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The Anti-Obesity Compound Asperuloside Reduces Inflammation in the Liver and Hypothalamus of High-Fat-Fed Mice 抗肥胖化合物曲霉苷减轻高脂肪喂养小鼠肝脏和下丘脑的炎症
Pub Date : 2022-10-18 DOI: 10.3390/endocrines3040055
M. Ishaq, D. Tran, Cheng Yang, Min Jia Ng, Arlene Kackanattil, Karthik Tata, B. Deans, M. Bleasel, Silvia Vicenzi, Cameron Randall, T. Ahmad, Carmelo Vicario, M. Ronci, M. Zuccarini, R. Ciccarelli, P. Scowen, D. Chellappan, Glenn Jacobson, Alex C. Bissember, Jason A Smith, R. Eri, J. Canales, M. Iglesias, Nuri Guven, V. Caruso
Obesity produces a systemic low-grade inflammation associated with many adverse health conditions and, as we recently learned, with complications of COVID-19. Functional studies in animal models have demonstrated that asperuloside, an iridoid glycoside found in many medicinal plants, has produced promising anti-obesity results. However, the safety profile and the anti-inflammatory properties of asperuloside remain unknown. Here, we confirmed the previously reported anti-obesity properties of asperuloside, and, importantly, we performed toxicity studies assessing cell viability providing a dose reference for future animal experiments. Asperuloside significantly reduced blood levels of leptin and the mRNA levels of orexigenic peptides, such as NPY and AgRP in mice consuming HFD, with no effect on mice eating a standard chow diet. In addition, our results indicate that ASP reduced both hypothalamic and hepatic mRNA levels of pro-inflammatory cytokines such as IL-1, IL-6 and TNF-α as well as the blood levels of plasminogen activator inhibitor-1 (PAI-1), which are known to play a major role in the development of insulin resistance and cardiovascular complications. Collectively, our findings suggest that asperuloside is a safe compound for long-term use in animal models and that it reduces the elevated levels of pro-inflammatory cytokines occurring in obesity.
肥胖会产生一种全身性低级别炎症,与许多不良健康状况有关,正如我们最近了解到的,还与新冠肺炎并发症有关。动物模型的功能研究表明,在许多药用植物中发现的一种环烯醚萜苷——阿糖醇酯已经产生了有希望的抗肥胖效果。然而,曲柳糖苷的安全性和抗炎特性仍然未知。在这里,我们证实了先前报道的阿糖醇酯的抗肥胖特性,重要的是,我们进行了评估细胞活力的毒性研究,为未来的动物实验提供了剂量参考。在食用HFD的小鼠中,Asperulside显著降低了血液中瘦素水平和食欲肽(如NPY和AgRP)的mRNA水平,而对食用标准食物的小鼠没有影响。此外,我们的研究结果表明,ASP降低了下丘脑和肝脏促炎细胞因子(如IL-1、IL-6和TNF-α)的mRNA水平,以及血液中纤溶酶原激活物抑制物-1(PAI-1)的水平,众所周知,PAI-1在胰岛素抵抗和心血管并发症的发展中起着重要作用。总之,我们的研究结果表明,阿糖醇苷是一种安全的化合物,可长期用于动物模型,并可降低肥胖患者体内促炎细胞因子水平的升高。
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引用次数: 0
Myoma with Hypermenorrhea Treated with Ultrasound-Guided Microwave Ablation of the Inflowing Blood Vessels to the Uterine Myoma: A Case 超声引导微波消融子宫肌瘤流入血管治疗子宫肌瘤伴月经过多1例
Pub Date : 2022-10-13 DOI: 10.3390/endocrines3040054
Toshiyuki Kakinuma, Takahumi Ohkusa, Takumi Shinohara, A. Shimizu, Rora Okamoto, M. Kagimoto, Ayaka Kaneko, Kaoru Kakinuma, K. Yanagida, N. Takeshima, M. Ohwada
Microwave endometrial ablation (MEA) is a minimally invasive treatment for uterine myoma with hypermenorrhea, which can replace conventional hysterectomy. However, cases requiring additional treatment because of postoperative recurrence are often encountered. MEA cauterizes the endometrium and is not recommended for patients who wish to preserve fertility. We present the cases of a patient with myoma-related hypermenorrhea who underwent microwave ablation of the inflowing blood vessels to the uterine myoma under transvaginal ultrasound guidance. A 43-year-old woman was diagnosed with chronic myeloid leukemia and treated with dasatinib 2 years ago. Worsening hypermenorrhea was observed after treatment initiation. Ultrasound and pelvic magnetic resonance imaging revealed a uterine myoma. Therefore, she underwent MEA under transvaginal ultrasound guidance. Visual analog scale evaluation demonstrated considerable improvement in hypermenorrhea and dysmenorrhea; the myoma size showed reduction. The postoperative course was uneventful, and the patient was discharged on the day after surgery. No postoperative complications were observed. This patient is currently undergoing infertility treatment. The microwave ablation of myoma under transvaginal ultrasound guidance can effectively and safely reduce the myoma size. These findings suggest that this method is a novel treatment option for patients with myoma-related hypermenorrhea who wish to preserve their fertility and have children.
