Incidentalom nadledvičnice je sprememba brez simptomov, naključno odkrita pri slikovnih preiskavah zaradi razlogov, ki ne vključujejo bolezni nadledvičnic. Njihova prevalenca strmo narašča na račun ...vedno večjega števila opravljenih slikovnih preiskav. Pretežno gre za benigne, hormonsko neaktivne adenome. Ob odkritju incidentaloma moramo razlikovati med benignimi in malignimi spremembami ter ugotoviti morebitno hormonsko aktivnost. Sodobno obravnavo incidentalomov predstavljava na izjemnem kliničnem primeru bolnice z drobnim incidentalomom leve nadledvičnice. Kljub visoki gostoti na nativni računalniški tomografiji (CT) smo na podlagi izplavljanja kontrasta v skladu s takratno prakso spremembo označili za benigno in odsvetovali nadaljnje morfološko spremljanje. Kljub temu je bolnica v naslednjih letih zaradi različnih zdravstvenih težav opravila več slikovnih preiskav, vendar spremembe velikosti tumorja ni bilo. Šele 6 let od odkritja so zaradi posledic covida-19 svetovali CT prsnega koša, ki je razkril izrazito rast tumorja. Bolnico smo napotili na levostransko laparoskopsko adrenalektomijo. Patohistološko je bil potrjen karcinom skorje nadledvične žleze, zato smo uvedli adjuvantno adrenolitično zdravljenje z mitotanom. Incidentalomi nadledvičnic so pretežno benigni in klinično nepomembni, včasih pa lahko ogrozijo življenje. Zato je pomembno, da jih obravnavamo v skladu s predstavljenimi smernicami. V izjemnih primerih z atipičnim potekom, kot je bilo pri naši bolnici, bo za ugoden razplet ključna obravnava v okviru interdisciplinarnega tima.
Plasma/serum microRNAs (miRNAs) are proposed to have a role in the development of osteoporosis, and their levels can be affected by physical activity. Therefore, the aim of this study was to analyze ...differences in plasma miRNAs levels in postmenopausal women and to simultaneously find novel extracellular miRNAs that are associated with variations in physical activities.
We measured hsa-miR-148a-3p, hsa-miR-125b, hsa-miR-21-5p, hsa-miR-93-5p, and hsa-miR-30d-5p in a cohort of 149 postmenopausal women divided into subgroups based on the amount of physical activity by using quantitative polymerase chain reaction (qPCR). Further, the correlation of plasma microRNAs with sit-to-stand performance was examined. DIANA web server was used to find which Kyoto Encyclopedia of Genes and Genomes pathways (P < 0.05) were regulated by miRNAs associated with physical activity and sit-to-stand performance.
Plasma levels of hsa-miR-30d-5p were significantly (P = 0.015) lower in participants with higher physical activity, and a borderline trend for hsa-miR-21-5p (P = 0.06) was noticed. Higher plasma levels of hsa-miR-21-5p (P = 0.01) and hsa-miR-93-5p (P = 0.04) were observed in the group with reduced sit-to-stand performance. The two miRNAs seem to primarily regulate fatty acid metabolism-related processes.
Our results suggest that levels of selected cell-free miRNAs in postmenopausal women are associated with different physical activity regimes.
The 20-point clinical prediction SPACE score, the aldosterone-to-lowest potassium ratio (APR), aldosterone concentration (AC) and the AC relative reduction rate after saline infusion test (SIT) have ...recently been proposed for primary aldosteronism (PA) subtyping prior to adrenal vein sampling (AVS). To validate those claims, we performed a retrospective cross-sectional study that included all patients at our center who had positive SIT to confirm PA and were diagnosed with either bilateral disease (BPA) according to AVS or with lateralized disease (LPA) if biochemically cured after adrenalectomy from November 2004 to the end of 2019. Final diagnoses were used to evaluate the diagnostic performance of proposed clinical prediction tools. Our cohort included 144 patients (40 females), aged 32–72 years (mean 54 years); 59 with LPA and 85 with BPA. The originally suggested SPACE score ≤8 and SPACE score >16 rules yielded about 80% positive predictive value (PPV) for BPA and LPA, respectively. Multivariate analyses with the predictors constituting the SPACE score highlighted post-SIT AC as the most important predictor of PA subtype for our cohort. APR-based tool of <5 for BPA and >15 for LPA yielded about 75% PPV for LPA and BPA. The proposed post-SIT AC <8.79 ng/dL criterion yielded 41% sensitivity and 90% specificity, while the relative post-SIT AC reduction rate of >33.8% criterion yielded 80% sensitivity and 51% specificity for BPA prediction. The application of any of the validated clinical prediction tools to our cohort did not predict the PA subtype with the high diagnostic performance originally reported.
