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Patient and caregiver perspectives of fluid discharge protocols following pituitary surgery 患者和护理人员对垂体手术后液体排出规程的看法
IF 3 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-03-01 DOI: 10.1016/j.jcte.2024.100336
Julia J. Chang , Alexis Amano , Cati Brown-Johnson , Olivia Chu , Victoria Gates-Bazarbay , Erin Wipff , Samantha M.R. Kling , Mohamed Alhadha , Juan Carlos Fernandez-Miranda , Stacie Vilendrer

Background

Post-operative fluid restriction after transsphenoidal surgery (TSS) for pituitary tumors may effectively prevent delayed hyponatremia, the most common cause of readmission. However, implementation of individualized fluid restriction interventions after discharge is often complex and poses challenges for provider and patient. The purpose of this study was to understand the factors necessary for successful implementation of fluid restriction and discharge care protocols following TSS.

Methods

Semi-structured interviews with fifteen patients and four caregivers on fluid discharge protocols were conducted following TSS. Patients and caregivers who had surgery before and after the implementation of updated discharge protocols were interviewed. Data were analyzed inductively using a procedure informed by rapid and thematic analysis.

Results

Most patients and caregivers perceived fluid restriction protocols as acceptable and feasible when indicated. Facilitators to the protocols included clear communication about the purpose of and strategies for fluid restriction, access to the care team, and involvement of patients’ caregivers in care discussions. Barriers included patient confusion about differences in the care plan between teams, physical discomfort of fluid restriction, increased burden of tracking fluids during recovery, and lack of clarity surrounding desmopressin prescriptions.1

Conclusion

Outpatient fluid restriction protocols are a feasible intervention following pituitary surgery but requires frequent patient communication and education. This evaluation highlights the importance of patient engagement and feedback to effectively develop and implement complex clinical interventions.

背景垂体瘤经蝶窦手术(TSS)术后限制液体摄入可有效预防延迟性低钠血症,这是最常见的再入院原因。然而,出院后实施个体化的液体限制干预措施通常比较复杂,给医疗服务提供者和患者带来了挑战。本研究旨在了解在 TSS 术后成功实施液体限制和出院护理方案的必要因素。方法在 TSS 术后就液体出院方案对 15 名患者和 4 名护理人员进行了半结构式访谈。访谈对象包括在实施最新出院方案之前和之后进行手术的患者和护理人员。结果大多数患者和护理人员认为限制输液协议是可以接受的,并且在需要时是可行的。协议的促进因素包括关于限制输液的目的和策略的明确沟通、与护理团队的联系以及患者护理人员参与护理讨论。障碍包括患者对不同团队之间护理计划的差异感到困惑、限制输液造成的身体不适、增加恢复期间追踪输液的负担以及去氨加压素处方的不明确性。这项评估强调了患者参与和反馈对于有效制定和实施复杂的临床干预措施的重要性。
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引用次数: 0
GLP-1 receptor agonists: A novel pharmacotherapy for binge eating (Binge eating disorder and bulimia nervosa)? A systematic review GLP-1 受体激动剂:治疗暴食症(暴食症和贪食症)的新型药物疗法?系统综述
IF 3 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-03-01 DOI: 10.1016/j.jcte.2024.100333
Laurence Aoun , Shaza Almardini , Fares Saliba , Fadi Haddadin , Omar Mourad , Jennifer Jdaidani , Zeina Morcos , Ibrahim Al Saidi , Elie Bou Sanayeh , Saliba Saliba , Michel Almardini , Julie Zaidan

Objective

Systematically review evidence on using GLP-1RAs for reducing BEB in BED and BN.

Methods

Comprehensive literature search (PubMed and Google Scholar) conducted for studies evaluating GLP-1Ras for BEB. Extracted data on study characteristics, efficacy, and safety.

Results

Studies show that GLP-1RAs (liraglutide and dulaglutide) reduce BE frequency and comorbidities in addition to favorable psychiatric side effect profile compared to current options. However, large-scale, blinded placebo-controlled trials are lacking.

Conclusion

Early findings suggest promising effects of GLP-1RAs on BEB. However, rigorous clinical trials are needed to firmly establish efficacy, dosing, safety, and comparative effectiveness before considering GLP-1RAs a viable novel approach.

