Purpose
The aim of our study was to compare the incidence of idiopathic central precocious puberty (CPP) in our highly specialized Endocrinological Center before and after the onset of COVID-19 ...lockdown; we also aimed to identify any potential difference between girls with CPP from the two different time periods.
Methods
We retrospectively analyzed the auxological profile of 49 girls with idiopathic CPP: 30 with pre-lockdown onset and 19 with post-lockdown onset of the disease. We collected patients’ characteristics (medical history, physical examination, baseline and dynamic hormonal assessment, bone age, pelvic ultrasound) and compared them between the two groups.
Results
We registered an almost threefold increase in CPP incidence in the 2020–2021 period compared to the previous six years. In post-lockdown patients we found a trend for an earlier diagnosis in terms of both chronological age (
p
0.0866) and days between the onset of first pubertal signs and diagnosis (
p
0.0618). We also found that post-lockdown patients had a significantly lower hypothalamus-pituitary–gonadal axis activation (lower ∆LH% after GnRH test,
p
0.0497), a significantly lower increase in bone age calculated at RUS with TW3 method (
p
0.0438) and a significantly reduced ovarian activation in females (lower delta-4-androstenedione levels, p 0.0115). Interestingly, post-lockdown patients were born from mothers with an older age at menarche (
p
0.0039).
Conclusions
Besides confirming a significant increase in new diagnoses of CPP in the post-lockdown period, our findings among Post-lockdown girls also suggest a less progressive form of CPP and a stronger environmental influence compared to genetic background in determining the timing of pubertal onset.
OBJECTIVE:Acute exposure to high/moderate altitude (HMA) induces increase in ambulatory blood pressure (BP), which may be particularly pronounced during the night, leading to reduced nocturnal BP ...dipping. Occurrence of central sleep apneas (CSA) is also typical for HMA exposure. Aim of this study was to investigate the relationship between variables characterizing respiration during sleep with nocturnal BP in subjects acutely exposed to HMA.
DESIGN AND METHOD:Aggregate data from several studies performed in the framework of HIGHCARE projects were analysed (HIGHCARE-Himalaya – 5400 m, Alps - 4559 m, Sestriere 2035 m, all in healthy volunteers; Andes – 3260 m, hypertensive subjects). HMA exposure duration ranged between 1 and 15 days. Data of subjects with at least 1 ambulatory BP monitoring at sea level (SL) and HMA (validated oscillometric device) and at least 1 cardio-respiratory sleep study (CSS) were analysed. Study variables includedmean nocturnal systolic(S) and diastolic (D)BP; size of nocturnal BP fall (%), apnea-hypopnea index (AHI), central apnea index (cAI), mean and minimum nocturnal oxygen saturation (SpO2mean and SpO2 min). Mixed linear models adjusting for age, sex, BMI, study, treatment were used to assess the relationship between variables of interest.
RESULTS:After excluding participants with incomplete data, 178 subjects were included (52.8% male, age 45.6 ± 11.7, BMI 25.3 ± 4.3). During HMA exposure we observed an increase in nocturnal SBP/DBP by 10.8 ± 12.9 mmHg, a reduction in nocturnal SBP/DBP fall by 2.5 ± 7.9%. Median SpO2mean was 82.6%, SpO2 min 70%, AHI 22.5, cAI 1.1. 82% of participants had AHI > 5. After adjusting for covariates no association was found between changes in nocturnal BP/dipping and AHI or cAI. We observed a direct relationship between SpO2mean and the change in nocturnal SBP fall (β=0.21 0.04–0.39, p = 0.017). In categorical analysis participants who at HMA became nondippers (SBP fall < 10%) had lower SpO2mean than those who maintained nocturnal dipping (77.9 vs. 84.2%, adjusted p = 0.044).
CONCLUSIONS:Attenuation of physiological nocturnal BP fall at HMA is associated with the degree of nocturnal hypoxemia but not with the severity of sleep breathing disorders induced by HMA exposure. These results may be relevant in conditions associated with nocturnal hypoxia and/or CSA.