微波子宫内膜消融术(MEA)是一种微创治疗伴有痛经的子宫肌瘤的方法,可以取代传统的子宫切除术。然而,由于术后复发而需要额外治疗的情况经常发生。MEA会烧灼子宫内膜,不建议希望保留生育能力的患者使用。我们报告了一例与子宫肌瘤相关的痛经患者,他们在经阴道超声引导下接受了子宫肌瘤流入血管的微波消融。一名43岁的女性被诊断为慢性粒细胞白血病,两年前接受了达沙替尼治疗。治疗开始后观察到痛经加重。超声和盆腔磁共振成像显示子宫肌瘤。因此,她在经阴道超声引导下接受了MEA。视觉模拟量表评估显示,在痛经和痛经方面有相当大的改善;肌瘤缩小。术后进展顺利,患者于术后第二天出院。未观察到术后并发症。这名患者目前正在接受不孕不育治疗。经阴道超声引导下微波消融肌瘤可以有效、安全地缩小肌瘤大小。这些发现表明,对于那些希望保持生育能力并生育孩子的子宫肌瘤相关痛经患者来说,这种方法是一种新的治疗选择。
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引用次数: 0
The IGF1/FSH Ratio Correlates with Sperm Count and Testicular Volume IGF1/FSH比值与精子数量和睾丸体积的关系
Pub Date : 2022-10-11 DOI: 10.3390/endocrines3040053
R. Cannarella, S. La Vignera, R. Condorelli, A. Calogero
BACKGROUND. Several studies have already investigated the relationship between IGF1 and semen parameters. However, clinical studies rarely concluded on the existence of a relationship between IGF1 and the sperm number, and whether the IGF1 serum levels have a practical value in the diagnostic work-up of patients with oligozoospermia is still unclear. OBJECTIVE. Molecular evidence reported that IGF1 and FSH belongs to the same molecular pathway. The aim of this study is to assess whether insulin-like growth factor-1 (IGF1)/follicle-stimulating hormone (FSH) ratio has an impact on testicular function and, specifically, on sperm number and testicular volume in a cohort of unselected men. METHODS. This is a cross-sectional study on 59 patients who attended the Seminology laboratory of the Division of Endocrinology of the University of Catania (Catania, Italy) for semen analysis. Data were analyzed to evaluate the relationships between IGF1 or IGF1/FSH ratio and sperm concentration, total sperm count (TSC), and testicular volume (TV). We also evaluated the occurrence of any difference in IGF1 and FSH serum levels and the IGF1/FSH ratio in patients with oligozoospermia and those with a TSC > 39 million/ejaculate. MAIN RESULTS AND ROLE OF CHANGE. Patients had a mean age of 31.0 ± 8.5 years. The mean FSH and IGF1 levels were 3.95 ± 2.55 mIU/mL and 232.59 ± 65.13 ng/mL, respectively. IGF1 serum levels did not correlate with sperm concentration, TSC, and TV. The IGF1/FSH ratio showed a positive correlation with sperm concentration (r = 0.408; p = 0.004), TSC (r = 0.468; p = 0.001), and TV (0.463; p = 0.002). Patients with oligozoospermia (Group 1, 23.7%, n = 14) had a significant lower IGF1/FSH ratio (57.9 ± 9.5 vs. 94.1 ± 8.7; p = 0.03) compared to those with TSC > 39 million/ejaculate (Group 2, 76.3%, n = 45). They did not differ significantly for neither IGF1 nor FSH serum levels. CONCLUSION. We found a positive correlation between the IGF1/FSH ratio and sperm concentration, TSC and TV. Furthermore, patients with oligozoospermia showed a significantly lower ratio compared to those with a normal TSC, while neither IGF1 nor FSH differed significantly in the two groups. Our results may reflect the existence of a molecular pathway to which IGF1 and FSH belongs. However, further studies are needed.
