Context:
Cushing's syndrome (CS) is challenging to diagnose. Increased prevalence of CS in specific patient populations has been reported, but routine screening for CS remains questionable. To ...decrease the diagnostic delay and improve disease outcomes, simple new screening methods for CS in at-risk populations are needed.
Objective:
To develop and validate a simple scoring system to predict CS based on clinical signs and an easy-to-use biochemical test.
Design:
Observational, prospective, multicenter.
Setting:
Referral hospital.
Patients:
A cohort of 353 patients attending endocrinology units for outpatient visits.
Interventions:
All patients were evaluated with late-night salivary cortisol (LNSC) and a low-dose dexamethasone suppression test for CS.
Main Outcome Measures:
Diagnosis or exclusion of CS.
Results:
Twenty-six cases of CS were diagnosed in the cohort. A risk scoring system was developed by logistic regression analysis, and cutoff values were derived from a receiver operating characteristic curve. This risk score included clinical signs and symptoms (muscular atrophy, osteoporosis, and dorsocervical fat pad) and LNSC levels. The estimated area under the receiver operating characteristic curve was 0.93, with a sensitivity of 96.2% and specificity of 82.9%.
Conclusions:
We developed a risk score to predict CS in an at-risk population. This score may help to identify at-risk patients in non-endocrinological settings such as primary care, but external validation is warranted.
A prediction model for Cushing's syndrome diagnosis in at-risk populations was developed based on clinical variables and late night salivary cortisol levels.
Background
Total 25-OH-vitamin D (25(OH)D) levels are decreased in patients with obesity, but few data exist regarding free-vitamin D3 (f25(OH)D3) concentrations. We aimed to evaluate the effect of ...bariatric surgery on 25(OH)D and f25(OH)D3 in a cohort of patients with morbid obesity.
Methods
Twenty-four patients submitted to sleeve gastrectomy (SG) (mean age 48 years, body mass index (BMI) 48.16±10.73k/m
2
) were evaluated before and 1 year after surgery. Anthropometric data, parathormone (PTH), calcium, alkaline phosphatase, 25(OH)D, and f25(OH)D3 were recorded.
Results
25(OH)D and f25(OH)D3 correlated well before and after SG. Baseline determinations did not correlate with BMI, but they inversely correlated with BMI 1 year after surgery (r
s
=−0.46,
p
=0.02 and r
s
=−0.60,
p
=0.002, respectively). Post-surgery % total body weight loss (%TBWL) was 27.4±13.8 %; f25(OH)D3 concentrations increased significantly (5.28±2.29 pg/mL vs 6.64±2.25 pg/mL; p=0.03), whereas 25(OH)D did not change. Patients who achieved a BMI <35 kg/m
2
1 year after surgery had significantly higher concentrations of f25(OH)D3 (7.9±1 pg/mL vs 4.8±1.1,
p
<0.001) and 25(OH)D (30.9±9.4 ng/mL vs 22.3±13.4;
p
=0.03) compared to those who remained with BMI >35 kg/m
2
.
Conclusion
There is a significant inverse relationship between BMI and both f25(OH)D3 and 25(OH)D 1 year after surgery. Only f25(OH)D3 concentrations increased 1 year after surgery, which could be explained by a greater f25(OH)D3 sequestration before SG in the adipose tissue, potentially due to the more liposoluble nature of f25(OH)D3 than the protein-bound form 25(OH)D.
