Pub Date : 2024-09-16DOI: 10.1080/17446651.2024.2403039
Reema Karasneh, Sayer Al-Azzam, Karem H Alzoubi, Muna Ebbini, Asma'a Alselwi, Dania Rahhal, Suad Kabbaha, Mamoon A Aldeyab, Aisha F Badr
Background: The current study sets out to develop and validate a robust machine-learning model utilizing electronic health records (EHR) to forecast the risk of hypoglycemia among ICU patients in Jordan.
Research design and methods: The present study drew upon a substantial cohort of 13,567 patients admitted 26,248 times to the intensive care unit (ICU) over 10 years from July 2012 to July 2022. The primary outcome of interest was the occurrence of any hypoglycemic episode during the patient's ICU stay. Developing and testing predictor models was conducted using Python machine-learning libraries.
Results: A total of 1,896 were eligible to participate in the study, 206 experienced at least one hypoglycemic episode. Eight machine-learning models were trained to predict hypoglycemia. All models showed predicting power with a range of 74.53-99.69 for AUROC. Except for Naive Bayes, the six remaining models performed distinctly better than the basic logistic regression usually used for prediction in epidemiological studies. CatBoost model was consistently the best performer with the highest AUROC (0.99), accuracy and precision, sensitivity and specificity, and recall.
Conclusions: We used machine learning to anticipate the likelihood of hypoglycemia, which can significantly decrease hypoglycemia incidents and enhance patient outcomes.
{"title":"Predicting hypoglycemia in ICU patients: a machine learning approach.","authors":"Reema Karasneh, Sayer Al-Azzam, Karem H Alzoubi, Muna Ebbini, Asma'a Alselwi, Dania Rahhal, Suad Kabbaha, Mamoon A Aldeyab, Aisha F Badr","doi":"10.1080/17446651.2024.2403039","DOIUrl":"https://doi.org/10.1080/17446651.2024.2403039","url":null,"abstract":"<p><strong>Background: </strong>The current study sets out to develop and validate a robust machine-learning model utilizing electronic health records (EHR) to forecast the risk of hypoglycemia among ICU patients in Jordan.</p><p><strong>Research design and methods: </strong>The present study drew upon a substantial cohort of 13,567 patients admitted 26,248 times to the intensive care unit (ICU) over 10 years from July 2012 to July 2022. The primary outcome of interest was the occurrence of any hypoglycemic episode during the patient's ICU stay. Developing and testing predictor models was conducted using Python machine-learning libraries.</p><p><strong>Results: </strong>A total of 1,896 were eligible to participate in the study, 206 experienced at least one hypoglycemic episode. Eight machine-learning models were trained to predict hypoglycemia. All models showed predicting power with a range of 74.53-99.69 for AUROC. Except for Naive Bayes, the six remaining models performed distinctly better than the basic logistic regression usually used for prediction in epidemiological studies. CatBoost model was consistently the best performer with the highest AUROC (0.99), accuracy and precision, sensitivity and specificity, and recall.</p><p><strong>Conclusions: </strong>We used machine learning to anticipate the likelihood of hypoglycemia, which can significantly decrease hypoglycemia incidents and enhance patient outcomes.</p>","PeriodicalId":12107,"journal":{"name":"Expert Review of Endocrinology & Metabolism","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142282601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-08DOI: 10.1080/17446651.2024.2400706
Abdullah Alkattan, Abdullah Al-Zeer, Fahad Alsaawi, Alanoud Alyahya, Raghad Alnasser, Raoom Alsarhan, Mona Almusawi, Deemah Alabdulaali, Nagla Mahmoud, Rami Al-Jafar, Faisal Aldayel, Mustafa Hassanein, Alhan Haji, Abdulrahman Alsheikh, Amal Alfaifi, Elfadil Elkagam, Ahmed Alfridi, Amjad Alfaleh, Khaled Alabdulkareem, Nashwa Radwan, Edward W Gregg
Background: According to previous reports, very high percentages of individuals in Saudi Arabia are undiagnosed for type 2 diabetes mellitus (T2DM). Despite conducting several screening and awareness campaigns, these efforts lacked full accessibility and consumed extensive human and material resources. Thus, developing machine learning (ML) models could enhance the population-based screening process. The study aims to compare a newly developed ML model's outcomes with the validated American Diabetes Association's (ADA) risk assessment regarding predicting people with high risk for T2DM.