目的系统回顾使用 GLP-1RAs 减少 BED 和 BN 中 BEB 的证据。方法对评估 GLP-1Ras 治疗 BEB 的研究进行全面文献检索(PubMed 和 Google Scholar)。结果研究表明,GLP-1RAs(利拉鲁肽和度拉鲁肽)与目前的选择相比,除了具有良好的精神副作用外,还能减少 BEB 的频率和合并症。结论早期研究结果表明,GLP-1RA 对 BEB 具有良好的疗效。然而,在将 GLP-1RAs 视为一种可行的新方法之前,还需要进行严格的临床试验,以牢固确立其疗效、剂量、安全性和比较有效性。
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引用次数: 0
Quality of life, daily functioning, and symptoms in hypothyroid patients on thyroid replacement therapy: A Dutch survey 接受甲状腺替代疗法的甲状腺功能减退症患者的生活质量、日常功能和症状:荷兰调查
IF 3 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-02-02 DOI: 10.1016/j.jcte.2024.100330
Ellen Molewijk , Eric Fliers , Koen Dreijerink , Ad van Dooren , Rob Heerdink

Objective

To explore the nature and extent of possible residual complaints among Dutch hypothyroid patients using thyroid replacement therapy, we initiated a comprehensive study measuring health-related quality of life (QoL), daily functioning, and hypothyroidism-associated symptoms in patients and control persons.

Methods

An online survey measuring thyroid-specific QoL (ThyPRO), daily functioning, and hypothyroidism-associated symptoms (ThySHI) was distributed among treated hypothyroid patients and control individuals. The advertising text was formulated in an open-ended manner. Patients also provided their most recent thyroid blood values and their thyroid medication.

Results

There was a large-sized impairment of QoL (Cohen’s d = 1.04, +93 % ThyPRO score) in hypothyroid patients on thyroid replacement therapy (n = 1195) as compared to controls (n = 236). Daily functioning was significantly reduced i.e., general health (-38 %), problems with vigorous- (+64 %) and moderate activities (+77 %). Almost 80 % of patients reported having complaints despite thyroid medication and in-range thyroid blood values, with 75 % expressing a desire for improved treatment options for hypothyroidism (total n = 1194). Hypothyroid patients experienced 2.8 times more intense hypothyroidism-associated symptoms than controls (n = 865, n = 203 resp). Patients' median reported serum concentrations were: TSH 0.90 mU/L, FT4 17.0 pmol/L, and FT3 2.67 pmol/L, with 52 % having low T3 levels (<3.1 pmol/L). The QoL was not found to be related to age, sex, BMI, menopausal status, stress, serum thyroid parameters, the origin and duration of hypothyroidism, the type of thyroid medication, or the LT4 dose used.

Conclusions

Our study revealed major reductions in quality of life and daily functioning, and nearly three times more intense hypothyroidism-associated symptoms in treated hypothyroid patients as compared to controls, despite treatment and largely in-range serum TSH/FT4 concentrations. The QoL was not associated with serum thyroid parameters. We recommend future research into the origin of persisting complaints and the development of improved treatment modalities for hypothyroidism.

方法在接受治疗的甲状腺功能减退症患者和对照组患者中发放了一份在线调查问卷,测量甲状腺特异性生活质量(ThyPRO)、日常功能和甲状腺功能减退症相关症状(ThySHI)。广告文本以开放式方式拟定。结果与对照组(n = 236)相比,接受甲状腺替代治疗的甲减患者(n = 1195)的生活质量大幅下降(Cohen's d = 1.04,+93 % ThyPRO评分)。日常功能明显降低,即一般健康(-38 %)、剧烈活动(+64 %)和中度活动(+77 %)出现问题。近 80% 的患者表示,尽管服用了甲状腺药物,甲状腺血值也在正常范围内,但仍有抱怨,75% 的患者表示希望改进甲减的治疗方案(总人数 = 1194)。甲减患者甲减相关症状的严重程度是对照组的 2.8 倍(n = 865,n = 203 resp)。患者报告的血清浓度中位数为TSH 0.90 mU/L、FT4 17.0 pmol/L、FT3 2.67 pmol/L,其中 52% 的患者 T3 水平较低(<3.1 pmol/L)。结论我们的研究发现,与对照组相比,尽管接受了治疗且血清促甲状腺激素/FT4浓度基本在正常范围内,但甲状腺功能减退症患者的生活质量和日常功能明显下降,甲状腺功能减退症相关症状的严重程度几乎是对照组的三倍。生活质量与血清甲状腺参数无关。我们建议今后对持续性症状的起因进行研究,并开发出更好的甲减治疗方法。
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引用次数: 0
Histopathology of telomerase reverse transcriptase promoter (TERT) mutated indeterminate thyroid nodules 端粒酶逆转录酶启动子(TERT)突变的不确定甲状腺结节的组织病理学研究
IF 3 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-12-02 DOI: 10.1016/j.jcte.2023.100329
Jessica O. Pinto , Masha J. Livhits , Michael W. Yeh , Atanas Kaykov , Joshua P. Klopper , Richard T. Kloos , Mohammed Alshalalfa , Yangyang Hao , Jing Huang , Mayumi Endo

Objective

The objective of this study was to analyze the risk of malignancy and the histopathology of telomerase reverse transcriptase promoter (TERT) mutated cytologically indeterminate thyroid nodules (ITN).

