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From cortisol-producing adrenal adenoma to atrial myxoma, through nivolumab-induced hypophysitis: a complicated case report of Carney Complex. 从产生皮质醇的肾上腺腺瘤到心房肌瘤,再到尼妥珠单抗诱发的肾上腺皮质功能减退症:卡尼综合征的复杂病例报告。
IF 3 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-12-01 Epub Date: 2024-09-01 DOI: 10.1007/s12020-024-03997-9
Ludovico Di Gioia, Giovanni Dambrosio, Angelo Cignarelli, Annalisa Natalicchio, Sebastio Perrini, Luigi Laviola, Francesco Giorgino, Gian Pio Sorice

Purpose: Carney complex (CNC) is a rare, autosomal dominant syndrome, most commonly caused by PRKAR1A gene mutations and characterized by pigmented skin and mucosal changes with multiple endocrine and non-endocrine tumours. This case report highlights the diagnostic challenges associated with CNC in a patient with multiple neoplasms and a complex medical history, including cortisol-producing adrenal adenoma, breast cancer, melanoma, and atrial myxoma.

Methods: We report the case of a 41-year-old woman with a medical history of left adrenalectomy for cortisol producing adenoma (2005) with no sign of adrenal insufficiency at follow-up, right mastectomy for BRCA1/2 negative carcinoma (2013) and left parotid BRAF-V600E wild-type melanoma (2019), treated with nivolumab adjuvant therapy. In August 2019, following the fifth nivolumab administration, the patient developed central hypocortisolism due to iatrogenic hypophysitis, confirmed by brain MRI and properly treated with oral hydrocortisone. Nivolumab was discontinued due to the patient's decision. In October 2020 and April 2021, the patient had ischaemic strokes, requiring systemic thrombolysis. Echocardiographic examination then revealed a left atrial mass, with histological finding of myxoma.

Results: Given the rarity of this neoplasm and the suspicion of a syndromic disorder, a genetic evaluation was conducted, which confirmed a PRKAR1A gene mutation and the diagnosis of Carney complex.

Conclusion: This case illustrates the diagnostic challenges in CNC, especially in patients with multiple tumourous manifestations and a wide spectrum of life-threatening clinical presentations. It underscores the importance of a multidisciplinary approach to diagnose and manage rare diseases, improving patient outcomes through timely genetic testing and coordinated care.

目的:卡尼综合征(CNC)是一种罕见的常染色体显性遗传综合征,最常见的病因是 PRKAR1A 基因突变,其特征是皮肤和粘膜色素性改变,伴有多种内分泌和非内分泌肿瘤。本病例报告强调了与 CNC 相关的诊断难题,该患者患有多种肿瘤,病史复杂,包括皮质醇分泌型肾上腺腺瘤、乳腺癌、黑色素瘤和心房肌瘤:我们报告了一例41岁女性的病例,她曾因皮质醇生成腺瘤接受左肾上腺切除术(2005年),随访时未发现肾上腺功能不全迹象,又因BRCA1/2阴性癌接受右乳房切除术(2013年)和左腮腺BRAF-V600E野生型黑色素瘤(2019年),并接受了nivolumab辅助治疗。2019年8月,在第五次使用尼妥珠单抗后,患者因先天性肾上腺皮质功能减退症而出现中枢性皮质醇增多症,经脑核磁共振成像证实,并接受了口服氢化可的松的适当治疗。根据患者的决定,停用了 Nivolumab。2020 年 10 月和 2021 年 4 月,患者出现缺血性中风,需要全身溶栓治疗。随后,超声心动图检查发现左心房肿块,组织学发现为肌瘤:结果:鉴于这种肿瘤的罕见性以及对综合征疾病的怀疑,对患者进行了遗传学评估,结果证实患者存在 PRKAR1A 基因突变,诊断为卡尼综合征:本病例说明了 CNC 的诊断难题,尤其是对于具有多种肿瘤表现和多种危及生命的临床表现的患者。它强调了采用多学科方法诊断和管理罕见病的重要性,通过及时的基因检测和协调护理改善了患者的预后。
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引用次数: 0
Use of hypertonic saline in severe symptomatic hyponatraemia; results from a national survey of endocrinologists in the United Kingdom. 在严重症状性低钠血症中使用高渗盐水;英国内分泌专家全国调查的结果。
IF 3 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-12-01 Epub Date: 2024-06-15 DOI: 10.1007/s12020-024-03927-9
Muhammad Fahad Arshad, Ahmed Iqbal

Background: Severe symptomatic hyponatraemia is potentially life-threatening and hypertonic saline (HTS) is effective at rapidly correcting serum sodium. Several clinical guidelines have aimed to standardise the administration of HTS. However, evidence supporting the guidelines is limited, and concerns have been raised regarding the potential for overcorrection.

Objective: To assess the practices and perceptions surrounding HTS use in severe symptomatic hyponatraemia among United Kingdom (UK) endocrinologists and trainees.

Methods: An anonymous online survey was disseminated to Society for Endocrinology (UK) clinical members between 24/10/2023 and 30/11/2023 using a web-based multiple-choice questionnaire.

Results: We received 133 responses with a survey response rate of 8.3% (60.1% consultants, 33.1% trainees, 6.8% others). 85% of respondents employed bolus treatment with HTS only, with 9.8% using both bolus and continuous infusions. Most (53.2%) preferred 150 mL boluses, followed by 100 mL boluses (19.8%), while 5.5% of respondents used weight-based dosage. Commonly used HTS strengths were 2.7% (45.1%), followed by 1.8% (31.6%), while the 3% HTS strength recommended in guidelines was used by 21.8%. Contrary to guidelines, 78.6% did not administer a second bolus without waiting for the sodium result after the first bolus. Moreover, 86% have experience using venous blood gas sodium readings for monitoring. Overcorrection targets defined by 10 and 8 mmol/24 h cut-offs were used by 48.9% and 39.9%, respectively. For definite or anticipated overcorrection, 75.9% preferred 5% dextrose, while 40.6% had experience with desmopressin.

