Everything below concerns receptor targets. We keep the language plain, cite what the science says, and separate well-supported claims from open questions.
Last reviewed on 2026-02-12. Where a claim depends on a specific study, the study is described rather than over-claimed.
Body composition is assessed with dual-energy X-ray absorptiometry or comparable methods, which separate fat mass from lean mass. Reported losses include both compartments, and the ratio between them is a subject of ongoing analysis rather than a settled result. Waist circumference, blood pressure, and lipid panels are collected as supporting measures. Resting energy expenditure and substrate oxidation are measured in smaller mechanistic studies, where glucagon receptor activity is expected to matter. These substudies are typically short and small, so their findings carry wide uncertainty.
Interpretation depends on study phase and duration. Phase 2 programs are powered for weight and safety signals, not for cardiovascular or renal outcomes, which require event-driven designs. Gastrointestinal events such as nausea, diarrhea, vomiting, and constipation are the most frequently reported adverse effects and tend to cluster around dose escalation. Small increases in heart rate have been described. Because follow-up after treatment discontinuation is limited, questions about weight regain and durability are open rather than answered.
Human evidence remains limited to controlled studies. A phase 2 trial in adults with obesity reported large, dose-dependent reductions in body weight over 48 weeks, with gastrointestinal events as the most frequently recorded adverse effect. Phase 3 programs designated TRIUMPH, for obesity, and TRANSCEND, for type 2 diabetes, are intended to confirm efficacy and to characterize safety in larger populations. Related studies are examining conditions such as knee osteoarthritis in people with obesity and metabolic liver disease. Open questions include long-term tolerability, effects on lean mass, and what happens after treatment is stopped.
Retatrutide is an investigational synthetic peptide that acts on three receptor targets at once: glucose-dependent insulinotropic polypeptide, glucagon-like peptide-1, and glucagon. It is developed by Eli Lilly and appears in the literature and in trial registries under the code LY3437943. The molecule belongs to a class of engineered peptides designed to resist rapid breakdown and permit infrequent subcutaneous administration. No regulatory agency has approved it for clinical use, and all available human data come from controlled trials rather than from routine practice.
The intended pharmacology combines three signals in one molecule. GLP-1 receptor activation reduces appetite and slows gastric emptying, effects already exploited by approved incretin-based therapies. GIP receptor engagement is associated with improved insulin sensitivity and with direct effects on adipose tissue, although how much it contributes to overall outcomes is still debated. Glucagon receptor agonism raises energy expenditure and supports hepatic lipid handling, a mechanism that also tends to increase glucose output. The triple profile is hypothesized to produce a larger metabolic effect than single or dual agonism, but the relative weight of each receptor in humans is not settled.
| Property | Value | Notes |
|---|---|---|
| Trial design | Randomized, double-blind, placebo-controlled | Frequently includes dose-escalation arms |
| Weight endpoint | Percent change from baseline | Reported at a prespecified week |
| Liver fat endpoint | MRI proton density fat fraction | Non-invasive imaging measure |
| Body composition method | Dual-energy X-ray absorptiometry | Separates fat mass from lean mass |
| Common adverse events | Nausea, diarrhea, vomiting | Reported most often during dose escalation |
化学修饰延长了分子在体内的停留时间，使较低频次的给药安排成为可能。脂肪酸侧链通过与白蛋白结合延缓清除，非天然氨基酸则降低酶解速率。这些修饰同时改变分子的溶解性与稳定性，需要在制剂设计和储存条件中一并考虑。修饰引入的免疫原性风险也属于开发过程中需要评估的项目。
该化合物处于临床试验阶段，尚未在多数地区取得上市许可。公开信息主要来自企业公告、学术会议摘要与试验注册平台记录，完整数据仍在逐步披露。关于长期疗效与安全性的判断，需要等待规模更大、随访更久的研究结果，目前不宜对最终结论作出预判。
Mechanistic proposals link each receptor to a different physiological role. Activation of the glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptors is associated with reduced appetite, slower gastric emptying, and glucose-dependent insulin release. Glucagon receptor signaling, by contrast, is associated with increased energy expenditure and altered lipid handling, though it can also raise blood glucose. The design intent is to balance these contributions so that weight reduction is enhanced without unacceptable glycemic trade-offs. How well that balance holds across individuals is not fully resolved.
