To investigate the impact of pituitary surgery on glucose metabolism and to identify predictors of remission of diabetes after pituitary surgery in patients with acromegaly.AIMTo investigate the ...impact of pituitary surgery on glucose metabolism and to identify predictors of remission of diabetes after pituitary surgery in patients with acromegaly.A national multicenter retrospective study of patients with acromegaly undergoing transsphenoidal surgery for the first time at 33 tertiary Spanish hospitals (ACRO-SPAIN study) was performed. Surgical remission of acromegaly was evaluated according to the 2000 and 2010 criteria.METHODSA national multicenter retrospective study of patients with acromegaly undergoing transsphenoidal surgery for the first time at 33 tertiary Spanish hospitals (ACRO-SPAIN study) was performed. Surgical remission of acromegaly was evaluated according to the 2000 and 2010 criteria.A total of 604 acromegaly patients were included in the study with a total median follow up of 91 months (interquartile range IQR 45-163). At the acromegaly diagnosis, 23.8% of the patients had diabetes mellitus (DM) with a median glycated hemoglobin (HbA1c) of 6.9% (IQR 6.4-7.9) 51.9 mmol/mol (IQR 46.4-62.8). In the multivariate analysis, older age (odds ratio OR 1.02, 95% CI 1.00-1.05), dyslipidemia (OR 5.25, 95% CI 2.81 to 9.79), arthropathy (OR 1.39, 95% CI 2.82 to 9.79), and higher IGF-I levels (OR 1.30, 95% CI 1.05 to 1.60) were associated with a greater prevalence of DM. At the last follow-up visit after surgery, 21.1% of the DM patients (56.7% of them with surgical remission of acromegaly) experienced diabetes remission. The cure rate of DM was more common in older patients (hazard ratio HR 1.77, 95% CI 1.31 to 2.43), when surgical cure was achieved (HR 2.10, 95% CI 1.01 to 4.37) and when anterior pituitary function was not affected after surgery (HR 3.38, 95% CI 1.17 to 9.75).RESULTSA total of 604 acromegaly patients were included in the study with a total median follow up of 91 months (interquartile range IQR 45-163). At the acromegaly diagnosis, 23.8% of the patients had diabetes mellitus (DM) with a median glycated hemoglobin (HbA1c) of 6.9% (IQR 6.4-7.9) 51.9 mmol/mol (IQR 46.4-62.8). In the multivariate analysis, older age (odds ratio OR 1.02, 95% CI 1.00-1.05), dyslipidemia (OR 5.25, 95% CI 2.81 to 9.79), arthropathy (OR 1.39, 95% CI 2.82 to 9.79), and higher IGF-I levels (OR 1.30, 95% CI 1.05 to 1.60) were associated with a greater prevalence of DM. At the last follow-up visit after surgery, 21.1% of the DM patients (56.7% of them with surgical remission of acromegaly) experienced diabetes remission. The cure rate of DM was more common in older patients (hazard ratio HR 1.77, 95% CI 1.31 to 2.43), when surgical cure was achieved (HR 2.10, 95% CI 1.01 to 4.37) and when anterior pituitary function was not affected after surgery (HR 3.38, 95% CI 1.17 to 9.75).Glucose metabolism improved in patients with acromegaly after surgery and 21% of the diabetic patients experienced diabetes remission; being more frequent in patients of older age, and those who experienced surgical cure and those with preserved anterior pituitary function after surgery.CONCLUSIONGlucose metabolism improved in patients with acromegaly after surgery and 21% of the diabetic patients experienced diabetes remission; being more frequent in patients of older age, and those who experienced surgical cure and those with preserved anterior pituitary function after surgery.
Craniopharyngioma (CP) is a rare tumor in the elderly whose clinical features and prognosis are not well known in this population.
To evaluate the clinicopathological features and therapeutic ...outcomes of CP diagnosed in the elderly.
This was a retrospective, multicenter, national study of CP patients diagnosed over the age of 65 years and surgically treated.
From a total of 384 adult CP patients, we selected 53 (13.8%) patients (27 women 50.9%, mean age 72.3 ± 5.1 years range 65-83 years) diagnosed after the age of 65 years. The most common clinical symptoms were visual field defects (71.2%) followed by headache (45.3%). The maximum tumor diameter was 2.9 ± 1.1 cm. In most patients, the tumor was suprasellar (96.2%) and mixed (solid-cystic) (58.5%). The surgical approach most commonly used was transcranial surgery (52.8%), and more than half of the patients (54.7%) underwent subtotal resection (STR). Adamantinomatous CP and papillary CP were present in 51 and 45.1%, respectively, with mixed forms in the remaining. Surgery was accompanied by an improvement in visual field defects and in headaches; however, pituitary hormonal hypofunction increased, mainly at the expense of an increase in the prevalence of diabetes insipidus (DI) (from 3.9 to 69.2%). Near-total resection (NTR) was associated with a higher prevalence of DI compared with subtotal resection (87.5 vs. 53.6%, p = 0.008). Patients were followed for 46.7 ± 40.8 months. The mortality rate was 39.6% with a median survival time of 88 (95% CI: 57-118) months. DI at last visit was associated with a lower survival.
