Pituitary apoplexy (PA) is an acute, life-threatening clinical syndrome caused by hemorrhage and/or infarction of the pituitary gland. It is clinically characterized by the sudden onset of headache. ...Depending on the severity, it may also be accompanied by nausea, vomiting, visual disturbances, varying degrees of adenohypophyseal hormone deficiency, and decreased level of consciousness. Corticotropic axis involvement may result in severe hypotension and contribute to impaired level of consciousness. Precipitating factors are present in up to 30% of cases. PA may occur at any age and sometimes develops during pregnancy or the immediate postpartum period. PA occurs more frequently in men aged 50-60, being rare in children and adolescents. It can develop in healthy pituitary glands or those affected by inflammation, infection, or tumor. The main cause of PA is usually spontaneous hemorrhage or infarction of a pituitary adenoma (pituitary neuroendocrine tumor, PitNET). It is a medical emergency requiring immediate attention and, in many cases, urgent surgical intervention and long-term follow-up. Although the majority of patients (70%) require surgery, about one-third can be treated conservatively, mainly by monitoring fluid and electrolyte levels and using intravenous glucocorticoids. There are scoring systems for PA with implications for management and therapeutic outcomes that can help guide therapeutic decisions. Management of PA requires proper evaluation and long-term follow-up by a multidisciplinary team with expertise in pituitary pathology. The aim of the review is to summarize and update the most relevant aspects of the epidemiology, etiopathogenesis, pathophysiology, clinical presentation and clinical forms, diagnosis, therapeutic strategies, and prognosis of PA.
Pituitary neuroendocrine tumors (PitNETs) are the most common pituitary tumors and the second most common brain tumors. Although the vast majority (>90%) are benign, a small percentage (<2%) are ...aggressive. These aggressive PitNETs (AgPitNETs) are defined by the presence of radiological invasion, a high rate of cell proliferation, resistance to conventional treatments, and/or a high propensity for recurrence. Lastly, there are the rare pituitary carcinomas, also known as metastatic PitNETs (MetPitNETs), which account for only 0.2% of cases and are defined by the presence of craniospinal or distant metastases. At present, there are no definitive factors that allow us to predict with certainty the aggressive behavior of PitNETs, making the therapeutic management of AgPitNETs a real challenge. Surgery is considered the first-line treatment for AgPitNETs and MetPitNETs. Radiation therapy can be effective in controlling tumor growth and regulating hormone hypersecretion. Currently, there are no approved non-endocrine medical therapies for the management of AgPitNETs/MetPitNETs, mainly due to the lack of randomized controlled clinical trials. As a result, many of the medical therapies used are off-label drugs, and several are under investigation. Temozolomide (TMZ) is now recognized as the primary medical treatment following the failure of standard therapy (medical treatment, surgery, and radiotherapy) in AgPitNETs/MetPitNETs due to its ability to improve overall and progression-free survival rates in responding patients over 5 years. Other therapeutic options include pituitary-targeted therapies (dopamine agonists and somatostatin analogs), hormonal antisecretory drugs, non-hormonal targeted therapies, radionuclide treatments, and immunotherapy. However, the number of patients who have undergone these treatments is limited, and the results obtained to date have been inconsistent. As a result, it is imperative to expand the cohort of patients undergoing treatment to better determine the therapeutic efficacy and safety of these drugs for individuals with AgPitNETs/MetPitNETs.