Published information places retatrutide in clinical development rather than on the market as an approved therapy. Early-stage and mid-stage trials have examined tolerability and changes in body weight, and larger studies continue to report results over time. Open questions include the durability of effects after treatment stops, the composition of weight lost, and cardiovascular outcomes over long periods. Statements about definitive benefit should therefore be treated as provisional. Regulatory status varies by jurisdiction and changes as applications are reviewed.
Retatrutide is an investigational synthetic peptide designed to activate three distinct receptor systems within a single molecule. Its pharmacological profile combines activity at the glucose-dependent insulinotropic polypeptide receptor, the glucagon-like peptide-1 receptor, and the glucagon receptor. This arrangement places it within a broader class of agents often described as multi-agonists, which contrast with compounds that engage one or two targets. Research interest centers on whether simultaneous signaling produces effects that single-receptor agonists cannot achieve alone. A single molecular entity also simplifies manufacturing and delivery logistics compared with combining separate agents.
Lymphadenopathy refers to one or more enlarged lymph nodes. Small groups or individually enlarged lymph nodes are generally reactive in response to infection or inflammation. This is called local lymphadenopathy. When many lymph nodes in different areas of the body are involved, this is called generalised lymphadenopathy. Generalised lymphadenopathy may be caused by infections such as infectious mononucleosis, tuberculosis and HIV, connective tissue diseases such as SLE and rheumatoid arthritis, and cancers, including both cancers of tissue within lymph nodes, discussed below, and metastasis of cancerous cells from other parts of the body, that have arrived via the lymphatic system.
== Overdose == Methamphetamine overdose is a diverse term. It frequently refers to the exaggeration of the unusual effects with features such as irritability, agitation, hallucinations and paranoia. The cardiovascular effects are typically not noticed in young healthy people. Hypertension and tachycardia are not apparent unless measured. A moderate overdose of methamphetamine may induce symptoms such as: abnormal heart rhythm, confusion, difficult or painful urination, high or low blood pressure, high body temperature, over-active or over-responsive reflexes, muscle aches, severe agitation, rapid breathing, tremor, urinary hesitancy, and an inability to pass urine. An extremely large overdose may produce symptoms such as adrenergic storm, methamphetamine psychosis, substantially reduced or no urine output, cardiogenic shock, bleeding in the brain, circulatory collapse, hyperpyrexia (i.e., dangerously high body temperature), pulmonary hypertension, kidney failure, rapid muscle breakdown, serotonin syndrome, and a form of stereotypy ("tweaking"). A methamphetamine overdose will likely also result in mild brain damage owing to dopaminergic and serotonergic neurotoxicity. Death from methamphetamine poisoning is typically preceded by convulsions and coma.
The Battle of Binh Ba, also known as Operation Hammer, was a hard-fought, but one-sided, battle. Troops from the 5th Battalion, Royal Australian Regiment (5RAR) fought a PAVN/VC force in the village of Binh Ba, 5 kilometres (3.1 mi) north of Nui Dat in Phuoc Tuy Province resulting in 107 PAVN/VC killed and eight captured for the loss of one Australian killed.
== Adenlylylation in Eukaryotes == Plants and yeasts have no known endogenous AMPylating enzymes, but animal genomes are endowed with a single copy of a gene encoding a Fic-domain AMPylase, that was likely acquired by an early ancestor of animals via horizontal gene transfer from a prokaryote. The human protein referred to commonly as FICD, had been previously identified as Huntingtin associated protein E (HypE; an assignment arising from a yeast two-hybrid screen, but of questionable relevance, as Huntingtin and HypE/FICD are localised to different cellular compartments). CG9523 Homologues in Drosophila melanogaster (CG9523) and C. elegans (Fic-1) have also received attention. In all animals FICD has a similar structure. It is a type II transmembrane domain protein, with a short cytoplasmic domain followed by membrane anchor that holds the protein in the endoplasmic reticulum (ER) and long C-terminal portion that resides in ER and encompasses tetratricopeptide repeats (TPRs) followed by a catalytic Fic domain.
