Archives of Endocrinology Metabolism最新文献

Objective: To determine the prevalence of protective sensory loss in patients with diabetes mellitus at a university hospital and to identify clinical and sociodemographic factors associated with this condition.

Methods: This cross-sectional study was conducted with diabetic patients attending specialized outpatient clinics. Data were collected through patient interviews and medical record reviews, in conjunction with using the monofilament test to assess protective sensory loss in the feet. Statistical analyses included descriptive and exploratory tests, as well as bivariate and multivariate analyses to identify factors associated with sensory loss (p < 0.05).

Results: A total of 184 patients were interviewed, but only 169 were included in the primary outcome analyses. The median age was 61 years, with the majority being female (72%), self-identifying as mixed-race (54%), and diagnosed with type 2 diabetes mellitus (87%). The prevalence of protective sensory loss was 20%. Factors such as a longer duration of diabetes mellitus (95%CI 1.01-1.09; p = 0.022), the presence of target organ damage (95%CI 1.25-6.84; p = 0.015), and increased body weight (OR = 1.04; 95%CI 1.01-1.07; p = 0.007) were significantly associated with sensory loss. Although systemic arterial hypertension was initially associated in the bivariate analysis, it did not remain an independent predictor.

Conclusion: The significant prevalence of protective sensory loss and the lack of awareness about the monofilament test among many patients emphasize the need to expand neuropathy screening and health education in diabetes management.

Objective: This study investigated the clinical value of ultrasound-guided fine-needle aspiration biopsy (US-FNAB), computed tomography (CT) and BRAFV600E combination for papillary thyroid carcinoma (PTC) diagnosis.

Subjects and methods: A total of 300 patients with thyroid nodules were assigned to the PTC group (n = 184) and the nodular goiter (NG) group (n = 116). The positive detection rates of US-FNAB, CT and BRAFV600E gene mutation and their relationship with tumor number, tumor diameter, lymphatic metastasis, capsule invasion and tumor-node-metastasis (TNM) staging were analyzed, with their diagnostic value for PTC analyzed by the receiver operating characteristic (ROC) curve. The area under multiple ROC curves (AUCs) were compared using MEDCALC software.

Results: The positive detection rates of US-FNAB, CT and BRAFV600E gene mutation were 78.80%, 72.28% and 83.15% in the PTC group, and 30.17%, 27.59% and 9.48% in the NG group, while the negative detection rates were 21.20%, 27.72% and 16.85% in the PTC group, and 69.82%, 72.41% and 90.52% in the NG group. Positive US-FNAB and BRAFV600E gene mutation in PTC patients related to TNM staging. Positive CT and BRAFV600E gene mutation linked to lymphatic metastasis. US-FNAB (AUC: 0.743, sensitivity: 78.80%, specificity: 69.83%), CT (AUC: 0.723, sensitivity: 77.28%, specificity: 72.41%) and BRAFV600E (AUC: 0.868, sensitivity: 83.15%, specificity: 90.52%) gene detections helped PTC diagnosis, with their combined diagnostic value (AUC: 0.938, sensitivity: 78.26%, specificity: 96.55%) surpassing that of them alone.

Conclusion: US-FNAB, CT and BRAFV600E gene tests helped PTC diagnosis, and their combined detection had higher diagnostic value for PTC than their single detection.

Introduction: Familial chylomicronemia syndrome (FCS) is an autosomal recessive disorder that affects approximately 1 to 10 individuals per million and is caused by variants in the genes encoding for the lipoprotein lipase (LPL) enzyme. In addition to its heterogeneous clinical presentation, FCS is characterized by a higher risk of life-threatening, recurrent acute pancreatitis and type 3 diabetes. Since available evidence on FCS in Latin America is limited, there is a clear need for a consensus document that provides relevant recommendations to guide the management of suspected cases and optimize disease diagnosis across the region.