OBJECTIVE:24-hour blood pressure variability (BPV) is independently related to cardiovascular outcomes, but conflicting evidence is available on the relative prognostic importance of systolic and ...diastolic BPV. Aim of this study was to verify the hypothesis that the association of systolic and diastolic blood pressure variability over 24 hours with cardiovascular mortality in untreated subjects is affected by age.
DESIGN AND METHOD:24-hour ambulatory blood pressure monitoring was obtained in 10,500 untreated individuals assessed for hypertension in the frame of the Dublin Outcome Study (age 54.4 ± 14.5 years, 47% males) followed up over a median time of 5.4 years. The association of short-term systolic and diastolic blood pressure variability with cardiovascular deaths (N = 498) was assessed in the entire sample and separately in younger and older age subgroups.
RESULTS:Diastolic BPV was directly and independently related to cardiovascular mortality (adjusted hazard ratio (adjHR) for 24-hour weighted standard deviation 1.15 95% confidence interval 1.07–1.24) and the strength of this association did not differ significantly among age groups. Conversely, systolic BPV was independently associated with cardiovascular mortality only in younger (<50 years) subjects (adjHR for 24-hour weighted standard deviation 1.68 95% confidence interval 1.30–2.17), superseding the predictive value of diastolic BPV in this group (Figure).(Figure is included in full-text article.)
CONCLUSIONS:Diastolic short-term BPV independently predicts cardiovascular mortality in hypertensive subjects at all ages, while systolic BPV seems a particularly strong predictor in young adults. If confirmed, these findings might improve the understanding of the prognostic value of BPV, with new perspectives for its possible clinical application.
OBJECTIVE:Treatment of obstructive sleep apnoea (OSA) has been shown to reduce blood pressure (BP). However, the effect size is modest and treatment of OSA is not recommended as the only treatment ...target when treating hypertension. Despite the limited effect of continuous positive airway pressure (CPAP) therapy on BP, it is likely that certain phenotypes of OSA patients respond better to CPAP than others. The aim of the present systematic review and meta-analysis was to identify potential predictors for BP response in patients with OSA undergoing CPAP treatment.(Figure is included in full-text article.)
DESIGN AND METHOD:A systematic search was conducted in three databases (MEDLINE, Embase and Web of Science) using terms exploring three domains (obstructive sleep apnoea, CPAP, clinical trial) based on the following inclusion criteriai) randomised controlled clinical trials published between January 1st 1960 to December 31st 2017 including a reasonable control group; iii) OSA diagnosis using polysomnography; iv) age >18 years; v) OSA severity of at least 5 AHI/h. The random effect model was fitted to estimate the pooled BP reductions calculated as the difference between the BP change (end-treatment minus baseline) in the CPAP and control group. Moreover, the original estimates have been stratified according to selected patient characteristics.
RESULTS:Out of 2445 articles, 59 RCTs were included (n = 7,329 subjects) comparing CPAP with control groups. CPAP was associated with a net reduction in systolic BP of −2.12 (95% CI −2.82 to −1.42) mmHg and in diastolic BP of −1.97 (95% CI −2.46 to −1.48) mmHg, favouring treatment of OSA using CPAP (both p-values < 0.001). The subgroup analysis showed that systolic BP reduction was greater in subjects younger than 60 years (−2.88 fro age 40–50, −2.78 for age 50–60 and −0.61 for age more than 60 years, p = 0.007) and in patients with controlled BP at baseline versus uncontrolled BP (−1.45 vs −4.14, p = 0.002) (Figure 1).
CONCLUSIONS:Younger patients (< 60 years) with uncontrolled blood pressure at baseline are more likely to experience significant BP reductions with CPAP therapy. Phenotypisation of specific cohorts of patients can guide clinicians to target OSA treatment and help to optimise patients’ cardiovascular risk.
Purpose
Arthropathy is a common and disabling complication of acromegaly. Since in this condition radiological findings rarely correspond to functional impairment, we elected to quantify in a large ...cohort of acromegalic patients: the degree of motor disability compared with data from general population, the impact of joint involvement on quality of life and work productivity, and to look for associated factors.
Methods
In 211 acromegalic patients, 131 with controlled disease and 80 with active disease, eight validated scales were used to evaluate the (i) prevalence and distribution of arthropathy, (ii) degree of motor disability and joint symptoms (VAS, AIMS symptoms and WOMAC), (iii) quality of life (AcroQoL and PASQ) and work capability (WPAI:GH) as consequences of joint complications.