CP diagnosed in the elderly shows a similar distribution by sex and histologic forms than that diagnosed at younger ages. At presentation, visual field alterations and headaches are the main clinical symptoms which improve substantially with surgery. However, surgery, mainly NTR, is accompanied by worsening of pituitary function, especially DI, which seems to be a predictor of mortality in this population.
Abstract
Context
Few data exist about the clinical course of acromegaly, surgical and medical outcomes in patients with GH- and prolactin cosecreting pituitary adenomas (GH&PRL-PAs). Nevertheless, ...some series described a more aggressive clinic-radiological behavior than in growth hormone–secreting pituitary adenomas (GH-PAs).
Objective
This work aims to evaluate differences in clinical presentation and in surgical outcomes between GH-PAs and GH&PRL-PAs.
Methods
A multicenter retrospective study was conducted of 604 patients with acromegaly who underwent pituitary surgery. Patients were classified into 2 groups according to serum PRL levels at diagnosis and immunohistochemistry (IHC) for PRL: a) GH&PRL-PAs when PRL levels were above the upper limit of normal (ULN) and IHC for GH and PRL was positive or PRL levels were greater than 100 ng/dL and PRL IHC was not available (n = 130) and b) GH-PA patients who did not meet the previously mentioned criteria (n = 474).
Results
GH&PRL-PAs represented 21.5% (n = 130) of patients with acromegaly. The mean age at diagnosis was lower in GH&PRL-PAs than in GH-PAs (P < .001). GH&PRL-PAs were more frequently macroadenomas (90.6% vs 77.4%; P = .001) and tended to be more invasive (33.6% vs 24.7%; P = .057) than GH-PAs. Furthermore, they had presurgical hypopituitarism more frequently (odds ratio 2.8; 95% CI, 1.83-4.38). Insulin-like growth factor ULN levels at diagnosis were lower in patients with GH&PRL-PAs (median 2.4 interquartile range (IQR) 1.73-3.29 vs 2.7 IQR 1.91-3.67; P = .023). There were no differences in the immediate (41.1% vs 43.3%; P = .659) or long-term postsurgical acromegaly biochemical cure rate (53.5% vs 53.1%; P = .936) between groups. However, there was a higher incidence of permanent arginine-vasopressin deficiency (AVP-D) (7.3% vs 2.4%; P = .011) in GH&PRL-PA patients.
Conclusion
GH&PRL-PAs are responsible for 20% of acromegaly cases. These tumors are more invasive, larger, and cause hypopituitarism more frequently than GH-PAs and are diagnosed at an earlier age. The biochemical cure rate is similar between both groups, but patients with GH&PRL-PAs tend to develop permanent postsurgical AVP-D more frequently.
To evaluate differences in clinical presentation and in surgical outcomes between growth hormone-secreting pituitary adenomas (GH-PAs) and GH and prolactin co-secreting pituitary adenomas ...(GH&PRL-PAs).
Multicenter retrospective study of 604 patients with acromegaly submitted to pituitary surgery. Patients were classified into two groups according to serum PRL levels at diagnosis and immunohistochemistry (IHC) for PRL: a) GH&PRL-PAs when PRL levels were above the upper limit of normal and IHC for GH and PRL was positive or PRL levels were >100ng/and PRL IHC was not available (n=130) and b) GH-PAs who did not meet the previously mentioned criteria (n=474).
GH&PRL-PAs represented 21.5% (n=130) of patients with acromegaly. The mean age at diagnosis was lower in GH&PRL-PAs than in GH-PAs (P<0.001). GH&PRL-PAs were more frequently macroadenomas (90.6% vs. 77.4%, P=0.001) and tended to be more invasive (33.6% vs. 24.7%, P=0.057) than GH-PAs. Furthermore, they had presurgical hypopituitarism more frequently (OR 2.8, 95% CI 1.83-4.38). IGF-1 upper limit of normality (ULN) levels at diagnosis were lower in patients with GH&PRL-PAs (median 2.4 IQR 1.73-3.29 vs. 2.7 IQR 1.91-3.67, P=0.023). There were no differences in the immediate (41.1% vs 43.3%, P=0.659) or long-term post-surgical acromegaly biochemical cure rate (53.5% vs. 53.1%, P=0.936) between groups. However, there was a higher incidence of permanent arginine-vasopressin deficiency (AVP-D) (7.3% vs. 2.4%, P=0.011) in GH&PRL-PAs patients.
GH&PRL-PAs are responsible for 20% of acromegaly cases. These tumors are more invasive, larger and cause hypopituitarism more frequently than GH-PAs and are diagnosed at an earlier age. The biochemical cure rate is similar between both groups, but patients with GH&PRL-PAs tend to develop permanent postsurgical AVP-D more frequently.