Methods

A PUBMED search of molecularly tested ITN was conducted and data on TERT mutated ITN with histopathology correlation were extracted.

Results

Twenty-six manuscripts (published between 2014 and 2022) reported on 77 TERT mutated ITN. Sixty-five nodules were malignant (84 %), with 16 (25 %) described with high-risk histopathology, 5 (8 %) described as low-risk, and most without any description. Isolated TERT mutations were malignant in 26/30 ITNs (87 %) with 9 (35 %) described as high risk and none described as low risk. TERT + RAS mutated ITNs were malignant in 29/34 ITNs (85 %) with 3 (10 %) described as high risk and 4 (14 %) described as low risk. Finally, all 5 TERT + BRAFV600E mutated nodules were malignant and 3/5 (60 %) were described as high risk.

Conclusion

TERT mutated ITNs have a high risk of malignancy (84 %), and the current data does not show a difference in malignancy rate between isolated TERT mutations and TERT + RAS co-mutated ITNs. When described, TERT + RAS co-mutated ITNs did not have a higher rate of high-risk histopathology as compared to isolated TERT mutated lesions. Most TERT mutated ITNs did not have a description of histopathology risk and the oncologic outcomes, including rate of recurrence, metastases, and disease specific survival, are unknown. Further data is needed to determine if TERT mutated ITNs should be subjected to aggressive initial treatment.

目的分析端粒酶逆转录酶启动子(TERT)突变的细胞学不确定甲状腺结节(ITN)发生恶性肿瘤的风险及组织病理学特征。方法在PUBMED上检索分子检测的ITN,提取TERT突变的ITN与组织病理学相关性的数据。结果2014 ~ 2022年间发表的26篇文献报道了77例TERT突变的ITN。65个结节是恶性的(84%),16个(25%)被描述为高危组织病理学,5个(8%)被描述为低风险,大多数没有任何描述。分离的TERT突变在26/30的itn(87%)中为恶性,其中9例(35%)为高风险,无一例为低风险。TERT + RAS突变的itn在29/34(85%)中为恶性,其中3(10%)为高风险,4(14%)为低风险。最后,5例TERT + BRAFV600E突变结节均为恶性结节,其中3/5(60%)为高危结节。结论TERT突变的itn具有较高的恶性肿瘤风险(84%),目前的数据未显示分离TERT突变与TERT + RAS共突变的itn在恶性肿瘤发生率上存在差异。当被描述时,TERT + RAS共突变的itn与孤立的TERT突变病变相比,没有更高的高风险组织病理学发生率。大多数TERT突变的itn没有组织病理学风险描述,肿瘤学结果,包括复发率、转移率和疾病特异性生存率,都是未知的。需要进一步的数据来确定TERT突变的itn是否应该进行积极的初始治疗。
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引用次数: 0
Utilizing a quality of life tool to examine the presence of fatigue in subjects with diabetes mellitus 利用生活质量工具检查糖尿病患者是否存在疲劳
IF 3 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-11-10 DOI: 10.1016/j.jcte.2023.100328
Catherine Nguyen , Henri K. Parson , Jordan Pettaway , Amber Ingram , Taneisha Sears , Jason T. Bard , Steven Forte , Jennifer A. Wintringham , Etta Vinik , Elias S. Siraj , Carolina M. Casellini

Introduction

The prevalence of fatigue in patients with diabetes mellitus (DM) can be as high as 50 %. Physical, mental, and psychosocial components of fatigue negatively impact quality of life (QOL), morbidity and mortality. Several tools have been developed to address fatigue, but none specifically for measuring fatigue in DM. The aim of this study was to assess the impact of diabetes and neuropathy on fatigue using the Norfolk QOL-Fatigue (QOL-F) survey.

Methods

605 adult participants from [Anonymous] were recruited (400 subjects with type 1 or type 2 DM and 205 subjects without diabetes (controls)). All subjects completed the Norfolk QOL-F. Demographics, weight, BMI, and duration of diabetes were obtained. The Norfolk QOL-F, a 35-item validated questionnaire, assesses five domains: subjective fatigue, physical and cognitive fatigue, reduced activities, impaired activities of daily living, and depression.

