Expert Review of Endocrinology & Metabolism最新文献

Background: The effects of pomegranate juice (PJ) and its components on uterine smooth muscle are unknown. Hence, this study unequivocally demonstrates that pomegranate juice (PJ) significantly impacts myometrial function, providing crucial insights into its relaxant properties and their potential therapeutic applications for uterine-related disorders.

Research design and methods: Rat uterine smooth muscle horn strips were suspended in Krebs solution organ baths. Contractions were measured isometrically using a transducer (AD instrument Australia). The effects of PJ were evaluated on contractile activity elicited by potassium chloride (KCl 60 Mm) depolarization. Inhibitors of nitric oxide (L-NAME 3 X 10^-4), guanylate cyclase (methylene blue 1 X 10^-5), and Prostaglandin I₂ (indomethacin 3 X 10^-5), as well as Potassium Channels blockers, were determined.

Results: The juice at concentrations from 1.5-5 mg/ml significantly decreased the rat uterine horn contraction induced by KCl. The NO, cGMP, and PGI₂ inhibitors did not block the relaxation response. Furthermore, the PGI₂ inhibitor significantly enhanced the relaxation effects; K⁺ channel blockers had no inhibitory effects on the relaxation responses. Contrarily, GLIB improved considerably relaxation.

Conclusion: Research suggests pomegranate juice's active ingredient may reduce uterine contractions and treat uterotonic disorders, potentially preventing preterm birth and dysmenorrhea. Further research is needed to determine its mechanism of action.

Trial registration: Code: AEC-013.

Introduction: Neuroendocrine neoplasms (NENs) represent a complex group of tumors arising from neuroendocrine cells, characterized by heterogeneous behavior and challenging diagnostics. Despite advancements in medical technology, NENs present a major challenge in early detection, often leading to delayed diagnosis and variable outcomes. This review aims to provide an in-depth analysis of current diagnostic methods as well as the evolving and future directions of diagnostic strategies for NENs.

Area covered: The review extensively covers the evolution of diagnostic tools for NENs, from traditional imaging and biochemical tests to advanced genomic profiling and next-generation sequencing. The emerging role of technologies such as artificial intelligence, machine learning, and liquid biopsies could improve diagnostic precision, as could the integration of imaging modalities such as positron emission tomography (PET)/magnetic resonance imaging (MRI) hybrids and innovative radiotracers.

Expert opinion: Despite progress, there is still a significant gap in the early diagnosis of NENs. Bridging this diagnostic gap and integrating advanced technologies and precision medicine are crucial to improving patient outcomes. However, challenges such as low clinical awareness, limited possibility of noninvasive diagnostic tools and funding limitations for rare diseases like NENs are acknowledged.

Objectives: This study aimed to investigate the relationship between glycemic control and diabetes self-management (DSM) and other associated factors among adult Omanis with Type-1 Diabetes Mellitus (T1DM).

Methods: A cross-sectional, descriptive design was used to collect data among 210 adult Omanis with T1DM who were conveniently recruited. All tools were self-reported, whereas the HbA1c was collected from the patient's electronic medical records.

Results: The HbA1c mean value was 8.6 (SD = 2.5), 30.5% had optimal glycemic control (<7.0). A significant negative relationship between HbA1c and DSM (r = - 0.191, p = 0.006) and diabetes knowledge (r = - 0.153, p = 0.026) was found. Furthermore, the mean HbA1c was significantly lower for persons with a single marital status, have higher education level, have children, are unemployed, were not admitted to the hospital in the last year, and have a health care professional as a family member. Additionally, marital status, level of education, DSM, and social support were significant predictors of glycemic control.

Conclusions: The results suggested that better glycemic control could be achieved by optimizing DSM, social support, and diabetes knowledge. Sociodemographic factors should be considered when treating individuals with T1DM to reach good glycemic control.

Background: Public knowledge about the role of lifestyle in managing type two diabetes (T2D) is an essential preventive strategy. Despite efforts in public awareness, the prevalence continues to rise, with the majority relying on the availability of effective therapeutics, underestimating the role of healthy lifestyle changes. This study aims to assess public awareness of the impact of lifestyle modification in managing T2D in a major metropolitan city in Saudi Arabia, which will help inform the health management authority in the country on the level of public awareness and advise on the development of educational programs.

Methods: An observational cross-sectional survey study comprising 16 knowledge and 6 attitude questions was conducted among the population over 18 years old using online survey. After validation, the online self-developed questionnaire was distributed through social media.

Results: The knowledge and attitude scores were similar between males and females. Participants with a family member or friend with T2D demonstrated higher knowledge scores. However, the attitude scores did not differ significantly based on family or friend relationships.

Conclusion: The knowledge and attitude on the role of lifestyle modifications in preventing and managing T2D is moderate, implying an opportunity for innovative strategies to raise public knowledge and attitude.

Introduction: Adverse reactions to tuberculosis treatment can impact patient adherence and prognosis. Hypothyroidism is a frequent adverse reaction caused using ethionamide, prothionamide, and para-aminosalicylic acid and is often underdiagnosed.

