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Ectopic insulinoma: a systematic review. 异位胰岛素瘤:系统综述。
IF 8.2 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-12-01 Epub Date: 2023-07-12 DOI: 10.1007/s11154-023-09824-2
Fernando Guerrero-Pérez, Nuria Vilarrasa, Lidia V Huánuco, Juli Busquets, Lluis Secanella, José L Vercher-Conejero, Noemi Vidal, Silvia Näf Cortés, Carles Villabona

Knowledge of ectopic insulinomas comes from single cases. We performed a systematic review through PubMed, Web of Science, Embase, eLibrary and ScienceDirect of all cases reported in the last four decades. We also describe one unreported patient. From 28 patients with ectopic insulinoma, 78.6% were female and mean age was 55.7 ± 19.2 years. Hypoglycaemia was the first symptom in 85.7% while 14.3% complained of abdominal pain or genital symptoms. Median tumour diameter was 27.5 [15-52.5] mm and it was localised by CT (73.1%), MRI (88.9%), [68Ga]Ga-DOTA-exedin-4 PET/CT (100%), 68Ga-labelled-DOTA-conjugated somatostatin analogue PET/TC (100%), somatostatin receptor scintigraphy (40%) and endoscopic ultrasound (50%). Ectopic insulinomas were located at duodenum (n = 3), jejunum (n = 2), and one respectively at stomach, liver, appendix, rectum, mesentery, ligament of Treitz, gastrosplenic ligament, hepatoduodenal ligament and splenic hilum. Seven insulinomas were affecting the female reproductive organs: ovary (n = 5), cervix (n = 2) and remaining tumours were at retroperitoneum (n = 3), kidney (n = 2), spleen (n = 1) and pelvis (n = 1). 89.3% underwent surgery (66.7% surgery vs. 33.3% laparoscopy) and 16% underwent an ineffective pancreatectomy. 85.7% had localized disease at diagnosis and 14.3% developed distant metastasis. Median follow-up time was 14.5 [4.5-35.5] months and mortality was reported in 28.6% with median time until death of 60 [5-144] months. In conclusion, ectopic insulinomas are presented as hypoglycaemia with female preponderance. Functional imaging [68Ga]Ga-DOTA-exedin-4 PET/CT and 68Ga-labelled-DOTA-conjugated somatostatin analogue PET/TC have very high sensitivity. Clinicians should be alert to the possibility of extra-pancreatic insulinomas when classic diagnostic tests and intraoperative pancreas exploration failed to locate the tumour.

异位胰岛素瘤的知识来自单个病例。我们通过PubMed、Web of Science、Embase、library和ScienceDirect对过去40年报告的所有病例进行了系统回顾。我们还描述了一个未报告的病人。28例异位胰岛素瘤患者中,78.6%为女性,平均年龄55.7±19.2岁。85.7%的患者以低血糖为首发症状,14.3%的患者主诉腹痛或生殖器症状。肿瘤中位直径为27.5 [15-52.5]mm,通过CT(73.1%)、MRI(88.9%)、[68Ga]Ga-DOTA-exedin-4 PET/CT(100%)、68Ga标记- dota -共轭生长抑素类似物PET/TC(100%)、生长抑素受体显像(40%)和内镜超声(50%)进行定位。异位胰岛素瘤分别位于十二指肠(3例)、空肠(2例)和胃、肝、阑尾、直肠、肠系膜、Treitz韧带、胃脾韧带、肝十二指肠韧带和脾门各1例。7例胰岛素瘤累及女性生殖器官:卵巢(n = 5)、子宫颈(n = 2),其余肿瘤位于腹膜后(n = 3)、肾脏(n = 2)、脾脏(n = 1)和骨盆(n = 1)。89.3%行手术(66.7%手术vs 33.3%腹腔镜),16%行无效胰切除术。85.7%诊断时有局限性病变,14.3%有远处转移。中位随访时间为14.5[4.5 ~ 35.5]个月,死亡率为28.6%,中位至死亡时间为60[5 ~ 144]个月。总之,异位胰岛素瘤表现为低血糖,女性居多。功能成像[68Ga]Ga-DOTA-exedin-4 PET/CT和68Ga标记的dota -共轭生长抑素类似物PET/TC具有非常高的灵敏度。当经典诊断检查和术中胰腺探查未能定位肿瘤时,临床医生应警惕胰腺外胰岛素瘤的可能性。
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引用次数: 0
Drug-induced hyperinsulinemic hypoglycemia: An update on pathophysiology and treatment. 药物性高胰岛素性低血糖:病理生理学和治疗的最新进展。
IF 8.2 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-12-01 Epub Date: 2023-08-08 DOI: 10.1007/s11154-023-09828-y
Evelina Maines, Silvana Anna Maria Urru, Letizia Leonardi, Elisabetta Fancellu, Annalisa Campomori, Giovanni Piccoli, Arianna Maiorana, Massimo Soffiati, Roberto Franceschi