Graphical abstract
Carballeira, E, Morales, J, Fukuda, DH, Granada, ML, Carratalá-Deval, V, López Díaz de Durana, A, and Stout, JR. Intermittent cooling during Judo training in a warm/humid environment reduces ...autonomic and hormonal impact. J Strength Cond Res 33(8): 2241-2250, 2019-The purpose of this study was to identify the effects of superficial cooling on physiological responses while training in a warm, humid environment during an international Judo training camp. Sixteen judokas (8 women and 8 men) participated in the experiment. Four high-level women and 4 men were randomly assigned to wear a cooling vest (vest group VG) during the recovery periods within a training session (i.e., 8 bouts of 5-minute fighting with 5-minute rest) and up to 10 minutes after the session, whereas the remaining athletes in the control group (CG) trained without the use of any cooling aids. No differences between groups were reported in well-being before the session or in perceived fatigue after the session. The temperature was increased after the training session (p = 0.02) without significant differences between groups; however, CG demonstrated a moderate effect size (ES = 0.95, 90% confidence interval CI = 0.09-1.82; probability of superiority PS = 74.9%) in contrast to the small effect for VG (ES = 0.28, 90% CI = -0.55 to 1.11; PS = 57.9%). There were time × group interactions for heart rate variability (lnRMSSD) (p = 0.006; VG vs. CG, PS = 79.0%) and the dehydroepiandrosterone-cortisol ratio (DHEA/C ratio) (p = 0.04; VG vs. CG, PS = 99.9%). Vest group preserved the cardiac autonomic control (p > = 0.05; ES = -0.06, 90% CI = -0.88 to 0.76; PS = 51.7%) compared with the large decrement of CG (p < 0.05; ES = -1.18, 90% CI = -2.07 to -0.29; PS = 74.9%). Furthermore, VG showed an increase of DHEA/C (p = 0.002) from presession to postsession based on a moderate decrease of cortisol (p > = 0.05; ES = -0.67, 90% CI = -1.52 to 0.17; PS = 68.2%) with a concomitant small increase of DHEA (p > = 0.05; ES = 0.46, 90% CI = -0.38 to 1.29; PS = 62.7%). Conversely, the CG showed a moderate effect for increased DHEA and a small effect for increased cortisol after training. No significant interactions or main effects were shown for isometric handgrip values. Cooling vests diminished the cardiovascular strain and hormonal impact of the Judo training session in high-level athletes and may be considered for recovery purposes during exercise in warm/humid environments.
Abstract Background Predictors of weight loss (WL) or weight regain (WR) after Roux-en-Y gastric bypass (RYGBP) are not established. The aim of this study was to analyze the usefulness of some ...baseline peptides (leptin, insulin, and ghrelin) as biomarkers of WL and WR in morbid obese patients after RYGBP at long term. Methods Seventy-six morbid obese (47 women, age 41.6 ± 9.6 years, body mass index BMI 52.1 ± 8 kg/m2 ) patients were evaluated at baseline and at 1, 2, and 6 years after surgery. Results Excess body weight loss after 6 years was of 63.9%. Age, BMI, and studied hormones at baseline or their changes over time did not predict long-term excess body weight loss. WR greater than 10% was observed in 36.8% of patients between 2 and 6 years of follow-up, but it was not correlated with BMI, age, or baseline peptide concentrations. Conclusion Measurement of ghrelin, insulin, and leptin before surgery is not useful as predictors of WL or WR at long term after RYGBP.
Summary
Objective
Ghrelin and obestatin have apparent opposite orexigenic and anorexigenic effects, although the latter has not been firmly demonstrated in humans. So far, little data have been ...reported in relation to its potential association with metabolic syndrome (MS). The objective was to study obestatin concentrations in relation to nutritional parameters and eating behaviours in old women.
Design, Patients and Measurements
Prospective study; a total of 110 women (age: 76·93 ± 6·32) from the Mataró Ageing Study were included. Individuals were characterized by anthropometric variables, lipids, glucose, blood pressure, MS components (Adult Treatment Panel III criteria), anorexia and nutritional status by Mini Nutritional Assessment Short Form (MNA‐SF) and re‐evaluated at 2‐year follow‐up. Obestatin was measured by IRMA.
Results
58·2% of the subjects had MS; at 2‐year follow‐up 24·1% had a weight loss >5%, 7·2% >10%, and 26·4% changed their MNA‐SF score to risk of malnutrition category. Anorexia was present in 38·4%. Obestatin levels were not related to either change of weight, MNA‐SF or anorexia, but a positive correlation was found with the absolute difference between basal and 2‐year waist circumference (WC) (r = 0·429; P < 0·001) and relative difference between basal and 2‐year WC (r = 0·420; P < 0·001); both remained significant after adjusting for age and body mass index. When obestatin was divided into quartiles, a significant lineal trend was observed in relation to WC (P = 0·049), absolute and relative difference between basal and 2‐year WC (both P < 0·001). Obestatin was associated with glucose impairment (69·0% in 4th quartile vs 47·5% in 1st to 3rd, P = 0·047; after adjustment, P = 0·098) and MS (77·8% in 4th vs 51·3% in 1st to 3rd, P = 0·017; after adjustment, P = 0·046, OR 2·90 (1·02–8·25) 4th vs 1st to 3rd).
Conclusions
Obestatin is elevated in aged women bearing MS but is otherwise not associated with other nutritional parameters, weight loss or anorexia.
