Endocrine最新文献

The word "cancer" evokes myriad emotions, ranging from fear and despair to hope and determination. Cancer is aptly defined as a complex and multifaceted group of diseases that has unapologetically led to the loss of countless lives and affected innumerable families across the globe. The battle with cancer is not only a physical battle, but also an emotional, as well as a psychological skirmish for patients and for their loved ones. Cancer has been a part of our history, stories, and lives for centuries and has challenged the ingenuity of health and medical science, and the resilience of the human spirit. From the early days of surgery and radiation therapy to cutting-edge developments in chemotherapeutic agents, immunotherapy, and targeted treatments, the medical field continues to make significant headway in the fight against cancer. However, even after all these advancements, cancer is still among the leading cause of death globally. This urges us to understand the central hallmarks of neoplastic cells to identify novel molecular targets for the development of promising therapeutic approaches. Growing research suggests that stress mediators, including epinephrine, play a critical role in the development and progression of cancer by inducing neoplastic features through activating adrenergic receptors, particularly β-adrenoreceptors. Further, our experimental data has also shown that epinephrine mediates the growth of T-cell lymphoma by inducing proliferation, glycolysis, and apoptosis evasion via altering the expression levels of key regulators of these vital cellular processes. The beauty of receptor-based therapy lies in its precision and higher therapeutic value. Interestingly, the enhanced expression of β-adrenergic receptors (ADRBs), namely ADRB2 (β2-adrenoreceptor) and ADRB3 (β3-adrenoreceptor) has been noted in many cancers, such as breast, colon, gastric, pancreatic, and prostate and has been reported to play a pivotal role in facilitating cancer growth mainly by promoting proliferation, evasion of apoptosis, angiogenesis, invasion and metastasis, and chemoresistance. The present review article is an attempt to summarize the available findings which indicate a distinct relationship between stress hormones and cancer, with a special emphasis on epinephrine, considered as a key stress regulatory molecule. This article also discusses the possibility of using beta-blockers for cancer therapy.

Background: The impact of fatty liver disease on lumbar bone mineral density (BMD) represents an intriguing area of study, particularly in light of established research linking obesity to bone metabolism. However, there remains limited investigation into the correlation between quantifying liver fat content (LFC) and lumbar BMD among overweight and obese populations, particularly within the Chinese demographic. This study aims to accurately quantify LFC and investigate its association with lumbar BMD in overweight or obese individuals.

Methods: This cross-sectional study was conducted at the Health Management Center of Henan Provincial People's Hospital from January 2019 to February 2023, involving 6996 participants with a body mass index (BMI) of 24 kg/m² or higher. LFC and lumbar BMD were assessed using computed tomography. The study utilized one-way ANOVA, subgroup analysis, multifactor regression analysis, smooth curve fitting, and threshold and saturation effect analysis to explore the relationship between LFC and lumbar BMD. Furthermore, inflammatory cell analysis was included to investigate the potential mediating role of inflammatory cells in the association between LFC and lumbar BMD.

Results: After adjusting for confounding variables, multivariate regression analysis revealed a significant negative association between LFC and lumbar BMD (β = -0.323, 95% CI: -0.464 to -0.183, P < 0.001). Particularly, participants in the highest baseline LFC quartile (Q4 group) exhibited a more pronounced negative impact on lumbar BMD compared to those in the lowest quartile (Q1 group) (β = -5.026, 95% CI: -7.040 to -3.012, P < 0.001). Threshold saturation effect analysis identified a turning point in the LFC-BMD relationship (K = 5.4). Below this point, LFC showed a positive correlation with lumbar BMD (β = 0.962, 95% CI: 0.016-1.907, P < 0.05), whereas above it, LFC was significantly negatively correlated with lumbar BMD (β = -0.405, 95% CI: -0.558 to -0.253, P < 0.001). Additionally, mediation analysis indicated that leukocytes and monocytes potentially mediated the association between LFC and lumbar BMD, with mediation ratios of -5.78 and -6.68%, respectively.

Conclusion: Among individuals categorized as overweight or obese, elevated levels of LFC were associated with reduced lumbar BMD, particularly noticeable above a threshold of 5.4%. Additionally, various types of inflammatory cells are presumed to exert a substantial mediating influence on the correlation between LFC and lumbar BMD.