The initial step for the differential diagnosis of hypoglycemia is to determine whether it is hyperinsulinemic or non hyperinsulinemic. Existing literature discusses drug-related hypoglycemia, but it misses a focus on drug-induced hyperinsulinemic hypoglycemia (DHH). Here we reviewed the association existing between drugs and hyperinsulinemic hypoglycemia. We primarily selected on the main electronic databases (MEDLINE, EMBASE, Web of Science, and SCOPUS) the reviews on drug-induced hypoglycemia. Among the drugs listed in the reviews, we selected the ones linked to an increase in insulin secretion. For the drugs missing a clear association with insulin secretion, we investigated the putative mechanism underlying hypoglycemia referring to the original papers. Our review provides a list of the most common agents associated with hyperinsulinemic hypoglycemia (HH), in order to facilitate both the recognition and the prevention of DHH. We also collected data about the responsiveness of DHH to diazoxide or octreotide.

低血糖鉴别诊断的第一步是确定是高胰岛素血症还是非高胰岛素血症。现有文献讨论了药物相关性低血糖,但对药物性高胰岛素性低血糖(DHH)缺乏关注。本文综述了药物与高胰岛素性低血糖之间的关系。我们主要从主要的电子数据库(MEDLINE, EMBASE, Web of Science, SCOPUS)中选择有关药物性低血糖的综述。在综述中列出的药物中,我们选择了与胰岛素分泌增加有关的药物。对于与胰岛素分泌缺乏明确关联的药物,我们参考原始文献对低血糖的可能机制进行了研究。我们的综述提供了与高胰岛素性低血糖(HH)相关的最常见药物清单,以促进DHH的识别和预防。我们还收集了DHH对二氮唑或奥曲肽的反应性数据。
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引用次数: 0
Non-alcoholic fatty liver disease and gut microbial dysbiosis- underlying mechanisms and gut microbiota mediated treatment strategies. 非酒精性脂肪肝和肠道微生物失调——潜在机制和肠道微生物群介导的治疗策略。
IF 8.2 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-12-01 Epub Date: 2023-10-16 DOI: 10.1007/s11154-023-09843-z
Muthukumaran Jayachandran, Shen Qu

Non-alcoholic fatty liver disease (NAFLD) is by far the most prevalent form of liver disease worldwide. It's also the leading cause of liver-related hospitalizations and deaths. Furthermore, there is a link between obesity and NAFLD risk. A projected 25% of the world's population grieves from NAFLD, making it the most common chronic liver disorder. Several factors, such as obesity, oxidative stress, and insulin resistance, typically accompany NAFLD. Weight loss, lipid-lowering agents, thiazolidinediones, and metformin help prominently control NAFLD. Interestingly, pre-clinical studies demonstrate gut microbiota's potential causal role in NAFLD. Increased intestinal permeability and unhindered transport of microbial metabolites into the liver are the major disruptions due to gut microbiome dysbiosis, contributing to the development of NAFLD by dysregulating the gut-liver axis. Hence, altering the pathogenic bacterial population using probiotics, prebiotics, synbiotics, and fecal microbiota transplantation (FMT) could benefit patients with NAFLD. Therefore, it is crucial to acknowledge the importance of microbiota-mediated therapeutic approaches for NAFLD and comprehend the underlying mechanisms that establish a connection between NAFLD and gut microbiota. This review provides a comprehensive overview of the affiliation between dysbiosis of gut microbiota and the progress of NAFLD, as well as the potential benefits of prebiotic, probiotic, synbiotic supplementation, and FMT in obese individuals with NAFLD.