Results

Subjects with DM reported significantly higher fatigue total scores (52.63vs33.89, p < 0.0001) and in all five domains when compared to controls. Patients with DM with neuropathy were significantly more fatigued than those without (59.72vs27.83, p < 0.0001). Fatigue scores in patients with DM without neuropathy were similar to controls (27.83vs33.89, p = NS). In multivariate analysis, age, gender, and presence of neuropathy significantly impacted fatigue scores.

Conclusions

The Norfolk QOL-F questionnaire can potentially identify the impact of chronic diseases such as diabetes on fatigue. Assessing the different components of fatigue is important for clinicians in improving disease management and outcomes. Further investigations are needed to confirm these observations in specific cohorts with other comorbidities.

糖尿病(DM)患者的疲劳患病率可高达50%。疲劳的身体、精神和社会心理因素会对生活质量(QOL)、发病率和死亡率产生负面影响。已经开发了一些工具来解决疲劳问题,但没有一个专门用于测量糖尿病患者的疲劳。本研究的目的是使用诺福克qol -疲劳(QOL-F)调查来评估糖尿病和神经病变对疲劳的影响。方法从[匿名]招募605名成人受试者(400名1型或2型糖尿病患者和205名非糖尿病患者(对照组))。所有受试者完成诺福克QOL-F。统计数据、体重、BMI和糖尿病病程。诺福克生活质量量表(Norfolk QOL-F)是一份包含35个项目的有效问卷,评估了五个领域:主观疲劳、身体和认知疲劳、活动减少、日常生活活动受损和抑郁。结果DM组疲劳总分明显高于DM组(52.63vs33.89, p <0.0001),与对照组相比,在所有五个领域。伴有神经病变的糖尿病患者疲劳程度明显高于无神经病变的糖尿病患者(59.72vs27.83, p <0.0001)。无神经病变DM患者的疲劳评分与对照组相似(27.83vs33.89, p = NS)。在多变量分析中,年龄、性别和有无神经病变显著影响疲劳评分。结论Norfolk QOL-F问卷可以潜在地识别慢性疾病如糖尿病对疲劳的影响。评估疲劳的不同组成部分对临床医生改善疾病管理和结果很重要。在有其他合并症的特定队列中,需要进一步的调查来证实这些观察结果。
{"title":"Utilizing a quality of life tool to examine the presence of fatigue in subjects with diabetes mellitus","authors":"Catherine Nguyen ,&nbsp;Henri K. Parson ,&nbsp;Jordan Pettaway ,&nbsp;Amber Ingram ,&nbsp;Taneisha Sears ,&nbsp;Jason T. Bard ,&nbsp;Steven Forte ,&nbsp;Jennifer A. Wintringham ,&nbsp;Etta Vinik ,&nbsp;Elias S. Siraj ,&nbsp;Carolina M. Casellini","doi":"10.1016/j.jcte.2023.100328","DOIUrl":"https://doi.org/10.1016/j.jcte.2023.100328","url":null,"abstract":"<div><h3>Introduction</h3><p>The prevalence of fatigue in patients with diabetes mellitus (DM) can be as high as 50 %. Physical, mental, and psychosocial components of fatigue negatively impact quality of life (QOL), morbidity and mortality. Several tools have been developed to address fatigue, but none specifically for measuring fatigue in DM. The aim of this study was to assess the impact of diabetes and neuropathy on fatigue using the Norfolk QOL-Fatigue (QOL-F) survey.</p></div><div><h3>Methods</h3><p>605 adult participants from <em>[Anonymous]</em> were recruited (400 subjects with type 1 or type 2 DM and 205 subjects without diabetes (controls)). All subjects completed the Norfolk QOL-F. Demographics, weight, BMI, and duration of diabetes were obtained. The Norfolk QOL-F, a 35-item validated questionnaire, assesses five domains: subjective fatigue, physical and cognitive fatigue, reduced activities, impaired activities of daily living, and depression.</p></div><div><h3>Results</h3><p>Subjects with DM reported significantly higher fatigue total scores (52.63vs33.89, p &lt; 0.0001) and in all five domains when compared to controls. Patients with DM with neuropathy were significantly more fatigued than those without (59.72vs27.83, p &lt; 0.0001). Fatigue scores in patients with DM without neuropathy were similar to controls (27.83vs33.89, p = NS). In multivariate analysis, age, gender, and presence of neuropathy significantly impacted fatigue scores.</p></div><div><h3>Conclusions</h3><p>The Norfolk QOL-F questionnaire can potentially identify the impact of chronic diseases such as diabetes on fatigue. Assessing the different components of fatigue is important for clinicians in improving disease management and outcomes. Further investigations are needed to confirm these observations in specific cohorts with other comorbidities.</p></div>","PeriodicalId":46328,"journal":{"name":"Journal of Clinical and Translational Endocrinology","volume":"34 ","pages":"Article 100328"},"PeriodicalIF":3.0,"publicationDate":"2023-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2214623723000169/pdfft?md5=e82955bf55a2a4f7ba46649fc8861ed5&pid=1-s2.0-S2214623723000169-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134655022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Peripheral sensory neuropathy is associated with circulating angiopoietins in type 2 diabetes patients in Ghana 加纳2型糖尿病患者外周感觉神经病与循环血管生成素相关
IF 3 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-10-06 DOI: 10.1016/j.jcte.2023.100327
Jennifer A. Agyekum , Kwame Yeboah

