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Ayanthi Wijewardene A Wijewardene, Endocrinology, St Leonards, 2066, Australia

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Matti Gild M Gild, Department of Endocrinology, Royal North Shore Hospital, St Leonards, Australia

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Lyndal J Tacon L Tacon, St Leonards, Australia

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Venessa Tsang V Tsang, Cancer Genetics, Kolling Institute of Medical Research, St Leonards, Australia

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Anthony J Gill A Gill, Dept of Anatomical Pathology, Royal North Shore Hospital, St Leonards, Australia

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Anthony R. Glover A Glover, St Leonards, Australia

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Mark Sywak M Sywak, Department of Endocrine Surgery, Royal North Shore Hospital, St Leonards, Australia

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Stan Sidhu S Sidhu, Department of Endocrine Surgery, Royal North Shore Hospital, St Leonards, Australia

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Bruce G Robinson B Robinson, St Leonards, Australia

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Paul Roach P Roach, Department of Nuclear Medicine, Royal North Shore Hospital, St Leonards, Australia

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Geoffrey Schembri G Schembri, Department of Nuclear Medicine, Royal North Shore Hospital, St Leonards, Australia

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Jeremy Hoang J Hoang, Department of Nuclear Medicine, Royal North Shore Hospital, St Leonards, Australia

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Roderick Clifton-Bligh R Clifton-Bligh, Endocrinology, Royal North Shore Hospital, Sydney, Australia

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Background: Noise, an unwanted variability in judgement, is ubiquitous in medicine, including in the prescription of radioactive iodine (RAI). Building upon our recently developed predictive risk model, we created an online clinical support tool to facilitate the translation of our model into clinical practice. The aim of this study is to assess the utility of an online clinical support tool to reduce noise in the treatment for patients with DTC.

Methods: The tool was accessible via weblink or a QR code. Activity recommendations were applied to the calculators four risk catgeories: 0GBq for very low risk, 1GBq for low risk; 4GBq for intermediate risk, and 6GBq for high risk. The tool was applied prospectively to 103 patients who received RAI at Royal North Shore Hospital between 2021-2022, and retrospectively to 393 patients treated with RAI between 2017-2021.

Results: A significant difference was observed in administered activity between the 2021-2022 vs 2017-2021cohorts in patients stratified as intermediate (median activity 3.95GBq, IQR 2.03-4.04 vs 4GBq, 4-4), and high risk (4.07GBq, 3.95-5.7 vs 6GBq, 6-6) with p-values of 0.01 and <0.01 respectively. No difference was seen in low risk patients (2.01GBq, 1.03-3.98 vs 1GBq, 1-4,p = 0.30). Additionally, no clinically significant recurrence was observed between the two cohorts (6.6% vs 4.5%,p = 0.628).

Conclusion: Optimal risk classification and activity recommendation continues to be established; our data suggests providing risk stratification and activity recommendation in an easy to access online tool can reduce noise and variability in activity prescription for patients with DTC.

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Yunting Lin Department of Surgical Medicine, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang, China

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Endi Song Department of Internal Medicine, Ningbo Yinzhou No.2 Hospital, Ningbo, Zhejiang, China

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Han Jin Department of Medicine, Ningbo University, Ningbo, Zhejiang, China

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Yong Jin Department of Internal Medicine, Ningbo Yinzhou No.2 Hospital, Ningbo, Zhejiang, China

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Background

Reproductive hormones may be a risk factor for cardiovascular disease (CVD), but their influence is often underestimated. Obesity can exacerbate the progression of CVD. Arterial stiffness (AS) is correlated with the risk of CVD. Brachial-ankle pulse wave velocity (baPWV) has served as a practical tool for assessing AS with broad clinical applications. This study aimed to investigate the association between reproductive hormones and baPWV in obese male and female subjects.

Methods

A retrospective case–control design was designed. AS was assessed using baPWV, with a baPWV ≥ 1400 cm/s indicating increased AS. Between September 2018 and October 2022, 241 obese subjects with increased AS were recruited from Ningbo Yinzhou No. 2 Hospital. The control group consisted of 241 obese subjects without increased AS. A 1:1 propensity score matching was performed to correct potential confounders by age and sex. We additionally performed a sex-based sub-analysis.