Be stars are surrounded by cool and dense circumstellar environments where molecules and dust are formed. These stars are rare and display complex spectra whose photospheric features are frequently ...veiled by their circumstellar envelopes, making it difficult to assign them spectral types and evolutionary phases. On the basis of a detailed analysis of medium-resolution spectra in the near-infrared region, together with optical observations and available data from astronomical databases, we attempt to improve their spectral classification and infer the properties of their circumstellar environments. To this aim, we have selected a group of five bright IRAS sources (IRAS 02155+6410, MWC728, AS 119, MWC819, and IRAS 07080+0605): one star with large infrared excess and four unclassified Be stars or FS CMa stars, most of which have been poorly studied. We present and describe our observations and discuss possible classifications of the sample objects. For all stars, medium-resolution spectra in the region of 2.17–2.39 μm and in the L band are shown for the first time. Infrared features, such as the absorption molecular CO bands and metallic lines, reveal the presence of a late-type companion in MWC 728, and suggest the possible binary nature in AS 119. IRAS 07080+0605 shows evidence of a surrounding cool CO molecular cloud. CS molecular emission may be present in MWC 819 L-band spectra. We suggest that this object is a protoplanetary nebulae.
Summary
Objective
Pregnancy‐associated plasma protein‐A (PAPP‐A) is a protease promoting IGF1 tissue availability and considered as a new biomarker of cardiovascular disease.
Aim
To evaluate the ...relationship between PAPP‐A concentrations and anthropometric variables, physical activity, smoking status, glucose homoeostasis and adipocytokines in healthy adults.
Design and methods
One hundred and forty‐nine subjects (77 women; mean age 39·7 ± 14 years; mean BMI 23·7 ± 1·9 kg/m2) were randomly selected from 8000 adults of The Health Survey of Catalonia. Possible effects of gender, age, body composition, smoking status, physical activity, glucose homoeostasis and adipocytokines on PAPP‐A concentrations were assessed.
Results
Pregnancy‐associated plasma protein‐A was significantly higher in men than in women 1·04 (0·61–0·44) vs 0·61 (0·41–0·90) μIU/ml; P < 0·0001; there were no differences in relation to physical activity or smoking status. PAPP‐A showed a negative correlation with leptin in men (P = 0·01) and women (P = 0·05), and a positive correlation with adiponectin (P = 0·006) in women and a trend (P = 0·073) in men. Homoeostasis model assessment of insulin resistance (HOMA‐IR) showed a negative correlation with PAPP‐A only in women (P = 0·019). No association was found with blood pressure, IGF1, lipids or glucose in either gender. When a multiple regression analysis was performed including gender, age, BMI, waist‐hip ratio, HOMA‐IR, adiponectin and leptin as confounders, PAPP‐A was independently correlated with adiponectin (β = 0·23; P = 0·02) and leptin (β = −0·33; P = 0·04).
Conclusions
Our study shows a sexual dimorphism of PAPP‐A, and a possible influence of leptin and adiponectin on its concentrations in healthy subjects. The mechanisms responsible for this relationship remain to be determined.
Summary
Context
One of the side effects of interferon‐alpha therapy is interferon‐induced thyroiditis (IIT). The role of lymphocyte subpopulations in IIT melanoma patients remains to be defined.
...Objective
Our objective was to assess different peripheral blood lymphocyte subpopulations, mainly regulatory T cells (Tregs), in melanoma patients who developed IIT.
Design, patients and methods
From 30 melanoma patients receiving high‐dose interferon (HDI)‐alpha 2b (IFN‐α2b) treatment, those who developed IIT (IIT patients) were selected and compared with patients who did not develop IIT (Co‐MM) and healthy controls (Co‐H). Peripheral blood mononuclear cells were obtained before treatment (BT), mid‐treatment (MT), end of treatment (ET), 24 weeks post‐treatment and at appearance of IIT (TT).