Tumor-induced hypoglycemia (TIH) is a rare clinical entity that may occur in patients with diverse kinds of tumor lineages and that may be caused by different mechanisms. These pathogenic mechanisms ...include the eutopic insulin secretion by a pancreatic islet β-cell tumor, and also the ectopic tumor insulin secretion by non-islet-cell tumor, such as bronchial carcinoids and gastrointestinal stromal tumors. Insulinoma is, by far, the most common tumor associated with clinical and biochemical hypoglycemia. Insulinomas are usually single, small, sporadic, and intrapancreatic benign tumors. Only 5–10% of insulinomas are malignant. Insulinoma may be associated with the multiple endocrine neoplasia type 1 in 4–6% of patients. Medical therapy with diazoxide or somatostatin analogs has been used to control hypoglycemic symptoms in patients with insulinoma, but only surgical excision by enucleation or partial pancreatectomy is curative. Other mechanisms that may, more uncommonly, account for tumor-associated hypoglycemia without excess insulin secretion are the tumor secretion of peptides capable of causing glucose consumption by different mechanisms. These are the cases of tumors producing IGF2 precursors, IGF1, somatostatin, and glucagon-like peptide 1. Tumor autoimmune hypoglycemia occurs due to the production of insulin by tumor cells or insulin receptor autoantibodies. Lastly, massive tumor burden with glucose consumption, massive tumor liver infiltration, and pituitary or adrenal glands destruction by tumor are other mechanisms for TIH in cases of large and aggressive neoplasias.
The objective of this study was to determine the association between hypothyroidism and overall and site-specific cancer in Spanish population. A cross-sectional study was performed using the ...population-based database BDCAP (Base de Datos Clínicos de Atención Primaria, primary care clinical database) to analyze the relative risk of cancer in Spanish population with hypothyroidism. In a total of 2,414,165 patients diagnosed with hypothyroidism in BDCAP in 2019, the relative risk (OR) of cancer, compared to the non-hypothyroid population, was 1.73 (1.72-1.74) (P<0.0001). The higher risk was observed in both men (OR 2.15 2.13-2.17; P<0.0001) and women (OR 1.67 1.636-1.68; P<0.0001). However, hypothyroid persons aged 65 years or older had a reduced risk of cancer (OR 0.98 0.97-0.98; P<0.0001). In addition, hypothyroid patients aged 65 or over showed a decreased risk of cancers of the bladder, colorectal, gastric, pancreatic and prostate. Socioeconomic characteristics such as income level, municipality size, country of birth and employment situation had limited influence on the association between hypothyroidism and cancer. However, hypothyroid patients receiving replacement therapy exhibited higher cancer risk compared with patients without treatment (OR 1.30 1.28-1.31; P<0.0001). Spanish hypothyroid patients of both genders have a risk of overall cancer higher than that found in non-hypothyroid population. However, people over 65 years have a reduced risk of various malignancies. This peculiarity of hypothyroidism should be considered by the health authorities.
This paper presents the results of a Participatory Action Research, whose main objective was to validate a pedagogical intervention characterized by adopting an inquiry-based learning methodology ...(IBL), and the paradigm of Practice as Research focused on musical performativity. This intervention sought to foster autonomy, the relationship between theory and practice, and the development of critical reflexive skills in professional music students. The co-participants (12 students in the first cycle and 9 in the second) belonged to university training programs in vocal and instrumental interpretation, composition, and music pedagogy at different levels. In the intervention cycles, students were able to organize themselves collaboratively to achieve the learning objectives and research products designed in the intervention. During the process, they redefined research as a tool for professional development in their discipline. This empowered the participants, as they became aware that they themselves could build knowledge in their field. The intervention was validated, and the results highlight the potential of inquiry activities focused on musical performativity and Practice as Research in the context of higher music education, playing an integrating role in the construction of knowledge by and for practitioners.
In this paper we present a study of global optimality conditions for Point Set Registration (PSR) with missing data. PSR is the problem of aligning multiple point clouds with an unknown target point ...cloud. Since non-linear rotation constraints are present the problem is inherently non-convex and typically relaxed by computing the Lagrange dual, which is a Semidefinite Program (SDP). In this work we show that given a local minimizer the dual variables of the SDP can be computed in closed form. This opens up the possibility of verifying the optimally, using the SDP formulation without explicitly solving it. In addition it allows us to study under what conditions the relaxation is tight, through spectral analysis. We show that if the errors in the (unknown) optimal solution are bounded the SDP formulation will be able to recover it.
