken three times daily.

This is because it is vital to avoid making any kind of changes, whether natural or medical, without seeking the advice of your doctor. Above all, those who have gallbladder problems should never have turmeric, as it can exacerbate the symptoms. Without going into too much detail, diabetes is essentially a condition where the body is not able to regulate its blood glucose levels.
Exosomes are generated in the endosomal structure participating the plasma membrane in this process, and secreted via constitutive endosomal pathways involving the Golgi complex from various cell types.
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.
Daryl Norwood Diabetes CasePresentationR.C is a 57-year-old man with Type 2 diabetes first diagnosed two years ago.
Daryl Norwood Weight changes should be monitored to assess the need for more aggressive treatments or diet restriction. Whatever may be the case; the sugar level gets negatively affected to trigger the medical condition of diabetes. Furthermore, it also regulates the function of pancreas cells, liver, and fat tissue as well as deals effectively with the obesity related ailments. They found that curcumin, when consumed with the onion skin and black pepper extracts, was more effective in regulating blood glucose, cholesterol, triglycerides, weight, and low-density lipoprotein (LDL). But I don’t want to freak anyone out here, what I do want to talk about is how weight training can help with management of diabetes. Villous chorionic explant-derived exosomes were isolated by ultracentrifugation and purified using a sucrose gradient. The exosomes contain specific proteins and miRNA as a new form of exosome-mediated intercellular communication and with different biological function.
10 ug of exosome proteins and trophoblast cell lysate were separated on 4-12% SDS-PAGE and stained with SimplyBlue™ SafeStain (Invitrogen). Rice2[1] Cellular and Molecular Physiology Laboratory (CMPL), Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile[2] University of Queensland Centre for Clinical Research, University of Queensland, Herston, Queensland, Australia[3] Department of Obstetric and Gynaecology, Universidad de los Andes, Santiago, Chile1.
Exosomes appear to play an essential role in preventing an excessive immune response and in the development of autoimmunity in human pregnancy. Glucose (sugar) is carried in the blood and uses a hormone called insulin (produced by the pancreas) to convert into energy for use by the cells of our muscles. IntroductionGestational Diabetes Mellitus (GDM) affects ~5% of all pregnancies and parallels the global increase in obesity and type 2 diabetes. Recently, it has been demonstrated that placental miRNAs circulate in the blood of pregnant women [66, 67]. In people with diabetes insulin is no longer produced, or not produced in enough amounts so the glucose remains in the blood stream. For example, maternal plasma concentration of placental miRNA-141 increases with gestational age [66].
Lifestyle changes that impact adversely on caloric balance are thought to be a contributing factor in this emerging pandemic [1, 2].
Placenta-specific miRNA-517A is released from chorionic villous trophoblasts into maternal circulation, where it may affect maternal tissues (e.g.
The current ‘gold standard’ for the diagnosis of GDM is the oral glucose tolerance test (OGTT) at 24–28 weeks of gestation [3, 4]. When GDM is diagnosed in the late second or early third trimester of pregnancy the ‘pathology’ is most likely well-established and the possibility to reverse or limit potential adverse effects on perinatal outcomes may be limited [ 5]. There is a paucity of data, however characterising the release of exosome from endothelial cells during normal and pathological pregnancies. In addition to its contributions to hyperglycemia, alcohol has a negative interaction on the drugs Metformin and Simvastatin that can cause liver toxicities. It will be important to determine if the placenta communicates with the maternal endothelium via microvesicles, and, if so, to elucidate the role and mechanism of action of exosome pathologies associated with endothelial dysfunction, such as GDM. To achieve adequate control of diabetes, lifestyle modifications are an important part of therapy. If such early detection tests were available, they would represent a major advance and contribution to the discipline and afford the opportunity to evaluate alternate treatment and clinical management strategies to improve health outcomes for both mother and baby.