非酒精性脂肪肝(NAFLD)是迄今为止世界范围内最常见的肝病形式。它也是肝脏相关住院和死亡的主要原因。此外,肥胖与NAFLD风险之间存在联系。预计全球25%的人口因非酒精性肝病而悲伤,使其成为最常见的慢性肝病。一些因素,如肥胖、氧化应激和胰岛素抵抗,通常伴随NAFLD。减肥、降脂药、噻唑烷二酮和二甲双胍有助于显著控制NAFLD。有趣的是,临床前研究证明了肠道微生物群在NAFLD中的潜在因果作用。肠道通透性增加和微生物代谢产物不受阻碍地运输到肝脏是肠道微生物组失调造成的主要破坏,通过失调肠肝轴导致NAFLD的发展。因此,使用益生菌、益生元、合生元和粪便微生物群移植(FMT)改变病原菌群可能有利于NAFLD患者。因此,至关重要的是要认识到微生物群介导的NAFLD治疗方法的重要性,并理解在NAFLD和肠道微生物群之间建立联系的潜在机制。这篇综述全面概述了肠道微生物群失调与NAFLD进展之间的关系,以及益生元、益生菌、合生元补充剂和FMT对患有NAFLD的肥胖个体的潜在益处。
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引用次数: 0
Postprandial plasma GLP-1 levels are elevated in individuals with postprandial hypoglycaemia following Roux-en-Y gastric bypass - a systematic review. 一项系统综述:Roux-en-Y胃旁路治疗后餐后低血糖患者餐后血浆GLP-1水平升高。
IF 8.2 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-12-01 Epub Date: 2023-07-13 DOI: 10.1007/s11154-023-09823-3
Ryan Joseph Jalleh, Mahesh Michael Umapathysivam, Mark Philip Plummer, Adam Deane, Karen Louise Jones, Michael Horowitz

Background and aims: Bariatric surgery is the most effective treatment in individuals with obesity to achieve remission of type 2 diabetes. Post-bariatric surgery hypoglycaemia occurs frequently, and management remains suboptimal, because of a poor understanding of the underlying pathophysiology. The glucoregulatory hormone responses to nutrients in individuals with and without post-bariatric surgery hypoglycaemia have not been systematically examined.

Materials and methods: The study protocol was prospectively registered with PROSPERO. PubMed, EMBASE, Web of Science and the Cochrane databases were searched for publications between January 1990 and November 2021 using MeSH terms related to post-bariatric surgery hypoglycaemia. Studies were included if they evaluated individuals with post-bariatric surgery hypoglycaemia and included measurements of plasma glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), insulin, C-peptide and/or glucagon concentrations following an ingested nutrient load. Glycated haemoglobin (HbA1c) was also evaluated. A random-effects meta-analysis was performed, and Hedges' g (standardised mean difference) and 95% confidence intervals were reported for all outcomes where sufficient studies were available. The τ2 estimate and I2 statistic were used as tests for heterogeneity and a funnel plot with the Egger regression-based test was used to evaluate for publication bias.

Results: From 377 identified publications, 12 were included in the analysis. In all 12 studies, the type of bariatric surgery was Roux-en-Y gastric bypass (RYGB). Comparing individuals with and without post-bariatric surgery hypoglycaemia following an ingested nutrient load, the standardised mean difference in peak GLP-1 was 0.57 (95% CI, 0.32, 0.82), peak GIP 0.05 (-0.26, 0.36), peak insulin 0.84 (0.44, 1.23), peak C-peptide 0.69 (0.28, 1.1) and peak glucagon 0.05 (-0.26, 0.36). HbA1c was less in individuals with hypoglycaemia - 0.40 (-0.67, -0.12). There was no evidence of substantial heterogeneity in any outcome except for peak insulin: τ2 = 0.2, I2 = 54.3. No publication bias was evident.

Conclusion: Following RYGB, postprandial peak plasma GLP-1, insulin and C-peptide concentrations are greater in individuals with post-bariatric surgery hypoglycaemia, while HbA1c is less. These observations support the concept that antagonism of GLP-1 would prove beneficial in the management of individuals with hypoglycaemia following RYGB.PROSPERO Registration Number: CRD42021287515.