Conclusion: Significant variation exists in HTS use for severe symptomatic hyponatraemia in the UK. Most clinicians prefer a more cautious approach in administering HTS. These data offer insight into real-life care and call for future research.

背景:严重的无症状低钠血症可能会危及生命,而高渗盐水 (HTS) 能有效快速纠正血清钠。一些临床指南旨在规范高渗盐水的施用。然而,支持这些指南的证据有限,而且人们对过度纠正的可能性表示担忧:目的:评估英国(UK)内分泌专家和受训人员对严重症状性低钠血症使用 HTS 的做法和看法:方法:在 2023 年 10 月 24 日至 2023 年 11 月 30 日期间,使用基于网络的多项选择问卷向英国内分泌学会的临床会员进行匿名在线调查:我们收到了 133 份回复,调查回复率为 8.3%(60.1% 为顾问,33.1% 为受训人员,6.8% 为其他人员)。85%的受访者仅使用 HTS 栓注治疗,9.8%的受访者同时使用栓注和持续输注。大多数受访者(53.2%)首选 150 毫升栓剂,其次是 100 毫升栓剂(19.8%),5.5% 的受访者使用基于体重的剂量。常用的 HTS 浓度为 2.7%(45.1%),其次是 1.8%(31.6%),而 21.8% 的受访者使用了指南推荐的 3% HTS 浓度。与指南相反,78.6% 的人在第一次给药后没有等待钠结果就进行了第二次给药。此外,86% 的人有使用静脉血气钠读数进行监测的经验。分别有 48.9% 和 39.9% 的人使用 10 和 8 mmol/24 h 临界值定义的过度纠正目标。对于明确或预期的过度纠正,75.9% 的人首选 5%葡萄糖,而 40.6% 的人有使用去氨加压素的经验:结论:在英国,对严重症状性低钠血症使用 HTS 的情况存在很大差异。大多数临床医生在使用 HTS 时更倾向于采取更为谨慎的方法。这些数据有助于深入了解现实生活中的护理情况,并呼吁开展未来研究。
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引用次数: 0
Non-invasive diagnosis of papillary thyroid microcarcinoma using a novel metabolomics analysis of urine. 利用新型尿液代谢组学分析对甲状腺乳头状微癌进行无创诊断
IF 3 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-24 DOI: 10.1007/s12020-024-04105-7
Mingjian Zhao, Ruowen Li, Chengxu Miao, Paolo Miccoli, Jinghui Lu

Background: The severity of thyroid cancer is judged on the basis of histologic and clinical features. A limited number of studies have considered urinary metabolite signatures for its diagnosis, and no reliable urinary metabolite biomarkers have been proposed. This diagnostic method would be particularly valuable because of its non-invasive nature.

Method: A nuclear magnetic resonance (NMR)-based metabolomics approach was used as the analytical platform to study the urine samples of patients with PTMC. Urine samples collected from 41 PTMC patients, 52 healthy subjects, and 13 patients with benign tumors were analyzed using 1H-NMR spectroscopy to identify metabolic changes. PLS-DA, or partial least squares discriminant analysis, was used to analyze the NMR spectra. A double cross-validation method and randomization tests were used to validate PLS-DA models.

Results: Clear discriminations between PTMC patients and healthy controls, as well as between PTMC patients and patients with benign tumors were obtained. Collectively, pi-methyhistidine, trimethylamine, myo-inositol, acetate, suberate, azelate, mannitol, tau-methylhistine, ascorbate, 3-aminoisobutyric acid, 2-oxoglutarate, and methanol contributed to the discrimination. Apart from myo-inositol and methanol, all of these metabolites exhibited increased levels in the urine samples of PTMC patients as compared to that of patients with benign tumors.

Conclusions: The application of this NMR-based metabolomics approach allowed the detection of anomalous metabolic traits directly connected PTMC, potentially yielding a more sensitive and comprehensive diagnostic results for PTMC.

背景:甲状腺癌的严重程度是根据组织学和临床特征来判断的。考虑用尿液代谢物特征来诊断甲状腺癌的研究数量有限,而且尚未提出可靠的尿液代谢物生物标志物。这种诊断方法因其非侵入性而特别有价值:方法:采用基于核磁共振(NMR)的代谢组学方法作为分析平台,研究 PTMC 患者的尿液样本。采用 1H-NMR 光谱法分析了从 41 名 PTMC 患者、52 名健康受试者和 13 名良性肿瘤患者采集的尿液样本,以确定代谢变化。采用 PLS-DA 或偏最小二乘判别分析法分析核磁共振波谱。采用双重交叉验证法和随机化测试来验证 PLS-DA 模型:结果:PTMC 患者与健康对照组之间、PTMC 患者与良性肿瘤患者之间均有明显的区分。π-甲基组氨酸、三甲胺、肌醇、乙酸盐、琥珀酸盐、泽泻盐、甘露醇、牛磺酸-甲基组氨酸、抗坏血酸、3-氨基异丁酸、2-氧代戊二酸和甲醇都有助于区分。与良性肿瘤患者相比,除肌醇和甲醇外,所有这些代谢物在 PTMC 患者尿样中的含量都有所增加:结论:应用这种基于核磁共振的代谢组学方法可直接检测出与 PTMC 相关的异常代谢特征,从而有可能为 PTMC 带来更灵敏、更全面的诊断结果。
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引用次数: 0
Causal association between serum 25-hydroxyvitamin D levels and gestational diabetes mellitus: a bidirectional two-sample Mendelian randomization study. 血清 25- 羟维生素 D 水平与妊娠糖尿病之间的因果关系:双向双样本孟德尔随机研究。
IF 3 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-23 DOI: 10.1007/s12020-024-04100-y
Wei Li, Kaili Zhu, Zhongqiang Ma, Tao Wang

Purpose: Previous investigations have assessed the connection between vitamin D deficiency and an increased risk of gestational diabetes mellitus (GDM); however, the findings remain inconsistent. The purpose of this study was to investigate the causal relationship between 25-hydroxyvitamin D (25OHD) levels and GDM.