Dietary restrictions, increase in physical activity, and gradual weight loss will be more beneficial than taking medication, alone. Based upon recent technological developments and studies, we consider it realistic that a clinically useful antenatal screening test can be developed. It remains to be elucidated how much of this “free” miRNA and mRNA is actually contained within exosomes and thereby confers stability. Unlike diseases such as cancer where biomarkers need to be exquisitely specific, a useful antenatal screening test would ideally be highly sensitive, but not necessarily highly specific.
Indeed, the exact mechanisms involved in the release of miRNA from the placenta remain to be established. The consequence of a false positive would be no worse than an erroneous triage to high-risk care. A recent study, however, reported that miRNAs are selectively packaged into microvesicles and are actively secreted [68-70].
Effects There remains a paucity of data about the effect of placenta-derived exosomes on both fetus and mother. To date there is a paucity of data defining changes in the release, role and diagnostic utility of placenta-derived nanovesicles (e.g.
The available data, however, support a role for placental exosomes in mediating communication at the materno-fetal interface and, possibly, at the distal site within the mother. Recent data show that trophoblast-derived exosomes induce proinflammatory cytokines such IL-1 ? in human macrophages cells [8]. The aim of this brief commentary, thus, is to review the biogenesis, isolation and role of nanovesicles; and their release from the placenta. Interestingly, protein analysis revealed that exosome release from trophoblast cells increases with low oxygen tension and their exosome promote the cell migration in extravillous cytotrophoblast (HTR- 8) (Salomon et al. Exosomes and GDMExosomes released from the placentae of women with GDM may alter maternal physiology. BiogenesisExosomes are small [40-100 nm) membrane vesicles that are released following the exocytotic fusion of multi-vesicular bodies with the cell membrane (Figure 1). While the process(es) of exosome formation remains to be fully elucidated, available data support an endosomal origin and formation by the inward budding of multi-vesicular bodies [16] (see Figure 2). Exosomes may also be directly transported from the Golgi complex to multi-vesicular bodies [14].

In pathological pregnancies characterised by compromised placental perfusion and ischaemia, such as GDM, exosome secreted from the placenta can participate in an adaptive response of the mother and fetus and so interact with target tissue and modulate different biological processes, such as immune response, cellular adhesion, development and metabolism.Exosomes have been identified in plasma under both normal and pathological conditions. Recent data, however, suggest that the release of nanovesicles from cells may represent a normal mechanism for cell-to-cell communication [17]. Packaging of exosomal contents appears to be a direct process in which the ESCRT (endosomal sorting complex required for transport) systems play a significant role [18-20]. Exosomes are released from the placenta and the concentration of exosomes in maternal plasma increases during normal pregnancy [21-23]. They contain placenta-specific proteins and miRNA and, as such, may be differentiated from maternally-derived exosomes [25]. The concentration of exosomes has been reported to increase in association with pre-eclampsia [22, 23, 26].
Composition The exosomal content is highly dependent on the origin cell and on pre-conditioning of the cell. One of the first exosomal proteomes characterised was from mesothelioma cells, in which 38 different proteins were identified [27]. Studies in cancer cells show the great variability of proteins expressed in exosomes [28-32]. This study provides the first extensive analysis of the proteome of the exosome-derived trophoblast cells [7].
The data obtained in this study, highlights the extent of putative functional interactions that may be mediated by exosomes. While the composition of exosomes appears to be cell-specific, a subset of common proteins has been identified. Among the most commonly used markers for characterisation of exosomes are tetraspanin proteins, including: CD63, CD81, CD9, and CD82.
Exosomes derived from antigen-presenting cells (APC) express MHC-I and MHC-II on their surface [36-38]. Significantly, single cell types display the capacity to generate different subpopulations of exosomes. 2005 demonstrated that RBL-2H3 cells (basophilic leukemia cell line) released two main subpopulations of exosomes that can be discriminated by protein and lipid contents.