== Deterministic versus stochastic epidemic models == The deterministic models presented here are valid only in case of sufficiently large populations, and as such should be used cautiously. These models are only valid in the thermodynamic limit, where the population is effectively infinite. In stochastic models, the long-time endemic equilibrium derived above, does not hold, as there is a finite probability that the number of infected individuals drops below one in a system. In a true system then, the pathogen may not propagate, as no host will be infected. But, in deterministic mean-field models, the number of infected can take on real, namely, non-integer values of infected hosts, and the number of hosts in the model can be less than one, but more than zero, thereby allowing the pathogen in the model to propagate. The reliability of compartmental models is limited to compartmental applications. One of the possible extensions of mean-field models considers the spreading of epidemics on a network based on percolation theory concepts. Stochastic epidemic models have been studied on different networks and more recently applied to the COVID-19 pandemic.
Sources: en.wikipedia.org
Humphreys is best known for his published PhD dissertation, Tearoom Trade: Impersonal Sex in Public Places (1970), an ethnographic study of anonymous male-male sexual encounters in public toilets (a practice known as "tea-rooming" in US gay slang and "cottaging" in British English). Humphreys asserted that the men participating in such activity came from diverse social backgrounds, had differing personal motives for seeking sexual partners in such venues, and variously self-perceived as "straight," "bisexual," or "gay." Because Humphreys was able to confirm that over 50% of his subjects identified as heterosexual men who were married to women, a primary thesis of Tearoom Trade is the incongruence between the private self and the social self for many of the men engaging in this form of homosexual activity. Specifically, they put on a "breastplate of righteousness" (social and political conservatism) in an effort to conceal their sexual behavior and prevent being exposed as deviants. Humphreys tapped into a theme of incongruence between one's words and deeds that has become a primary methodological and theoretical concern in sociology throughout the 20th and 21st centuries.
In other systems considered non-traditional, droplet-based microfluidic system, magnetic microdroplets can be a facile means of fabrication and control of micro and nanomaterials, sometimes called "robots". These nanostructures are formed of magnetic nanoparticles in microdroplets that have been manipulated into specific structures by an applied magnetic field. Microhelices are a multifunctional application of this technology. Monodisperse droplets containing magnetic nanoparticles are generated and subjected to a magnetic field which organizes the nanoparticles into a helical template that is fabricated in place through photoinduced polymerization. These microhelices were shown to be effective at clearing channels that were blocked with semi-solid composites of fats, oils, and proteins, such as those found in arteries. Microhelices and microparticle clusters in magnetic droplets have been demonstrated to be a means of transport for small (500 μm diameter) microparticles, showing applications in drug delivery as well. Non-spherical microstructures have also been fabricated using magnetic microfluidics, demonstrating the minute control that is available. Among the non-spherical microstructures to be fabricated were graphene oxide microcapsules that could be aspirated and reinflated using a micropipette, while also exhibiting photoresponsive and magnetoresponsive behavior.
Due to their numerous sources indoors, concentrations of VOCs indoors are consistently higher (up to ten times higher) than outdoors. VOCs are emitted by thousands of indoor products. Examples include: paints, varnishes, waxes and lacquers, paint strippers, cleaning and personal care products, pesticides, building materials and furnishings, office equipment such as copiers and printers, correction fluids and carbonless copy paper, graphics and craft materials including glues and adhesives, permanent markers, and photographic solutions. Human activities such as cooking and cleaning can also emit VOCs. Cooking can release long-chain aldehydes and alkanes when oil is heated and terpenes can be released when spices are prepared and/or cooked. Cleaning products contain a range of VOCs, including monoterpenes, sesquiterpenes, alcohols and esters. Once released into the air, VOCs can undergo reactions with ozone and hydroxyl radicals to produce other VOCs, such as formaldehyde. Some VOCs are emitted directly indoors, and some are formed through the subsequent chemical reactions. The total concentration of all VOCs (TVOC) indoors can be up to five times higher than that of outdoor levels. New buildings experience particularly high levels of VOC off-gassing indoors because of the abundant new materials (building materials, fittings, surface coverings and treatments such as glues, paints and sealants) exposed to the indoor air, emitting multiple VOC gases.