Results
Nine patients developed IIT (30%): four Hashimoto's thyroiditis and five destructive thyroiditis. An increase in Tregs was observed in both melanoma groups during HDI treatment. A decrease in CD3+, NKT lymphocyte subpopulations and Bcl2 expression on B cells was also observed in both groups. However, no changes were observed in the percentage of CD4+, CD8+, CD3+γδ+, CD19+, transitional B cells (CD24highCD38highCD19+CD27−), natural killer (NK), invariant NKT (iNKT) lymphocytes and Th1/Th2 balance when BT was compared with ET. At TT, IIT patients had a higher Tregs percentage than Co‐MM (P = 0·012) and Co‐H (P = 0·004), a higher iNKT percentage than Co‐MM (P = 0·011), a higher transitional B cells percentage than Co‐H (P = 0·015), a lower CD3+ percentage than Co‐H (P = 0·001) and a lower Bcl2 expression on B cells than Co‐H (P < 0·001).
Conclusions
Our results point to the immunomodulatory effects of IFN‐α on different lymphocyte subpopulations and a possible role of Tregs in melanoma patients who developed IIT.
Context One of the side effects of interferon-alpha therapy is interferon-induced thyroiditis (IIT). The role of lymphocyte subpopulations in IIT melanoma patients remains to be defined. Objective ...Our objective was to assess different peripheral blood lymphocyte subpopulations, mainly regulatory T cells (Tregs), in melanoma patients who developed IIT. Design, patients and methods From 30 melanoma patients receiving high-dose interferon (HDI)-alpha 2b (IFN- alpha 2b) treatment, those who developed IIT (IIT patients) were selected and compared with patients who did not develop IIT (Co-MM) and healthy controls (Co-H). Peripheral blood mononuclear cells were obtained before treatment (BT), mid-treatment (MT), end of treatment (ET), 24 weeks post-treatment and at appearance of IIT (TT). Results Nine patients developed IIT (30%): four Hashimoto's thyroiditis and five destructive thyroiditis. An increase in Tregs was observed in both melanoma groups during HDI treatment. A decrease in CD3 super(+), NKT lymphocyte subpopulations and Bcl2 expression on B cells was also observed in both groups. However, no changes were observed in the percentage of CD4 super(+), CD8 super(+), CD3 super(+)gammadelta super(+), CD19 super(+), transitional B cells (CD24 super(high)CD38 super(high)CD19 super(+)CD27 super(-)), natural killer (NK), invariant NKT (iNKT) lymphocytes and Th1/Th2 balance when BT was compared with ET. At TT, IIT patients had a higher Tregs percentage than Co-MM (P = 0.012) and Co-H (P = 0.004), a higher iNKT percentage than Co-MM (P = 0.011), a higher transitional B cells percentage than Co-H (P = 0.015), a lower CD3 super(+) percentage than Co-H (P = 0.001) and a lower Bcl2 expression on B cells than Co-H (P < 0.001). Conclusions Our results point to the immunomodulatory effects of IFN- alpha on different lymphocyte subpopulations and a possible role of Tregs in melanoma patients who developed IIT.
Summary
Objective One of the side effects of interferon‐alpha (IFN‐α) therapy is interferon‐induced thyroiditis (IIT). The role of lymphocyte subpopulations in IIT remains to be defined. The aim of ...this study was to assess different peripheral blood lymphocyte subpopulations, mainly CD4+CD25+CD127low/‐FoxP3+ regulatory T cells (Tregs), in patients with chronic hepatitis C virus (HCV) infection who developed IIT.
Design, patients and methods From 120 patients with chronic HCV who started antiviral treatment, those who developed IIT (IIT patients) were selected and compared with patients who did not develop IIT (Co‐HCV). Peripheral blood mononuclear cells were obtained before treatment (BT), mid‐treatment (MT), end of treatment (ET), 24 weeks post‐treatment (PT) and at appearance of IIT (TT).
Results Eleven patients developed IIT: three Hashimoto’s thyroiditis, one Graves’disease, one positive antithyroidal antibodies, one nonautoimmune hypothyroidism and five destructive thyroiditis. During antiviral treatment, an increase in CD8+ and in Tregs was observed in both groups. A decrease in CD3+, CD19+ and NKT lymphocyte subpopulations was also observed (all P < 0·05). However, no changes were observed in the percentage of CD4+, CD3+γδ+ and iNKT lymphocytes, Th1/Th2 balance and Bcl2 expression on B cells when BT was compared with ET. At the appearance of IIT (TT), IIT patients had a higher Th1 response (CCR5+CCR7−) (P < 0·01) and a higher Tregs percentage (P < 0·05) than Co‐HCV.
Conclusions Our results point to the immunomodulatory effects of IFN‐α on different lymphocyte subpopulations and a possible role of Th1 response and Tregs in patients with HCV who developed IIT.
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