Results

Correlation analysis demonstrated that luteinizing hormone (LH) (r = 0.214, P = 0.001) and follicle-stimulating hormone (FSH) (r = 0.328, P < 0.001) were positively correlated with baPWV in obese male subjects. In the multivariate conditional logistic regression analysis, FSH (OR = 1.407, 95% CI = 1.040–1.902, P = 0.027) rather than LH (OR = 1.210, 95% CI = 0.908–1.612, P = 0.194) was independently and positively associated with increased AS in obese male subjects. However, there was no significant correlation between reproductive hormones and baPWV in women.

Conclusions

Our study identified FSH as a potential risk factor for arteriosclerosis in obese male subjects. This provides a novel and intriguing perspective on the pathogenesis of CVD in obese subjects.

Open access
Saroj Kumar Sahoo Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
Division of Endocrinology, Mid and South Essex NHS Trust, Broomfield, UK

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Jayakrishnan C Menon Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India

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Nidhi Tripathy Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India

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Monalisa Nayak Department of Liver Intensive Care Unit, King’s College Hospital, London, UK

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Subhash Yadav Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India

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Objective

We studied the temporal course of hypothalamic–pituitary–adrenal (HPA) dysfunction in patients with coronavirus disease 2019 (COVID-19).

Methods

Three hundred and two patients (median age 54 years (interquartile range (IQR) 42–64), 76% males) were recruited. The HPA axis was evaluated by morning cortisol and adrenocorticotrophic hormone (ACTH) at admission (n = 232). Adrenal insufficiency (AI) during acute illness was defined using a morning cortisol <83 nmol/L. AI at 12 months follow-up was defined using a peak cortisol <406 nmol/L in the ACTH stimulation test (APST) (n = 90). Those with AI at 12 months were further assessed by APST every 6 months for recovery of hypoadrenalism.

Results

The median morning cortisol and ACTH levels during COVID-19 were 295 (IQR 133–460) nmol/L and 3.9 (0.8–6.9) pmol/L, respectively. AI was present in 33 (14%) patients; ACTH was elevated in three and low or inappropriately normal in the rest 30 patients. At 12 months, AI was seen in 13% (12/90) patients, with all cases being hypothalamic–pituitary in origin; five (42%) of them had not met the diagnostic criteria for AI during COVID-19. AI diagnosed at admission persisted at 12 months in seven patients and recovered in seven; the remaining 19 patients were lost to follow-up. The presence of AI at 12 months was independent of severity and steroid use during COVID-19. A morning cortisol <138 nmol/L during COVID-19 predicted the presence of AI at 12 months. All patients showed recovery of the HPA axis in the ensuing 12 months.

Conclusion

Central AI was common during acute COVID-19 and at 12 months of follow-up. AI can be late onset, developing after recovery from COVID-19, and was transient in nature.

Open access
Zeting Li Z Li, Department of Endocrinology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, China

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Ling Pei L Pei, Department of Endocrinology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, China

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Huangmeng Xiao H Xiao, Department of Endocrinology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, China

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Nan Chen N Chen, Department of Endocrinology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, China

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Fenghua Lai F Lai, Department of Endocrinology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, China

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Shufan Yue S Yue, Department of Endocrinology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, China

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Changliu Xu C Xu, Department of Endocrinology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, China

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Yanbing Li Y Li, Department of Endocrinology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, China

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Haipeng Xiao H Xiao, Department of Endocrinology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, China

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Xiaopei Cao X Cao, Department of Endocrinology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, China