Objective

Peripheral sensory neuropathy (PSN) is a common complication of type 2 diabetes (T2DM) that can lead to frequent ulcerations, lower extremities, and reduced quality of life. Imbalance in the circulating levels of angiogenic growth factors, notably, angiopoietin (Ang)-1, Ang-2 and vascular endothelial growth factor (VEGF) may be among the underlying mechanisms of PSN in T2DM patients. We studied the association between PSN and angiogenic growth factors, Ang-1, Ang-2 and VEGF in T2DM patients in Ghana.

Methods

In a case-control study design, PSN was evaluated in 160 patients with T2DM and 108 nondiabetic controls using vibration perception threshold (VPT) and diabetic neurological examination (DNE). The definition of PSN was abnormal VPT (≥25 mV) or the presence of neuropathic symptoms on examination (DNE score > 3). In addition, fasting venous blood samples were collected to measure circulating levels of Ang-1, Ang-2 and VEGF.

Results

Compared to non-diabetic controls, patients with T2DM had a higher prevalence of PSN using abnormal VPT (20.6 % vs 2.8 %, p < 0.001) or neuropathic symptoms (35.6 % vs 3.7 %, p < 0.001). Compared to nondiabetic controls, patients with T2DM had increased levels of Ang-2 [597 (274 – 1005) vs 838 (473 – 1241) ng/ml, p = 0.018] and VEGF [48.4 (17.4 – 110.1) vs 72.2 (28 – 201.8), p = 0.025] and decreased Ang-1 levels [41.1 (30 – 57.3) vs 36.1 (24.7 – 42.1) ng/ml, p = 0.01]. In regression analyses, an increase in Ang-1 levels was associated with decreased odds, while an increase in Ang-2 levels was associated with increased odds, of abnormal VPT and neuropathic symptoms in T2DM patients.

Conclusion

In our study population, PSN was associated with reduced plasma levels of Ang-1 and increased plasma levels of Ang-2 in patients with T2DM. Therefore, an imbalance of angiopoietins may be associated with PSN in T2DM.

目的周围感觉神经病变(PSN)是2型糖尿病(T2DM)的常见并发症,可导致频繁的溃疡、下肢和生活质量下降。血管生成生长因子循环水平失衡,尤其是血管生成素(Ang)-1、Ang-2和血管内皮生长因子(VEGF),可能是T2DM患者PSN的潜在机制之一。我们研究了加纳T2DM患者的PSN与血管生成生长因子、Ang-1、Ang-2和VEGF之间的关系。方法在病例对照研究设计中,使用振动感知阈值(VPT)和糖尿病神经检查(DNE)对160名T2DM患者和108名非糖尿病对照者的PSN进行了评估。PSN的定义是VPT异常(≥25mV)或检查时存在神经性症状(DNE评分>;3)。此外,采集空腹静脉血样本以测量循环中Ang-1、Ang-2和VEGF的水平。结果与非糖尿病对照组相比,T2DM患者使用异常VPT(20.6%对2.8%,p<0.001)或神经性症状(35.6%对3.7%,p<001)的PSN患病率更高,T2DM患者的Ang-2水平升高[597(274-1005)vs 838(473-1241)ng/ml,p=0.018]和VEGF水平升高[48.4(17.4-110.1)vs 72.2(28-201.8),p=0.025],Ang-1水平降低[41.1(30-57.3)vs 36.1(24.7-42.1)ng/ml,而Ang-2水平的增加与T2DM患者异常VPT和神经性症状的几率增加有关。结论在我们的研究人群中,PSN与T2DM患者血浆Ang-1水平降低和Ang-2水平升高有关。因此,血管生成素失衡可能与T2DM患者的PSN有关。
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引用次数: 0
The relationship between diabetic ketoacidosis and suicidal or self-injurious behaviour: A systematic review 糖尿病酮症酸中毒与自杀或自残行为的关系:系统综述
IF 3 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-09-29 DOI: 10.1016/j.jcte.2023.100325
Lina Al Alshaikh , Anne M. Doherty

Background

It has been suggested that there may be an association between type 1 diabetes (T1DM) and suicide, with one study reporting a rate 11 times that of the general population The aim of this paper was to investigate the association between Diabetic ketoacidosis (DKA: a life-threatening acute complication of T1DM) and suicidal behaviours in people with T1DM.