背景。一些研究已经调查了IGF1和精液参数之间的关系。然而,临床研究很少得出IGF1与精子数量之间存在关系的结论,以及IGF1血清水平在少精子症患者的诊断检查中是否具有实际价值仍不清楚。目标。分子证据表明IGF1和FSH属于同一分子通路。本研究的目的是评估胰岛素样生长因子-1(IGF1)/卵泡刺激素(FSH)的比例是否对未经选择的男性队列的睾丸功能,特别是精子数量和睾丸体积有影响。方法。这是一项针对59名患者的横断面研究,这些患者在卡塔尼亚大学(意大利卡塔尼亚)内分泌学系的Seminology实验室进行精液分析。对数据进行分析,以评估IGF1或IGF1/FSH比率与精子浓度、精子总数(TSC)和睾丸体积(TV)之间的关系。我们还评估了少精症患者和TSC>3900万/次射精患者的IGF1和FSH血清水平以及IGF1/FSH比率是否存在任何差异。变化的主要结果和作用。患者的平均年龄为31.0±8.5岁。FSH和IGF1的平均水平分别为3.95±2.55 mIU/mL和232.59±65.13 ng/mL。IGF1血清水平与精子浓度、TSC和TV无关。IGF1/FSH比值与精子浓度呈正相关(r=0.408;p=0.004),TSC(r=0.468;p=0.001),少精子症患者(第1组,23.7%,n=14)的IGF1/FSH比值(57.9±9.5 vs.94.1±8.7;p=0.03)显著低于TSC>3900万/次射精的患者(第2组,76.3%,n=45)。IGF1和FSH血清水平均无显著差异。结论。我们发现IGF1/FSH比值与精子浓度、TSC和TV呈正相关。此外,与TSC正常的患者相比,少精症患者的比值明显较低,而IGF1和FSH在两组中均无显著差异。我们的结果可能反映了IGF1和FSH所属的分子途径的存在。然而,还需要进一步的研究。
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引用次数: 1
Special Issue “Genetics in Pediatric Endocrinology” 特刊《小儿内分泌遗传学》
Pub Date : 2022-10-07 DOI: 10.3390/endocrines3040051
M. Draznin, S. Kanungo
The inception of pediatric endocrinology in the United States began little less than a century ago, but it has grown as a subspecialty field since the 1950s [...]
儿科内分泌学在美国的创立始于不到一个世纪前,但自20世纪50年代以来,它已发展成为一个亚专业领域〔…〕
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引用次数: 0
Are the Modern Diets for the Treatment of Obesity Better than the Classical Ones? 治疗肥胖的现代饮食比传统饮食好吗?