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Glucose-like peptide-1 (GLP-1) is a vital hormone in the intestines that regulates glucose metabolism. Although pancreatic derived factor (PANDER) overexpression is known to suppress GLP-1, the underlying mechanisms are unclear. Our study aims to uncover how PANDER influences GLP-1 synthesis and secretion. We established a PANDER overexpression model in STC-1 intestinal cells, confirming its inhibitory effect on GLP-1 secretion. This effect was reversed in PANDER-knockout cells. Additionally, a negative correlation between PANDER and GLP-1 was observed in patients with gestational diabetes history. Subsequently, through whole transcriptome gene sequencing in PANDER-overexpressed STC-1 cells, we discovered that the activation of IL-6 and its related STAT3 signaling pathway was significantly inhibited, and this finding was validated by WB and QPCR. Finally, rescue experiments confirmed that the IL-6-related STAT3/Akt/GSK3β/β-catenin signaling pathway mediates the negative regulatory effect of PANDER on GLP-1. Taken together, our data identify IL-6 as a bridge connecting PANDER and GLP-1 in the STC-1 cells, demonstrating the potential therapeutic targets for diabetes treatment by targeting PANDER-IL-6-GLP-1 axis.

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Chan Yang School of Nursing, Ningxia Medical University, Yinchuan, Ningxia, China
School of Public Health, Ningxia Medical University, Yinchuan, Ningxia, China

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Yadi Zhang School of Public Health, Ningxia Medical University, Yinchuan, Ningxia, China

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Juan Li School of Public Health, Ningxia Medical University, Yinchuan, Ningxia, China

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Xiaowei Liu School of Public Health, Ningxia Medical University, Yinchuan, Ningxia, China

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Jiangwei Qiu School of Public Health, Ningxia Medical University, Yinchuan, Ningxia, China

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Jiaxing Zhang School of Public Health, Ningxia Medical University, Yinchuan, Ningxia, China

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Xiuying Liu School of Public Health, Ningxia Medical University, Yinchuan, Ningxia, China
Key Laboratory of Environmental Factors and Chronic Disease Control, Ningxia Medical University, Yinchuan, Ningxia, China

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Yuhong Zhang School of Public Health, Ningxia Medical University, Yinchuan, Ningxia, China
Key Laboratory of Environmental Factors and Chronic Disease Control, Ningxia Medical University, Yinchuan, Ningxia, China

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Yi Zhao School of Public Health, Ningxia Medical University, Yinchuan, Ningxia, China
Key Laboratory of Environmental Factors and Chronic Disease Control, Ningxia Medical University, Yinchuan, Ningxia, China

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In the last 40 years, there has been a notable rise in the occurrence of diabetes within China, leading to the country now having the highest number of individuals affected by this condition globally. This prospective observational study examined the effect of different baseline relative leukocyte telomere length (RTL) and the combined effect of baseline RTL and plasma phospholipid fatty acid (PPFA) on the risk of developing diabetes. Adults from Ningxia Province who underwent baseline and follow-up surveys were included in the study. The correlation between the baseline RTL and PPFA was investigated using a multiple linear regression model. The combined effects of baseline RTL and PPFA levels on the risk of developing type 2 diabetes mellitus (T2DM) were investigated using a Cox regression model with time as the covariate. A total of 1461 study subjects were included in this study. According to the diagnostic criteria of the Chinese Diabetes Society, 141 subjects developed T2DM during the follow-up period. The baseline age was negatively correlated with RTL. After adjustment for age, C16:0, C18:1 n-9, C20:4 n-6, C20:3 n-3, and monounsaturated fatty acid (MUFA) concentrations were negatively correlated with RTL. Multiple linear regression analysis showed that C16:0 and MUFA concentrations influenced RTL. Subjects with shorter RTL at baseline had a higher risk of developing diabetes than those with longer RTL. Subjects with shorter RTL and higher C16:0 and MUFA concentrations at baseline had a higher risk of developing T2DM than those with longer RTL and lower C16:0 and MUFA concentrations. Our findings indicated that PPFA affects changes in RTL. In addition, RTL and PPFA are associated with the occurrence of T2DM.