Failure of adrenal vein sampling (AVS) due to difficult cannulation of the right adrenal vein (AV) frequently precludes subtyping of patients with primary aldosteronism (PA) before adrenalectomy. ...According to a recent study, lateralized PA could be accurately predicted from partial AVS data based on the gradient of the aldosterone-to-cortisol ratios (ACR) between left AV and inferior vena cava (IVC) (LAV/IVC index). We aimed to validate the diagnostic utility of this index for PA subtyping in our cohort.
A retrospective cross-sectional study included all patients who underwent bilaterally successful AVS at our centre and were diagnosed with either bilateral PA according to AVS or with lateralized PA after successful adrenalectomy from November 2004 to the end of 2019. Final diagnoses were compared to originally suggested LAV/IVC index cut-offs of ≥ 5.5 for ipsilateral disease and of ≤ 0.5 for contralateral disease, respectively.
The inclusion criteria were met in 168 patients: 46 women and 122 men, aged 54 years on average (range 32-72 years); 67 with lateralized and 101 with bilateral PA. LAV/IVC index using cut-offs of ≥ 5.5 or ≤ 0.5 anticipated ipsilateral (left lateralized) PA with a sensitivity of 32% and specificity of 97%, while a sensitivity of 47% and specificity of 95%, were found for contralateral (right lateralized) PA in our cohort. The overall inappropriate adrenalectomy rate was 29.7% (p = 0.314 for comparison between sides). When ascertaining ipsilateral disease (LAV/IVC index ≥ 5.5), 4 out of 16 patients (25%) would have been incorrectly sent to left adrenalectomy. Inappropriate right adrenalectomy would have occurred in 7 out of 21 patients (33.3%) when predicting contralateral disease (LAV/IVC index of ≤ 0.5). Thus, 11 patients with bilateral PA (6.5% of the entire cohort) would have been misclassified as lateralized PA and referred to surgery. Failed lateralization would have occurred in 61.2% of patients overall (53.3% for overlooked contralateral disease, 67.6% for missed ipsilateral disease; p = 0.723 for comparison between sides).
Based on our cohort, we conclude that application of the suggested LAV/IVC index cut-offs did not predict lateralized PA with the high accuracy previously reported.
Summary
Recognizing hip and other fragility fractures as an adverse event of chronic geriatric conditions led to the concept of orthogeriatric co-management (OGC). OGC today represents various forms ...of structural cooperation between orthopedic trauma surgeons and multiprofessional geriatric teams taking care of frail elderly patients. The models are country specific. Despite several published models there are still no clear recommendations on how this service should be best organized. The 12 outcome parameters published by the Experts’ Roundtable in 2013 were recommended to be used for the further assessment of different OCG models. This literature review was prepared accordingly and showed the need for further studies to determine the best OGC model and to define a uniform set of outcome parameters for use in future clinical studies.
Obravnava žensk v obdobju predmenopavze, ob menopavzi in kasneje se je v novem tisočletju pomembno spremenila. Randomizirane klinične raziskave so bistveno omejile indikacije za uvedbo hormonskega ...zdravljenja (HZ) in s tem menopavzno medicino postavile pred velik izziv. Na srečo so najnovejša dognanja potrdila, da je ob pravilni uporabi in izbiri HZ korist še vedno bistveno večja od tveganja. Zato smo pripravili posodobljena stališča o menopavzni medicini, ki so v skladu z aktualnimi mednarodnimi priporočili in prilagojena posebnostim slovenskega prostora.
Predstavljamo bolnika s tumorjem leve nadledvičnice, ki je bil vrsto let obravnavan zaradi odporne hipertenzije in hipokaliemije. Potrjen je bil izrazit primarni aldosteronizem, vendar kljub ...večkratnim poskusom s selektivno kateterizacijo nadledvičnih ven enostranske bolezni nismo uspeli dokazati. Z antagonisti mineralokortikoidnih receptorjev bolezni nismo uspeli obvladati, trdne osnove za operativno zdravljenje pa tudi ni bilo. Klinične in laboratorijske značilnosti bolnika so govorile za enostransko bolezen, zato smo ga napotili še na PET CT z 11-C-metomidatom v Veliko Britanijo. Tako smo dokazali enostransko bolezen in bolnika ozdravili z levostransko laparoskopsko adrenalektomijo.