Methods: Summary statistics data from genome-wide association studies (GWASs) were used to perform a bidirectional two-sample Mendelian randomization (MR) study. A total of 417,580 Europeans from the UK Biobank provided summary statistics data for 25OHD. The tenth data release of the FinnGen study provided the data for GDM, comprising 14,718 cases and 215,592 controls. For the univariate MR (uvMR) investigations, we employed the inverse variance weighted (IVW) method as our major analytical approach. Multiple sensitivity analyses were performed to evaluate the robustness of the results. Moreover, multivariate MR (mvMR) studies were conducted to account for potential confounding variables, including obesity, insulin resistance, and lipid traits.

Results: In the forward MR study, uvMR analysis did not provide evidence supporting a causal effect of 25OHD levels on the risk of GDM [IVW odds ratio (OR): 1.07, 95% confidence interval (CI): 0.95 to 1.19, p = 0.273]. After adjusting for obesity, fasting insulin levels, and lipid traits, the findings from the mvMR analysis aligned with those of the uvMR analysis. In the reverse MR study, uvMR analysis indicated that GDM had no causal effect on serum 25OHD levels (IVW β = -0.003, p = 0.804), and the robustness of this finding was confirmed in the mvMR study.

Conclusion: Our MR research revealed no causal effect of serum 25OHD levels on GDM, suggesting that 25OHD deficiency does not correlate with an increased risk of GDM. Furthermore, our reverse analysis revealed no causal effect of GDM on 25OHD levels.

目的:以往的研究评估了维生素 D 缺乏与妊娠糖尿病(GDM)风险增加之间的关系,但研究结果仍不一致。本研究旨在探讨 25- 羟基维生素 D(25OHD)水平与妊娠糖尿病之间的因果关系:方法:利用全基因组关联研究(GWAS)的汇总统计数据进行双向双样本孟德尔随机化(MR)研究。英国生物库(UK Biobank)共为 417,580 名欧洲人提供了 25OHD 的汇总统计数据。FinnGen研究的第十次数据发布提供了GDM的数据,包括14718个病例和215592个对照。在单变量磁共振(uvMR)调查中,我们采用了反方差加权法(IVW)作为主要分析方法。我们进行了多重敏感性分析,以评估结果的稳健性。此外,我们还进行了多变量磁共振(mvMR)研究,以考虑潜在的混杂变量,包括肥胖、胰岛素抵抗和脂质特征:在前瞻性 MR 研究中,uvMR 分析未提供证据支持 25OHD 水平对 GDM 风险的因果效应[IVW 比值比 (OR):1.07,95% 置信区间 (CI):0.95 至 1.19,p = 0.273]。对肥胖、空腹胰岛素水平和血脂特征进行调整后,mvMR 分析结果与 uvMR 分析结果一致。在反向 MR 研究中,uvMR 分析表明 GDM 对血清 25OHD 水平没有因果效应(IVW β = -0.003,p = 0.804),这一结果的稳健性在 mvMR 研究中得到了证实:我们的磁共振研究显示,血清 25OHD 水平对 GDM 没有因果效应,这表明 25OHD 缺乏与 GDM 风险的增加无关。此外,我们的反向分析表明,GDM 与 25OHD 水平没有因果关系。
{"title":"Causal association between serum 25-hydroxyvitamin D levels and gestational diabetes mellitus: a bidirectional two-sample Mendelian randomization study.","authors":"Wei Li, Kaili Zhu, Zhongqiang Ma, Tao Wang","doi":"10.1007/s12020-024-04100-y","DOIUrl":"https://doi.org/10.1007/s12020-024-04100-y","url":null,"abstract":"<p><strong>Purpose: </strong>Previous investigations have assessed the connection between vitamin D deficiency and an increased risk of gestational diabetes mellitus (GDM); however, the findings remain inconsistent. The purpose of this study was to investigate the causal relationship between 25-hydroxyvitamin D (25OHD) levels and GDM.</p><p><strong>Methods: </strong>Summary statistics data from genome-wide association studies (GWASs) were used to perform a bidirectional two-sample Mendelian randomization (MR) study. A total of 417,580 Europeans from the UK Biobank provided summary statistics data for 25OHD. The tenth data release of the FinnGen study provided the data for GDM, comprising 14,718 cases and 215,592 controls. For the univariate MR (uvMR) investigations, we employed the inverse variance weighted (IVW) method as our major analytical approach. Multiple sensitivity analyses were performed to evaluate the robustness of the results. Moreover, multivariate MR (mvMR) studies were conducted to account for potential confounding variables, including obesity, insulin resistance, and lipid traits.</p><p><strong>Results: </strong>In the forward MR study, uvMR analysis did not provide evidence supporting a causal effect of 25OHD levels on the risk of GDM [IVW odds ratio (OR): 1.07, 95% confidence interval (CI): 0.95 to 1.19, p = 0.273]. After adjusting for obesity, fasting insulin levels, and lipid traits, the findings from the mvMR analysis aligned with those of the uvMR analysis. In the reverse MR study, uvMR analysis indicated that GDM had no causal effect on serum 25OHD levels (IVW β = -0.003, p = 0.804), and the robustness of this finding was confirmed in the mvMR study.</p><p><strong>Conclusion: </strong>Our MR research revealed no causal effect of serum 25OHD levels on GDM, suggesting that 25OHD deficiency does not correlate with an increased risk of GDM. Furthermore, our reverse analysis revealed no causal effect of GDM on 25OHD levels.</p>","PeriodicalId":49211,"journal":{"name":"Endocrine","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Risk of ophthalmic adverse drug reactions in patients prescribed glucagon-like peptide 1 receptor agonists: a pharmacovigilance study based on the FDA adverse event reporting system database. 处方胰高血糖素样肽 1 受体激动剂的患者发生眼科不良药物反应的风险:基于美国食品药物管理局不良事件报告系统数据库的药物警戒研究。
IF 3 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-22 DOI: 10.1007/s12020-024-04112-8
Jianxing Zhou, Wei Huang, Yunzhen Xie, Haobin Shen, Maobai Liu, Xuemei Wu