In measurement systems, it is essential to have a procedure to obtain not only the calibration curve but also its associated uncertainty for the entire operating range. To achieve it, different ...alternatives should be taken into account according to the characteristics of the measurement, the way they are taken, the repeatability and reproducibility of the experiments or the nature of the measurement itself. This work presents a step-by-step procedure, to obtain simultaneously the calibration and uncertainty curves of a measurement system, which takes advantage of the maximum likelihood estimation (MLE), the weighted least squares (WLS) method, and the ISO-28037 recommendations. As an application, a U-Bent plastic optical fiber (POF) sensor measuring the sucrose solution density related to the refractive index (RI) is implemented and calibrated according to the proposed procedure.
The purpose of this study was to detect coronavirus disease 2019 (COVID-19) cases with persistent positive reverse transcription-PCR (RT-PCR) results for severe acute respiratory syndrome coronavirus ...2 (SARS-CoV-2), for which viable virus can be inferred due to the presence of subgenomic (SG) viral RNA, which is expressed only in replicating viruses. RNA remnants purified from diagnostic nasopharyngeal specimens were used as the templates for RT-PCR-specific detection of SG E gene RNA. As controls, we also detected viral genomic RNA for the E gene and/or a human housekeeping gene (RNase P). We assessed the samples of 60 RT-PCR-positive cases with prolonged viral SARS-CoV-2 shedding (24 to 101 days) since the first diagnostic RT-PCR. SG viral RNA was detected in 12/60 (20%) of the persistent cases, 28 to 79 days after the onset of symptoms. The age range of the cases with prolonged viral shedding and the presence of SG RNA was quite wide (40 to 100 years), and the cases were equally distributed between males (42%) and females (58%). No case was HIV positive, although seven were immunosuppressed. According to the severities of the COVID-19 episodes, they were mild (40%), intermediate (20%), and severe (40%). In a percentage of persistent SARS-CoV-2 PCR-positive cases, the presence of actively replicating virus may be inferred, far beyond diagnosis. We should not assume a universal lack of infectiousness for COVID-19 cases with prolonged viral shedding.
To characterize the behavior of quartz crystal microbalance (QCM) oscillator sensors, it is not enough to determine their experimental sensitivity, but rather it is essential to study the frequency ...fluctuations in order to establish the sensor resolution. The development of an FPGA-based system on a chip (SoC) intended to measure the frequency noise and mass resolution of QCM sensors is presented in this paper. The implemented system integrates the frequency measurement and the computation of the Allan deviation and mass resolution of the sensor in a single FPGA. By this way, a reconfigurable and low cost QCM sensor system is obtained working as a standalone measurement instrument. It permits to set the lower limit to the mass variations that can be observed with a sensor in the conditions of the application. A Virtex-4 FPGA from Xilinx was chosen as hardware platform due to its suitable architecture to support SoC and DSP applications. The developed measurement system combines the 32-bit embedded MicroBlazereg soft processor with a specific hardware coprocessor designed to accelerate the computations required for real-time processing. A data flow based on techniques as recursive formulas and jump prediction was proposed in order to reduce the computations and memory requirements of the coprocessor. Also the coprocessor uses a pipeline architecture and time-sharing modules in order to achieve an optimal balance between velocity and area. Finally, the implemented system was validated with a 9 MHz QCM sensor in damping media used for electrochemical applications and the results were compared with a full floating point implementation
This paper describes the design of an FPGA-based SoC system intended to measure the mass resolution of quartz crystal microbalance (QCM) sensors. The implemented system integrates the frequency ...measurement and the computation of the sensor resolution in a single FPGA to configure a standalone measurement system. A Virtex-4 FPGA from Xilinx was chosen as hardware platform due to its suitable architecture to support SoC and DSP applications. The developed measurement system combines the 32-bit embedded MicroBlazereg soft processor with a specific hardware coprocessor designed to accelerate the computations required for real-time processing. A data flow based on techniques as recursive formulas and jump prediction was proposed in order to reduce the computations and memory requirements of the coprocessor. Finally, the implemented system was validated with a 9 MHz QCM sensor in damping media used for electrochemical applications and the results were compared with a full floating point implementation
This paper presents the design of a FPGA-based digital counter for the measurement of the oscillation frequency of quartz crystal microbalance (QCM) sensors. This work is part of a bigger project ...focused on the development of a standalone QCM system for the analysis and characterization of organic coatings. The method used to implement the digital counter is the direct frequency measurement. Therefore, special attention is paid in the design of the time-base generator. Measurement errors due to the drift of the system oscillator are discussed, and several solutions are proposed taking advantage of the embedded PLL circuits available in the FPGAs. The designed digital counter is implemented and tested using the Altera's Stratix EP1S10F780C6 FPGA.
This paper presents the design of a FPGA-based digital counter for the measurement of the oscillation frequency of Quartz Crystal Microbalance (QCM) sensors. This work is part of a bigger project ...focused on the development of a standalone QCM system for the analysis and characterization of organic coatings. The method used to implement the digital counter is the direct frequency measurement. Therefore, special attention is paid in the design of the time-base generator. Measurement errors due to the drift of the system oscillator are discussed, and several solutions are proposed taking advantage of the embedded DLL circuits available in the FPGAs. The designed digital counter is implemented and tested using the Xilinxpsilas Spartan XC3S200 FPGA.
PDF