背景和目的:减肥手术是肥胖患者缓解2型糖尿病最有效的治疗方法。减肥手术后低血糖经常发生,由于对潜在病理生理的了解不足,治疗仍然不够理想。在有或没有减肥手术后低血糖的个体中,血糖调节激素对营养的反应尚未被系统地研究过。材料和方法:研究方案在PROSPERO前瞻性注册。在PubMed、EMBASE、Web of Science和Cochrane数据库中检索1990年1月至2021年11月期间发表的与减肥手术后低血糖相关的MeSH术语。如果研究评估了减肥手术后低血糖患者,并测量了摄入营养负荷后血浆胰高血糖素样肽-1 (GLP-1)、葡萄糖依赖性胰岛素性多肽(GIP)、胰岛素、c肽和/或胰高血糖素浓度,则纳入研究。糖化血红蛋白(HbA1c)也被评估。进行了随机效应荟萃分析,在有足够研究的情况下,报告了所有结果的Hedges' g(标准化平均差)和95%置信区间。使用τ2估计和I2统计量作为异质性检验,并使用基于Egger回归检验的漏斗图来评估发表偏倚。结果:从377篇确定的出版物中,12篇被纳入分析。在所有12项研究中,减肥手术的类型都是Roux-en-Y胃旁路手术(RYGB)。在摄入营养负荷后,比较有和没有减肥手术后低血糖的个体,GLP-1峰的标准化平均差异为0.57 (95% CI, 0.32, 0.82), GIP峰0.05(-0.26,0.36),胰岛素峰0.84 (0.44,1.23),c肽峰0.69(0.28,1.1)和胰高血糖素峰0.05(-0.26,0.36)。低血糖患者的HbA1c较低,为0.40(-0.67,-0.12)。除胰岛素峰值τ2 = 0.2, I2 = 54.3外,其他结果均无显著异质性。没有明显的发表偏倚。结论:RYGB后,减肥手术后低血糖患者餐后血浆GLP-1、胰岛素和c肽浓度峰值较高,而HbA1c较低。这些观察结果支持了GLP-1拮抗剂将被证明对RYGB后低血糖患者的管理有益的概念。普洛斯彼罗注册号:CRD42021287515。
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引用次数: 0
Follicular fluid composition and reproductive outcomes of women with polycystic ovary syndrome undergoing in vitro fertilization: A systematic review. 卵泡液组成和多囊卵巢综合征妇女体外受精的生殖结果:系统综述。
IF 8.2 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-12-01 Epub Date: 2023-07-26 DOI: 10.1007/s11154-023-09819-z
Mafalda V Moreira, Emídio Vale-Fernandes, Inês C Albergaria, Marco G Alves, Mariana P Monteiro

Polycystic ovary syndrome (PCOS) is recognized as one of the most prevalent endocrinopathy in women at reproductive age. As affected women tend to have poorer assisted reproductive technology (ART) outcomes, PCOS has been suggested to endanger oocyte quality and competence development. The aim of this systematic review was to summarize the available evidence on how the follicular fluid (FF) profile of women with PCOS undergoing in vitro fertilization (IVF) treatment differs from the FF of normo-ovulatory women. For that, an electronic search in PubMed and Web of Science databases was conducted (up to December 2021). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses - PRISMA guidelines were followed, and the Newcastle-Ottawa Scale was used to assess the risk of bias in the included studies. Data retrieved from papers included (n=42), revealed that the FF composition of women with PCOS compared to those without PCOS predominantly diverged at the following molecular classes: oxidative stress, inflammatory biomarkers, growth factors and hormones. Among those biomarkers, some were proposed as being closely related to pathophysiological processes, strengthening the hypothesis that low-grade inflammation and oxidative stress play a critical role in the pathogenesis of PCOS. Notwithstanding, it should be noticed that the available data on PCOS FF fingerprints derives from a limited number of studies conducted in a relatively small number of subjects. Furthermore, phenotypic heterogeneity of PCOS hampers wider comparisons and weakens putative conclusions. Therefore, future studies should be focused at comparing well characterized patient subgroups according to phenotypes.

多囊卵巢综合征(PCOS)是公认的育龄期女性最常见的内分泌疾病之一。由于患者的辅助生殖技术(ART)效果较差,PCOS已被认为危及卵母细胞质量和能力发育。本系统综述的目的是总结现有的证据,证明接受体外受精(IVF)治疗的多囊卵巢综合征(PCOS)妇女的卵泡液(FF)特征与排卵正常妇女的FF有什么不同。为此,在PubMed和Web of Science数据库中进行了电子搜索(截至2021年12月)。遵循系统评价和荟萃分析首选报告项目- PRISMA指南,并使用纽卡斯尔-渥太华量表评估纳入研究的偏倚风险。从文献中获取的数据(n=42)显示,与未患PCOS的女性相比,PCOS女性的FF组成主要在以下分子类别上存在差异:氧化应激、炎症生物标志物、生长因子和激素。在这些生物标志物中,一些被认为与病理生理过程密切相关,加强了低级别炎症和氧化应激在PCOS发病机制中起关键作用的假设。尽管如此,应该注意的是,PCOS FF指纹的现有数据来自于相对较少的受试者进行的有限数量的研究。此外,多囊卵巢综合征的表型异质性阻碍了更广泛的比较,削弱了推定的结论。因此,未来的研究应侧重于根据表型比较具有良好特征的患者亚组。
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引用次数: 0
White adipose tissue mitochondrial bioenergetics in metabolic diseases. 代谢疾病中的白色脂肪组织线粒体生物能量学。
IF 8.2 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-12-01 Epub Date: 2023-08-10 DOI: 10.1007/s11154-023-09827-z
Rugivan Sabaratnam, Didde Riisager Hansen, Per Svenningsen

