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Erratum to Correct Informed Patient Consent Statement. 更正患者知情同意声明的勘误。
Pub Date : 2024-04-01 Epub Date: 2023-12-07 DOI: 10.17925/EE.2024.20.1.2
Hiya Boro, Harish Sharma, Deepak Mittal, Mohit Pareek, Shilpa Chugh, Mohar Singh Jakhar, Neeraj Nagar, Lovekesh Bhatia, Sanjay Saini, Vashishth Joshi, Sahil Vaid, Velmurugan Mannar, Lakshmi Nagendra, Mazhar Dalv, Vikash Bundela

[This corrects the article DOI: 10.17925/EE.2023.19.2.6.].

[此处更正了文章 DOI:10.17925/EE.2023.19.2.6.]。
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引用次数: 0
The Placental Role in Gestational Diabetes Mellitus: A Molecular Perspective. 胎盘在妊娠糖尿病中的作用:分子视角。
Pub Date : 2024-04-01 Epub Date: 2024-03-14 DOI: 10.17925/EE.2024.20.1.5
María José Calvo, Heliana Parra, Raquel Santeliz, Jordan Bautista, Eliana Luzardo, Nelson Villasmil, María Sofía Martínez, Maricamen Chacín, Clímaco Cano, Ana Checa-Ros, Luis D'Marco, Valmore Bermúdez, Juan Bautista De Sanctis

During pregnancy, women undergo several metabolic changes to guarantee an adequate supply of glucose to the foetus. These metabolic modifications develop what is known as physiological insulin resistance. When this process is altered, however, gestational diabetes mellitus (GDM) occurs. GDM is a multifactorial disease, and genetic and environmental factors play a crucial role in its aetiopathogenesis. GDM has been linked to both macroscopic and molecular alterations in placental tissues that affect placental physiology. This review summarizes the role of the placenta in the development of GDM from a molecular perspective, including hormonal and pro-inflammatory changes. Inflammation and hormonal imbalance, the characteristics dominating the GDM microenvironment, are responsible for placental changes in size and vascularity, leading to dysregulation in maternal and foetal circulations and to complications in the newborn. In conclusion, since the hormonal mechanisms operating in GDM have not been fully elucidated, more research should be done to improve the quality of life of patients with GDM and their future children.

在怀孕期间,妇女的新陈代谢会发生一些变化,以保证胎儿获得充足的葡萄糖供应。这些新陈代谢的变化形成了所谓的生理性胰岛素抵抗。然而,当这一过程发生改变时,就会出现妊娠糖尿病(GDM)。GDM 是一种多因素疾病,遗传和环境因素在其发病机制中起着至关重要的作用。GDM 与影响胎盘生理的胎盘组织的宏观和分子改变有关。本综述从分子角度总结了胎盘在 GDM 发病中的作用,包括激素和促炎症变化。炎症和激素失衡是 GDM 微环境的主要特征,是导致胎盘大小和血管变化的原因,从而导致母体和胎儿循环失调以及新生儿并发症。总之,由于 GDM 的激素作用机制尚未完全阐明,因此应开展更多的研究,以提高 GDM 患者及其未来子女的生活质量。
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引用次数: 0
Panhypopituitarism in a Patient with Burkitt Lymphoma: A Diagnostic and Therapeutic Challenge. 伯基特淋巴瘤患者的泛垂体功能障碍:诊断和治疗的挑战。
Pub Date : 2024-04-01 Epub Date: 2023-12-15 DOI: 10.17925/EE.2024.20.1.11
Augusto Dextre-Espinoza, Sofía Pilar Ildefonso-Najarro, Marcio José Concepción-Zavaleta, Juan Eduardo Quiroz-Aldave, Diana Carolina Deutz-Gómez Condori, Fiorella Beatriz Gonzales-Chiroque, Rodrigo Martín Rodríguez-Solis

Pituitary infiltration by systemic lymphoma is an exceedingly rare occurrence. Given its high mortality rate, it is crucial to recognize its clinical, biochemical and radiological features in order to provide timely intervention. We present the case of a 26-year-old male with a history of human immunodeficiency virus (HIV) infection who presented to the hospital with severe anemia, persistent fever, weight loss and diarrhea over the previous 4 months. Physical examination revealed a compromised general condition, fever, pallor, hepatomegaly and lymphadenopathy. Cervical lymph node biopsy confirmed Burkitt lymphoma (BL). During hospitalization, the patient developed polyuria, polydipsia, hypernatremia, fluid-resistant hypotension and hypoglycaemia. Corticosteroid therapy was initiated due to suspected adrenal insufficiency, resulting in clinical improvement but exacerbation of polyuria and hypernatremia. Plasma and urinary osmolarity confirmed arginine vasopressin deficiency, and assessment of anterior pituitary reserve revealed hypopituitarism, necessitating hormonal replacement therapy. Sellar magnetic resonance imaging with contrast revealed pituitary infiltration. The patient subsequently developed septic shock and died. BL accounts for approximately 10% of the cases of pituitary infiltration associated with lymphoma. Clinical presentation is heterogeneous, with panhypopituitarism often serving as the initial manifestation. Sellar magnetic resonance imaging plays a pivotal role in the differential diagnosis. Management typically entails chemotherapy, immunotherapy, radiation and hormonal replacement therapy. This case report describes a patient with BL and HIV infection who developed panhypopituitarism due to pituitary infiltration, an exceedingly rare presentation considered a medical emergency.

