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Open access

Thomas Reinehr, Martin Carlsson, Dionisios Chrysis and Cecilia Camacho-Hubner

Background: The precision of adult height prediction by bone age determination in children with idiopathic growth hormone deficiency (IGHD) is unknown.

Methods: The near adult height (NAH) of patients with IGHD in the KIGS database was compared to adult height prediction based on the Bayley Pinneau (BP) in 315 children and based on the Tanner-Whitehouse 2 (TW2) method in 121 children. Multiple linear regression analyses adjusted for age at GH start, mean dose and years of of GH treatment, and maximum GH peak in stimulation test were calculated.

Results: The mean underestimation of adult height based on the GP method was at baseline 4.0±0.5cm in girls and 4.4±0.4cm in boys, at 1 year of GH treatment 2.0±0.3cm in girls and 0.5±0.3cm in boys, while at last bone age determination adult height was overestimated in mean by 0.4±0.4cm in girls and 3.7±0.3cm in boys. The mean underestimation of adult height based on the TW2 method was at baseline 1.4±1.3cm in girls and 6.6±0.6cm in boys, at 1 year of GH treatment adult height was overestimated in girls 0.9±0.6cm in girls and underestimated 3.8±0.4 cm in boys, while at last bone age determination adult height was overestimated in mean by 1.1±0.9cm in girls and 4.5±0.5cm in boys.

Conclusions: Height prediction by bone age determinations at onset and in the first year of GH treatment underestimates adult height in prepubertal IGHD children. In contrast, in mean 6 years after onset of GH treatment height prediction based on bone ages overestimated adult height.

Open access

Angelica Lindén Hirschberg

Emerging evidence indicates that testosterone, which can increase muscle mass and strength, stimulates erythropoiesis, promotes competitive behaviour, and enhances the physical performance of women. Indeed, the levels of testosterone within the normal female range are related to muscle mass and athletic performance in female athletes. Furthermore, among these athletes, the prevalence of hyperandrogenic conditions, including both polycystic ovary syndrome and rare differences/disorders of sex development (DSD), which may greatly increase testosterone production, are elevated. Thus, if the androgen receptors of an individual with XY DSD are functional, her muscle mass will develop like that of a man. These findings have led to the proposal that essential hyperandrogenism is beneficial for athletic performance and plays a role in the choice by women to compete in athletic activities. Moreover, a recent randomized controlled trial demonstrated a significant increase in the lean mass and aerobic performance by young exercising women when their testosterone levels were enhanced moderately. Circulating testosterone is considered the strongest factor to explain the male advantage in sport performance, ranging between 10 and 20%. It appears to be unfair to allow female athletes with endogenous testosterone levels in the male range (i.e. 10–20 times higher than normal) to compete against those with normal female androgen levels. In 2012, this consideration led international organizations to establish eligibility regulations for the female classification in order to ensure fair and meaningful competition, but the regulations are controversial and have been challenged in court.

Open access

Jie Shi, Zhen Yang, Yixin Niu, Weiwei Zhang, Ning Lin, Xiaoyong Li, Hongmei Zhang, Hongxia Gu, Jie Wen, Guang Ning, Li Qin and Qing Su

Objective

A small thigh circumference is associated with an increased risk of diabetes, cardiovascular diseases, and total mortality. The purpose of this study was to evaluate the association between thigh circumference and hypertension in the middle-aged and elderly population.

Methods

A total of 9520 individuals aged 40 years and older with measurement of thigh circumference were available for analysis. The measurement of thigh circumference was performed directly below the gluteal fold of the thigh. The association of thigh circumference with hypertension was tested in logistic regression analyses and reported as odds ratio (OR) with 95% CI.

Results

Thigh circumference was negatively correlated with systolic blood pressure, diastolic blood pressure, fasting glucose, and total cholesterol. Compared with the lowest thigh circumference tertile group, the risk of hypertension was significantly lower in the highest tertile group, both in overweight individuals (OR 0.68; 95% CI 0.59–0.79, P < 0.001) and obese individuals (OR 0.51; 95% CI 0.38–0.70, P < 0.001).

Conclusion

In the present study, large thigh circumference is associated with lower risk of hypertension in overweight and obese Chinese individuals.

Open access

Julia Modesto Vicente, Junia Carolina Santos-Silva, Caio Jordão Teixeira, Dailson Nogueira de Souza, Jean Franciesco Vettorazzi, Fabiola Sales Furtuoso, Isabel Gouveia Adabo, Fabio Takeo Sato, Marco Aurélio Ramirez Vinolo, Everardo Magalhães Carneiro, Silvana Bordin and Gabriel Forato Anhê

Purpose

Observational studies show that longer breastfeeding periods reduce maternal risk of type 2 diabetes mellitus. However, it is currently unknown if the long-term benefits of breastfeeding for maternal glucose homeostasis are linked to changes in the endocrine pancreas.

Methods

We presently evaluated functional, morphological and molecular aspects of the endocrine pancreas of mice subjected to two sequential cycles of pregnancy and lactation (L21). Age-matched mice not allowed to breastfeed (L0) and virgin mice were used as controls.

