Purpose
Evaluation of the phenotype of primary hyperparathyroidism (PHPT), adherence to International Guidelines for parathyroidectomy (PTx), and rate of surgical cure.
Method
From January ...2014–January 2016, we performed a prospective, multicenter study in patients with newly diagnosed PHPT. Biochemical and instrumental data were collected at baseline and during 1-year follow-up.
Results
Over the first year we enrolled 604 patients (age 61 ± 14 years), mostly women (83%), referred for further evaluation and treatment advice. Five hundred sixty-six patients had sporadic PHPT (93.7%, age 63 ± 13 years), the remaining 38 (6.3%, age 41 ± 17 years) had familial PHPT. The majority of patients (59%) were asymptomatic. Surgery was advised in 281 (46.5%). Follow-up data were available in 345 patients. Eighty-seven of 158 (55.1%) symptomatic patients underwent PTx. Sixty-five (53.7%) of 121 asymptomatic patients with at least one criterion for surgery underwent PTx and 56 (46.3%) were followed without surgery. Negative parathyroid imaging studies predicted a conservative approach symptomatic PHPT: OR 18.0 (95% CI 4.2–81.0)
P
< 0.001; asymptomatic PHPT: OR 10.8, (95% CI 3.1–37.15)
P
< 0.001). PTx was also performed in 16 of 66 (25.7%) asymptomatic patients without surgical criteria. Young age, serum calcium concentration, 24 h urinary calcium, positive parathyroid imaging (either ultrasound or MIBI scan positive in 75% vs. 16.7%,
P
= 0.001) were predictors of parathyroid surgery. Almost all (94%) of patients were cured by PTx.
Conclusions
Italian endocrinologists do not follow guidelines for the management of PHPT. Negative parathyroid imaging studies are strong predictors of a non-surgical approach. PTx is successful in almost all patients.
The bright, erratic black hole X-ray binary GRS 1915+105 has long been a target for studies of disk instabilities, radio/infrared jets, and accretion disk winds, with implications that often apply to ...sources that do not exhibit its exotic X-ray variability. With the launch of the Neutron star Interior Composition Explorer (NICER), we have a new opportunity to study the disk wind in GRS 1915+105 and its variability on short and long timescales. Here we present our analysis of 39 NICER observations of GRS 1915+105 collected during five months of the mission data validation and verification phase, focusing on Fe xxv and Fe xxvi absorption. We report the detection of strong Fe xxvi in 32 (>80%) of these observations, with another four marginal detections; Fe xxv is less common, but both likely arise in the well-known disk wind. We explore how the properties of this wind depend on broad characteristics of the X-ray lightcurve: mean count rate, hardness ratio, and fractional rms variability. The trends with count rate and rms are consistent with an average wind column density that is fairly steady between observations but varies rapidly with the source on timescales of seconds. The line dependence on spectral hardness echoes the known behavior of disk winds in outbursts of Galactic black holes; these results clearly indicate that NICER is a powerful tool for studying black hole winds.
Kallikrein-8, a serine protease, is a target for structure-based drug design due to its therapeutic potential in treating Alzheimer’s disease and is also useful as a biomarker in ovarian cancer. We ...present a binding assessment of ligands to kallikrein-8 using a residue-wise decomposition of the binding energy. Binding of four putative inhibitors of kallikrein-8 is investigated through molecular dynamics simulation and ligand binding energy evaluation with two methods (MM/PBSA and WaterSwap). For visualization of the residue-wise decomposition of binding energies, chemical energy-wise decomposition or CHEWD is introduced as a plugin to UCSF Chimera and Pymol. CHEWD allows easy comparison between ligands using individual residue contributions to the binding energy. Molecular dynamics simulations indicate one ligand binds stably to the kallikrein-8 S1 binding site. Comparison with other members of the kallikrein family shows that residues responsible for binding are specific to kallikrein-8. Thus, ZINC02927490 is a promising lead for development of novel kallikrein-8 inhibitors.
Foster youth encounter numerous challenges before reaching adulthood, with lingering impacts in many aspects of their lives once they leave state care: academic, employment, financial, housing, ...mental health, parenting, and social. In Hamilton County, Ohio, emancipating youth encounter similar struggles, limiting academic success for some participants in the Higher Education Mentoring Initiative (HEMI). This study utilized a Group-Level Assessment (GLA), an action-based, participatory research process, to generate information from various foster care system stakeholders, including foster youth, about the specific barriers and contextual factors that impact transitioning foster youth locally. Five themes emerged from the GLA process along with two, critical capacities necessary for successful outcomes: individual support and personal development. Post-research local action group community endeavors and implications to help transitioning youth experience more positive outcomes are discussed.
•Group-Level Assessment identifies ways to help aging-out foster youth.•Transitioning youth need a person to support and guide them.•Promote early personal asset development to maximize positive outcomes•Increase resource longevity to help emancipated youth navigate challenges•Cultivate relationship-building skills so that youth have supportive relationships
This study identified factors associated with canceling nonemergency medical transportation appointments among older adult Medicaid patients.
Data from 125,913 trips for 2,913 Delaware clients were ...examined. Mediation analyses, as well as, multivariate logistic regressions were conducted.
Over half of canceled trips were attributed to client reasons (e.g., no show, refusal). Client characteristics (e.g., race, sex, functional status) were associated with cancelations; however, these differed based on the cancelation reason. Regularly scheduled trips were less likely to be canceled.
The evolving American health care system may increase service availability. Additional policies can improve service accessibility and overcome utilization barriers.
Higher vertebrates use similar genetic tools to derive very different facial features. This diversity is believed to occur through temporal, spatial and species-specific changes in gene expression ...within cranial neural crest (NC) cells. These contribute to the facial skeleton and contain species-specific information that drives morphological variation. A few signaling molecules and transcription factors are known to play important roles in these processes, but little is known regarding the role of micro-RNAs (miRNAs). We have identified and compared all miRNAs expressed in cranial NC cells from three avian species (chicken, duck, and quail) before and after species-specific facial distinctions occur. We identified 170 differentially expressed miRNAs. These include thirty-five novel chicken orthologs of previously described miRNAs, and six avian-specific miRNAs. Five of these avian-specific miRNAs are conserved over 120 million years of avian evolution, from ratites to galliforms, and their predicted target mRNAs include many components of Wnt signaling. Previous work indicates that mRNA gene expression in NC cells is relatively static during stages when the beak acquires species-specific morphologies. However, miRNA expression is remarkably dynamic within this timeframe, suggesting that the timing of specific developmental transitions is altered in birds with different beak shapes. We evaluated one miRNA:mRNA target pair and found that the cell cycle regulator p27(KIP1) is a likely target of miR-222 in frontonasal NC cells, and that the timing of this interaction correlates with the onset of phenotypic variation. Our comparative genomic approach is the first comprehensive analysis of miRNAs in the developing facial primordial, and in species-specific facial development.
This cohort study assesses population-level associations of COVID-19 with birth parent and infant health, distinguishing the COVID-19 pandemic period from individual SARS-CoV-2 infection.
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