Zdravljenje z glukokortikoidi je najpogostejši vzrok sekundarne osteoporoze. Za glukokortikoidno osteoporozo je značilno zelo hitro zmanjšanje mineralne kostne gostote z naglim zvišanjem tveganja za ...osteoporozne zlome, zato priporočamo ob uvedbi glukokortikoida oceniti bolnikovo tveganje za zlom in mu svetovati glede zdravega načina življenja ter vnosa kalcija, vitamina D in beljakovin. Če je indicirano, uvedemo tudi eno od zdravil za zaščito kosti, s čimer povečamo mineralno kostno gostoto in zmanjšamo tveganje za zlome vretenc. Večinoma predpišemo bisfosfonate, bolj ogroženim bolnikom, ki so zlome že utrpeli, lahko tudi teriparatid.
The Wnt pathway has a bifunctional role in bone mass regulation, influencing osteoblasts and osteoclasts. The Wnt pathway genes are therefore candidate genes for susceptibility to osteoporosis. In ...our study, we focused on the effects of polymorphisms in selected Wnt pathway genes: low-density lipoprotein receptor-related proteins 5 and 6 (
LRP5
and
LRP6
), Dickkopf1 (
DKK1
), sclerostin (
SOST
), and β-catenin (
CTNNB1
). We genotyped 652 subjects for the following polymorphisms: A1330V in
LRP5
; I1062V in
LRP6
; E232K in
DKK1
; D32Y, G34V, and N287S in
CTNNB1
; and -1397_-1396insGGA in
SOST
. Bone mineral density (BMD) was also measured. The allele frequencies were as follows: for A1330V C:T = 87%:13%, for I1062V C:T = 20%:80%, and for -1397_-1396insGGA-:GGA = 64%:36%. The studied nucleotide changes in the
DKK1
and
CTNNB1
genes were shown not to be polymorphic. In a Slovenian population, no association was shown between lumbar spine and femoral neck BMD in A1330V (
P
= 0.151 and 0.243) and in I1062V (
P
= 0.209 and 0.405). We observed a difference between
SOST
genotypes, corresponding to an allele dose effect, which was borderline significant for lumbar spine and femoral neck BMD (
P
= 0.047 and 0.085); but this did not survive the adjustment for multiple testing. These results indicate that a larger sample size would be necessary to detect these subtle effects. Our results suggest that A1330V in
LRP5
, I1062V in
LRP6
, and -1397_-1396insGGA in
SOST
are not associated with BMD in the Slovenian population.
Summary
Background
Osteoporosis is a prevalent skeletal disorder characterized by reduced bone mineral density and microarchitectural deterioration of bone tissue, resulting in bone fragility and ...low-trauma fractures. Imaging techniques are routinely used to detect low bone mass; however, they are unable to identify deterioration of bone quality. Recently, microRNAs have emerged as regulators of bone remodelling and potentially also as a new class of sensitive biomarkers of bone health to aid in diagnosis and treatment monitoring of osteoporosis.
Methods
To identify new plasma-based biomarkers associated with osteoporosis we analyzed microRNAs isolated from plasma samples of 74 postmenopausal women divided into osteoporotic (
N =
17) and control groups (
N =
57). A prior microRNA screening was performed where a few showed promise for further analysis. Quantitative polymerase chain reaction was used to investigate differences in expression of let-7d-5p, let-7e-5p, miR-30d-5p, miR-30e-5p, miR-126-3p, miR-148a-3p, miR-199a-3p, miR-423-5p and miR-574-5p between the two groups. Furthermore, correlation analysis between microRNA expression levels and patient bone mineral density measurements and fracture risk assessment tool (FRAX) as well as trabecular bone scores were performed.
Results
Expression of miR-148a-3p was significantly higher (
p
= 0.042) in the osteoporotic patient group compared to the controls. In addition, we identified correlations between miR-126-3p (ρ = 0.253,
p
= 0.032) and 423-5p (ρ = −0.230,
p
= 0.049) and parameters of bone quality and quantity.
Conclusion
The results from our study, together with the functional role of miR-148a-3p in bone suggest that this microRNA could be considered as a potential new plasma-based biomarker for pathological changes associated with osteoporosis.
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