Results

L21 mice exhibited increased tolerance and increased glucose-stimulated insulin secretion (GSIS) by isolated islets. Pancreatic islets of L21 mice did not present evident morphological changes to justify the increased GSIS. On the other hand, islets of L21 mice exhibited a reduction in Cavb3 and Kir6.2 expression with concordant increased intracellular Ca2+ levels after challenge with glucose.

Conclusion

Altogether, the present findings show the breastfeeding exerts long-term benefits for maternal endocrine pancreas by increasing intracellular Ca2+ levels and GSIS.

Open access

Wei Sun, Boyuan Zheng, Zhihong Wang, Wenwu Dong, Yuan Qin and Hao Zhang

Background: Papillary thyroid cancer (PTC) patients with clinical negative central lymph nodes (cN0), the use of prophylactic central lymph node dissection remains controversial. Patients with cN0 disease receive contralateral central lymph node metastasis (CCLNM) 3.88–30.63% of cases. Therefore, the present study aimed to obtain evidence for CCLNM risk factors in unilateral cN0 PTC.

Materials and methods: Relevant studies were searched in the PubMed, SCIE, and Wanfang databases up to 31 Oct 2019. The included patients had undergone lobectomy or total thyroidectomy with bilateral central lymph node dissection and were diagnosed pathologically with PTC.

Results: Thirteen studies comprising 2449 patients were included. The factors associated with increased CCLNM risk in cN0 unilateral PTC were: age < 45 years (odds ratio (OR) = 1.89, 95% confidence interval (CI) = 1.43–2.49, P < 0.00001), male sex (OR = 1.67, 95% CI = 1.24–2.24, P = 0.0007), extrathyroidal extension (OR = 1.63; 95% CI = 1.17-2.28; P = 0.004), tumor size ≥ 1 cm (OR = 2.63, 95% CI 1.85–3.74, P < 0.00001), lymphovascular invasion (OR = 4.27, 95% CI =2.47-7.37, P < 0.00001) and ipsilateral CLNM (OR = 11.42, 95% CI = 5.25-24.86, P < 0.00001). However, no association was found for capsular invasion, multifocality and Hashimoto thyroiditis.

Conclusion: The study identified that age <45 years, tumor ≥1 cm, male sex, lymphovascular invasion, extrathyroidal extension and ipsilateral CLNM are related to CCLNM in CN0 PTC. These factors should influence the use of prophylactic central lymph node dissection in these patients.

Open access

Hongyan Wang, Bin Wu, Zichuan Yao, Xianqing Zhu, Yunzhong Jiang and Song Bai

Purpose

Although resection is the primary treatment strategy for pheochromocytoma, surgery is associated with a high risk of morbidity. At present, there is no nomogram for prediction of severe morbidity after pheochromocytoma surgery, thus the aim of the present study was to develop and validate a nomogram for prediction of severe morbidity after pheochromocytoma surgery.

Methods

The development cohort consisted of 262 patients who underwent unilateral laparoscopic or open pheochromocytoma surgery at our center between 1 January 2007 and 31 December 2016. The patients’ clinicopathological characters were recorded. The least absolute shrinkage and selection operator (LASSO) binary logistic regression model was used for data dimension reduction and feature selection, then multivariable logistic regression analysis was used to develop the predictive model. An independent validation cohort consisted of 128 consecutive patients from 1 January 2017 and 31 December 2018. The performance of the predictive model was assessed in regards to discrimination, calibration, and clinical usefulness.

Results

Predictors of this model included sex, BMI, coronary heart disease, arrhythmia, tumor size, intraoperative hemodynamic instability, and surgical duration. For the validation cohort, the model showed good discrimination with an AUROC of 0.818 (95% CI, 0.745, 0.891) and good calibration (Unreliability test, P = 0.440). Decision curve analysis demonstrated that the model was also clinically useful.

Conclusions

A nomogram was developed to facilitate the individualized prediction of severe morbidity after pheochromocytoma surgery and may help to improve the perioperative strategy and treatment outcome.

Open access

Petar Milovanovic and Björn Busse

An increasing number of patients worldwide suffer from bone fractures that occur after low intensity trauma. Such fragility fractures are usually associated with advanced age and osteoporosis but also with long-term immobilization, corticosteroid therapy, diabetes mellitus, and other endocrine disorders. It is important to understand the skeletal origins of increased bone fragility in these conditions for preventive and therapeutic strategies to combat one of the most common health problems of the aged population. This review summarizes current knowledge pertaining to the phenomenon of micropetrosis (osteocyte lacunar mineralization). As an indicator of former osteocyte death, micropetrosis is more common in aged bone and osteoporotic bone. Considering that the number of mineralized osteocyte lacunae per bone area can distinguish healthy, untreated osteoporotic and bisphosphonate-treated osteoporotic patients, it could be regarded as a novel structural marker of impaired bone quality. Further research is needed to clarify the mechanism of lacunar mineralization and to explore whether it could be an additional target for preventing or treating bone fragility related to aging and various endocrine diseases.