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Aglaia Kyrilli Department of Endocrinology, Hôpital Universitaire de Bruxelles (H.U.B.) - Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium

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Bernard Corvilain Department of Endocrinology, Hôpital Universitaire de Bruxelles (H.U.B.) - Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium

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Sofie Bliddal Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
Department of Gynecology and Obstetrics, Copenhagen University Hospital (Hvidovre Hospital), Hvidovre, Denmark

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Dorthe Hansen Precht Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
Carelink Nærhospital, Roskilde, Denmark

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Ulla Feldt-Rasmussen Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
Institute of Clinical Medicine, Faculty of Health and Clinical Research, Copenhagen University, Copenhagen, Denmark

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Kris Poppe Department of Endocrinology, Centre Hospitalier Universitaire Saint-Pierre, Brussels, Belgium
Université Libre de Bruxelles (ULB), Brussels, Belgium

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Background

Thyroid autoimmunity (TAI) may be present in 1–17% of pregnant women. Monitoring of thyroid function in euthyroid pregnant women positive for anti-thyroperoxidase antibodies (TPOAb+) is recommended.

Objective

To determine the prevalence and possible clinical and biological risk factors of biochemical progression (rise in serum thyroid-stimulating hormone (TSH) > 2.5 mU/L) at second blood sampling during pregnancy, in euthyroid women (TSH ≤ 2.5 mU/L) according to their TPOAb status.

Methods

This study included demographic and biological data from two previously published cohorts (n = 274 women from August 1996 to May 1997 Copenhagen cohort, and n = 66 women from January 2013 to December 2014 Brussels cohort) having at least two measurements of TSH and free thyroxine (FT4) and at least one of TPOAb during spontaneously achieved singleton pregnancies.

Results

The majority of women studied did not show biochemical progression. Only 4.2% progressed, significantly more frequently among TPOAb+ women, as compared to TPOAb− group (9.4 vs 2.7%, P = 0.015). No rise in serum TSH > 4 mU/L at 2nd sampling was observed. Higher baseline TSH levels were associated with biochemical progression in both TPOAb+ (P = 0.05) and TPOAb− women (P < 0.001), whereas maternal age, BMI, multiparity, smoking, FT4, and TPOAb concentrations were not significantly different between women with and without progression.

Conclusions

Only a minority of euthyroid women with thyroid autoimmunity presented biochemical progression and none with a TSH > 4 mU/L. Larger studies are needed to better target the subset of women who would benefit most from repeated thyroid function monitoring during pregnancy.

Open access
Li Zhang L Zhang, Department of Neurology, Nanyang Central Hospital, Nanyang, China

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Shuai Yan S Yan, Department of Neurological Function Examination, Affiliated Hospital of Hebei University, Baoding, China

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Shen-ke Xie S Xie, Department of Neurosurgery, Nanyang Central Hospital, Nanyang, China

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Yi-tong Wei Y Wei, Department of Neurosurgery, Nanyang Central Hospital, Nanyang, China

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Hua-peng Liu H Liu, Department of Endocrinology, Nanyang Central Hospital, Nanyang, China

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Yin Li Y Li, Department of Pathology, Nanyang Central Hospital, Nanyang, China

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Hai-bo Wu H Wu, Department of Neurology, Nanyang Central Hospital, Nanyang, China

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Hai-liang Wang H Wang, Department of Neurosurgery, The Second Hospital of Jilin University, Changchun, China

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Peng-Fei Xu P Xu, Department of Neurosurgery, Nanyang Central Hospital, Nanyang, China

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Purpose:

This study aimed to investigate the relation of magnetic resonance image (MRI) features and immunohistochemistrical subtypes of pituitary microadenomas (PMAs) characterized by location and growth pattern.

Materials and methods:

A double-center, retrospective review of MRI characteristics was conducted in 57 PMA cases recorded from February 2014 to September 2023 and identified on the basis of 2017 WHO classification of pituitary gland tumors. The geometric center of the tumor was defined, and the possibility of PMA vertical or lateral growth pattern was evaluated according to ratio of maximum diameter between the X and Y axes.

Results:

Among the PMAs, somatotroph adenomas (STAs) significantly frequented the lateral–anteroinferior portion of pituitary gland (P=0.036). Lactotroph adenomas (LTAs) showed significant locational preference for the lateral–posteroinferior portion (P=0.037), and gonadotroph adenomas (GTAs) were predominately located in the central–anteroinferior portion (P=0.022). Furthermore, the PMAs in the suprasellar portion exhibited vertical extension with statistical significance (P=0.0).