Pub Date : 2022-10-07 DOI: 10.3390/endocrines3040052
C. Koliaki, N. Katsilambros
Conventional hypocaloric diets, providing continuous energy restriction, are considered to be the cornerstone of dietary management of obesity. Although energy-restricted diets are overall safe, healthy, and modestly effective, their long-term adherence is difficult to accomplish. Intermittent fasting and ketogenic diets have emerged as attractive alternative dietary options for weight loss and improvement in cardiometabolic risk. Intermittent fasting is a unique dietary pattern characterized by periods of eating alternated with periods of fasting. Ketogenic diets are very low in carbohydrate, modest in protein, and high in fat. Several systematic reviews and meta-analyses of randomized controlled trials (RCTs) have reported beneficial but short-lived effects of intermittent fasting and ketogenic diets on various obesity-related health outcomes. Although for both diets, the current evidence is promising and steadily evolving, whether they are better than traditional calorie-restricted diets, whether they can safely lead to sustained weight loss and overall health benefits, and their effects on body composition, weight loss maintenance, energy intake and expenditure, diet quality, and cardiometabolic risk factors are still not unequivocally proven. The aim of the present review is to summarize the current state of evidence regarding the effects of these two popular modern diets, namely intermittent fasting and ketogenic diets. We describe the rationale and characteristics of different dietary protocols, we analyze the major mechanisms explaining their weight loss and cardiometabolic effects, and we provide a concise update on their effects on body weight and cardiometabolic risk factors, focusing on meta-analyses of RCTs. We also discuss knowledge gaps in the field of these diets, and we indicate directions for future research.
传统的低热量饮食,提供持续的能量限制,被认为是肥胖饮食管理的基石。虽然能量限制饮食总体上是安全、健康和适度有效的,但长期坚持是很难实现的。间歇性禁食和生酮饮食已成为减肥和改善心脏代谢风险的有吸引力的替代饮食选择。间歇性禁食是一种独特的饮食模式,其特点是进食与禁食交替。生酮饮食的碳水化合物含量很低,蛋白质含量适中,脂肪含量高。一些随机对照试验(rct)的系统综述和荟萃分析报告了间歇性禁食和生酮饮食对各种肥胖相关健康结果的有益但短暂的影响。虽然对于这两种饮食,目前的证据都是有希望的和稳步发展的,但它们是否比传统的卡路里限制饮食更好,它们是否能安全地导致持续的体重减轻和整体健康益处,以及它们对身体成分、减肥维持、能量摄入和消耗、饮食质量和心脏代谢风险因素的影响仍然没有明确的证明。本综述的目的是总结关于这两种流行的现代饮食,即间歇性禁食和生酮饮食的影响的证据的现状。我们描述了不同饮食方案的基本原理和特点,分析了其减肥和心脏代谢作用的主要机制,并简要介绍了它们对体重和心脏代谢危险因素的影响,重点是随机对照试验的荟萃分析。我们还讨论了这些饮食领域的知识差距,并指出了未来研究的方向。
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引用次数: 3
Different Expression Patterns of Metabolic Reprogramming Proteins in Testicular Germ Cell Cancer 代谢重编程蛋白在睾丸生殖细胞癌中的不同表达模式
Pub Date : 2022-10-01 DOI: 10.3390/endocrines3040049
A. Perri, D. Lofaro, S. Bossio, L. Maltese, I. Casaburi, L. Tucci, S. La Vignera, A. Aversa, S. Aquila, V. Rago
Metabolic reprogramming is an emerging hallmark of cancer, involving the overexpression of metabolism-related proteins, such as glucose and monocarboxylate transporters and intracellular glycolytic enzymes. The biology of testicular germ cell tumors (TGCTs) is very complex, and although their metabolic profile has been scantily explored, some authors have recently reported that the metabolic rewiring of cancer cells resulted in an association with aggressive clinicopathological characteristics. In this study we have investigated, by immunohistochemical analysis, the expression of key proteins sustaining the hyperglycolytic phenotype in pure seminoma (SE, nr. 35), pure embryonal carcinoma (EC, nr. 17) tissues samples, and normal testes (nr. 5). GLUT1, CD44, PFK-1, MCT1, MCT4, LDH-A, and PDH resulted in more expression in EC cells compared to SE cells. TOM20 was more expressed in SE than in EC. GLUT1, MCT1, and MCT4 expression showed a statistically significant association with SE histology, while for EC, the association resulted in being significant only for GLUT1 and MCT4. Finally, we observed that EC resulted as negative for p53, suggesting that the GLUT1 and MTC overexpression observed in EC could be also attributed to p53 downregulation. In conclusion, our findings evidenced that EC exhibits a higher expression of markers of active aerobic glycolysis compared to SE, suggesting that the aggressive phenotype is associated with a higher glycolytic rate. These data corroborate the emerging evidence on the involvement of metabolic reprogramming in testicular malignancies as well, highlighting that the metabolic players should be explored in the future as promising therapeutic targets.