Results
Using the WOMAC questionnaire, for which population based normative values are available, a significantly higher prevalence and severity of motor disability was detected in acromegalics compared to the general population from literature. The results provided by the different questionnaires turned out to be highly concordant. All measures of motor disability correlated both with impaired quality of life and motor disability and were worse in females and in patients with higher BMI.
Conclusions
The questionnaires VAS, AIMS symptoms, and WOMAC (this latter both as a whole and with its functionality subscale), with their scores, proved to be the most adequate tools to evaluate motor disability and its consequences on both quality of life and work productivity in acromegaly. Female gender and higher BMI are associated with worse articular symptoms.
OBJECTIVE:Office and 24-h ambulatory (A) blood pressure (BP) measurement are the main techniques to quantify the BP effects of treatment in clinical trials and practice. Several clinical trials have ...made it clear that the BP reduction as evaluated by the two techniques differs. We performed a meta-analysis to quantify the magnitude of this difference in patients given a variety of drug treatments. Moreover, we stratified the analysis for antihypertensive class.
DESIGN AND METHOD:A MEDLINE research based on the following inclusion criteria was performedi) randomized clinical trials published from the 1st of January 1960 to the 9th of July 2015; ii) patients treated with any antihypertensive drug either in monotherapy or in combination; iii) treatment-induced office and 24-h mean BP reduction in the same patients; iv) availability of variability measures of BP reduction or sufficient raw data to calculate it. Fixed and random effect models were fitted to estimate the pooled BP reductions for both techniques on condition that the corresponding estimates were reported by at least three studies. Between study heterogeneity was tested using Q statistics and measured with the I2 index. Publication bias was evaluated using funnel plot and Eggerʼs regression asymmetry test.
RESULTS:41 studies satisfying inclusion criteria and including 8,171 patients were analyzed. The main results are showed in Table 1. Compared to office 24-h mean BP reduction was always less. The ratio between office and 24-h BP reduction was similar for the different treatments (range 1.4–1.9), its value being somewhat lower for patients under combination treatment and markedly higher and more variable for placebo.(Figure is included in full-text article.)
CONCLUSIONS:The effect of antihypertensive treatment is systematically greater for office than for ABP. The difference is marked and visible for all major antihypertensive drugs as well as for combination treatment as compared to monotherapy.
Objective: Angiogenin (ANG) is a pro-angiogenic and neurotrophic factor with an important role in stress-induced injury, by promoting neovascularization and neuronal survival. Identification of ...loss-of-function mutations and evidence of beneficial effect of ANG administration in transgenic SOD1
G93A
mice have linked ANG to the pathogenesis of Amyotrophic Lateral Sclerosis (ALS), stimulating interest in considering circulating ANG levels as an ALS disease biomarker although robust evidence is still lacking. Aim of our study was to assess differences of ANG levels in the cerebrospinal fluid (CSF) of a large cohort of patients with ALS and frontotemporal dementia (FTD) compared to controls and to explore correlations between ANG content and disease-related clinical variables. Methods: ANG levels were measured in CSF samples using a commercially available ELISA kit in 88 patients affected with ALS and/or FTD and 46 unrelated individuals (control group). Results: ANG levels didn't differ significantly between cases and controls. Patients with FTD or ALS-FTD showed significantly increased CSF concentration of ANG compared to ALS patients without dementia and controls in a multivariate regression model (p < 0.001). No correlations were found in ALS/FTD patients between ANG levels and clinical parameters, including age, presence of C9orf72 repeat expansion, body mass index (BMI). Conclusions: our findings highlight a role of ANG as CSF biomarker useful to identify ALS patients with concurrent FTD and suggest that it should be further explored as potential biomarker for FTD.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
OBJECTIVE:While Obstructive sleep apnea (OSA) is associated with increased risk of arterial hypertension and adverse cardiovascular outcomes, the link between arterial hypertension and periodic limb ...movement during sleep (PLMS), with or without OSA, is still controversial.