Background: Lung neuroendocrine neoplasms (NENs) represent about 20% of all lung cancers. Few therapeutic options are available for atypical carcinoids (ACs). Single-agent temozolomide (TEM) is active in lung NENs, but whether the addition of capecitabine (CAPTEM) is associated with improved outcomes, is unknown. We sought to investigate the TEM-based therapies (TEM or CAPTEM) in patients with advanced AC.

Material and methods: This was a retrospective analysis of prospectively collected data from patients with AC of the lung referred to our institution from January 2003 to January 2023 who have received chemotherapy with either TEM or CAPTEM as any line treatment. Primary endpoint was progression free survival (PFS), secondary endpoints included overall response rate (ORR) and overall survival (OS).

Results: In this study we included 31 patients with advanced AC. Median Ki-67 was 14.4% (3-30). CAPTEM in 17 patients (54.8%), while TEM was administered in 14 patients (45.2%). Overall, ORR was 39% (N = 12/31, all partial responses), while median PFS and OS were 57.4 months (95%CI: 43.2-71.7) and 24.4 months (95% confidence interval [95%CI]: 14.7-34.1). Median PFS was 33.9 months (15.6-52.1) in the CAPTEM group, while it was 15.5 (7.3-23.8) in the TEM group (p = 0.047). When adjusting for potential confounding factors, treatment with TEM vs CAPTEM retained its independent association with an increased risk of progression (HR: 4.01 [95%CI: 1.18-13.68]; p = 0.027).

Conclusions: Treatment with CAPTEM is associated with longer PFS than TEM alone in patients with AC. Prospective studies with larger sample size are needed to validate this finding.

Purpose: This study aims to evaluate the association between psychiatric disorders and diabetic ketoacidosis (DKA) in patients with type 1 diabetes (T1D) treated at a tertiary care hospital.

Methods: A propensity score-matched case-control study was conducted, comprising a total sample of 194 participants (97 DKA cases and 97 controls without DKA). Comprehensive data were collected on clinical, anthropometric, and socioeconomic characteristics, and psychiatric disorders were classified according to international standards.

Results: The mean age of the participants was 47.4 ± 17.7 years, with 55.6% being female. Psychiatric disorders were identified in 16.5% of the study population. The prevalence of psychiatric disorders was significantly higher in DKA cases compared to controls (24.7% vs. 7.2%, p < 0.001). Conditional logistic regression models revealed that the association between psychiatric disorders and DKA was not independent of HbA1c levels. Additionally, in HbA1c-stratified analyses, patients with psychiatric disorders developed DKA at lower HbA1c levels compared to controls.

Conclusion: Psychiatric disorders significantly increase the risk of DKA in adults with T1D, particularly among those with less elevated HbA1c levels. These findings highlight the critical importance of addresing psychiatric comorbidities in the management of T1D, given the severe implications and significant healthcare resource utilization associated with DKA.

Purpose: Metabolic syndrome (MetS) is a cluster of risk factors that increase the risk of cardiometabolic diseases. The prevalence of MetS and individual components across pregnancy has not been reviewed in the literature. This research was conducted to identify the prevalence of MetS and its components among pregnant women.

Methods: The PubMed, EMBASE, CINAHL, Web of Science and Scopus databases were searched. The review protocol is registered in PROSPERO (CRD42023460729). Quality assessment was performed using the JBI critical appraisal checklist. The study selection, data extraction and data analyses were performed in accordance with the MOOSE guidelines.

Results: The prevalence of MetS among pregnant women was 16.3%, (n = 3946). The prevalences for individual MetS components were: low HDL, 12.3% (n = 1108); high fasting glucose, 16.2% (n = 2333); high triglycerides, 48.5% (n = 2880); obesity, 42.7% (n = 5162) and high blood pressure 37.7% (n = 828). According to the definitions used to diagnose MetS, the prevalences were 18.2% according to the World Health Organization, 15.0% according to the International Diabetes Federation and 17.2% according to the National Cholesterol Education Program Adult Treatment Panel III. When stratified by gestational age at assessment, the prevalence of MetS was 9.9% before 16 weeks' and 24.1% after 20 weeks' of gestation.