Objective: To investigate the association between glucagon-like peptide 1 receptor agonists (GLP-1 RAs) and ophthalmic adverse drug reactions (OADRs) using data from the FDA Adverse Event Reporting System (FAERS).

Methods: This retrospective pharmacovigilance study analyzed post-marketing FAERS data from 2018 to 2023 to identify GLP-1 RA-related OADRs. This study employed the Weibull model for time-to-onset (TTO) analysis, Bayesian Information Component analysis for disproportionality comparing GLP-1 RAs with other drugs, and the Ω shrinkage method for co-medication analysis.

Results: FAERS reported 5003 OADRs associated with GLP-1 RAs, including retinopathy and visual impairment. Disproportionality analysis identified significant signals for semaglutide, liraglutide, and exenatide, suggesting potential associations with OADRs. Co-medication analysis indicated that OADRs primarily resulted from GLP-1 RA use. TTO analysis categorized most OADRs as early failures, emphasizing the need for early monitoring.

Conclusion: This study emphasizes the importance of ophthalmic surveillance in patients using GLP-1 RAs, particularly semaglutide, dulaglutide, and exenatide. Enhanced monitoring and patient education are essential for timely detection and management of potential OADRs. Regulatory agencies should consider updating drug labels to include comprehensive warnings about OADRs associated with GLP-1 RA therapies.

目的利用美国食品和药物管理局不良事件报告系统(FAERS)的数据,研究胰高血糖素样肽 1 受体激动剂(GLP-1 RA)与眼科药物不良反应(OADR)之间的关联:这项回顾性药物警戒研究分析了2018年至2023年上市后的FAERS数据,以确定GLP-1 RA相关的OADRs。本研究采用Weibull模型进行发病时间(TTO)分析,采用贝叶斯信息成分分析法比较GLP-1 RA与其他药物的不相称性,采用Ω收缩法进行联合用药分析:FAERS报告了5003例与GLP-1 RA相关的OADR,包括视网膜病变和视力损伤。比例失调分析确定了塞马鲁肽、利拉鲁肽和艾塞那肽的显著信号,表明它们与OADRs存在潜在关联。联合用药分析表明,OADRs 主要源于 GLP-1 RA 的使用。TTO分析将大多数OADR归类为早期失败,强调了早期监测的必要性:本研究强调了对使用 GLP-1 RA(尤其是塞马鲁肽、度拉鲁肽和艾塞那肽)的患者进行眼科监测的重要性。加强监测和患者教育对于及时发现和处理潜在的 OADR 至关重要。监管机构应考虑更新药物标签,全面警告与 GLP-1 RA 疗法相关的 OADR。
{"title":"Risk of ophthalmic adverse drug reactions in patients prescribed glucagon-like peptide 1 receptor agonists: a pharmacovigilance study based on the FDA adverse event reporting system database.","authors":"Jianxing Zhou, Wei Huang, Yunzhen Xie, Haobin Shen, Maobai Liu, Xuemei Wu","doi":"10.1007/s12020-024-04112-8","DOIUrl":"https://doi.org/10.1007/s12020-024-04112-8","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the association between glucagon-like peptide 1 receptor agonists (GLP-1 RAs) and ophthalmic adverse drug reactions (OADRs) using data from the FDA Adverse Event Reporting System (FAERS).</p><p><strong>Methods: </strong>This retrospective pharmacovigilance study analyzed post-marketing FAERS data from 2018 to 2023 to identify GLP-1 RA-related OADRs. This study employed the Weibull model for time-to-onset (TTO) analysis, Bayesian Information Component analysis for disproportionality comparing GLP-1 RAs with other drugs, and the Ω shrinkage method for co-medication analysis.</p><p><strong>Results: </strong>FAERS reported 5003 OADRs associated with GLP-1 RAs, including retinopathy and visual impairment. Disproportionality analysis identified significant signals for semaglutide, liraglutide, and exenatide, suggesting potential associations with OADRs. Co-medication analysis indicated that OADRs primarily resulted from GLP-1 RA use. TTO analysis categorized most OADRs as early failures, emphasizing the need for early monitoring.</p><p><strong>Conclusion: </strong>This study emphasizes the importance of ophthalmic surveillance in patients using GLP-1 RAs, particularly semaglutide, dulaglutide, and exenatide. Enhanced monitoring and patient education are essential for timely detection and management of potential OADRs. Regulatory agencies should consider updating drug labels to include comprehensive warnings about OADRs associated with GLP-1 RA therapies.</p>","PeriodicalId":49211,"journal":{"name":"Endocrine","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Deep learning based analysis of dynamic video ultrasonography for predicting cervical lymph node metastasis in papillary thyroid carcinoma. 基于深度学习的动态视频超声分析预测甲状腺乳头状癌的颈淋巴结转移
IF 3 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-18 DOI: 10.1007/s12020-024-04091-w
Tingting Qian, Yahan Zhou, Jincao Yao, Chen Ni, Sohaib Asif, Chen Chen, Lujiao Lv, Di Ou, Dong Xu

Background: Cervical lymph node metastasis (CLNM) is the most common form of thyroid cancer metastasis. Accurate preoperative CLNM diagnosis is of more importance in patients with papillary thyroid cancer (PTC). However, there is currently no unified methods to objectively predict CLNM risk from ultrasonography in PTC patients.This study aimed to develop a deep learning (DL) model to help clinicians more accurately determine the existence of CLNM risk in patients with PTC and then assist them with treatment decisions.

