High-frequency two-input CMOS OTA for continuous-time filter applications

“This material is presented to ensure timely dissemination of scholarly and technical work. Copyright and all rights therein are retained by authors or by other copyright holders. All persons copying this information are expected to adhere to the terms and constraints invoked by each author's copyright. In most cases, these works may not be reposted without the explicit permission of the copyright holder." “Copyright IEEE. Personal use of this material is permitted. However, permission to reprint/republish this material for advertising or promotional purposes or for creating new collective works for resale or redistribution to servers or lists, or to reuse any copyrighted component of this work in other works must be obtained from the IEEE.”A high-frequency fully differential CMOS operational transconductance amplifier (OTA) is presented for continuous-time filter applications in the megahertz range. The proposed design technique combines a linear cross-coupled quad input stage with an enhanced folded-cascode circuit to increase the output resistance of the amplifier. SPICE simulations show that DC-gain enhancement can be obtained without significant bandwidth limitation. The two-input OTA developed is used in high-frequency tuneable filter design based on IFLF and LC ladder simulation structures. Simulated results of parameters and characteristics of the OTA and filters in a standard 1.2 μm CMOS process (MOSIS) are presented. A tuning circuit is also discussed.Peer reviewe

The effect of short – term exercise on nitric oxide (NO) serum concentrations in overweight and obese women

Objective: The aims of the present study was to examine the effect of overweight and obesity on serum concentrations of nitric oxide metabolites and evaluate the differences of exercise induced NO production in obese and lean women. Materials and Methods: The study groups consisted of 154 women including 102 obese and 24 overweight patients and 28 lean controls. Serum concentrations of nitric oxide metabolites were measured before and after exercise with the use of ELISA kits. The serum concentrations of lactate before and after exercise were measured with the use of strip test (ACCUSPORT analyzer). Serum concentration of insulin was measured with the use of RIA. Plasma glucose, cholesterol, HDL cholesterol and triglicerydes were determined by enzymatic procedure. Impedance analysis (Bodystat) was used to determine body composition. Results: Serum concentration of NO in overweight group and obese group was significantly higher when compared to controls, p<0.05 and p<0.01, respectively. There was no difference in levels of NO between overweight and obese groups .During exercise NO concentrations increased significantly in all groups and the post- exercise levels did not differ statistically in overweight and obese groups from that in controls. The value of NO was the lowest in obese group but there were no significant differences between obese, overweight and control groups. Conclusions: Obesity may attenuate the exercise - induced endothelial NO release

The effect of weight loss on serum concentrations of nitric oxide induced by short - term exercise in obese women

Objective: The aim of present study was to examine the effect of weight loss comprising regular moderate physical activity on resting serum concentrations of nitric oxide metabolites and exercise induced NO release. Materials and Methods: The study was carried out in 43 obese women without additional diseases (age 41.8±11.9y, body weight 94.5±15.1kg, BMI 36.5±4.6kg/m2). All obese patients participated in a 3-month weight reduction programme that consisted of 1) a group instruction in behavioural and dietary methods of weight control every two weeks; 2) 1000-1400kcal/day balanced diet, and 3) moderate physical exercises (30 minutes, 3 times a week). Before and after treatment body mass and height were measured, body mass index (BMI) was calculated. Body composition was determined by impedance analysis using a Bodystat analyser. The serum concentration of nitric oxide metabolites before and after exercise was measured using spectrophotometry method by Griess. The serum concentrations of lactate before and after exercise were measured with the use of strip test (ACCUSPORT analyzer). Serum concentration of insulin was measured with the use of RIA. Plasma glucose, cholesterol, HDL cholesterol and triglicerydes were determined by enzymatic procedure. Results: The mean weight loss during treatment was 8.3±4.3 kg. We did not observe differences between resting serum concentrations of NO and lactate before and after weight loss. During exercise serum NO concentrations increased significantly both before and after weight loss treatment. After the weight reduction treatment, the time of exercise test increased significantly P<0.005, but there were no significant differences between the value of NO before and after weight loss. Conclusion: 3 – month regular physical activity and weight loss did not influence exercise-induced nitric oxide production

Components of metabolic syndrome in relation to plasma levels of retinol binding protein 4 (RBP4) in a cohort of people aged 65 years and older