Conclusion: This review demonstrates that MetS is detected in approximately one-fifth of pregnant women. Screening for MetS and its components during pregnancy may help identify young women at risk for future cardiovascular disease.

Purpose: To investigate the relationship between platelet-to-lymphocyte ratio (PLR) or neutrophil-to-lymphocyte ratio (NLR) and Immune checkpoint inhibitor (ICI)-induced thyroid dysfunction.

Methods: This was a single-center retrospective observational study of patients with solid tumors receiving ICI therapy. Clinical characteristics of patients were assessed at baseline and during ICI therapy. Logistic regression was implemented to assess the association of PLR and NLR with thyroid dysfunction. Kaplan-Meier method was used to analyze the difference in time between the onset of hypothyroidism and thyrotoxicosis.

Results: A total of 355 patients with solid tumors were included in our study. Sixty-nine (19.44%) patients developed ICI-induced thyroid dysfunction after receiving ICI therapy, with a median (IQR) time to onset of 91(34-203.5) days. Patients with high PLR (H-PLR) had an increased risk of ICI-induced thyroid dysfunction (OR = 1.87, 95% CI 1.07-3.28, P = 0.028) compared to those with low PLR (L-PLR). Specifically, H-PLR was associated with ICI-induced thyrotoxicosis but not hypothyroidism (OR = 2.40, 95% CI 1.09-5.29, P = 0.030). Meanwhile, NLR was not correlated with ICI-induced thyroid dysfunction as a continuous (P = 0.699) or categorical variable (P = 0.914). The sensitivity analysis showed that H-PLR remains positively correlated with ICI-induced thyroid dysfunction.

Conclusion: PLR rather than NLR was associated with the occurrence of ICI-induced thyroid dysfunction. Furthermore, PLR may serve as a predictive biomarker for ICI-induced thyroid dysfunction.

Background: There has been growing interest to study impact of night shift work on male reproductive health, which is regulated by the hypothalamic-pituitary-gonadal axis and influenced by circadian rhythms. This systematic review and meta-analysis aim to explore the association between night shift work and male reproductive health outcomes.

Methods: This systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines (PROSPERO: CRD42022379770). Studies comparing male reproductive parameters [e.g., semen profile, testosterone, follicle stimulating hormone (FSH), luteinizing hormone (LH)] between night shift workers and non-shift workers were systematically searched in PubMed, Scopus and EMBASE databases. Heterogeneity (I² and Cochran-Q test), risk of bias (Newcastle-Ottawa Scale and funnel plots), sensitivity analyses were performed when applicable.

Results: Eight studies were included in this review from 6397 citations screened. The pooled mean difference in sperm count was -18.38 × 10⁶ sperm (-59.82 to 23.07; n = 3, I² = 85.12%) and serum testosterone was 15 ng/dL (-19.3 to 49.39; n = 5, I² = 63%), indicating that shift workers had lower sperm counts but marginally higher serum testosterone levels compared to controls. The majority of included studies exhibited a high risk of bias in participant selection, group comparability and exposure assessment.

Conclusion: The analysis highlights the potential impact of night shift work on sperm parameters and hormone levels. Future research with standardized methods and larger samples is needed to better understand the circadian disruption's effects, informing healthcare practices and policies for male reproductive health.

Purpose: Shear wave elastography (SWE) is a valuable tool in discerning the malignancy risk of thyroid nodules. This study investigates whether 2D-SWE can reliably differentiate malignant thyroid nodules in patients with chronic autoimmune thyroiditis (CAT), despite the challenges posed by fibrosis, which can increase tissue stiffness and complicate diagnosis.

Methods: This retrospective observational study evaluated 130 thyroid nodules (91 benign, 39 malignant) in patients with underlying CAT using conventional ultrasound (B-mode) and 2D-SWE with SuperSonic Mach30 equipment (Supersonic Imagine, Aix-en-Provence, France). Pathology reports served as the reference standard.