Research design and methods: Patients' age, gender, and risk factors that were obtained from the National Health Information Center's dataset were used to build and train the ML model. To evaluate the developed ML model, an external validation study was conducted in three primary health care centers. A random sample (N = 3400) was selected from the non-diabetic individuals.
Results: The results showed the plotted data of sensitivity/100-specificity represented in the Receiver Operating Characteristic (ROC) curve with an AROC value of 0.803, 95% CI: 0.779-0.826.
Conclusions: The current study reveals a new ML model proposed for population-level classification that can be an adequate tool for identifying those at high risk of T2DM or who already have T2DM but have not been diagnosed.
背景:根据以往的报告,沙特阿拉伯有很高比例的人未被诊断出患有 2 型糖尿病(T2DM)。尽管开展了多次筛查和宣传活动,但这些工作缺乏全面的可及性,并消耗了大量的人力和物力资源。因此,开发机器学习(ML)模型可以加强基于人群的筛查过程。本研究旨在比较新开发的 ML 模型与经过验证的美国糖尿病协会(ADA)风险评估在预测 T2DM 高危人群方面的结果:研究设计和方法:从国家健康信息中心的数据集中获取患者的年龄、性别和风险因素,用于建立和训练 ML 模型。为了评估所开发的 ML 模型,在三个初级卫生保健中心进行了外部验证研究。从非糖尿病患者中随机抽取样本(N = 3400):结果显示,灵敏度/100-特异性数据绘制在接收者工作特征曲线(ROC)上,AROC 值为 0.803,95% CI:0.779-0.826:目前的研究揭示了一种新的用于人群分类的 ML 模型,该模型可作为识别 T2DM 高危人群或已患有 T2DM 但尚未确诊的人群的适当工具。
{"title":"The utility of a machine learning model in identifying people at high risk of type 2 diabetes mellitus.","authors":"Abdullah Alkattan, Abdullah Al-Zeer, Fahad Alsaawi, Alanoud Alyahya, Raghad Alnasser, Raoom Alsarhan, Mona Almusawi, Deemah Alabdulaali, Nagla Mahmoud, Rami Al-Jafar, Faisal Aldayel, Mustafa Hassanein, Alhan Haji, Abdulrahman Alsheikh, Amal Alfaifi, Elfadil Elkagam, Ahmed Alfridi, Amjad Alfaleh, Khaled Alabdulkareem, Nashwa Radwan, Edward W Gregg","doi":"10.1080/17446651.2024.2400706","DOIUrl":"https://doi.org/10.1080/17446651.2024.2400706","url":null,"abstract":"<p><strong>Background: </strong>According to previous reports, very high percentages of individuals in Saudi Arabia are undiagnosed for type 2 diabetes mellitus (T2DM). Despite conducting several screening and awareness campaigns, these efforts lacked full accessibility and consumed extensive human and material resources. Thus, developing machine learning (ML) models could enhance the population-based screening process. The study aims to compare a newly developed ML model's outcomes with the validated American Diabetes Association's (ADA) risk assessment regarding predicting people with high risk for T2DM.</p><p><strong>Research design and methods: </strong>Patients' age, gender, and risk factors that were obtained from the National Health Information Center's dataset were used to build and train the ML model. To evaluate the developed ML model, an external validation study was conducted in three primary health care centers. A random sample (<i>N</i> = 3400) was selected from the non-diabetic individuals.</p><p><strong>Results: </strong>The results showed the plotted data of sensitivity/100-specificity represented in the Receiver Operating Characteristic (ROC) curve with an AROC value of 0.803, 95% CI: 0.779-0.826.</p><p><strong>Conclusions: </strong>The current study reveals a new ML model proposed for population-level classification that can be an adequate tool for identifying those at high risk of T2DM or who already have T2DM but have not been diagnosed.</p>","PeriodicalId":12107,"journal":{"name":"Expert Review of Endocrinology & Metabolism","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142153498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-05DOI: 10.1080/17446651.2024.2400487
Takayuki Ohno, Daisuke Tsujino, Rimei Nishimura
Objective: Time in Tight Range (TITR), defined as the percentage of time within the glucose range of 70 to 140 mg/dL, is anticipated to be challenging to maintain without causing hypoglycemia, especially in individuals with type 1 diabetes (T1D). This study aimed to investigate the TITR target value in individuals with T1D on multiple daily injections (MDI).