Conclusion:

In our cohort, the micro-STAs were predominately located in the lateral–anteroinferior portion of pituitary gland, the micro-LTAs in the lateral–posteroinferior portion, and the micro-GTAs in the central–anteroinferior portion. The growth pattern of the PMAs was highly correlated with their vertical position instead of their immunohistochemistrical subtypes. Therefore, MRI shows potential in differentiating partial PMA subgroups, especially the cases in silent groups.

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Dandan Hu D Hu, Department of Endocrinology, Suzhou Municipal Hospital, Suzhou, China

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Xiangguo Cong X Cong, Department of Endocrinology, The Affiliated Suzhou Hospital of Nanjing Medical University, suzhou, China

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Beibei Gao B Gao, Department of Endocrinology, Suzhou Municipal Hospital, Suzhou, China

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Ying Wu Y Wu, Department of Endocrinology, Suzhou Municipal Hospital, Suzhou, China

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Qiong Shen Q Shen, Department of Endocrinology, Suzhou Municipal Hospital, Suzhou, China

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Lei Chen L Chen, The Affiliated Suzhou Hospital of Nanjing Medical University, 苏州, 2100000, China

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Background:

Evidence has demonstrated that visceral fat area (VFA) and subcutaneous fat area (SFA) had different influences on cardiovascular disease (CVD) risk in patients with type 2 diabetes mellitus (T2DM). We aimed to investigate the relationship between the visceral fat area (VFA) to subcutaneous fat area (SFA) ratio (V/S) and carotid atherosclerosis (CAS) in patients with T2DM.

Methods:

From January 2018 to May 2023, 1,838 patients with T2DM admitted to the National Metabolic Management Centre in our hospital were assigned to two groups based on comorbid CAS. Dual bioelectrical impedance analysis was used to measure the VAF and SFA, and the V/S was calculated. Patient characteristics and serum biochemical indices were compared between groups. Factors influencing comorbid CAS were determined, and correlations between V/S and other clinical indices were analyzed.

Results:

The group with comorbid CAS included 858 individuals and 980 without comorbid CAS. Those with comorbid CAS were older and had a longer disease duration, more significant systolic blood pressure, and greater V/S. The proportions of patients with comorbid hypertension increased significantly with the V/S ratio. The V/S ratio positively correlated with triglyceride (TG), low-density lipoprotein cholesterol levels, and waist circumference. According to binary logistic regression analysis, V/S was an independent risk factor for CAS.

Conclusion:

Elevated V/S is an independent risk factor for CAS in patients with T2DM.

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Marenao Tanaka M Tanaka, Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University, Sapporo, Japan

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Tomohito Gohda T Gohda, Department of Nephrology, Juntendo University, Bunkyo-ku, Japan

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Nozomu Kamei N Kamei, Department of Endocrinology and Metabolism, Hiroshima Red Cross Hospital and Atomic Bomb Survivors' Hospital, Hiroshima, Japan

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Maki Murakoshi M Murakoshi, Department of Nephrology, Juntendo University, Bunkyo-ku, Japan

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Tatsuya Sato T Sato, Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan

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Mitsunobu Kubota M Kubota, National Hospital Organization Kure Medical Center Attached Kure School of Nursing, Kure, Japan

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Michiyoshi Sanuki M Sanuki, National Hospital Organization Kure Medical Center Attached Kure School of Nursing, Kure, Japan

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Erika Ishiwata E Ishiwata, Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan

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Keisuke Endo K Endo, Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan

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Yusuke Suzuki Y Suzuki, Juntendo University, Bunkyo-ku, Japan

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Masato Furuhashi M Furuhashi, Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan

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Background: Fatty acid-binding protein 4 (FABP4) is an adipokine that plays significant roles in the development of insulin resistance and atherosclerosis. High levels of soluble tumor necrosis factor receptors (TNFRs) including TNFR1 and TNFR2 are associated with renal dysfunction and increased mortality in patients with diabetes mellitus (DM). However, the association between circulating levels of FABP4 and TNFRs remains unclear.