Methods

We performed a search of the following databases: PubMed, PsychInfo, and Embase for papers which explored the association between suicidal behaviours and self-harm with DKA in T1DM. We excluded case reports and review papers.

Results

Only three papers explored the relationship between DKA and self-harm. One study found an association between DKA and self-harm in a national cohort of people with type 1 diabetes and schizophrenia. The second found a significant increase in psychiatric admissions for self-harm following an episode of DKA. The third study reported that patients with diabetes and a history of self-harm were at elevated risk of a range of diabetes complications including DKA. These findings indicate an association between DKA and self-harm and support the guidelines in recommending a psychosocial assessment where DKA cannot be explained.

Conclusions

This review suggests that DKA is associated with suicidal or self-injurious behaviours. The small number of studies and the seriousness of this issue highlight the importance of further research on this topic, to improve the evidence base for the identification and treatment of risk of suicidal behaviours in people with T1DM.

背景1型糖尿病(T1DM)可能与自杀有关,其中一项研究报告的发病率是普通人群的11倍。本文的目的是调查糖尿病酮症酸中毒(DKA:一种危及生命的T1DM急性并发症)与T1DM患者自杀行为之间的关系。方法我们搜索了以下数据库:PubMed、PsychInfo、,Embase的论文探讨了T1DM患者自杀行为和自残与DKA之间的关系。我们排除了案例报告和审查文件。结果仅有3篇论文探讨了DKA与自残的关系。一项研究发现,在一个全国1型糖尿病和精神分裂症患者队列中,DKA与自残之间存在关联。第二项研究发现,DKA发作后,因自残入院的精神病患者显著增加。第三项研究报告称,有自残史的糖尿病患者发生包括DKA在内的一系列糖尿病并发症的风险较高。这些发现表明DKA与自残之间存在关联,并支持指导方针在无法解释DKA的情况下建议进行心理社会评估。结论本综述表明DKA与自杀或自残行为有关。数量较少的研究和这一问题的严重性突出了对这一主题进行进一步研究的重要性,以改善识别和治疗T1DM患者自杀行为风险的证据基础。
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引用次数: 0
Novel interactive text-messaging curriculum for endocrinology board review 内分泌委员会审查的新型交互式短信课程
IF 3 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-09-29 DOI: 10.1016/j.jcte.2023.100326
Priyanka Majety , Ayodele Ajayi , Anna M. Modest , Maria Vamvini , Jason A. Freed

Background

The ABIM certification exam is one of the measures to ensure that physicians have the clinical skills for good care delivery. The 5-year average pass rate for ABIM Endocrinology exam is 82%. The pass rate significantly decreased to a nadir of 74% in 2021 and 2022, lowest of all medicine subspecialties.

Objectives

To assess the feasibility of text messaging curriculum for fellows and its utility in improving their test performance.

Methods

In 2021, endocrinology fellows from 51 programs across the country were invited to participate in our curriculum. They completed a pre-test, joined a texting group via Remind application and received 1 multiple choice question daily (total n = 78). After 15 weeks, they completed a post-test and survey. Paired results from pre- and post-test were compared.

Results

A total of 89 fellows from 27 programs responded. Of these, 82 fellows, predominantly females (n = 60; 73 %), filled out the pre-test. On an average, 42 fellows (SD = 12) responded to the questions daily and 57 % of them answered the questions within 24 h. Thirty fellows completed the post-test. The median number of correct responses on the pre-test was 5 (IQR 3–6), compared to 8 (IQR 6–9) in the post-test. There was a significant improvement (p-value < 0.0001) in fellows’ performance in the post-test when compared with the pre-test following our intervention.

Conclusions

Text-messaging based curriculum for exam preparation is feasible and can improve test performance. Fellows find receiving a daily high yield multiple choice question via text-message as a useful tool for exam preparation.