Methods: A panel of specialists from Latin America with extensive experience in the diagnosis of chylomicronemia was invited to participate in the creation of this document. The modified Delphi technique was used to reach group consensus through multiple rounds of questionnaires using statistical techniques and controlled feedback. Results and discussion: Seventeen recommendations on diagnosis of FCS were generated. This consensus reflects the collaborative efforts of Latin American scientific societies and is essential to suspect and diagnose FCS. The organizations that support this document, including Sociedad Argentina de Lípidos, Federación Argentina de Sociedades de Endocrinología, Fundación Bioquímica Argentina, Corporación Grupo Chileno de Trabajo en Ateroesclerosis, Asociación Colombiana de Endocrinología, Diabetes y Metabolismo, Departamento de Aterosclerose da Sociedade Brasileira de Cardiología, and Sociedad Mexicana de Nutrición y Endocrinología, are a robust support network that might aid the adoption of these recommendations in local healthcare systems.

Objective: To investigate the Mitochondrial Open Reading Frame of the 12S rRNA type-c (MOTS-c) peptide levels in individuals with obesity compared to those with a normal body mass index and to examine the association of MOTS-c levels with markers of insulin resistance, endothelial function, and inflammation.

Methods: In this study 85 individuals were enrolled, including 48 with a body mass index ≥ 30 kg/m2 and 37 with a body mass index between 18.5 and 24.9 kg/m2. Individuals with smoking, pregnancy, type 2 diabetes mellitus and other chronic conditions were excluded. Blood samples were collected after at least 8 hours of fasting to measure serum MOTS-c, insulin, high-sensitivity C-reactive protein, and asymmetric dimethylarginine levels. Statistical analyses included t-tests, Mann-Whitney U tests, Chi-squared tests, correlation analyses, and multiple regression analyses.

Results: We found no significant difference in serum MOTS-c levels between individuals with obesity and those with normal body mass index (14.33 ± 3.76 pg/mL versus 13.67 ± 3.44 pg/mL; p = 0.395). Serum MOTS-c levels showed a significant positive correlation with the HOMA-IR index (p < 0.05) but did not correlate with high-sensitivity C-reactive protein or asymmetric dimethylarginine levels. Multiple regression analysis indicated that age and HOMA-IR were significant predictors of MOTS-c levels, with MOTS-c decreasing with age and increasing with higher insulin resistance.

Conclusion: Serum MOTS-c levels were similar in individuals with obesity and those with normal weight. The study highlighted age and insulin resistance as significant determinants of MOTS-c levels.

Objective: To evaluate the effect of diabetes mellitus and its chronic complications on thiol/disulfide homeostasis.

Methods: The study included 381 participants divided into six groups: healthy controls (Group 1; n = 91), patients with prediabetes (Group 2; n = 50), patients with diabetes mellitus without complications (Group 3; n = 70), patients with diabetic retinopathy (Group 4; n = 47), patients with diabetic nephropathy (Group 5; n = 70), and patients with diabetic foot (Group 6; n = 53). Thiol/disulfide homeostasis was determined by measuring the reduction reaction of oxidized thiols.

Results: Native thiol levels were low in patients with diabetes mellitus complications (Group 4, 264.7 ± 58.5 µmol/L; Group 5, 246.6 ± 67.5 µmol/L; Group 6, 174.3 ± 65.9 µmol/L), as were total thiol levels. The highest and lowest disulfide levels were observed in Group 1 (controls; 20.4 ± 5.2 µmol/L) and Group 6 (16.2 ± 5.7 µmol/L), respectively. The disulfide/native thiol ratio was increased in Groups 4, 5, and 6 compared with Groups 1, 2, and 3.

Conclusion: The presence of diabetes mellitus complications substantially decreased native thiol, total thiol, and disulfide levels.

Objective: To investigate the association of copeptin levels in the postpartum period with previous gestational diabetes mellitus, as well as its cardiometabolic phenotypes and biomarkers.