Open access

Wentao Zhou, Tiantao Kuang, Xu Han, Wenqi Chen, Xuefeng Xu, Wenhui Lou and Dansong Wang

Objectives

Systemic inflammation markers have been demonstrated to be associated with prognosis in various tumors. In this study, we aimed to assess the value of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index and the counts of lymphocyte, monocyte and neutrophil in predicting prognosis among patients with resected pancreatic neuroendocrine neoplasms (pNENs).

Methods

A total of 174 patients were included in the study. Univariate and multivariate analyses were performed to evaluate the predictive roles of inflammation markers for relapse-free survival (RFS) and overall survival (OS) in pNEN patients.

Results

The optimal cut-off values of NLR, LMR and lymphocyte count were 1.9, 5.0 and 1.4 × 109/L, respectively, determined by the X-tile software. RFS was found to be significantly longer in patients with NLR ≤1.9 (P = 0.041), LMR >5.0 (P < 0.001) and lymphocyte count >1.4 × 109/L (P = 0.002) in comparison to those with NLR >1.9, LMR ≤5.0 and lymphocyte count ≤1.4 × 109/L, respectively. Multivariate analysis revealed that LMR (hazard ratio 0.30, 95% CI 0.11–0.85, P = 0.023) was an independent predictor for RFS, but not NLR or lymphocyte count. For long-term survival analysis, patients with NLR ≤1.9 (P = 0.016) were found to be associated with favorable OS, but NLR was not an independent factor validated by multivariate analysis.

Conclusions

Preoperative LMR is an independent systemic inflammation marker to predict relapses in pNEN patients who underwent curative resections, whose clinical value needs to be verified in further large sample-based prospective studies.

Open access

Kim K B Clemmensen, Jonas S Quist, Dorte Vistisen, Daniel R Witte, Anna Jonsson, Oluf Pedersen, Torben Hansen, Jens J Holst, Torsten Lauritzen, Marit E Jørgensen, Signe Torekov and Kristine Færch

Fasting duration has been associated with lower fasting blood glucose levels, but higher 2-h post-load levels, and research has indicated an adverse effect of ‘weekend behavior’ on human metabolism. We investigated associations of fasting duration and weekday of examination with glucose, insulin, glucagon and incretin responses to an oral glucose tolerance test (OGTT). This cross-sectional study is based on data from the ADDITION-PRO study, where 2082 individuals attended a health examination including an OGTT. Linear regression analysis was applied to study the associations of overnight fasting duration and day of the week with glucose, insulin, glucagon, glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide 1 (GLP-1) responses to an OGTT. We found that a 1 h longer fasting duration was associated with 1.7% (95% CI: 0.8,2.5) higher 2-h glucose levels, as well as a 3.0% (95% CI: 1.3,4.7) higher GIP and 2.3% (95% CI: 0.3,4.4) higher GLP-1 response. Fasting insulin levels were 20.6% (95% CI: 11.2,30.7) higher on Mondays compared to the other weekdays, with similar fasting glucose levels (1.7%, 95% CI: 0.0,3.4). In this study, longer overnight fasting duration was associated with a worsening of glucose tolerance and increased incretin response to oral glucose. We found higher fasting insulin levels on Mondays compared to the other days of the week, potentially indicating a worsened glucose regulation after the weekend.

Open access

Monika Karczewska-Kupczewska, Agnieszka Nikolajuk, Magdalena Stefanowicz, Natalia Matulewicz, Irina Kowalska and Marek Straczkowski

Objective: The aim of the study was to assess serum chemerin concentration and subcutaneous adipose tissue (SAT) chemerin expression in relation to insulin sensitivity and obesity in young healthy subjects.

Design: We performed a cross-sectional study including 128 subjects, 44 normal-weight, 44 with overweight and 40 with obesity.

Methods: Hyperinsulinemic-euglycemic clamp and SAT biopsy were performed. Next, 30 subjects with obesity underwent 12-week weight-reducing dietary intervention.

Results: Serum chemerin was higher and SAT chemerin expression was lower in subjects with obesity in comparison with other groups. The relationships of serum chemerin with its SAT expression and insulin sensitivity were positive in individuals with normal-weight and with overweight and negative in individuals with obesity. In the entire study population, serum chemerin was also positively related to hsCRP, serum fetuin A and alanine aminotransferase. SAT chemerin was positively related to insulin sensitivity, SAT insulin signaling and adipogenic genes. Weight loss decreased serum chemerin, whereas SAT chemerin increased in subjects with the highest increase in insulin sensitivity.

Conclusions: Serum and SAT chemerin is differentially associated with insulin sensitivity and the relationship between serum chemerin and insulin sensitivity depends on adiposity. SAT chemerin is positively associated with insulin sensitivity across the wide range of BMI and may be proposed as a biomarker of metabolically healthy SAT. Our results suggest that SAT is not the main source of serum chemerin in obesity.