Methods: We investigated the associations of FABP4 with TNFRs and metabolic markers in Japanese patients with type 1 DM (T1DM, n=76, men/women: 31/45) and type 2 DM (T2DM, n=575, men/women: 312/263).

Results: FABP4 concentration was positively correlated with levels of TNFR1 and TNFR2 in both patients with T1DM and those with T2DM. Multivariable regression analyses showed that there were independent associations of FABP4 concentration with body mass index (BMI) and estimated glomerular filtration rate (eGFR) after adjustment of age and sex in both patients with T1DM and those with T2DM. FABP4 concentration was independently associated with circulating levels of TNFR1 and TNFR2 after adjustment of the confounders in patients with T2DM but not in those with T1DM. Similarly, levels of TNFR1 and TNFR2 were independently associated with FABP4 concentration after adjustment of age, sex, systolic blood pressure, duration of DM and levels of eGFR, high-density lipoprotein cholesterol and C-reactive protein in patients with T2DM but not in those with T1DM.

Conclusion: FABP4 concentration is independently associated with levels of TNFRs in patients with DM, but the association is more evident in patients with T2DM than in those with T1DM.

Open access
Dafydd Aled Rees Cardiff University, Cardiff, United Kingdom

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Deborah P Merke National Institutes of Health Clinical Center and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, USA

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Wiebke Arlt MRC LMS, London, United Kingdom

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Aude Brac De La Perriere Hospices Civils de Lyon - GHE - Endocrinologie, Bron, France

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Angelica Linden Hirschberg Karolinska Institute, Solna, Sweden

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Anders Juul Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark, and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark

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John Newell-Price The University of Sheffield, Sheffield, United Kingdom

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Alessandro Prete University of Birmingham, Birmingham, United Kingdom

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Nicole Reisch Endokrinologie, Nephrologie und weitere Sektionen - Medizinische Klinik und Poliklinik IV - Campus Innenstadt, München, Germany

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Nike M Stikkelbroeck Radboud University Nijmegen, Nijmegen, Netherlands

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Philippe A Touraine University Hospitals Pitié Salpêtrière - Charles Foix, Paris, France

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Alex Lewis Neurocrine Biosciences Inc, London, United Kingdom

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John Porter Neurocrine Biosciences Inc, London, United Kingdom

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Helen Coope Neurocrine Biosciences Inc, London, United Kingdom

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Richard J Ross The University of Sheffield, Sheffield, United Kingdom

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Background

Prednisolone and prednisone are recommended treatment options for adults with congenital adrenal hyperplasia (CAH); however, there is no randomised comparison of prednis(ol)one with hydrocortisone.

Design

Six-month open-label randomised phase 3 study and interim analysis of a single-arm extension study was the design of the study.

Methods

The method of the study was hydrocortisone dose equivalent and 09:00-h 17-hydroxyprogesterone (17OHP) from 48 patients taking prednis(ol)one at baseline.

Results

At baseline, the median hydrocortisone dose equivalent was 30 mg/day and 17OHP was < 36 nmol/L (3× upper limit of normal) in 56% of patients. Patients were randomised to continue prednis(ol)one or switch to modified-release hydrocortisone capsule (MRHC) at the same hydrocortisone-equivalent dose. At 4 weeks, 94% on MRHC and 71% on prednis(ol)one had 17OHP < 36 nmol/L. At 18 months in the extension study of MRHC, the median MRHC dose was 20 mg/day and 82% had 17OHP < 36 nmol/L. The per cent of patients with 17OHP < 36 nmol/L on a hydrocortisone dose equivalent ≤ 25 mg/day was greater at 18 months in the extension study on MRHC than while on prednis(ol)one at baseline: 57% vs 27%, P = 0.04. In the randomised study, no patients had an adrenal crisis on MRHC and one on prednisolone. In the extension study (221 patient years), there were 12 adrenal crises in 5 patients (5.4/100 patient years).

Conclusion

MRHC reduces 17OHP at 09:00 h compared to prednis(ol)one and the dose of MRHC can be down-titrated over time in the majority of patients.

Open access