Methods: The study included 101 individuals with T1D on MDI aged 15 to 75 who were hospitalized at Jikei University School of Medicine from September 2006 to November 2013 to conduct Continuous Glucose Monitoring (CGM). The cutoff values of TITR for predicting the attainment of GMI < 7.0%, and TBR < 4% were determined using Receiver Operating Characteristic (ROC) curves.
Results: The TITR cutoff value was calculated to be 41% (sensitivity 81%, specificity 88%) and 40% (54%,72%) for predicting GMI < 7.0% and TBR < 4%.
Conclusions: In individuals with T1D on MDI without devices capable of preventing hypoglycemia, it is recommended to target TITR at 40% to address the risk of increased hypoglycemia sufficiently.
{"title":"Is there a target value for time in tight range for individuals with type 1 diabetes on MDI? Data from masked CGM.","authors":"Takayuki Ohno, Daisuke Tsujino, Rimei Nishimura","doi":"10.1080/17446651.2024.2400487","DOIUrl":"https://doi.org/10.1080/17446651.2024.2400487","url":null,"abstract":"<p><strong>Objective: </strong>Time in Tight Range (TITR), defined as the percentage of time within the glucose range of 70 to 140 mg/dL, is anticipated to be challenging to maintain without causing hypoglycemia, especially in individuals with type 1 diabetes (T1D). This study aimed to investigate the TITR target value in individuals with T1D on multiple daily injections (MDI).</p><p><strong>Methods: </strong>The study included 101 individuals with T1D on MDI aged 15 to 75 who were hospitalized at Jikei University School of Medicine from September 2006 to November 2013 to conduct Continuous Glucose Monitoring (CGM). The cutoff values of TITR for predicting the attainment of GMI < 7.0%, and TBR < 4% were determined using Receiver Operating Characteristic (ROC) curves.</p><p><strong>Results: </strong>The TITR cutoff value was calculated to be 41% (sensitivity 81%, specificity 88%) and 40% (54%,72%) for predicting GMI < 7.0% and TBR < 4%.</p><p><strong>Conclusions: </strong>In individuals with T1D on MDI without devices capable of preventing hypoglycemia, it is recommended to target TITR at 40% to address the risk of increased hypoglycemia sufficiently.</p>","PeriodicalId":12107,"journal":{"name":"Expert Review of Endocrinology & Metabolism","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142132234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-28DOI: 10.1080/17446651.2024.2395540
Syed Arman Rabbani, Mohamed El-Tanani, Ismail I Matalka, Imran Rashid Rangraze, Alaa A A Aljabali, Mohammad Ahmed Khan, Murtaza M Tambuwala
Introduction: Incretin-based therapies have emerged as effective treatments for type 2 diabetes (T2D) and obesity. However, not all patients achieve optimal outcomes with existing treatments, highlighting the need for more effective solutions.
Areas covered: We present a comprehensive evaluation of Tirzepatide (TZP), a novel dual glucose-dependent insulinotropic polypeptide/glucagon-like peptide-1 (GIP/GLP-1) receptor agonist, for managing obesity and T2D. We conducted a systematic search of Cochrane, PubMed, Scopus, and Web of Science databases from inception to April 2024. The focus of the review is on the development and therapeutic potential of TZP, with detailed exploration on pharmacodynamics, pharmacokinetics, clinical efficacy, and safety. Furthermore, it reviews TZP's impacts on glycemic control, weight management, and its potential cardiovascular (CV) benefits.
Expert opinion: TZP represents a significant advancement in the dual-targeted approach to treating T2D and obesity. Its unique mechanism of action offers superior efficacy in reducing glycemic levels and body weight compared to existing therapies. New data suggesting improvements in CV outcomes indicate that TZP could set a new standard in the treatment paradigm. While long-term data on efficacy and safety are still forthcoming, current evidence positions TZP as a promising option for patients who have not reached their therapeutic goals with existing treatments.