White adipose tissue (WAT) is an important endocrine organ that regulates systemic energy metabolism. In metabolically unhealthy obesity, adipocytes become dysfunctional through hypertrophic mechanisms associated with a reduced endocrine function, reduced mitochondrial function, but increased inflammation, fibrosis, and extracellular remodelling. A pathologic WAT remodelling promotes systemic lipotoxicity characterized by fat accumulation in tissues such as muscle and liver, leading to systemic insulin resistance and type 2 diabetes. Several lines of evidence from human and animal studies suggest a link between unhealthy obesity and adipocyte mitochondrial dysfunction, and interventions that improve mitochondrial function may reduce the risk of obesity-associated diseases. This review discusses the importance of mitochondrial function and metabolism in human adipocyte biology and intercellular communication mechanisms within WAT. Moreover, a selected interventional approach for better adipocyte mitochondrial metabolism in humans is reviewed. A greater understanding of mitochondrial bioenergetics in WAT might provide novel therapeutic opportunities to prevent or restore dysfunctional adipose tissue in obesity-associated diseases.

白色脂肪组织(WAT)是调节全身能量代谢的重要内分泌器官。在代谢不健康的肥胖中,脂肪细胞通过与内分泌功能降低、线粒体功能降低、炎症、纤维化和细胞外重构增加相关的肥厚机制变得功能失调。病理性WAT重塑促进全身性脂肪毒性,其特征是脂肪在肌肉和肝脏等组织中积累,导致全身性胰岛素抵抗和2型糖尿病。来自人类和动物研究的几条证据表明,不健康的肥胖与脂肪细胞线粒体功能障碍之间存在联系,改善线粒体功能的干预措施可能会降低肥胖相关疾病的风险。本文综述了线粒体功能和代谢在人体脂肪细胞生物学中的重要性以及WAT细胞间通讯机制。此外,一种选择的介入方法,以更好的脂肪细胞线粒体代谢在人类进行了回顾。对WAT中线粒体生物能量学的更深入了解可能为预防或恢复肥胖相关疾病中功能失调的脂肪组织提供新的治疗机会。
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引用次数: 0
Childhood obesity, metabolic syndrome, and oxidative stress: microRNAs go on stage. 儿童肥胖、代谢综合征和氧化应激:microrna登台。
IF 8.2 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-12-01 Epub Date: 2023-09-06 DOI: 10.1007/s11154-023-09834-0
Álvaro González-Domínguez, Thalía Belmonte, Raúl González-Domínguez

The incidence of childhood obesity and metabolic syndrome has grown notably in the last years, becoming major public health burdens in developed countries. Nowadays, oxidative stress is well-recognized to be closely associated with the onset and progression of several obesity-related complications within the framework of a complex crosstalk involving other intertwined pathogenic events, such as inflammation, insulin disturbances, and dyslipidemia. Thus, understanding the molecular basis behind these oxidative dysregulations could provide new approaches for the diagnosis, prevention, and treatment of childhood obesity and associated disorders. In this respect, the transcriptomic characterization of miRNAs bares great potential because of their involvement in post-transcriptional modulation of genetic expression. Herein, we provide a comprehensive literature revision gathering state-of-the-art research into the association between childhood obesity, metabolic syndrome, and miRNAs. We put special emphasis on the potential role of miRNAs in modulating obesity-related pathogenic events, with particular focus on oxidative stress.