代谢重编程是癌症的一个新特征,涉及代谢相关蛋白的过度表达,如葡萄糖和单羧酸转运蛋白以及细胞内糖酵解酶。睾丸生殖细胞肿瘤(tgct)的生物学非常复杂,尽管对其代谢谱的研究很少,但一些作者最近报道,癌细胞的代谢重新布线导致与侵袭性临床病理特征相关。在这项研究中,我们通过免疫组织化学分析,研究了维持高糖酵解表型的关键蛋白在纯精原细胞瘤(SE,编号35)、纯胚胎癌(EC,编号17)组织样本和正常睾丸(nr. 5)中的表达。GLUT1、CD44、PFK-1、MCT1、MCT4、LDH-A和PDH在EC细胞中的表达高于SE细胞。TOM20在SE中的表达量高于EC。GLUT1、MCT1和MCT4的表达与SE的组织学有统计学意义,而对于EC,只有GLUT1和MCT4的表达有统计学意义。最后,我们观察到EC导致p53呈阴性,这表明EC中GLUT1和MTC的过表达也可能与p53下调有关。总之,我们的研究结果证明,与SE相比,EC表现出更高的活性有氧糖酵解标志物的表达,这表明侵袭性表型与更高的糖酵解率相关。这些数据也证实了代谢重编程参与睾丸恶性肿瘤的新证据,强调代谢参与者应该在未来作为有希望的治疗靶点进行探索。
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引用次数: 0
Serum IL-1ra Is Associated with but Has No Genetic Link to Type 1 Diabetes 血清IL-1ra与1型糖尿病相关,但无遗传联系
Pub Date : 2022-09-13 DOI: 10.3390/endocrines3030048
P. Tran, Fran Dong, Khaled Bin Satter, Katherine P. Richardson, Roshni Patel, L. K. Tran, D. Hopkins, R. Kolhe, Kathleen C. Waugh, M. Rewers, S. Purohit
Interleukin-1 antagonism is a proposed biomarker and potential therapy for the delay and/or treatment of type 1 diabetes (T1D). We evaluated the role of circulating interleukin-1 receptor antagonist (IL-1ra) in a prospectively monitored cohort of T1D patients. In order to determine a mechanistic association between IL-1ra and T1D, we performed co-localization analyses between serum IL-1ra protein quantitative trait loci and T1D genome-wide analysis studies. Adjusting for human leukocyte antigen (HLA) genotypes, first degree relative status, gender, and age, serum levels of IL-1ra were lower in subjects who progressed to T1D compared to the controls (p = 0.023). Our results suggest that females have higher levels of IL-1ra compared to males (p = 0.005). The 2q14.1 region associated with serum IL-1ra levels is not associated with a risk of developing T1D. Our data suggest that IL-1 antagonism by IL-1ra is not an effective therapy in T1D, but IL-1ra may be a biomarker for progression to T1D.