Methods: In this cross-sectional analysis, women followed at a specialized gestational diabetes mellitus outpatient clinic were studied. Eligibility criteria included age ≥ 18 years and body mass index > 25 kg/m2. Participants were divided into two groups: those with (n = 42) and without gestational diabetes mellitus (n = 43). In the postpartum period (2 to 6 months), between September 2018 and May 2020, blood samples were collected for measurement of copeptin and E-selectin (by enzyme-linked immunosorbent assay), adiponectin, blood glucose, insulin, glycated hemoglobin, lipid profile, thyroid stimulating hormone, and gamma-GT.

Results: Eighty-five women were studied; 42 had previous gestational diabetes mellitus and 43 did not. There were no significant differences in copeptin levels between women with and without previous gestational diabetes mellitus (1.48 ± 0.66 versus 1.49 ± 0.68 pmol/L; p = 0.89). No associations were observed between copeptin levels and the other studied parameters. However, a positive association was found between copeptin and E-selectin levels in both groups (Kruskal-Wallis; p = 0.007).

Conclusion: Circulating copeptin levels were not associated with previous gestational diabetes mellitus or other related phenotypes in the postpartum period. A positive association was observed between copeptin and plasma E-selectin levels in women with and without previous gestational diabetes mellitus, which warrants further investigation.

Objective: This study aimed to investigate the presence of tertiary lymphoid structures (TLSs) and tumor-infiltrating B cells within the germinal centers of TLSs in the tumor microenvironment of thyroid cancer, utilizing a morphological approach.

Materials and methods: Histological samples from patients with papillary thyroid carcinoma (PTC) (n = 112) stained with hematoxylin and eosin were examined. The presence of lymphoid neogenesis in PTC was determined based on morphological features and classified according to TLS location and maturation status. Immunofluorescence staining was performed on selected cases to identify B cells within mature TLSs. Additionally, 499 scanned slides from the PTC cohort in The Cancer Genome Atlas - Thyroid Carcinoma (TCGA-THCA) dataset were accessed via cBioPortal to assess the presence of TLSs and compare the clinical and molecular characteristics of PTC cases with and without TLSs.

Results: Tertiary lymphoid structures, resembling ectopic lymph nodes, were identified in 41% (46/112) of the histological PTC samples. Among these, 63% (29/46) were located in peritumoral regions, while 13% (6/46) were found within the intratumoral area. Mature TLSs containing germinal centers, in which B cells were detected, were observed in 15% (7/46) of cases. Immature TLSs were detected in 52% (24/46) of PTC cases with TLSs. Analysis of PTC scanned images from cBioPortal revealed TLSs in 8.4% of cases, of which 62% harbored the BRAFV600E mutation, along with upregulation of immune cell markers and SLC5A5 (NIS) expression.

Conclusion: The identification of TLSs across multiple malignancies underscores their functional significance in modulating tumor-immune interactions with clinical implications. Therefore, the identification and morphological characterization of TLSs in PTC may provide valuable insights into their potential as immunobiomarkers in thyroid cancer.

Objective: To develop a practical and cost-effective test to distinguish patients with malignant thyroid nodules eligible for active surveillance from those requiring immediate surgery.

Methods: This prospective observational study included patients with malignant thyroid nodules (3 to 15 mm) who were assigned to either an Active Surveillance Group (n = 30) or a Surgery Group (n = 21) based on the institutional protocol. The Surgery Group was further stratified according to the American Thyroid Association risk of recurrence/persistence. Preoperative serum levels of miR-146b-5p and miR-204, normalized to miR-16, were analyzed. Receiver operating characteristic curves were used to establish cut-off values to differentiate between low and intermediate/high risk of recurrence/persistence, which were subsequently applied to the Active Surveillance Group.