Methods: Ultrasound dynamic videos of 388 patients with 717 thyroid nodules were retrospectively collected from Zhejiang Cancer Hospital between January 2020 and June 2022. Five deep learning (DL) models were investigated to examine its efficacy for predicting CLNM risks and their performances were also compared with those predicted using two-dimensional ultrasound static images.

Results: In the testing dataset (n = 78), the DenseNet121 model trained on ultrasound dynamic videos outperformed the other four DL models as well as the DL model trained using the two-dimensional (2D) static images across all metrics. Specifically, using DenseNet121, the comparison between the 3D model and 2D model for all metrics are shown as below: AUROC: 0.903 versus 0.828, sensitivity: 0.877 versus 0.871, specificity: 0.865 versus 0.659.

Conclusions: This study demonstrated that the DenseNet121 model has the greatest potential in distinguishing CLNM from non-CLNM in patients with PTC. Dynamic videos also offered more information about the disease states which have proven to be more efficient and robust in identifying CLNM compared to statis images.

背景:颈淋巴结转移(CLNM)是甲状腺癌最常见的转移形式。对于甲状腺乳头状癌(PTC)患者来说,术前准确诊断CLNM更为重要。本研究旨在开发一种深度学习(DL)模型,帮助临床医生更准确地判断PTC患者是否存在CLNM风险,进而协助他们做出治疗决策:方法:回顾性收集了浙江省肿瘤医院2020年1月至2022年6月期间388例717个甲状腺结节患者的超声动态视频。研究了五个深度学习(DL)模型,以检验其预测CLNM风险的有效性,并将其性能与使用二维超声静态图像预测的性能进行了比较:在测试数据集(n = 78)中,根据超声动态视频训练的 DenseNet121 模型在所有指标上都优于其他四个 DL 模型以及使用二维(2D)静态图像训练的 DL 模型。具体来说,使用 DenseNet121,三维模型和二维模型在所有指标上的比较如下:AUROC:0.903 对 0.828,灵敏度:0.877 对 0.871,特异性:0.865 对 0.659:这项研究表明,DenseNet 121 模型在区分 PTC 患者的 CLNM 和非 CLNM 方面具有最大的潜力。动态视频还提供了更多有关疾病状态的信息,事实证明,与静态图像相比,动态视频在识别 CLNM 方面更有效、更稳健。
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引用次数: 0
Impact of nodal status evaluation on therapeutic strategy for clinically unifocal T1b/small T2 node negative papillary thyroid carcinoma. 结节状态评估对临床单灶T1b/小T2结节阴性甲状腺乳头状癌治疗策略的影响。
IF 3 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-18 DOI: 10.1007/s12020-024-04101-x
Antonio Laurino, Francesco Pennestrì, Priscilla Francesca Procopio, Annamaria Martullo, Gloria Santoro, Pierpaolo Gallucci, Francesca Prioli, Luca Sessa, Esther Diana Rossi, Alfredo Pontecorvi, Carmela De Crea, Marco Raffaelli

Purpose: In absence of nodal metastases or aggressive features, thyroid lobectomy (TL) should be preferred over total thyroidectomy (TT) for 1-4 cm unifocal, papillary thyroid carcinoma (PTC). However, occult, despite non-microscopic (≥2 mm), nodal metastases may be present in clinically node-negative (cN0) PTC.

Methods: Among 4216 thyroidectomies for malignancy (2014-2023), 110 TL plus ipsilateral central neck dissection (I-CND) were scheduled for unifocal cT1b/small cT2 (≤3 cm) cN0 PTCs. Frozen section examination (FSE) of removed nodes was performed: when positive, completion thyroidectomy (CT) was accomplished during the same procedure. In presence of aggressive pathologic features, CT was suggested within 6 months from index operation.

Results: FSE was positive for occult not-microscopic nodal metastases in 33 cases (30%), underwent synchronous CT. Among the remaining 77 patients, 24 (31.2%) were scheduled for CT, after multidisciplinary tumor board discussion, due to at least 2 high-risk factors. The median number of removed and metastatic nodes was 8 (5-11) and 2 (1-5), respectively, at definitive histopathology. Furthermore, multifocality was present in 53 (48.2%) cases, lymphovascular invasion in 66 (60%) cases, aggressive subtypes in 20 (18.2%) cases and extracapsular invasion in 5 (4.5%) cases. Overall, 57 (51.8%) patients underwent immediate or delayed CT.

Conclusion: More than 50% of patients with unifocal cT1b/small cT2 cN0 PTC scheduled for TL may be eligible for CT because of aggressive tumor features. An intraoperative decision-making approach based on I-CND and nodes FSE may ensure accurate staging and risk stratification, thus reducing the risk of recurrence and the need for reoperation.