白细胞介素-1拮抗作用是一种拟议的生物标志物,也是延迟和/或治疗1型糖尿病(T1D)的潜在疗法。我们评估了循环白细胞介素-1受体拮抗剂(IL-1ra)在前瞻性监测的T1D患者队列中的作用。为了确定IL-1ra和T1D之间的机制联系,我们在血清IL-1ra蛋白定量性状基因座和T1D全基因组分析研究之间进行了共定位分析。调整人类白细胞抗原(HLA)基因型、一级相对状态、性别和年龄,与对照组相比,进展为T1D的受试者的血清IL-1ra水平较低(p=0.023)。我们的研究结果表明,女性的IL-1ra水平高于男性(p=0.005)。与血清IL-1ra浓度相关的2q14.1区域与T1D的风险无关。我们的数据表明,IL-1ra对IL-1的拮抗作用不是治疗T1D的有效方法,但IL-1ra可能是进展为T1D的生物标志物。
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引用次数: 0
Complications and Treatments in Adult X-Linked Hypophosphatemia 成人x连锁低磷血症的并发症及治疗
Pub Date : 2022-09-08 DOI: 10.3390/endocrines3030047
Y. Imanishi, T. Shoji, M. Emoto
X-linked hypophosphatemia (XLH) is a rare inherited disorder involving elevated levels of fibroblast growth factor (FGF) 23, and is caused by loss-of-function mutations in the PHEX gene. FGF23 induces renal phosphate wasting and suppresses the activation of vitamin D, resulting in defective bone mineralization and rachitic changes in the growth plate and osteomalacia. Conventional treatment with combinations of oral inorganic phosphate and active vitamin D analogs enhances bone calcification, but the efficacy of conventional treatment is insufficient for adult XLH patients to achieve an acceptable quality of life. Burosumab, a fully human monoclonal anti-FGF23 antibody, binds and inhibits FGF23, correcting hypophosphatemia and hypovitaminosis D. This review describes a typical adult with XLH and summarizes the results of clinical trials of burosumab in adults with XLH.
X连锁低磷血症(XLH)是一种罕见的遗传性疾病,涉及成纤维细胞生长因子(FGF)23水平升高,由PHEX基因的功能缺失突变引起。FGF23诱导肾脏磷酸盐消耗并抑制维生素D的激活,导致骨矿化缺陷、生长板的轴性变化和骨软化。口服无机磷酸盐和活性维生素D类似物组合的常规治疗可增强骨钙化,但常规治疗的疗效不足以使成年XLH患者达到可接受的生活质量。Burosumab是一种全人类单克隆抗FGF23抗体,结合并抑制FGF23,纠正低磷血症和低维生素D。这篇综述描述了一名典型的XLH成人,并总结了Burosuma在XLH成人中的临床试验结果。
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引用次数: 1
The Possible Role of SARS-CoV-2 in Male Fertility: A Narrative Review SARS-CoV-2在男性生育能力中的可能作用:一项叙事回顾
Pub Date : 2022-09-05 DOI: 10.3390/endocrines3030046
Claudia Leanza, L. Mongioì, R. Cannarella, S. La Vignera, R. Condorelli, A. Calogero
The spread of severe acute respiratory syndrome—Coronavirus 2 (SARS-CoV-2) around the world has rapidly sparked the interest of the scientific community to discover its implications in human health. Many studies have suggested that SARS-CoV-2 is directly or indirectly involved in the male reproductive tract impairment. Some evidence supports the possible role of the virus in male infertility. Therefore, this review aims to summarize the relationship between the male urogenital tract, male fertility, and the gonadal hormone profile. The testis is one of the organs with the highest expression of the angiotensin-converting enzyme (ACE) 2-receptor that allows the virus to penetrate human cells. Orchitis is a possible clinical manifestation of COVID-19 and testicular damage has been found on autopsy in the testes of patients who died from the disease. SARS-CoV-2 infection can compromise the blood-testis barrier, favoring testicular damage and the production of anti-sperm autoantibodies. Some studies have detected the presence of SARS-CoV-2 in semen and a high percentage of patients with COVID-19 have altered sperm parameters compared to controls. Finally, lower testosterone levels, higher luteinizing hormone (LH) levels, and decreased follicle-stimulating (FSH)/LH and testosterone/LH ratios suggest primary testicular damage. In conclusion, further studies are needed to evaluate the exact mechanisms by which SARS-CoV-2 affects the male reproductive system and fertility and to evaluate the reversibility of its long-term effects.