This broad classification is based on the empirical makeup and atomic structure of the solid materials, and most solids fall into one of these broad categories. An item that is often made from each of these materials types is the beverage container. The material types used for beverage containers accordingly provide different advantages and disadvantages, depending on the material used. Ceramic (glass) containers are optically transparent, impervious to the passage of carbon dioxide, relatively inexpensive, and are easily recycled, but are also heavy and fracture easily. Metal (aluminum alloy) is relatively strong, is a good barrier to the diffusion of carbon dioxide, and is easily recycled. However, the cans are opaque, expensive to produce, and are easily dented and punctured. Polymers (polyethylene plastic) are relatively strong, can be optically transparent, are inexpensive and lightweight, and can be recyclable, but are not as impervious to the passage of carbon dioxide as aluminum and glass.
=== Puberty === Puberty usually lasts from 2 to 5 years, and typically occurs between the ages of 12 and 17. During puberty, voice change is controlled by sex hormones. In females during puberty, the vocal muscle thickens slightly, but remains very supple and narrow. The squamous mucosa also differentiates into three distinct layers (the lamina propria) on the free edge of the vocal folds. The sub- and supraglottic glandular mucosa becomes hormone-dependent to estrogens and progesterone. For females, the actions of estrogens and progesterone produce changes in the extravascular spaces by increasing capillary permeability which allows the passage of intracapillary fluids to the interstitial space as well as modification of glandular secretions. Estrogens have a hypertrophic and proliferative effect on mucosa by reducing the desquamating effect on the superficial layers. The thyroid hormones also affect dynamic function of the vocal folds; (Hashimoto's thyroiditis affects the fluid balance in the vocal folds). Progesterone has an anti-proliferative effect on mucosa and accelerates desquamation. It causes a menstrual-like cycle in the vocal fold epithelium and a drying out of the mucosa with a reduction in secretions of the glandular epithelium. Progesterone has a diuretic effect and decreases capillary permeability, thus trapping the extracellular fluid out of the capillaries and causing tissue congestion.
Sources: en.wikipedia.org
==== United States ==== Between 1973 and 1978, eleven states decriminalized marijuana. In 2001, Nevada reduced marijuana possession to a misdemeanor and since 2012, several other states have decriminalized and even legalized marijuana. In 2018, surveys indicated that almost half of the people in the United States had tried marijuana, 16% had used it in the past year, and 11% had used it in the past month. In 2014, surveys said daily marijuana use amongst US college students had reached its highest level since records began in 1980, rising from 3.5% in 2007 to 5.9% in 2014 and had surpassed daily cigarette use. In the US, men are over twice as likely to use marijuana as women, and 18–29-year-olds are six times more likely to use as over-65-year-olds. In 2015, a record 44% of the US population has tried marijuana in their lifetime, an increase from 38% in 2013 and 33% in 1985. Marijuana use in the United States is three times above the global average, but in line with other Western democracies. Forty-four percent of American 12th graders have tried the drug at least once, and the typical age of first-use is 16, similar to the typical age of first-use for alcohol but lower than the first-use age for other illicit drugs. A 2022 Gallup poll concluded Americans are smoking more marijuana than cigarettes for the first time.
== Assessment == There are several methods available for the assessment of sudomotor function. They vary in cost, technical complexity, reproducibility, variability and the availability of normative data. However, all sudomotor function assessments are not specific for small fiber or sudomotor neuropathy, as they can also yield abnormal results from disorders of the sweat glands themselves. The following is a list of methods used in clinical practice and clinical research for sudomotor assessment. Thermoregulatory Sweat Test (TST) and Quantitative Sudomotor Axon Reflex Test (QSART) are considered the gold standards for assessment of sudomotor function. Newer methods may offer simpler, potentially more sensitive, and more widely available alternatives for screening and monitoring in the clinic of autonomic and small fiber neuropathies, particularly those associated with diabetes.