Giant pituitary adenomas comprise about 6–10% of all pituitary tumors. They are mostly clinically non-functioning adenomas and occur predominantly in males. The presenting symptoms are usually ...secondary to compression of neighboring structures, but also due to partial or total hypopituitarism. Functioning adenomas give rise to specific symptoms of hormonal hypersecretion. The use of dopamine agonists is considered a first-line treatment in patients with giant macroprolactinomas. Somatostatin analogs can also be used as primary treatment in cases of growth hormone and thyrotropin producing giant adenomas, although remission of the disease is not achieved in the vast majority of these patients. Neurosurgical treatment, either through transsphenoidal or transcranial surgery, continues to be the treatment of choice in the majority of patients with giant pituitary adenomas. The intrinsic complexity of these tumors requires the use of different therapies in a combined or sequential way. A multimodal approach and a therapeutic strategy involving a multidisciplinary team of expert professionals form the basis of the therapeutic success in these patients.
Water temperature is often monitored at water sources and treatment works; however, there is limited monitoring of the water temperature in the drinking water distribution system (DWDS), despite a ...known impact on physical, chemical and microbial reactions which impact water quality. A key parameter influencing drinking water temperature is soil temperature, which is influenced by the urban heat island effects. This paper provides critique and comprehensive summary of the current knowledge, policies and challenges regarding drinking water temperature research and presents the findings from a survey of international stakeholders. Knowledge gaps as well as challenges and opportunities for monitoring and research are identified. The conclusion of the study is that temperature in the DWDS is an emerging concern in various countries regardless of the water source and treatment, climate conditions, or network characteristics such as topology, pipe material or diameter. More research is needed, especially to determine (i) the effect of higher temperatures, (ii) a legislative limit on temperature and (iii) measures to comply with this limit.
Why is it that semidefinite relaxations have been so successful in numerous applications in computer vision and robotics for solving non-convex optimization problems involving rotations? In studying ...the empirical performance, we note that there are few failure cases reported in the literature, in particular for estimation problems with a single rotation, motivating us to gain further theoretical understanding. A general framework based on tools from algebraic geometry is introduced for analyzing the power of semidefinite relaxations of problems with quadratic objective functions and rotational constraints. Applications include registration, hand–eye calibration, and rotation averaging. We characterize the extreme points and show that there exist failure cases for which the relaxation is not tight, even in the case of a single rotation. We also show that some problem classes are always tight given an appropriate parametrization. Our theoretical findings are accompanied with numerical simulations, providing further evidence and understanding of the results.
Como medida de emergencia en respuesta a la pandemia producida por el COVID-19, la mayoría de las universidades en el mundo debió cerrar sus campus físicos y reprogramar sus actividades en formato ...online. Si bien las estadísticas oficiales indican que prácticamente la totalidad de las instituciones continuó con sus actividades formativas, la responsabilidad de las modificaciones didácticas y curriculares recayó sobre el profesorado que venía realizando clase en formatos presenciales y que no tenía experiencia en realizar docencia en formato online. Esta migración forzada significó que las universidades pudieron continuar con la formación del estudiantado de forma más o menos regular. No obstante, la estadística oficial que habla de tasas de aprobación no da cuenta de la efectividad del aprendizaje en este nuevo formato. A través una combinación de diseño de investigación de teoría fundamentada y un estudio de caso en una carrera de Pedagogía en Música en una universidad privada chilena, se busca describir, argumentar y evaluar desde el punto de vista del profesorado las modificaciones realizadas a las diferentes asignaturas, visualizar las dificultades que tuvieron durante el período y analizar sus percepciones sobre la efectividad y proyección de la enseñanza online en disciplinas musicales. Nuestros resultados apuntan a una gran diversidad de modificaciones realizadas por cada docente, destacando varias relacionadas con las metodologías activas, como el Aprendizaje Basado en Proyectos y el Aula Invertida. También, se da cuenta de una sobrecarga laboral importante y una percepción de que los aprendizajes se ven disminuidos en contextos online respecto a los presenciales.
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