DESIGN AND METHOD:A cross-sectional analysis of 2686 participants in the multinational European Sleep Apnoea Cohort (ESADA) study was performed, by assessing the relation of blood pressure (BP) values (systolic and diastolic) with PLMS in subjects with or without OSA.All patients underwent full polysomnography (PSG) and office BP evaluation.From the polysomnographic examination we obtained quantification of OSA by assessing the apnea-hypopnea index (AHI) and quantification of PLMS as quantified by PLMS index (PLMSI).
RESULTS:1528 subjects (1036 males, mean age 51 yrs, mean BMI 30) were included in the final cohort. To analyze the relationship between office blood pressure values (systolic and diastolic), and AHI and PLMSI we identified four patients’ groups according to the AHI and PLMSI results as followingGroup 1 (N = 120) patients with PLMSI > = 25 and AHI > = 10; Group 2 (N = 992) PLMSI < 25 and AHI > = 10; Group 3 (N = 21) PLMSI > = 25 and AHI < 10; Group 4 (N = 395) PLMSI <25 and AHI<10.Systolic and diastolic blood pressure means estimated by ANCOVA models for each group are shown in Table 1. The p-values are related to the contrasts between each group mean and reference group mean (Group 1).(Figure is included in full-text article.)The mean of systolic blood pressure was significantly higher in group 1 as compared with group 4. No significant differences we observed in diastolic values.
CONCLUSIONS:Our results confirm the link between apnea-hypopnea index and BP levels. The novel observation of our study is that the simultaneous presence of OSA and PLMS is associated with significantly higher office BP values than in OSA patients without PLMS. Further studies are needed to better characterize such an association by assessing the link between PLMS and 24 h ambulatory BP.
OBJECTIVE:Blood pressure (BP) measuring devices may become inaccurate at high altitude due to low barometric pressure. Aim of this study was to assess the changes in the accuracy of different types ...of BP measuring devices between sea level and high altitude, taking auscultatory measurements with mercury sphygmomanometer as reference.
DESIGN AND METHOD:In the frame of HIGHCARE-ALPS project, we obtained multiple BP measurements in 39 healthy, normotensive volunteers (age:36.4 ± 8.5y, M/F:21/18), using a mercury (MER, reference), an aneroid (ANE), and two validated oscillometric devices one for home (OSC-HBP; AND UA-767PC) and one for ambulatory (OSC-ABP; AND TM2430) BP monitoring, at sea level and during acute exposure to high altitude (4559m, 437–439 Torr). BP measurements with the different devices were performed sequentially on the same arm in random order, consistent under both study conditions.
RESULTS:Mean systolic (S) and diastolic (D)BP were higher at high altitude than at sea level (MER117.6/80.3 vs. 110.9/74.1 mmHg, p < 0.001) The mean differences in SBP between MER (reference) and the other devices at baseline and high altitude were 1.7 ± 6.5/0.6 ± 7.1 (OSC-ABP), −3.1 ± 5.3*/−3.8 ± 6.3* (ANE) and −1.2 ± 7.0/−5.0 ± 6.7* (OSC-HBP) respectively. The corresponding differences for DBP were −3.9 ± 5.9*/−4.5 ± 6.5* (OSC-ABP), −2.2 ± 5.1*−5.3 ± 6.7* (ANE) and −4.8 ± 7.6*/−1.8 ± 7.1 (OSC-HBP), (mmHg, *p < 0.01 vs. MER). The over or underestimations of BP values by tested devices as compared with MER were consistent and similar at sea level and high altitude, except for a greater underestimation of SBP by OSC-HBP (p = 0.01), and of DBP by ANE (p = 0.03) at altitude, and for a greater underestimation of DBP by OSC-HBP (p = 0.02) at sea level. In spite of the statistical significance, the absolute changes in the size of error between sea level and high altitude never exceeded 4 mmHg. The distribution of mean between-device differences within the group was consistent between sea level and high altitude, with about 50% of subjects displaying between-devices differences always smaller than 5 mmHg (Figure).(Figure is included in full-text article.)
CONCLUSIONS:BP measuring devices commonly used at sea level remain reasonably accurate at high altitude. We did not find consistent and clinically relevant changes in the accuracy of the tested devices caused by low barometric pressure at altitude.
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