简介:基于胰岛素的疗法已成为治疗2型糖尿病(T2D)和肥胖症的有效方法。然而,并非所有患者都能通过现有疗法获得最佳疗效,这凸显了对更有效解决方案的需求:我们对新型葡萄糖依赖性促胰岛素多肽/胰高血糖素样肽-1(GIP/GLP-1)受体双重激动剂--替扎帕肽(TZP)进行了全面评估,以控制肥胖和 T2D。我们对从开始到 2024 年 4 月的 Cochrane、PubMed、Scopus 和 Web of Science 数据库进行了系统检索。综述的重点是 TZP 的开发和治疗潜力,详细探讨了药效学、药代动力学、临床疗效和安全性。此外,它还回顾了 TZP 对血糖控制、体重管理的影响及其潜在的心血管(CV)益处:TZP代表了治疗T2D和肥胖症的双靶向方法的重大进展。与现有疗法相比,其独特的作用机制在降低血糖水平和体重方面具有卓越的疗效。新的数据显示,TZP 可改善心血管疾病的治疗效果,这表明 TZP 可为治疗模式设定新的标准。虽然有关疗效和安全性的长期数据仍有待获得,但目前的证据表明,TZP 是现有疗法无法达到治疗目标的患者的一个很有前景的选择。
{"title":"Tirzepatide: unveiling a new dawn in dual-targeted diabetes and obesity management.","authors":"Syed Arman Rabbani, Mohamed El-Tanani, Ismail I Matalka, Imran Rashid Rangraze, Alaa A A Aljabali, Mohammad Ahmed Khan, Murtaza M Tambuwala","doi":"10.1080/17446651.2024.2395540","DOIUrl":"https://doi.org/10.1080/17446651.2024.2395540","url":null,"abstract":"<p><strong>Introduction: </strong>Incretin-based therapies have emerged as effective treatments for type 2 diabetes (T2D) and obesity. However, not all patients achieve optimal outcomes with existing treatments, highlighting the need for more effective solutions.</p><p><strong>Areas covered: </strong>We present a comprehensive evaluation of Tirzepatide (TZP), a novel dual glucose-dependent insulinotropic polypeptide/glucagon-like peptide-1 (GIP/GLP-1) receptor agonist, for managing obesity and T2D. We conducted a systematic search of Cochrane, PubMed, Scopus, and Web of Science databases from inception to April 2024. The focus of the review is on the development and therapeutic potential of TZP, with detailed exploration on pharmacodynamics, pharmacokinetics, clinical efficacy, and safety. Furthermore, it reviews TZP's impacts on glycemic control, weight management, and its potential cardiovascular (CV) benefits.</p><p><strong>Expert opinion: </strong>TZP represents a significant advancement in the dual-targeted approach to treating T2D and obesity. Its unique mechanism of action offers superior efficacy in reducing glycemic levels and body weight compared to existing therapies. New data suggesting improvements in CV outcomes indicate that TZP could set a new standard in the treatment paradigm. While long-term data on efficacy and safety are still forthcoming, current evidence positions TZP as a promising option for patients who have not reached their therapeutic goals with existing treatments.</p>","PeriodicalId":12107,"journal":{"name":"Expert Review of Endocrinology & Metabolism","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142079752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-12DOI: 10.1080/17446651.2024.2390416
Tashunka Taylor-Miller, Ravi Savarirayan
Introduction: Achondroplasia is a heritable disorder of the skeleton that affects approximately 300,000 individuals worldwide. Until recently, treatment for this condition has been purely symptomatic. Efficacious treatment options for children are now approved or are in clinical trials.
Areas covered: This review discusses key advances in the therapeutic management of children with achondroplasia, including vosoritide, the first approved drug, and other emerging precision therapies. These include navepegritide, a long-acting form of C-type natriuretic peptide, and infigratinib, a tyrosine kinase receptor inhibitor, summarizing trial outcomes to date.
Expert opinion: The advent of the first approved precision therapy for achondroplasia in vosoritide has been a paradigm shifting advance for children affected by this condition. In addition to changing their natural growth history, it is hoped that it will decrease their medical complications and enhance functionality. These new treatment options highlight the importance of prompt prenatal identification and subsequent testing of a suspected fetus with achondroplasia and counseling of families. It is hoped that, in the near future, families will have the option to consider a range of effective targeted therapies that best suit their child with achondroplasia, starting from birth should they choose.