Areas covered: We searched Scielo, Scopus, and EMBASE databases, including 67 articles. Antitubercular drug-induced hypothyroidism has a prevalence of 17%. It occurs after 2 to 3 months of treatment and resolves within 4 to 6 weeks after discontinuation. It is postulated to result from the inhibition of thyroperoxidase function, blocking thyroid hormone synthesis. Symptoms are nonspecific, necessitating individualized thyroid-stimulating hormone measurement for detection. Specific guidelines for management are lacking, but initiation of treatment with levothyroxine, as is customary for primary hypothyroidism, is recommended. Discontinuation of antitubercular drugs is discouraged, as it may lead to unfavorable consequences.

Expert opinion: Antitubercular drug-induced hypothyroidism is more common than previously thought, affecting one in six MDR-TB patients. Despite diagnostic and treatment recommendations, implementation is hindered in low-income countries due to the lack of certified laboratories. New drugs for tuberculosis treatment may affect thyroid function, requiring vigilant monitoring for complications, including hypothyroidism.

Introduction: Intracranial aneurysms (IAs) occur in 3-5% of the general population and are characterized by localized structural deterioration of the arterial wall with loss of internal elastic lamina and disruption of the media. The risk of incidence and rupture of aneurysms depends on age, sex, ethnicity, and other different factors, indicating the influence of genetic and environmental factors. When an aneurysm ruptures, there is an estimated 20% mortality rate, along with an added 30-40% morbidity in survivors. The alterations in hormonal levels can influence IAs, while the rupture of an aneurysm can have various impacts on endocrine pathways and affect their outcome.

Area covered: This review explores the reciprocal relationship between endocrinological changes (estrogen, growth hormone, and thyroid hormones) and IAs, as well as the effects of aneurysm ruptures on endocrine fluctuations.

Expert opinion: Based on the data presented in this paper, we recommend further exploration into the influence of hormones on aneurysm formation and rupture. Additionally, we propose conducting endocrine assessments for patients who have experienced a rupture of IAs. Monitoring hormonal changes in patients with IAs could serve as a potential risk factor for rupture, leading to interventions in the approach to managing IAs.

Introduction: Type 1 diabetes (T1D) mellitus is an autoimmune disease in which immune cells, predominantly effector T cells, destroy insulin-secreting beta-cells. Beta-cell destruction led to various consequences ranging from retinopathy and nephropathy to neuropathy. Different strategies have been developed to achieve normoglycemia, including exogenous glucose compensation, whole pancreas transplantation, islet transplantation, and beta-cell replacement.

Areas covered: The last two decades of experience have shown that indigenous glucose compensation through beta-cell regeneration and protection is a peerless method for T1D therapy. Tremendous studies have tried to find an unlimited source for beta-cell regeneration, on the one hand, and beta-cell protection against immune attack, on the other hand. Recent advances in stem cell technology, gene editing methods, and immune modulation approaches provide a unique opportunity for both beta-cell regeneration and protection.

Expert opinion: Pluripotent stem cell differentiation into the beta-cell is considered an unlimited source for beta-cell regeneration. Devising engineered pancreas-specific regulatory T cells using Chimeric Antigen Receptor (CAR) technology potentiates an effective immune tolerance induction for beta-cell protection. Beta-cell regeneration using pluripotent stem cells and beta-cell protection using pancreas-specific engineered regulatory T cells promises to develop a curative protocol in T1D.

Introduction: Heart transplantation is an important treatment for end-stage heart failure. Early post-transplant hyperglycemia (EPTH) and post-transplant diabetes mellitus (PTDM) are common following heart transplantation and are associated with increased morbidity and mortality.

Areas covered: This review summarizes the clinical characteristics, diagnosis, and treatment of EPTH and PTDM in cardiac transplant patients, incorporating findings from non-cardiac solid organ transplant studies where relevant due to limited heart-specific research.

Expert opinion: EPTH following heart transplantation is common yet understudied and is associated with the later development of PTDM. PTDM is associated with adverse outcomes including infection, renal dysfunction, microvascular disease, and an increased risk of re-transplantation and mortality. Risk factors for EPTH include the post-operative immunosuppression regimen, recipient and donor age, body mass index, infections, and chronic inflammation. Early insulin treatment is recommended for EPTH, whereas PTDM management is varied and includes lifestyle modification, anti-glycemic agents, and insulin. Given the emerging evidence on the transplant benefits associated with effective glucose control, and the cardioprotective potential of newer anti-glycemic agents, further focus on the management of EPTH and PTDM within heart transplant recipients is imperative.

Background: This study investigated the impact of the High Intensity Interval Resistance Training (HIIRT) protocol on hormonal changes in older women.

Research design and methods: Forty sarcopenic women were divided into an experimental group (EX = 30) and a control group (C = 10). The EX-group was further divided into Maintenance Training 1 (MT1 = 10), Maintenance Training 2 (MT2 = 10), and Detraining (DT = 10). The participants underwent 8 weeks of resistance training, consisting of hypertrophy and strength cycles. Following this, the EX-group had a 4-week period with no exercise or a reduced training volume. Measurements were taken at three time points.

Results: After 8 weeks, the EX-group showed significant improvements in Insulin Like Growth Factor-1 (IGF-1), Myostatin (MSTN), Follistatin (Fstn), Growth Hormone (GH) and Cortisol (Cort) compared to the control group. During the volume reduction period, there were no significant differences between MT1 and MT2 groups, but both groups saw increases in IGF-1, Fstn, GH, and decreases in MSTN and Cort compared to the DT group.

Conclusions: These findings suggest that performing at least one training session per week with the HIIRT protocol is crucial for maintaining hormonal adaptations in sarcopenic older women.