Results: Patients were initially assigned to the active surveillance (n = 30; 53.5 ± 12.6 years old) or Surgery Group (n = 21; 41.9 ± 7.9 years old). The mean follow-up duration for the Active Surveillance Group was 36.4 ± 25.8 months, during which no patients experienced disease progression. Five patients in the Active Surveillance Group were subsequently transitioned to the Surgery Group. Molecular analysis of the Surgery Group indicated that upregulation of miR-146b-5p/miR-16 and downregulation of miR-204/miR-16 were significantly associated with intermediate/high risk of recurrence/persistence (p = 0.005 and 0.006, respectively). Downregulation of miR-204/miR-16 demonstrated a sensitivity of 75% and a negative predictive value of 86.7%. The combination of upregulation of miR-146b-5p/miR-16 and downregulation of miR-204/miR-16 yielded both a specificity and negative predictive value of 100%.

Conclusion: Decision-making for patients with low-risk papillary thyroid carcinoma regarding eligibility for active surveillance can be facilitated through serum analysis of miR-204/miR-16 expression, which may be used as a rule-out test. In contrast, combined analysis of miR-146b-5p/miR-16 and miR-204/miR-16 can serve as a rule-in test.

Objective: To investigate the impact of laparoscopic sleeve gastrectomy (SG) on plasma metabolites in obese patients with type 2 diabetes mellitus (T2DM) and identify key metabolites associated with weight loss. Subjects and.

Methods: Nineteen obese T2DM patients who underwent SG surgery were selected as the study participants. Preoperative and postoperative plasma samples and clinical data were collected. High-performance liquid chromatography-mass spectrometry (LC-MS/MS) was used to detect plasma metabolites, and changes in the levels of metabolites before and after surgery were analysed and compared.

Results: After the surgery, metabolic indicators such as body weight, BMI, fasting blood glucose, and glycated haemoglobin significantly decreased. Metabolomic analysis revealed 85 metabolites with differential abundance, among which the levels of 50 metabolites (such as homocysteine and oleic acid) significantly increased after the surgery, and the levels of 35 metabolites (such as corticosterone and glutamic acid) significantly decreased. The changes in the abundance of these metabolites were closely related to surgical weight loss and improvements in glycolipid metabolism.

Conclusion: Laparoscopic sleeve gastrectomy effectively improves glycolipid metabolism in obese patients with T2DM by affecting the levels of specific metabolites. Metabolites such as homocysteine and chenodeoxycholic acid can serve as potential markers for assessing surgical efficacy. This study provides an important basis for developing a deeper understanding of the metabolic mechanisms of SG surgery and can aid clinicians in evaluating surgical outcomes and the prognosis of this surgery in patients.

Objective: Population-based data on the surgical treatment of adrenal diseases in Brazil remain limited. Therefore, this retrospective cohort study aimed to characterize patients treated within the Brazilian public health system who underwent adrenalectomy over the past 15 years.

Materials and methods: Records of adrenalectomies from the Sistema Único de Saúde (Datasus) database were analyzed from January 2008 to December 2022. Descriptive demographic information was evaluated using incidence rates. Clinical, therapeutic, and mortality data were compared according to hospital procedure volume stratification.

Results: Over the study period, there was a 49.6% increase in procedures, totaling 6,771 adrenalectomies, with high-volume hospitals performing 62.3% of the cases. Most patients were female (65.5%), white (52%), and had a median age of 48 years. Oncological adrenalectomies increased by 154%, particularly in the southern region of Brazil. Although an overall reduction in in-hospital mortality rates was observed, a higher risk persisted in low-volume centers for both oncological (OR: 2.75; 95% CI: 1.53-4.93; p < 0.01) and non-oncological surgeries (OR: 6.60; 95% CI: 3.98-10.96; p < 0.01).

Conclusion: Given the increasing number of adrenalectomies performed within the Brazilian public health system and the likely continuation of this trend, health policies should prioritize referral to high-volume centers equipped with advanced techniques and appropriate infrastructure.