儿童肥胖和代谢综合症的发病率在过去几年中显著增加,成为发达国家主要的公共卫生负担。如今,氧化应激被认为与几种肥胖相关并发症的发生和发展密切相关,这些并发症涉及其他相互交织的致病事件,如炎症、胰岛素紊乱和血脂异常。因此,了解这些氧化失调背后的分子基础可以为儿童肥胖及相关疾病的诊断、预防和治疗提供新的方法。在这方面,mirna的转录组学表征具有很大的潜力,因为它们参与了基因表达的转录后调节。在此,我们提供了一项全面的文献修订,收集了儿童肥胖、代谢综合征和miRNAs之间关系的最新研究。我们特别强调了mirna在调节肥胖相关致病事件中的潜在作用,特别关注氧化应激。
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引用次数: 0
Beyond glycemia: Comparing tirzepatide to GLP-1 analogues. 超越血糖:比较替西肽与GLP-1类似物。
IF 8.2 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-12-01 Epub Date: 2023-08-01 DOI: 10.1007/s11154-023-09825-1
John Andraos, Harleen Muhar, Shawn R Smith

Glucagon-like peptide-1 receptor analogs (GLP-1 RAs) have been an innovative and instrumental drug class in the management of both type 2 diabetes and obesity. Tirzepatide is a novel agent that acts as an agonist for both GLP-1 receptors and gastric inhibitory polypeptide (GIP) receptors, another incretin that lowers glucose and appetite. Although previous studies showed a lack of therapeutic benefit for GIP agonists, current studies show that the glucose lowering and weight loss effects of tirzepatide are at least as effective as GLP-1 RAs with a similar adverse effect profile. Some studies, though not conclusive, predict that tirzepatide may in fact be more potent than GLP-1 RAs at reducing weight. A thorough review of the studies that led to tirzepatide's approval allows for comparisons between tirzepatide and GLP-1 RAs; it also allows for predictions of tirzepatide's eventual place in therapy - an agent used preferentially over GLP-1 RAs in patients with or without diabetes desiring to lose weight.

胰高血糖素样肽-1受体类似物(GLP-1 RAs)已成为治疗2型糖尿病和肥胖的创新药物。替西肽是一种新型药物,作为GLP-1受体和胃抑制多肽(GIP)受体的激动剂,GIP是另一种降低葡萄糖和食欲的肠促胰岛素。尽管先前的研究表明GIP激动剂缺乏治疗益处,但目前的研究表明,替西肽的降糖和减肥效果至少与GLP-1 RAs一样有效,副作用相似。一些研究虽然没有结论性,但预测替西肽在减肥方面实际上可能比GLP-1 RAs更有效。通过对替西肽获批的研究进行全面审查,可以比较替西肽和GLP-1 RAs;它还可以预测替西帕肽在治疗中的最终地位——对于希望减肥的糖尿病患者或非糖尿病患者,替西帕肽比GLP-1 RAs更优先使用。
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引用次数: 0
Vitamin D status and supplementation before and after Bariatric Surgery: Recommendations based on a systematic review and meta-analysis. 减肥手术前后维生素D的状况和补充:基于系统综述和荟萃分析的建议。
IF 8.2 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-12-01 Epub Date: 2023-09-04 DOI: 10.1007/s11154-023-09831-3
Andrea Giustina, Luigi di Filippo, Antonio Facciorusso, Robert A Adler, Neil Binkley, Jens Bollerslev, Roger Bouillon, Felipe F Casanueva, Giulia Martina Cavestro, Marlene Chakhtoura, Caterina Conte, Lorenzo M Donini, Peter R Ebeling, Angelo Fassio, Stefano Frara, Claudia Gagnon, Giovanni Latella, Claudio Marcocci, Jeffrey I Mechanick, Salvatore Minisola, René Rizzoli, Ferruccio Santini, Joseph L Shaker, Christopher Sempos, Fabio Massimo Ulivieri, Jyrki K Virtanen, Nicola Napoli, Anne L Schafer, John P Bilezikian