背景ABIM认证考试是确保医生具备提供良好护理的临床技能的措施之一。ABIM内分泌学考试的5年平均通过率为82%。2021年和2022年,通过率显著下降至74%的最低点,是所有医学亚专业中最低的。目的评估研究生短信课程的可行性及其在提高考试成绩方面的实用性。方法2021年,来自全国51个项目的内分泌研究员受邀参加我们的课程。他们完成了一项预测试,通过Remind应用程序加入了一个短信小组,每天收到1道选择题(共n=78)。15周后,他们完成了后期测试和调查。比较测试前和测试后的配对结果。结果共有来自27个项目的89名研究员做出了回应。其中,82名研究员,主要是女性(n=60;73%),填写了预测试。平均每天有42名研究员(SD=12)回答问题,其中57%的人在24小时内回答了问题。30名研究员完成了后期测试。测试前正确回答的中位数为5(IQR 3-6),而测试后为8(IQR 6-9)。与我们干预后的测试前相比,研究人员在测试后的表现有显著改善(p值<;0.0001)。结论基于文本信息的备考课程是可行的,可以提高考试成绩。研究人员发现,每天通过短信收到一道高产的多选题是备考的一个有用工具。
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引用次数: 0
Prospective effects of cholecalciferol supplementation on irisin levels in sedentary postmenopausal women: A pilot study 补充胆钙化醇对绝经后久坐妇女鸢尾素水平的前瞻性影响:一项初步研究
IF 3 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-09-15 DOI: 10.1016/j.jcte.2023.100324
Luiz Phellipe Dell Aquila , Armando Morales , Patricia Moreira , Maysa Seabra Cendoroglo , Rosilene Motta Elias , Maria Aparecida Dalboni

Introduction

In postmenopausal women, vitamin D deficiency has been associated with disability, low muscle mass and fractures. Irisin is an important myokine that may contribute to the maintenance of muscle and bone density. Vitamin D is associated with the growth and function of muscle tissue through interactions between the vitamin D receptor and PGC-1α and activation of p38/MAPK (mitogen-activated protein kinase) in muscle, a mechanism similar to irisin action. The aim of this pilot study was to evaluate the effects of cholecalciferol supplementation on serum irisin levels in sedentary postmenopausal women with hypovitaminosis D (25(OH)D < 20 ng/mL).

Material and methods

80 sedentary postmenopausal women with hypovitaminosis D and low sun exposure were supplemented with cholecalciferol (30,000 IU/month) for 12 months. Calcium, parathyroid hormone, alkaline phosphatase (AP) and irisin levels were measured before and after supplementation.

Results

25(OH) vitamin D increased in all participants. Serum levels of irisin increased (from 0.52 ± 0.27 to 0.80 ± 0.53; p < 0.003), accompanied by a decrease in AP (from 80 ± 24 to 66 ± 23; p < 0.001).

Conclusions

Restoration of vitamin D status increased serum irisin levels in sedentary postmenopausal women. Whether increased serum irisin levels may have an impact on clinical outcomes deserves further evaluation.

引言在绝经后妇女中,维生素D缺乏与残疾、低肌肉质量和骨折有关。Irisin是一种重要的肌细胞因子,可能有助于维持肌肉和骨密度。维生素D通过维生素D受体和PGC-1α之间的相互作用以及肌肉中p38/MAPK(丝裂原活化蛋白激酶)的激活与肌肉组织的生长和功能有关,其机制类似于鸢尾素的作用。该初步研究的目的是评估补充胆钙化醇对患有低维生素D(25(OH)D<;20 ng/mL)。材料和方法80名患有低维生素D和低日照的久坐绝经后妇女补充胆钙化醇(30000 IU/月)12个月。钙、甲状旁腺激素、碱性磷酸酶(AP)和鸢尾素水平在补充前后进行测量。结果25(OH)维生素D在所有参与者中均增加。血清鸢尾素水平升高(从0.52±0.27升高到0.80±0.53;p<0.003),同时AP降低(从80±24降低到66±23;p<0.001)。血清鸢尾素水平的升高是否会对临床结果产生影响,值得进一步评估。
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引用次数: 0
Characteristics, staging and outcomes of differentiated thyroid cancer in patients with and without Graves’ disease 分化型甲状腺癌伴和不伴Graves病的特点、分期和预后
IF 3 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-09-01 DOI: 10.1016/j.jcte.2023.100321
Chaitra Gopinath , Hanna Crow , Sujata Panthi , Leonidas Bantis , Kenneth D. Burman , Chitra Choudhary

Background

The incidence of thyroid cancer has increased over the last three decades with studies showing incidence of thyroid cancer is higher among patients with Graves’ Disease (GD) when compared to Toxic multinodular goiter.1 We conducted a retrospective study to further investigate characteristics and outcomes in patients with thyroid cancer and GD.