Purpose Elevated plasma concentration of retinol binding protein 4 (RBP4) has recently emerged as a potential risk factor as a component of developing metabolic syndrome (MS). Therefore, this study aimed to analyse the relationship between components of MS and concentrations of plasma RBP4 in a population of subjects 65 years and older. Methods The study sample consisted of 3038 (1591 male) participants of the PolSenior study, aged 65 years and older. Serum lipid profile, concentrations of RBP4, glucose, insulin, C-reactive protein, IL-6, and activity of aminotransferases were measured. Nutritional status (BMI/waist circumference) and treatment with statins and fibrates were evaluated. Glomerular filtration rate (eGFR), de Ritis ratio, and fatty liver index (FLI), as well as HOMA-IR were calculated. Results Our study revealed a strong relationship between components of MS and RBP4 in both sexes: plasma RBP4 levels were increased in men by at least 3×, and in women by at least 4×. Hypertriglyceridemia was most strongly associated with elevated plasma RBP4 levels. Multivariate, sex-adjusted regression analysis demonstrated that chronic kidney disease [OR 1.86 (95% CI 1.78-1.94)], hypertriglyceridemia [OR 1.52 (1.24-1.87)], hypertension [OR 1.15 (1.12-1.19)], low serum HDL cholesterol [OR 0.94 (0.92-0.97)], and age > 80 years [OR 0.86 (0.81-0.90)] were each independently associated with RBP4 concentration (all p < 0.001). Conclusions In Caucasians 65 years and older, RBP4 serum levels are associated with a number of components of MS, independent of sex and kidney function. Hypertriglyceridemia as a component of MS is most signifcantly related to RBP4 concentration

The position of the Panel of Experts on use of medicinal product Mysimba® (bupropion hydrochloride and naltrexone hydrochloride) in supporting the treatment of obesity and overweight (BMI ≥ 27 kg/m2) with comorbidities

Leczenie nadwagi i otyłości jest trudnym i długotrwałym procesem, wymagającym zarówno prawidłowego rozpoznania przyczyn rozwoju tych chorób, jak i wdrażania metod adekwatnych do stanu zdrowia pacjenta. Podstawą leczenia jest zmiana stylu życia prowadząca do uzyskania ujemnego bilansu energetycznego (zmiana nawyków żywieniowych i zwiększenie aktywności fizycznej). Niemniej duża grupa pacjentów w celu ułatwienia realizacji zaleceń dotyczących zmian stylu życia wymaga wsparcia farmakologicznego i/lub sychoterapeutycznego. Ostatni szczebel leczenia otyłości II stopnia z powikłaniami i otyłości III stopnia stanowi leczenie operacyjne. Możliwości stosowania farmakoterapii wspomagającej leczenie otyłości są bardzo ograniczone, przez ostatnie 6 lat na polskim rynku dostępny był wyłącznie orlistat. Obecnie po zarejestrowaniu przez EMA w marcu 2015 roku, od listopada 2016 roku, dostępny jest złożony produkt leczniczy Mysimba® zawierający dwie substancje czynne — chlorowodorek bupropionu i chlorowodorek naltreksonu. Ze względu na addytywne działanie tych substancji czynnych w ośrodkowym układzie nerwowym zarówno na poziomie jądra łukowatego podwzgórza (stymulacja odczucia sytości), jak i zlokalizowanego w obszarze limbicznym układu nagrody (hamowanie apetytu) lek ten budzi nadzieję na zwiększenie skuteczności w leczeniu otyłości. Celem niniejszego stanowiska jest pomoc lekarzom praktykom w podejmowaniu decyzji o zastosowaniu produktu leczniczego Mysimba® tak, aby uzyskać jak najwięcej korzyści z leczenia dla pacjenta przy jak najniższym ryzyku.The treatment of overweight and obesity is a difficult and lengthy process, requiring both correctly identified causes of these diseases, and implementation of methods, which are adequate to the patient’s health status. The mainstay of treatment is lifestyle change leading to a negative energy balance (change in eating habits and increased physical activity). However, many patients in order to facilitate the implementation of recommendations for lifestyle changes require the pharmacological or sychotherapeutic support. The last level of the treatment of class II obesity with complications and class III obesity is a surgical procedure. The possibility of using pharmacologic agents to treat obesity is very limited. Orlistat is the only medicinal product, which has been available on the Polish market for the last 6 years. Mysimba® was authorized by the EMA in March 2015. Mysimba® has been available on the Polish market since November 2016. Mysimba® is a fixed dose combination medicinal product which contains two active substances, bupropion hydrochloride and naltrexone hydrochloride. Due to the additive effect of these active substances in the central nervous system in the arcuate nucleus of the hypothalamus (satiety stimulation) and in the limbic area where the reward system is located (appetite suppressing) the drug raises the hope for increasing efficacy in the treatment of obesity. The aim of this position statement is to help clinicians in making decisions about the use of the Mysimba® medicinal product in order to achieve the highest possible benefit/risk ratio for patients

Treatment of overweight and obesity during and after a pandemic. Let’s not wait for the development of complications — new guidelines for doctors