Bariatric surgery is associated with a postoperative reduction of 25(OH) vitamin D levels (25(OH)D) and with skeletal complications. Currently, guidelines for 25(OH)D assessment and vitamin D supplementation in bariatric patients, pre- and post-surgery, are still lacking. The aim of this work is to analyse systematically the published experience on 25(OH)D status and vitamin D supplementation, pre- and post-surgery, and to propose, on this basis, recommendations for management. Preoperatively, 18 studies including 2,869 patients were evaluated. Prevalence of vitamin D insufficiency as defined by 25(OH)D < 30 ng/mL (75 nmol/L) was 85%, whereas when defined by 25(OH)D < 20 ng/mL (50 nmol/L) was 57%. The median preoperative 25(OH)D level was 19.75 ng/mL. After surgery, 39 studies including 5,296 patients were analysed and among those undergoing either malabsorptive or restrictive procedures, a lower rate of vitamin D insufficiency and higher 25(OH)D levels postoperatively were observed in patients treated with high-dose oral vitamin D supplementation, defined as ≥ 2,000 IU/daily (mostly D3-formulation), compared with low-doses (< 2,000 IU/daily). Our recommendations based on this systematic review and meta-analysis should help clinical practice in the assessment and management of vitamin D status before and after bariatric surgery. Assessment of vitamin D should be performed pre- and postoperatively in all patients undergoing bariatric surgery. Regardless of the type of procedure, high-dose supplementation is recommended in patients after bariatric surgery.

减肥手术与术后25(OH)维生素D水平(25(OHD))的降低和骨骼并发症有关。目前,减肥患者手术前和手术后的25(OH)D评估和维生素D补充指南仍然缺乏。这项工作的目的是系统分析已发表的关于25(OH)D状态和维生素D补充的经验,手术前和手术后,并在此基础上提出管理建议。术前,对包括2869名患者在内的18项研究进行了评估。25(OH)D定义的维生素D缺乏症的患病率
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引用次数: 0
Preoperative systemic inflammatory markers as prognostic factors in differentiated thyroid cancer: a systematic review and meta-analysis. 术前全身炎症标志物作为分化型甲状腺癌症预后因素:一项系统综述和荟萃分析。
IF 8.2 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-12-01 Epub Date: 2023-10-13 DOI: 10.1007/s11154-023-09845-x
Elena Russo, Mathilda Guizzardi, Luca Canali, Francesca Gaino, Andrea Costantino, Gherardo Mazziotti, Andrea Lania, Silvia Uccella, Luca Di Tommaso, Fabio Ferreli, Luca Malvezzi, Giuseppe Spriano, Giuseppe Mercante

Background: Inflammation has been associated with tumor development and circulating inflammatory biomarkers have been proposed as possible predictors of recurrence of several solid tumors. However, the role of inflammation markers in differentiated thyroid carcinoma (DTC) is still uncertain.

Objective: This meta-analysis aimed to assess the prognostic value of neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) in patients with DTC.

Methods: Studies investigating the association between survival and preoperative circulating inflammatory markers in DTC patients were included. The primary outcome was disease-free survival (DFS). Cumulative logarithms of the hazard ratio (log-HRs) with 95% CI were calculated through the inverse variance method using a random-effects model.

Results: A total of 7599 patients with a mean age of 48.89 (95% CI 44.16-53.63) were included. The estimated pooled log-HRs for DFS were 0.07 for NLR (95% CI -0.12-0.26; p = 0.43), -0.58 for LMR (95% CI -1.21-0.05; p = 0.06), and 0.01 (95% CI 0-0.01; p = 0.21) for PLR.

Conclusions: Our meta-analysis showed no association between NLR, PLR, LMR and DFS in DTC; however, more prospective data are needed to better define the association between inflammatory status and prognosis of DTC.

背景:炎症与肿瘤发展有关,循环炎症生物标志物已被认为是几种实体瘤复发的可能预测因素。然而,炎症标志物在分化型甲状腺癌(DTC)中的作用仍不确定。目的:本荟萃分析旨在评估中性粒细胞与淋巴细胞之比(NLR)、淋巴细胞与单核细胞之比(LMR)和血小板与淋巴细胞之比来评估DTC患者的预后价值。方法:研究DTC患者的生存率与术前循环炎症标志物之间的关系。主要结果是无病生存率(DFS)。95%置信区间的风险比(log HR)的累积对数通过使用随机效应模型的逆方差法计算。结果:共纳入7599名患者,平均年龄48.89岁(95%CI 44.16-53.63)。对于NLR,DFS的估计合并对数HR为0.07(95%CI-0.12-0.26;p = 0.43),LMR为-0.58(95%CI-1.21-0.05;p = 0.06)和0.01(95%CI 0-0.01;p = 0.21)。结论:我们的荟萃分析显示,DTC中NLR、PLR、LMR和DFS之间没有关联;然而,需要更多的前瞻性数据来更好地定义DTC的炎症状态和预后之间的关系。
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Reviews in Endocrine & Metabolic Disorders
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