严重急性呼吸系统综合征-冠状病毒2 (SARS-CoV-2)在世界各地的传播迅速引发了科学界探索其对人类健康影响的兴趣。许多研究表明,SARS-CoV-2直接或间接参与了男性生殖道障碍。一些证据支持该病毒在男性不育中的可能作用。因此,本文就男性泌尿生殖道、男性生育能力和性腺激素之间的关系作一综述。睾丸是血管紧张素转换酶(ACE) 2受体表达最高的器官之一,这种受体使病毒能够穿透人体细胞。睾丸炎是COVID-19可能的临床表现,在尸检死于该病的患者的睾丸中发现了睾丸损伤。SARS-CoV-2感染可破坏血睾丸屏障,有利于睾丸损伤和抗精子自身抗体的产生。一些研究已经检测到精液中存在SARS-CoV-2,与对照组相比,很高比例的COVID-19患者精子参数发生了变化。最后,较低的睾丸激素水平,较高的黄体生成素(LH)水平,以及较低的促卵泡激素(FSH)/LH和睾丸激素/LH比值提示原发性睾丸损伤。总之,需要进一步研究评估SARS-CoV-2影响男性生殖系统和生育能力的确切机制,并评估其长期影响的可逆性。
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引用次数: 2
The Progression of Prediabetes to Type 2 Diabetes in Children and Adolescents in the United States: Current Challenges and Solutions 美国儿童和青少年糖尿病前期到2型糖尿病的进展:当前的挑战和解决方案
Pub Date : 2022-09-01 DOI: 10.3390/endocrines3030045
B. U. Nwosu
Prediabetes, the precursor of type 2 diabetes (T2D), is on the rise among children and adolescents in the United States. The natural history of prediabetes is poorly characterized in children compared to adults. The available data indicate a phenotype of an accelerated β-cell failure in youth with prediabetes. Data from randomized controlled trials showed no benefit on β-cell preservation or A1c in youth with prediabetes from therapeutic agents such as metformin and insulin. As a result, the American Diabetes Association recommends only lifestyle intervention, but not therapeutic agents, for the management of prediabetes in children and adolescents. These recommendations for lifestyle modification in youth, largely derived from data in adults, lack the precision necessary for efficacy in youth. However, a recent 4-year real-world study on youth reported that adherence to nutrition visits was associated with a 4-fold reduction in the likelihood of progressing from prediabetes to T2D. The finding that this reversal is associated with reduced insulin resistance (IR) and not with decreased body weight is novel and provides the foundation for trialing investigational products that may protect β-cells and reduce IR and/or body weight. This study provides the much-needed foundation for further exploration of the impact of lifestyle modification in conjunction with other approaches for the reversal of prediabetes in youth. The systematization of the protocol for medical nutrition therapy for the reversal of prediabetes in youth will ensure optimal and consistent results from adherent patients. This communication provides updates on the pathobiology of prediabetes in youth and a clear direction for efficacious studies in the field.
糖尿病前期是2型糖尿病(T2D)的前兆,在美国儿童和青少年中呈上升趋势。与成人相比,儿童糖尿病前期的自然病史特征较差。现有数据表明,青年糖尿病前期患者存在加速β细胞衰竭的表型。来自随机对照试验的数据显示,二甲双胍和胰岛素等治疗药物对糖尿病前期青年的β细胞保存或A1c没有益处。因此,美国糖尿病协会只建议对儿童和青少年的糖尿病前期进行生活方式干预,而不建议使用治疗剂。这些关于青少年生活方式改变的建议主要来自成年人的数据,缺乏对青少年疗效所需的准确性。然而,最近一项针对年轻人的4年现实世界研究报告称,坚持营养检查与从糖尿病前期进展为T2D的可能性降低4倍有关。这一逆转与胰岛素抵抗(IR)降低有关,而与体重下降无关,这一发现是新颖的,并为试验可能保护β细胞并降低IR和/或体重的研究药物提供了基础。这项研究为进一步探索生活方式改变与其他方法相结合对逆转青年糖尿病前期的影响提供了急需的基础。逆转青少年糖尿病前期的药物营养治疗方案的系统化将确保依从性患者获得最佳和一致的结果。这篇通讯提供了关于青年糖尿病前期病理生物学的最新信息,并为该领域的有效研究提供了明确的方向。
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引用次数: 2
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Endocrines
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