Results: Out of the 130 nodules, 30% were malignant, and 70% were benign. 2D-SWE proved to be an excellent distinguisher between benign and malignant nodules. Malignant nodules had significantly higher elasticity indices compared to benign nodules (mean elasticity index: 47.2 kPa vs. 18.1 kPa, p < 0.0001; maximum elasticity index: 75 kPa vs. 26.2 kPa, p < 0.0001). The mean elasticity index was the most reliable elastographic parameter (AUC 0.907, sensitivity 87.2% [95% CI: 77.3-94.0%], specificity 84.6% [95% CI: 75.4-91.5%], and NPV 93.9% for a cut-off value of 30.5 kPa).

Conclusion: Our results confirm that 2D-SWE can accurately diagnose malignant thyroid nodules in cases with CAT (p < 0.0001), supporting its use as a complementary tool to conventional ultrasound.

Purpose: Adrenal vascular tumors are mainly represented by adrenal cavernous hemangiomas (ACHs) and adrenal cystic lymphangiomas (ACLs). Their radiological features often overlap with malignant tumors, therefore ruling out malignancy becomes mandatory. We analyzed clinical, radiological, and histopathological data to identify specific characteristics of these tumors.

Methods: We reviewed 21 patients with ACHs (n = 12), ACLs (n = 8), or adrenal cysts (n = 1) confirmed by histopathology. We selected 82 papers from PubMed to provide a systematic review of the literature.

Results: In our cohort, median age at diagnosis was 58 years, with sex evenly distributed. All tumors were unilateral (median size = 44 mm), with 6 cases of increasing tumor size. All tumors exhibited non-contrast CT density > 10 Hounsfield Unit (HU). Calcifications were found in 5 cases. Hormonal studies revealed 11 non-functioning tumors and 2 cortisol-secreting tumors. Elevated urinary metanephrines were found in 2 cases. Immunostaining showed CD31/CD34/factor VIII expression in ACHs (n = 5, 24%) and podoplanin expression in ACLs (n = 6, 29%). The literature review revealed 71 reported cases of ACHs and 104 reported cases of ACLs. Median age at diagnosis was 46 years, with slightly female prevalence (63%). Median tumor size was 48 mm. 84 cases were symptomatic, with life-threatening hemorrhage reported in only 3 patients. Calcifications were found in 23% of cases. Surgical approaches varied, with open and laparoscopic adrenalectomy performed in 55 and 42 patients respectively.

Conclusions: ACHs and ACLs represent a diagnostic dilemma in clinical practice due to their rarity and their misleading imaging features.

Purpose: To evaluate the diagnostic value of different subtypes of non-punctate echogenic foci in thyroid malignancy.

Methods: Retrospective research of 342 thyroid nodules with calcification was performed. The echogenic foci were divided into punctate echogenic foci (type I) and non-punctate echogenic foci (type II), and type II were further divided into four subtypes: macrocalcification (type IIa), continuous peripheral calcification (type IIb), discontinuous peripheral calcification (type IIc) and isolated calcification (type IId). Postoperative histopathological results were used as the gold standard to evaluate the correlation between non-punctate echogenic foci subtypes and thyroid malignancy.

Results: The malignant risk of nodules with echogenic foci was type I (82.1%) > type IIa (66.2%) > type IIc (52.9%) > type IId (16.7%) > type IIb (13.9%), P < 0.001. Type I and type IIa echogenic foci were independent risk factors for thyroid cancer (OR = 16.593, 7.785). Solid, hypoechogenicity/marked hypoechogenicity and a single lesion in a unilateral thyroid lobe were independently associated with malignant thyroid nodules with macrocalcification(OR = 6.825, 40.042, 5.201). Irregular margins and uneven calcification thickness were independent factors for malignant thyroid nodules with peripheral calcification (OR = 5.676, 2.750).

Conclusion: Type IIa echogenic foci could independently predict thyroid malignancy. The diagnostic value of non-punctate echogenic foci depended on the differentiated combination of ultrasound characteristics. Type IIa nodules with solid composition, irregular margins, and a single lesion in a unilateral thyroid lobe implied a higher risk of malignancy; peripheral calcified nodules with irregular margins and uneven calcification thickness suggested an increased risk of malignancy.