{"title":"Progress in managing children with achondroplasia.","authors":"Tashunka Taylor-Miller, Ravi Savarirayan","doi":"10.1080/17446651.2024.2390416","DOIUrl":"https://doi.org/10.1080/17446651.2024.2390416","url":null,"abstract":"<p><strong>Introduction: </strong>Achondroplasia is a heritable disorder of the skeleton that affects approximately 300,000 individuals worldwide. Until recently, treatment for this condition has been purely symptomatic. Efficacious treatment options for children are now approved or are in clinical trials.</p><p><strong>Areas covered: </strong>This review discusses key advances in the therapeutic management of children with achondroplasia, including vosoritide, the first approved drug, and other emerging precision therapies. These include navepegritide, a long-acting form of C-type natriuretic peptide, and infigratinib, a tyrosine kinase receptor inhibitor, summarizing trial outcomes to date.</p><p><strong>Expert opinion: </strong>The advent of the first approved precision therapy for achondroplasia in vosoritide has been a paradigm shifting advance for children affected by this condition. In addition to changing their natural growth history, it is hoped that it will decrease their medical complications and enhance functionality. These new treatment options highlight the importance of prompt prenatal identification and subsequent testing of a suspected fetus with achondroplasia and counseling of families. It is hoped that, in the near future, families will have the option to consider a range of effective targeted therapies that best suit their child with achondroplasia, starting from birth should they choose.</p>","PeriodicalId":12107,"journal":{"name":"Expert Review of Endocrinology & Metabolism","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141916480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-22DOI: 10.1080/17446651.2024.2382958
Jaelim Cho, Maxim S Petrov
Introduction: Post-pancreatitis diabetes mellitus (PPDM) has long been recognized as one of the most challenging sub-types of diabetes to manage. Part of the problem is that the earlier literature on epidemiology of PPDM was confusing because of the presence of selection bias.
Areas covered: A concerted series of population-based nationwide studies on PPDM from New Zealand has recently been published as part of the COSMOS (Clinical and epidemiOlogical inveStigations in Metabolism, nutritiOn, and pancreatic diseaseS) program and is the main focus of the present article.
Expert opinion: The foundational knowledge on epidemiology of PPDM generated by the COSMOS program is generalizable to the population at large. It brings the field closer to a comprehensive narrative of risk factors, burden, mortality, and morbidity outcomes of PPDM. In producing new knowledge on epidemiology of PPDM, it will be important to adhere to the guidelines on identification of PPDM in population-based datasets advanced in the present article.
{"title":"Epidemiology of post-pancreatitis diabetes mellitus: insights from the COSMOS program.","authors":"Jaelim Cho, Maxim S Petrov","doi":"10.1080/17446651.2024.2382958","DOIUrl":"https://doi.org/10.1080/17446651.2024.2382958","url":null,"abstract":"<p><strong>Introduction: </strong>Post-pancreatitis diabetes mellitus (PPDM) has long been recognized as one of the most challenging sub-types of diabetes to manage. Part of the problem is that the earlier literature on epidemiology of PPDM was confusing because of the presence of selection bias.</p><p><strong>Areas covered: </strong>A concerted series of population-based nationwide studies on PPDM from New Zealand has recently been published as part of the COSMOS (Clinical and epidemiOlogical inveStigations in Metabolism, nutritiOn, and pancreatic diseaseS) program and is the main focus of the present article.</p><p><strong>Expert opinion: </strong>The foundational knowledge on epidemiology of PPDM generated by the COSMOS program is generalizable to the population at large. It brings the field closer to a comprehensive narrative of risk factors, burden, mortality, and morbidity outcomes of PPDM. In producing new knowledge on epidemiology of PPDM, it will be important to adhere to the guidelines on identification of PPDM in population-based datasets advanced in the present article.</p>","PeriodicalId":12107,"journal":{"name":"Expert Review of Endocrinology & Metabolism","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141733866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-08DOI: 10.1080/17446651.2024.2377687
José Paz-Ibarra, Marcio José Concepción-Zavaleta, Juan Eduardo Quiroz-Aldave
Introduction: The global incidence of thyroid cancer (TC) has increased in the last decades. While improvements in diagnosis may contribute, overdiagnosis is also a possibility. This review focuses on the epidemiology, risk factors, and immune microenvironment associated with differentiated TC (DTC).
Areas covered: A search was conducted in Scielo, Scopus, and EMBASE databases, involving 72 articles. TC is the most common endocrine neoplasm, with DTC form being predominant. Its incidence has globally risen, particularly among women aged over 45. Endogenous risk factors for DTC include genetic disorders, race, age, female gender, obesity, and type 2 diabetes mellitus. Environmental risks involve ionizing radiation, whether through therapeutic treatment or environmental contamination from nuclear accidents, iodine deficiency, endocrine disruptors, residence in volcanic areas, environmental pollution, and stress. The use of anti-obesity medications remains controversial. The tumor's immune microenvironment is the histological space where tumor cells interact with host cells, crucial for understanding aggressiveness. Immunotherapy emerges as a promising intervention.