The first subpopulation contains phospholipids obtained mainly from granules and the second contains phospholipids from Golgi. In addition, proteins CD63, MHC-II, CD81-containing exosomes accounted for 47%, 32%, and 21%, respectively, of total exosomes [39, 40].3. Isolation of exosomesExosome research is a burgeoning discipline with over 2000 articles published in the last 3 years.
The putative role of exosomes spans from intracellular signaling to biomarkers of disease [41]. Germane to any study seeking to elucidate the physiological or pathophysiological role of exosomes is their specific isolation. Exosomes may be further purified by differential sedimentation on sucrose gradients or sucrose-deuterium oxide (D2O) [ 7]. Alternative methods utilise size exclusion chromatography and density gradient centrifugation [44] or solid-phase immunoaffinity capture (i.e. In the absence of specific, cell surface exosome markers, the veracity of immuno-affinity methods remains to be established.More recently a commercial kit for the isolation of the exosomes has been released (ExoQuickTM, System Biosciences). While the commercial kit provides significant advantage with respect to processing time, the resulting preparation may not be equivalent to that obtained by ultracentrifugation and differential segmentation. In our own laboratory, parallel preparations of exosomes using both methods reveal differences in the biophysical characteristics of the exosomes isolated.
Exosome preparations isolated using the commercial kit were characterised by a great range in particle diameter (30-300 nm, as estimated by transmission electron microscopy (TEM) and have a higher protein content than similar preparations isolated using the ultracentrifugation method. The role for exosomes in cell-to-cell communicationRecently, evidence supporting a role for exosomes in cell-to-cell communication has been obtained [47, 48].
Exosome release may represent a significant, hitherto unappreciated, communication mechanism between cells, host cell and microbes [47].
For example, exosome function as a carrier of specific molecules such as mRNA and miRNA can interact with neighbouring cells or travel long distances in the bloodstream to reprogram the phenotype and regulate their function [40].
In the placenta, exosome- derived trophoblastic cells are able to reprogram monocytes to secrete specific cytokine profiles independent of cell-to-cell contact [8]. Placental-derived exosomes may also play a role in modulating immunological responses through the induction of lymphocyte apoptosis, [21, 44, 49].
In addition, in the absence of energy production, normal membrane phospholipid asymmetry is lost and amniophospholipids translocate to the outer leaflet of the cell membrane and generate a fusogenic and pro-coagulant surface.
Given that exosomes circulate in blood, these fusogenic moieties may be masked by, for example, annexin V.
In vitro effects of exposing cells to exosomal proteins has been reported and include: induction of differentiation of stem cells [51], suppression of activation of natural killer cells and macrophages [52, 53], and stimulation of cell migration [8, 54]. Putative roles of exosomes, thus, include cell differentiation, immunomodulation and migration [55]. Exosomes are not merely inert fragments of cell membrane but display capacity to affect cell function at remote loci and possibly be a source of disease biomarkers. Exosomes also contain miRNA that may transfer to other cells and alter the expression of the transcriptome and ultimately cell phenotype.
They act via binding to messenger RNA and, thus, prevent the translation of the encoded protein. Previous studies have reported that miRNAs are involved in the pathogenesis of diabetes and are required for pancreatic development and the regulation of glucose-stimulated insulin secretion [50, 58].
Placental exosome release Exosomes are released by the placenta during pregnancy and their release may correlate with pregnancy outcome.
The syncytiotrophoblasts and cytotrophoblasts are the most abundant cell types of the human placenta and sense and regulate oxygen and nutritional exchange between mother and fetus during the pregnancy [61, 62]. Pathologies of pregnancy including preeclampsia, intrauterine growth restriction (IUGR) and GDM are associated with placental dysfunction [4, 63, 64] and may display differential and specific exosome release profiles.It has been established that the concentration of exosomes in maternal peripheral blood is greater than that observed in non-pregnant women [21].
In this study, exosomes of placental origin were specifically isolated from the maternal blood using anti-PLAP (anti-placental-type alkaline phosphatase) conjugated to agarose micro-beads.

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