目的:对于1-4厘米单灶甲状腺乳头状癌(PTC),如果没有结节转移或侵袭性特征,甲状腺叶切除术(TL)应优于甲状腺全切除术(TT)。然而,临床结节阴性(cN0)的PTC可能存在隐匿性结节转移,尽管不显微(≥2 mm):在4216例恶性肿瘤甲状腺切除术(2014-2023年)中,110例TL加同侧颈部中央切除术(I-CND)是针对单灶cT1b/小cT2(≤3厘米)cN0 PTC而安排的。对切除的结节进行冷冻切片检查(FSE):如果结果呈阳性,则在同一手术过程中完成甲状腺切除术(CT)。如果出现侵袭性病理特征,建议在手术后 6 个月内进行 CT 检查:结果:33 例(30%)FSE 阳性的隐匿性非显微结节转移患者接受了同步 CT 检查。在剩余的 77 例患者中,有 24 例(31.2%)因至少两个高危因素而在多学科肿瘤委员会讨论后被安排接受 CT 检查。最终组织病理学结果显示,切除结节和转移结节的中位数分别为 8 个(5-11)和 2 个(1-5)。此外,53 例(48.2%)存在多灶性,66 例(60%)存在淋巴管侵犯,20 例(18.2%)存在侵袭性亚型,5 例(4.5%)存在囊外侵犯。总体而言,57 例(51.8%)患者接受了即时或延迟 CT 检查:结论:50%以上计划接受TL手术的单灶cT1b/小cT2 cN0 PTC患者可能因肿瘤侵袭性特征而符合CT检查条件。基于 I-CND 和结节 FSE 的术中决策方法可确保准确的分期和风险分层,从而降低复发风险和再次手术的需要。
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引用次数: 0
Identification and in vivo functional analysis of a novel missense mutation in GATA3 causing hypoparathyroidism, sensorineural deafness and renal dysplasia syndrome in a Chinese family. 在一个中国家族中鉴定并体内功能分析导致甲状旁腺功能减退症、感音神经性耳聋和肾发育不良综合征的新型 GATA3 错义突变。
IF 3 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-07 DOI: 10.1007/s12020-024-04087-6
Shuyao Pan, Shushu Long, Liangchun Cai, Junping Wen, Wei Lin, Gang Chen

Purpose: Hypoparathyroidism, sensorineural deafness, and renal dysplasia (HDR) syndrome is a rare autosomal dominant genetic disease associated with mutations in the GATA3 gene, which encodes GATA3 that plays essential roles in vertebrate development. This study aimed to identify and report the pathogenic mutation in GATA3 in a Chinese family diagnosed with HDR syndrome and determine its functional impacts in vivo.

Subjects and methods: The clinical features of a 25-year-old male patient with HDR syndrome and his parents were collected. GATA3 gene exome sequencing and Sanger sequencing were performed on the proband and his family, respectively. Functional analyses of GATA3 were performed using bioinformatics tools and zebrafish assays to determine pathogenicity and phenotype spectrum.

Results: A novel, heterozygous, missense mutation in exon 4 of the GATA3 gene, c.863 G > A, p.Cys288Tyr, in the proband and his mother who presented the complete HDR triad, was predicted to be deleterious by in silico tools. 3D structure modeling showed that the variant caused significant structural changes. In vivo studies using a zebrafish animal model revealed the deleterious impact of the variant on the gill buds, otoliths, and pronephros.

Conclusion: We identified a novel missense mutation, GATA3 p.Cys288Tyr, within a family with HDR syndrome and delineated it as a loss-of-function variant in vivo. This expands the spectrum of GATA3 mutations associated with HDR syndrome in the Chinese population and mimics HDR-related changes in vivo.

目的:甲状旁腺功能减退、感音神经性耳聋和肾发育不良(HDR)综合征是一种罕见的常染色体显性遗传病,与GATA3基因突变有关。本研究旨在发现并报告一个中国HDR综合征家族中GATA3基因的致病突变,并确定其在体内的功能影响:收集了一名25岁男性HDR综合征患者及其父母的临床特征。方法:收集 25 岁 HDR 综合征男性患者及其父母的临床特征,分别对该患者及其家族进行 GATA3 基因外显子组测序和 Sanger 测序。利用生物信息学工具和斑马鱼实验对 GATA3 进行了功能分析,以确定致病性和表型谱:结果:GATA3基因第4外显子上的一个新的杂合子错义突变,即c.863 G > A, p.Cys288Tyr, 在呈现完整HDR三联征的受试者及其母亲身上,被硅学工具预测为有害突变。三维结构建模显示,该变异体引起了显著的结构变化。利用斑马鱼动物模型进行的体内研究显示,该变异对鳃芽、耳石和前肾产生了有害影响:我们在一个 HDR 综合征家族中发现了一个新的错义突变 GATA3 p.Cys288Tyr,并将其界定为体内功能缺失变异。这扩大了中国人群中与 HDR 综合征相关的 GATA3 突变的范围,并模拟了体内与 HDR 相关的变化。
{"title":"Identification and in vivo functional analysis of a novel missense mutation in GATA3 causing hypoparathyroidism, sensorineural deafness and renal dysplasia syndrome in a Chinese family.","authors":"Shuyao Pan, Shushu Long, Liangchun Cai, Junping Wen, Wei Lin, Gang Chen","doi":"10.1007/s12020-024-04087-6","DOIUrl":"https://doi.org/10.1007/s12020-024-04087-6","url":null,"abstract":"<p><strong>Purpose: </strong>Hypoparathyroidism, sensorineural deafness, and renal dysplasia (HDR) syndrome is a rare autosomal dominant genetic disease associated with mutations in the GATA3 gene, which encodes GATA3 that plays essential roles in vertebrate development. This study aimed to identify and report the pathogenic mutation in GATA3 in a Chinese family diagnosed with HDR syndrome and determine its functional impacts in vivo.</p><p><strong>Subjects and methods: </strong>The clinical features of a 25-year-old male patient with HDR syndrome and his parents were collected. GATA3 gene exome sequencing and Sanger sequencing were performed on the proband and his family, respectively. Functional analyses of GATA3 were performed using bioinformatics tools and zebrafish assays to determine pathogenicity and phenotype spectrum.</p><p><strong>Results: </strong>A novel, heterozygous, missense mutation in exon 4 of the GATA3 gene, c.863 G > A, p.Cys288Tyr, in the proband and his mother who presented the complete HDR triad, was predicted to be deleterious by in silico tools. 3D structure modeling showed that the variant caused significant structural changes. In vivo studies using a zebrafish animal model revealed the deleterious impact of the variant on the gill buds, otoliths, and pronephros.</p><p><strong>Conclusion: </strong>We identified a novel missense mutation, GATA3 p.Cys288Tyr, within a family with HDR syndrome and delineated it as a loss-of-function variant in vivo. This expands the spectrum of GATA3 mutations associated with HDR syndrome in the Chinese population and mimics HDR-related changes in vivo.</p>","PeriodicalId":49211,"journal":{"name":"Endocrine","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142591944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Diagnostic value of TRIM22 in diabetic kidney disease and its mechanism. TRIM22 在糖尿病肾病中的诊断价值及其机制。
IF 3 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-07 DOI: 10.1007/s12020-024-04089-4
Qianhui Wang, Qingmiao Ge, Jingjing Wang, Yonggui Wu, Xiangming Qi