Expert opinion: Recent advances in DTC management offer transformative potential, requiring collaborative efforts for implementation. Emerging areas like precision medicine, molecular profiling, and immunotherapy present exciting prospects for future exploration, shaping the next era of diagnostic and therapeutic strategies in thyroid cancer research.
{"title":"Environmental factors related to the origin and evolution of differentiated thyroid cancer: a narrative review.","authors":"José Paz-Ibarra, Marcio José Concepción-Zavaleta, Juan Eduardo Quiroz-Aldave","doi":"10.1080/17446651.2024.2377687","DOIUrl":"https://doi.org/10.1080/17446651.2024.2377687","url":null,"abstract":"<p><strong>Introduction: </strong>The global incidence of thyroid cancer (TC) has increased in the last decades. While improvements in diagnosis may contribute, overdiagnosis is also a possibility. This review focuses on the epidemiology, risk factors, and immune microenvironment associated with differentiated TC (DTC).</p><p><strong>Areas covered: </strong>A search was conducted in Scielo, Scopus, and EMBASE databases, involving 72 articles. TC is the most common endocrine neoplasm, with DTC form being predominant. Its incidence has globally risen, particularly among women aged over 45. Endogenous risk factors for DTC include genetic disorders, race, age, female gender, obesity, and type 2 diabetes mellitus. Environmental risks involve ionizing radiation, whether through therapeutic treatment or environmental contamination from nuclear accidents, iodine deficiency, endocrine disruptors, residence in volcanic areas, environmental pollution, and stress. The use of anti-obesity medications remains controversial. The tumor's immune microenvironment is the histological space where tumor cells interact with host cells, crucial for understanding aggressiveness. Immunotherapy emerges as a promising intervention.</p><p><strong>Expert opinion: </strong>Recent advances in DTC management offer transformative potential, requiring collaborative efforts for implementation. Emerging areas like precision medicine, molecular profiling, and immunotherapy present exciting prospects for future exploration, shaping the next era of diagnostic and therapeutic strategies in thyroid cancer research.</p>","PeriodicalId":12107,"journal":{"name":"Expert Review of Endocrinology & Metabolism","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141554490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01Epub Date: 2024-06-06DOI: 10.1080/17446651.2024.2363540
Maria Fleseriu, Lisa B Nachtigall, Susan L Samson, Shlomo Melmed
Introduction: Acromegaly is a rare endocrine disorder usually caused by a benign growth hormone‒secreting pituitary adenoma. Surgical adenoma resection is typically the first line of treatment, and medical therapy is used for patients with persistent disease following surgery, for adenoma recurrence, or for patients ineligible for, or declining, surgery. Approved somatostatin receptor ligands (SRLs) have been limited to injectable options, until recently. Oral octreotide capsules (OOC) are the first approved oral SRL for patients with acromegaly.
Areas covered: We review published reports and provide case study examples demonstrating practical considerations on the use of OOC. Using two hypothetical case scenarios, we discuss current treatment patterns, breakthrough symptoms and quality of life (QoL), efficacy of SRLs, OOC dose titration, evaluation of OOC treatment response, and incidence and management of adverse events.
Expert opinion: OOC are an option for patients with acromegaly including those who experience breakthrough symptoms, who have preference for oral therapies, or other reasons for declining injectable SRLs. OOC have been associated with improved patient-reported QoL measures compared with those reported for lanreotide and octreotide. Continued real-world experience will determine whether OOC, alone or in combination with other therapies, provides further advantages over current injectable acromegaly treatments.