Methods

We retrospectively reviewed 62 patients with a diagnosis of Differentiated Thyroid Cancer (DTC). We compared age at diagnosis, type, size of tumor, radioactive iodine (RAI) use, and DTC recurrence amongst patients with GD, non-GD patients. We used Chi-square to test for independence among categorical variables at a nominal level of 0.05; comparison was based on t-test.

Results

Out of 62 patients, 29 patients had GD and DTC (47%). 94% had papillary thyroid cancer. Patients with GD were diagnosed with DTC at a younger age (mean 46 years) in comparison to patients without GD (mean 53 years). There was no difference in the type of DTC. Patients with GD had significantly smaller tumor size (mean size 1.035 cm; p value = 0.002), more Stage 1 and 2 compared to patients without GD (p-value = 0.009). Both groups of patients had similar rates of recurrence on follow up and RAI use.

Conclusion

We found patients with GD had smaller tumor size, early-stage DTC when compared to patients without GD and potentially favorable prognosis. More data is needed to understand whether this is due to pathogenesis like Graves antibodies promoting tumor formation or merely earlier detection of DTC in GD.

背景在过去三十年中,甲状腺癌症的发病率有所上升,研究表明,与毒性多结节性甲状腺肿相比,Graves病(GD)患者的甲状腺癌症发病率更高。1我们进行了一项回顾性研究,以进一步调查甲状腺癌症和GD患者的特征和结果诊断为分化型甲状腺癌症(DTC)的患者。我们比较了GD患者和非GD患者的诊断年龄、肿瘤类型、大小、放射性碘(RAI)使用和DTC复发情况。我们使用卡方检验分类变量之间的独立性,标称水平为0.05;结果在62例患者中,29例患者患有GD和DTC(47%)。94%的患者患有甲状腺乳头状癌症。与无GD患者(平均53岁)相比,GD患者在更年轻的年龄(平均46岁)被诊断为DTC。DTC的类型没有差异。与无GD的患者(p值=0.009)相比,GD患者的肿瘤大小明显较小(平均大小1.035cm;p值=0.002),1期和2期更多。两组患者在随访和使用RAI时的复发率相似。结论与无GD患者相比,GD患者肿瘤较小,早期DTC,预后良好。需要更多的数据来了解这是由于Graves抗体促进肿瘤形成等发病机制,还是仅仅是早期检测到GD中的DTC。
{"title":"Characteristics, staging and outcomes of differentiated thyroid cancer in patients with and without Graves’ disease","authors":"Chaitra Gopinath ,&nbsp;Hanna Crow ,&nbsp;Sujata Panthi ,&nbsp;Leonidas Bantis ,&nbsp;Kenneth D. Burman ,&nbsp;Chitra Choudhary","doi":"10.1016/j.jcte.2023.100321","DOIUrl":"10.1016/j.jcte.2023.100321","url":null,"abstract":"<div><h3>Background</h3><p>The incidence of thyroid cancer has increased over the last three decades with studies showing incidence of thyroid cancer is higher among patients with Graves’ Disease (GD) when compared to Toxic multinodular goiter.<sup>1</sup> We conducted a retrospective study to further investigate characteristics and outcomes in patients with thyroid cancer and GD.</p></div><div><h3>Methods</h3><p>We retrospectively reviewed 62 patients with a diagnosis of Differentiated Thyroid Cancer (DTC). We compared age at diagnosis, type, size of tumor, radioactive iodine (RAI) use, and DTC recurrence amongst patients with GD, non-GD patients. We used Chi-square to test for independence among categorical variables at a nominal level of 0.05; comparison was based on <em>t</em>-test.</p></div><div><h3>Results</h3><p>Out of 62 patients, 29 patients had GD and DTC (47%). 94% had papillary thyroid cancer. Patients with GD were diagnosed with DTC at a younger age (mean 46 years) in comparison to patients without GD (mean 53 years). There was no difference in the type of DTC. Patients with GD had significantly smaller tumor size (mean size 1.035 cm; p value = 0.002), more Stage 1 and 2 compared to patients without GD (p-value = 0.009). Both groups of patients had similar rates of recurrence on follow up and RAI use.</p></div><div><h3>Conclusion</h3><p>We found patients with GD had smaller tumor size, early-stage DTC when compared to patients without GD and potentially favorable prognosis. More data is needed to understand whether this is due to pathogenesis like Graves antibodies promoting tumor formation or merely earlier detection of DTC in GD.</p></div>","PeriodicalId":46328,"journal":{"name":"Journal of Clinical and Translational Endocrinology","volume":"33 ","pages":"Article 100321"},"PeriodicalIF":3.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/20/b3/main.PMC10400462.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9956318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Journal of Clinical and Translational Endocrinology
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