Purpose: Diabetic kidney disease (DKD) is the primary reason of chronic kidney disease. Our objective was to discover potential autophagy-related biomarkers of tubulointerstitial injury in DKD and assess their clinical value.

Methods: We retrieved four datasets (GSE104954, GSE30122, GSE30529, and GSE99340) of renal tubule samples from Gene Expression Omnibus (GEO) and used two algorithms (LASSO and SVM-RFE) to screen for autophagy-related differentially expressed genes (ARDEGs) in DKD. Tripartite motif containing 22 (TRIM22) was identified for subsequent validation. Validation of TRIM22 and autophagic indicators expression in clinical samples and HK-2 cells stimulated by high glucose using immunohistochemistry, immunofluorescence, and western blot.

Results: We identified four ARDEGs (TRIM22, PLK2, HTR2B, and FAS) using a diagnostic gene model. ROC curves further confirmed that TRIM22 had the best diagnostic efficacy for DKD. Both clinical samples and HK-2 cells stimulated by high glucose showed high protein expression of TRIM22. The correlation analysis revealed that TRIM22 correlates with SQSTM1, NGAL, and some clinical and pathological indicators in patients with DKD.

Conclusion: We identified TRIM22 as a potential diagnostic biomarker for DKD, revealing its high diagnostic value in patients with DKD with moderate-to-severe interstitial fibrosis and tubular atrophy (IFTA). TRIM22 is involved in tubulointerstitial injury and autophagy dysregulation in DKD.

目的:糖尿病肾病(DKD)是慢性肾病的主要原因。我们的目的是发现 DKD 肾小管间质损伤的潜在自噬相关生物标志物,并评估其临床价值:我们从基因表达总库(Gene Expression Omnibus,GEO)中检索了四个肾小管样本数据集(GSE104954、GSE30122、GSE30529和GSE99340),并使用两种算法(LASSO和SVM-RFE)筛选DKD中与自噬相关的差异表达基因(ARDEGs)。结果发现了含有三方基序 22(TRIM22)的自噬基因,并对其进行了后续验证。利用免疫组化、免疫荧光和免疫印迹技术验证了TRIM22和自噬指标在临床样本和受到高葡萄糖刺激的HK-2细胞中的表达:结果:我们利用诊断基因模型确定了四个 ARDEGs(TRIM22、PLK2、HTR2B 和 FAS)。ROC曲线进一步证实,TRIM22对DKD的诊断效果最佳。临床样本和受到高葡萄糖刺激的HK-2细胞都显示出TRIM22的高蛋白表达。相关性分析表明,TRIM22与SQSTM1、NGAL以及DKD患者的一些临床和病理指标相关:结论:我们发现TRIM22是一种潜在的DKD诊断生物标志物,它对伴有中重度间质纤维化和肾小管萎缩(IFTA)的DKD患者具有很高的诊断价值。TRIM22参与了DKD的肾小管间质损伤和自噬失调。
{"title":"Diagnostic value of TRIM22 in diabetic kidney disease and its mechanism.","authors":"Qianhui Wang, Qingmiao Ge, Jingjing Wang, Yonggui Wu, Xiangming Qi","doi":"10.1007/s12020-024-04089-4","DOIUrl":"https://doi.org/10.1007/s12020-024-04089-4","url":null,"abstract":"<p><strong>Purpose: </strong>Diabetic kidney disease (DKD) is the primary reason of chronic kidney disease. Our objective was to discover potential autophagy-related biomarkers of tubulointerstitial injury in DKD and assess their clinical value.</p><p><strong>Methods: </strong>We retrieved four datasets (GSE104954, GSE30122, GSE30529, and GSE99340) of renal tubule samples from Gene Expression Omnibus (GEO) and used two algorithms (LASSO and SVM-RFE) to screen for autophagy-related differentially expressed genes (ARDEGs) in DKD. Tripartite motif containing 22 (TRIM22) was identified for subsequent validation. Validation of TRIM22 and autophagic indicators expression in clinical samples and HK-2 cells stimulated by high glucose using immunohistochemistry, immunofluorescence, and western blot.</p><p><strong>Results: </strong>We identified four ARDEGs (TRIM22, PLK2, HTR2B, and FAS) using a diagnostic gene model. ROC curves further confirmed that TRIM22 had the best diagnostic efficacy for DKD. Both clinical samples and HK-2 cells stimulated by high glucose showed high protein expression of TRIM22. The correlation analysis revealed that TRIM22 correlates with SQSTM1, NGAL, and some clinical and pathological indicators in patients with DKD.</p><p><strong>Conclusion: </strong>We identified TRIM22 as a potential diagnostic biomarker for DKD, revealing its high diagnostic value in patients with DKD with moderate-to-severe interstitial fibrosis and tubular atrophy (IFTA). TRIM22 is involved in tubulointerstitial injury and autophagy dysregulation in DKD.</p>","PeriodicalId":49211,"journal":{"name":"Endocrine","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Evaluation of the impact Of ChatGPT support on acromegaly management and patient education. 评估 ChatGPT 支持对肢端肥大症管理和患者教育的影响。
IF 3 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-05 DOI: 10.1007/s12020-024-04086-7
Ekin Yiğit Köroğlu, Reyhan Ersoy, Muhammed Saçıkara, Fatma Dilek Dellal Kahramanca, Şefika Burçak Polat, Oya Topaloğlu, Bekir Çakır