{"title":"Oral octreotide capsules for acromegaly treatment: application of clinical trial insights to real-world use.","authors":"Maria Fleseriu, Lisa B Nachtigall, Susan L Samson, Shlomo Melmed","doi":"10.1080/17446651.2024.2363540","DOIUrl":"10.1080/17446651.2024.2363540","url":null,"abstract":"<p><strong>Introduction: </strong>Acromegaly is a rare endocrine disorder usually caused by a benign growth hormone‒secreting pituitary adenoma. Surgical adenoma resection is typically the first line of treatment, and medical therapy is used for patients with persistent disease following surgery, for adenoma recurrence, or for patients ineligible for, or declining, surgery. Approved somatostatin receptor ligands (SRLs) have been limited to injectable options, until recently. Oral octreotide capsules (OOC) are the first approved oral SRL for patients with acromegaly.</p><p><strong>Areas covered: </strong>We review published reports and provide case study examples demonstrating practical considerations on the use of OOC. Using two hypothetical case scenarios, we discuss current treatment patterns, breakthrough symptoms and quality of life (QoL), efficacy of SRLs, OOC dose titration, evaluation of OOC treatment response, and incidence and management of adverse events.</p><p><strong>Expert opinion: </strong>OOC are an option for patients with acromegaly including those who experience breakthrough symptoms, who have preference for oral therapies, or other reasons for declining injectable SRLs. OOC have been associated with improved patient-reported QoL measures compared with those reported for lanreotide and octreotide. Continued real-world experience will determine whether OOC, alone or in combination with other therapies, provides further advantages over current injectable acromegaly treatments.</p>","PeriodicalId":12107,"journal":{"name":"Expert Review of Endocrinology & Metabolism","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141261836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01Epub Date: 2024-05-19DOI: 10.1080/17446651.2024.2351885
Francesca Coperchini, Marsida Teliti, Alessia Greco, Laura Croce, Mario Rotondi
Introduction: The environmental spread of pollutants has led to a persistent exposure of living beings to multiple chemicals, by now become ubiquitous in the surrounding environment. Environmental exposure to these substances has been reported to cause multi- and/or transgenerational health effects. Per- and Polyfluorinated Substances (PFAS) raise great concern, given their known effects both as endocrine disruptors and potential carcinogens. The multi/trans-generational effects of different endocrine disruptors have been investigated by several studies, and harmful effects observed also for PFAS.
Areas covered: This review examines the current data on the multi-trans-generational effects of PFAS, with a focus on their impact on the thyroid axis. The aim is to determine if there is evidence of potential multi-trans-generational effects of PFAS on the thyroid and/or if more research is needed.
Expert opinion: PFAS exposure impacts thyroid homeostasis and can cross the placental barrier. In addition PFAS have shown multi-transgenerational effects in laboratory experiences and animal models, but thyroid disruptive effects of PFAS were also investigated only in a small number of these studies. Efforts are needed to study the adverse effects of PFAS, as not all PFAS are regulated and removal strategies are still being developed.
{"title":"Per-polyfluoroalkyl substances (PFAS) as thyroid disruptors: is there evidence for multi-transgenerational effects?","authors":"Francesca Coperchini, Marsida Teliti, Alessia Greco, Laura Croce, Mario Rotondi","doi":"10.1080/17446651.2024.2351885","DOIUrl":"10.1080/17446651.2024.2351885","url":null,"abstract":"<p><strong>Introduction: </strong>The environmental spread of pollutants has led to a persistent exposure of living beings to multiple chemicals, by now become ubiquitous in the surrounding environment. Environmental exposure to these substances has been reported to cause multi- and/or transgenerational health effects. Per- and Polyfluorinated Substances (PFAS) raise great concern, given their known effects both as endocrine disruptors and potential carcinogens. The multi/trans-generational effects of different endocrine disruptors have been investigated by several studies, and harmful effects observed also for PFAS.</p><p><strong>Areas covered: </strong>This review examines the current data on the multi-trans-generational effects of PFAS, with a focus on their impact on the thyroid axis. The aim is to determine if there is evidence of potential multi-trans-generational effects of PFAS on the thyroid and/or if more research is needed.</p><p><strong>Expert opinion: </strong>PFAS exposure impacts thyroid homeostasis and can cross the placental barrier. In addition PFAS have shown multi-transgenerational effects in laboratory experiences and animal models, but thyroid disruptive effects of PFAS were also investigated only in a small number of these studies. Efforts are needed to study the adverse effects of PFAS, as not all PFAS are regulated and removal strategies are still being developed.</p>","PeriodicalId":12107,"journal":{"name":"Expert Review of Endocrinology & Metabolism","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141064409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Molecular imaging of thyroid and parathyroid diseases has changed in recent years due to the introduction of new radiopharmaceuticals and new imaging techniques. Accordingly, we provided an clinicians-oriented overview of such techniques and their indications.