== Timeline and list of outbreaks == 1960: Outbreak of Turkey 'X' disease in England, and aflatoxin discovery. 1961: Identified Aspergillus flavus associated with toxicity of groundnuts. 1962: Aflatoxin B and G identified in TLC analysis. Isolation and synthesis of aflatoxins. 1963: Aflatoxin B2, G1, and G2 were identified and chemically characterized as difurocoumarin derivatives. 1965: FDA approved the first regulation on aflatoxins 30 μg/kg. 1966: Milk toxins were designated as AFM1 and AFM2, and AFM1 was detected in milk, urine, kidney, and liver. 1973 Poland: 10 died following the opening of the tomb of Casimir IV Jagiellon, which contained aflatoxin-producing molds. 2004 Kenya: acute outbreak of aflatoxicosis resulting from ingestion of contaminated maize, 125 confirmed deaths. 2005 US: Diamond Pet Foods recalled aflatoxin-contaminated pet food manufactured from corn at their facility in Gaston, South Carolina. 2009–2011 International: Commercial peanut butter, cooking oils (e.g. olive, peanut and sesame oil), and cosmetics were identified as contaminated with aflatoxin. In some instances, liquid chromatography–tandem mass spectrometry (LC–MS/MS), and other analytical methods, revealed that 48–80% of selected product samples contained detectable quantities of aflatoxin. In many of these contaminated food products, the aflatoxin exceeded the safe limits of the U.S. Food and Drug Administration (FDA) or other regulatory agencies. February–March 2013: Romania, Serbia, Croatia imported into western Europe – 2013 aflatoxin contamination. February 2013: Iowa contamination.
The main precursors of glyceroneogenesis are pyruvate, lactate, glutamine, and alanine. Glyceroneogenesis is also known as the branched pathway of gluconeogenesis because its first few steps are the same. When pyruvate or lactate is used as the precursor for glycerol 3-phosphate, glyceroneogenesis follows the same pathway as gluconeogenesis until it generates dihydroxyacetone phosphate. Lactate catalyzed by lactate dehydrogenase will form pyruvate at the expense of NAD+. By using one ATP and bicarbonate, pyruvate will be converted to oxaloacetate, catalysed by pyruvate carboxylase. The PEPC-K enzyme will catalyze oxaloacetate to generate phosphoenolpyruvate. This phosphorylation and decarboxylation of oxaloacetate is a significant step in glyceroneogenesis, since it regulates the entire pathway. After the production of phosphoenolpyruvate, gluconeogenesis will continue until dihydroxyacetone phosphate is generated, which produces 2-phosphoglycerate, 3-phosphoglycerate, 1,3-bisphosphoglycerate and glyceraldehyde 3-phosphate as intermediates. When dihydroxyacetone phosphate is produced, glyceroneogenesis will branch off from gluconeogenesis. With the expense of NADH, dihydroxyacetone phosphate will convert to glycerol 3-phosphate, which is the final product of glyceroneogenesis. In addition, triglyceride can be generated by re-esterifying 3 fatty acid chains on glycerol 3-phosphate. Instead of producing fructose 1,6- bisphosphate as gluconeogenesis does, glyceroneogenesis converts dihydroxyacetone phosphate to glycerol 3-phosphate.
Sources: en.wikipedia.org
A responder analysis counts participants who cross a threshold, such as five or ten percent weight loss. It complements average percent change by showing how widely results are distributed. The two measures can diverge when a subset of participants loses a large amount.
Mechanistic measures such as energy expenditure and liver fat change come from small substudies and should be read as preliminary. Long-term clinical outcomes are not yet available. Average weight loss figures are better supported than explanations for how the loss is achieved.
Endpoints reported at different weeks, in different baseline BMI ranges, or under different dose-escalation schedules are not directly comparable. Studies in type 2 diabetes often show smaller weight changes than studies in obesity without diabetes. Reporting the population alongside the number keeps comparisons honest.
It is an investigational peptide that activates three hormone receptors: GIP, GLP-1 and glucagon. It is being studied mainly for obesity and type 2 diabetes, and it is not approved for any clinical use. Published information comes from controlled trials rather than from general practice.