Purpose: ChatGPT is a widely used artificial intelligence modeling tool. Healthcare is one potential area of use of ChatGPT. This study aimed to test the usability and reliability of ChatGPT in acromegaly, which is less known in society and should be evaluated by a group of specialized physicians.

Methods: The study is designed in two parts. For the first part, 35 questions regarding acromegaly that patients frequently ask were identified, and these questions were asked to ChatGPT. In the second part, four patient examples were presented to ChatGPT using medical terminology. Three experts evaluated ChatGPT's answers to the questions and approaches in case management using 7-point scales in terms of safety, reliability, correctness, and usability.

Results: When the ChatGPT answers to the patient's questions were evaluated, a mean score of 6.78 ± 0.55 was given for correctness and 6.69 ± 0.60 for reliability. The mean scores given by the raters for correctness, safety and usability in the evaluation of the cases were as follows: 6.33 ± 0.88, 6.16 ± 0. 71 and 6.08 ± 0.79 points for case 1; 5.35 ± 1.88, 5.29 ± 1.80 and 5.20 ± 1.86 points for case 2; 6.08 ± 0.97, 6.00 ± 0.93 and 5.91 ± 0.82 points for case 3; 6.10 ± 1.29, 6.13 ± 1.30 and 6.16 ± 1.14 points for case 4.

Conclusion: ChatGPT can actively answer the questions of acromegaly patients. Although it is not a reliable source alone in managing patients with acromegaly, it can be a supportive tool for physicians.

目的:ChatGPT 是一种广泛使用的人工智能建模工具。医疗保健是 ChatGPT 的一个潜在应用领域。本研究旨在测试 ChatGPT 在肢端肥大症中的可用性和可靠性:研究分为两部分。在第一部分中,确定了患者经常提出的有关肢端肥大症的 35 个问题,并将这些问题输入 ChatGPT。在第二部分中,使用医学术语向 ChatGPT 介绍了四个患者案例。三位专家从安全性、可靠性、正确性和可用性等方面,使用 7 点量表对 ChatGPT 的问题解答和病例管理方法进行了评估:在对 ChatGPT 回答患者问题的情况进行评估时,正确性的平均得分为 6.78 ± 0.55,可靠性的平均得分为 6.69 ± 0.60。在对病例的评估中,评分者对正确性、安全性和可用性给出的平均分如下:6.33 ± 0.88, 6.16 ± 0.71和6.08±0.79分;案例2为5.35±1.88、5.29±1.80和5.20±1.86分;案例3为6.08±0.97、6.00±0.93和5.91±0.82分;案例4为6.10±1.29、6.13±1.30和6.16±1.14分:ChatGPT 可以积极回答肢端肥大症患者的问题。虽然它不是管理肢端肥大症患者的唯一可靠来源,但可以成为医生的辅助工具。
{"title":"Evaluation of the impact Of ChatGPT support on acromegaly management and patient education.","authors":"Ekin Yiğit Köroğlu, Reyhan Ersoy, Muhammed Saçıkara, Fatma Dilek Dellal Kahramanca, Şefika Burçak Polat, Oya Topaloğlu, Bekir Çakır","doi":"10.1007/s12020-024-04086-7","DOIUrl":"https://doi.org/10.1007/s12020-024-04086-7","url":null,"abstract":"<p><strong>Purpose: </strong>ChatGPT is a widely used artificial intelligence modeling tool. Healthcare is one potential area of use of ChatGPT. This study aimed to test the usability and reliability of ChatGPT in acromegaly, which is less known in society and should be evaluated by a group of specialized physicians.</p><p><strong>Methods: </strong>The study is designed in two parts. For the first part, 35 questions regarding acromegaly that patients frequently ask were identified, and these questions were asked to ChatGPT. In the second part, four patient examples were presented to ChatGPT using medical terminology. Three experts evaluated ChatGPT's answers to the questions and approaches in case management using 7-point scales in terms of safety, reliability, correctness, and usability.</p><p><strong>Results: </strong>When the ChatGPT answers to the patient's questions were evaluated, a mean score of 6.78 ± 0.55 was given for correctness and 6.69 ± 0.60 for reliability. The mean scores given by the raters for correctness, safety and usability in the evaluation of the cases were as follows: 6.33 ± 0.88, 6.16 ± 0. 71 and 6.08 ± 0.79 points for case 1; 5.35 ± 1.88, 5.29 ± 1.80 and 5.20 ± 1.86 points for case 2; 6.08 ± 0.97, 6.00 ± 0.93 and 5.91 ± 0.82 points for case 3; 6.10 ± 1.29, 6.13 ± 1.30 and 6.16 ± 1.14 points for case 4.</p><p><strong>Conclusion: </strong>ChatGPT can actively answer the questions of acromegaly patients. Although it is not a reliable source alone in managing patients with acromegaly, it can be a supportive tool for physicians.</p>","PeriodicalId":49211,"journal":{"name":"Endocrine","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142577072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Endocrine
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