Areas covered: A review of the literature was performed in the PubMed, Web of Science, and Scopus without time or language restrictions through the use of one or more fitting search criteria and terms as well as through screening of references in relevant selected papers. Literature up to and including December 2023 was included. Screening of titles/abstracts and removal of duplicates was performed and the full texts of the remaining potentially relevant articles were retrieved and reviewed.
Expert opinion: Thyroid and parathyroid scintigraphy remains integral in patients with thyrotoxicosis, thyroid nodules, differentiated thyroid cancer and, respectively, hyperparathyroidism. In the last years positron-emission tomography with different tracers emerged as a more accurate alternative in evaluating indeterminate thyroid nodules [18F-fluorodeoxyglucose (FDG)], differentiated thyroid cancer [124I-iodide, 18F-tetrafluoroborate, 18F-FDG] and hyperparathyroidism [18F-fluorocholine]. Other PET tracers are useful in evaluating relapsing/advanced forms of medullary thyroid cancer (18F-FDOPA) and selecting patients with advanced follicular and medullary thyroid cancers for theranostic treatments (68Ga/177Ga-somatostatin analogues).
导言:近年来,由于新放射性药物和新成像技术的引入,甲状腺和甲状旁腺疾病的分子成像发生了变化。因此,我们以临床医生为导向概述了这些技术及其适应症:我们在 PubMed、Web of Science 和 Scopus 上进行了文献综述,没有时间或语言限制,使用了一个或多个合适的检索标准和术语,并筛选了所选相关论文中的参考文献。截至 2023 年 12 月(含 2023 年 12 月)的文献均包括在内。对标题/摘要进行了筛选,删除了重复的文章,并检索和审查了其余可能相关文章的全文:甲状腺和甲状旁腺闪烁扫描仍然是甲状腺毒症、甲状腺结节、分化型甲状腺癌和甲状旁腺功能亢进患者不可或缺的检查项目。近年来,使用不同示踪剂的正电子发射断层扫描技术已成为评估不确定甲状腺结节[18F-氟脱氧葡萄糖(FDG)]、分化型甲状腺癌[124I-碘化物、18F-四氟硼酸盐、18F-FDG]和甲状旁腺功能亢进[18F-氟胆碱]的更准确的替代方法。其他 PET 示踪剂可用于评估甲状腺髓样癌的复发/晚期形式(18F-FDOPA),以及选择晚期滤泡性甲状腺癌和甲状腺髓样癌患者进行治疗(68Ga/177Ga-somatostatin 类似物)。
{"title":"Molecular imaging of thyroid and parathyroid diseases.","authors":"Petra Petranović Ovčariček, Letizia Calderoni, Alfredo Campenni, Stefano Fanti, Luca Giovanella","doi":"10.1080/17446651.2024.2365776","DOIUrl":"10.1080/17446651.2024.2365776","url":null,"abstract":"<p><strong>Introduction: </strong>Molecular imaging of thyroid and parathyroid diseases has changed in recent years due to the introduction of new radiopharmaceuticals and new imaging techniques. Accordingly, we provided an clinicians-oriented overview of such techniques and their indications.</p><p><strong>Areas covered: </strong>A review of the literature was performed in the PubMed, Web of Science, and Scopus without time or language restrictions through the use of one or more fitting search criteria and terms as well as through screening of references in relevant selected papers. Literature up to and including December 2023 was included. Screening of titles/abstracts and removal of duplicates was performed and the full texts of the remaining potentially relevant articles were retrieved and reviewed.</p><p><strong>Expert opinion: </strong>Thyroid and parathyroid scintigraphy remains integral in patients with thyrotoxicosis, thyroid nodules, differentiated thyroid cancer and, respectively, hyperparathyroidism. In the last years positron-emission tomography with different tracers emerged as a more accurate alternative in evaluating indeterminate thyroid nodules [<sup>18</sup>F-fluorodeoxyglucose (FDG)], differentiated thyroid cancer [<sup>124</sup>I-iodide, <sup>18</sup>F-tetrafluoroborate, <sup>18</sup>F-FDG] and hyperparathyroidism [18F-fluorocholine]. Other PET tracers are useful in evaluating relapsing/advanced forms of medullary thyroid cancer (<sup>18</sup>F-FDOPA) and selecting patients with advanced follicular and medullary thyroid cancers for theranostic treatments (<sup>68</sup>Ga/<sup>177</sup>Ga-somatostatin analogues).</p>","PeriodicalId":12107,"journal":{"name":"Expert Review of Endocrinology & Metabolism","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141426666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}