Guidelines developed by Experts endorsed by the Polish Association for the Study of Obesity, Polish Psychiatric Association, Polish Society of Hypertension, Scientific Section of Telepsychiatry of the Polish Psychiatric Association, Polish Association of Cardiodiabetology, Polish Association of Endocrinology, and The College of Family Physicians in Poland Social patronage of the Foundation for People with Obesity OD-WAGA    The treatment of obesity in the pandemic era has become more important than ever. The current situation is conducive to the worsening of disease and the development of new diseases, mainly as a result of compensating negative emotions with food. Taking into account the data on the impact of obesity and its complications on the severity of the course and the risk of death due to COVID-19, we recommend using the 2016 American Endocrine Society’s criteria for the diagnosis of obesity instead of the 1998 WHO criteria. We also recommend diagnosing eating under the influence of emotions and the occurrence of eating disturbances, such as compulsive eating syndrome, night eating syndrome and food addiction, and complications of obesity, in any person with a BMI ≥ 25 kg/m2. The approach to treatment should be individualised and should not be limited to nutritional and physical activity education alone. Each patient should be offered appropriately selected pharmacotherapy, and, if necessary, also psychotherapy. The first-line drug should be a combined preparation containing naltrexone and bupropion (Mysimba®). Liraglutide in a dose of 3 mg (Saxenda®) should be considered as a second-line drug in a situation where eating under the influence of emotions is excluded (reaching for food in situations of experiencing negative and positive emotions and boredom, eating disturbances: compulsive eating syndrome, night eating syndrome, and food addiction) and depressed mood or there are permanent contraindications to the use of the first-line drug. It is unethical not to treat obesity or refer the patient to another doctor for treatment. The use of telemedicine tools can facilitate work in therapeutic teams (doctor, dietitian, psychotherapist), as well as improve patient compliance with pharmacotherapy and changes in eating habits and the level of physical activity recommendations

Leczenie nadwagi i otyłości w czasie i po pandemii. Nie czekajmy na rozwój powikłań — nowe wytyczne dla lekarzy

Wytyczne opracowane przez Ekspertów pod patronatem Polskiego Towarzystwa Badań nad Otyłością, Polskiego Towarzystwa Psychiatrycznego, Polskiego Towarzystwa Nadciśnienia Tętniczego, Sekcji Naukowej Telepsychiatrii Polskiego Towarzystwa Psychiatrycznego, Polskiego Towarzystwa Kardiodiabetologicznego, Polskiego Towarzystwa Endokrynologicznego i Kolegium Lekarzy Rodzinnych w Polsce Patronat społeczny Fundacji Osób Chorych na Otyłość OD-WAGA Leczenie otyłości w dobie pandemii stało się jeszcze ważniejsze niż do tej pory. Aktualna sytuacja sprzyja rozwojowi istniejącej choroby, jak również nowym zachorowaniom, przede wszystkim z powodu kompensowania negatywnych emocji jedzeniem. Biorąc pod uwagę dane dotyczące wpływu otyłości i jej powikłań na przebieg i ryzyko zgonu z powodu COVID-19, rekomendujemy diagnozowanie otyłości z zastosowaniem kryteriów Amerykańskich Towarzystw Endokrynologicznych z 2016 r. zamiast kryteriów WHO z roku 1998. Zalecamy również diagnozowanie jedzenia pod wpływem emocji oraz takich zaburzeń odżywiania, jak zespół kompulsywnego jedzenia, zespół nocnego jedzenia i nałogowe jedzenie, oraz powikłań otyłości u każdej osoby z BMI &gt; 25 kg/m2. Podejście do leczenia powinno być zindywidualizowane i nie powinno ograniczać się do edukacji żywieniowej oraz wskazań dotyczących aktywności fizycznej. Każdemu choremu należy proponować odpowiednio dobraną farmakoterapię, a w razie potrzeby również psychoterapię. Lekiem I rzutu powinien być preparat złożony, który zawiera naltrekson i bupropion (Mysimba®). Liraglutyd w dawce 3 mg (Saxenda®) powinien być brany pod uwagę jako lek II rzutu, gdy zostaną wykluczone jedzenie pod wpływem emocji (sięganie po jedzenie w sytuacjach przeżywania emocji negatywnych i pozytywnych, nudy, zaburzenia odżywiania: zespół kompulsywnego jedzenia, zespół nocnego jedzenia i nałogowe jedzenie), obniżony nastrój lub istnieją trwałe przeciwwskazania do zastosowania leku I rzutu. Niepodejmowanie leczenia otyłości lub  nieskierowanie chorego do innego lekarza, który podejmie się jej leczenia, jest postępowaniem nieetycznym. Wykorzystanie narzędzi telemedycyny może ułatwić pracę w zespołach terapeutycznych (lekarz, dietetyk, psychoterapeuta), a także poprawić stosowanie się pacjentów do zaleceń dotyczących farmakoterapii, zmian nawyków żywieniowych i podjęcia aktywności fizycznej