全身性淋巴瘤浸润垂体的情况极为罕见。鉴于其死亡率较高,识别其临床、生化和放射学特征以便及时干预至关重要。本病例是一名 26 岁男性,有人类免疫缺陷病毒(HIV)感染史,因严重贫血、持续发热、体重减轻和腹泻 4 个月来就诊。体格检查显示患者全身状况不佳、发热、面色苍白、肝肿大和淋巴结肿大。宫颈淋巴结活检证实了伯基特淋巴瘤(BL)。住院期间,患者出现多尿、多饮、高钠血症、耐液体性低血压和低血糖症。由于怀疑肾上腺功能不全,患者开始接受皮质类固醇治疗,结果临床症状有所改善,但多尿和高钠血症症状加剧。血浆和尿液渗透压证实精氨酸加压素缺乏,垂体前叶储备功能评估显示垂体功能减退,需要进行激素替代治疗。造影剂ellar磁共振成像显示垂体浸润。患者随后出现脓毒性休克并死亡。在与淋巴瘤相关的垂体浸润病例中,BL 约占 10%。临床表现多种多样,泛垂体功能障碍通常是最初的表现。ellar磁共振成像在鉴别诊断中起着关键作用。治疗方法通常包括化疗、免疫疗法、放疗和激素替代疗法。本病例报告描述了一名患有BL和HIV感染的患者因垂体浸润而出现泛垂体功能障碍,这是一种极为罕见的表现,被视为医疗急症。
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引用次数: 0
Osilodrostat: A Novel Potent Inhibitor of 11-Beta-Hydroxylase for the Treatment of Cushing's Syndrome. 奥西洛司他用于治疗库欣综合征的新型强效 11-β-羟化酶抑制剂。
Pub Date : 2024-04-01 Epub Date: 2023-12-11 DOI: 10.17925/EE.2024.20.1.8
Rosario Pivonello, Chiara Simeoli, Nicola Di Paola, Angelica Larocca, Erminio Massimo Crescenzo, Annamaria Colao

Osilodrostat is a novel potent oral steroidogenesis inhibitor with a non-steroidal chemical structure, recently approved for the treatment of adult patients with endogenous Cushing's syndrome, and Cushing's disease not cured bytab pituitary surgery or in whom pituitary surgery is not an option. Osilodrostat has been evaluated in different multicentre phase II and III clinical studies, and has shown to have notable effects, such as significant reductions in cortisol secretion, associated with significant improvement in body weight, blood pressure, glucose metabolism, lipid profile, psychological status and quality of life. The favourable safety profile, combined with the relevant efficacy, could make osilodrostat suitable as medical treatment in several phases of the Cushing's syndrome treatment journey: before surgery, as preoperative treatment, or instead of surgery, in cases where surgery is not an option or refused, as first-line treatment; after surgery, in cases of persistent or recurrent disease, as second-line treatment; after second surgery or radiotherapy following pituitary surgery as bridging treatment waiting for the definitive disease control, as third-line treatment. Further real-world clinical experience data are needed to confirm the current knowledge.

奥西洛德司他是一种新型强效口服类固醇生成抑制剂,具有非类固醇化学结构,最近被批准用于治疗内源性库欣综合征、垂体手术无法治愈或无法选择垂体手术的库欣病患者。奥西洛德司他已在不同的多中心 II 期和 III 期临床研究中进行了评估,结果表明其疗效显著,如皮质醇分泌显著减少,体重、血压、糖代谢、血脂、心理状态和生活质量均有明显改善。奥西洛德司他具有良好的安全性和相关疗效,可在库欣综合征治疗的多个阶段作为药物治疗:手术前,作为术前治疗,或在不能选择或拒绝手术的情况下替代手术,作为一线治疗;手术后,在疾病持续或复发的情况下,作为二线治疗;垂体手术后第二次手术或放疗后,作为等待疾病最终控制的过渡治疗,作为三线治疗。需要更多真实世界的临床经验数据来证实当前的知识。
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引用次数: 0
Bexagliflozin as an Adjunct Therapy to Diet and Exercise to Improve Glycaemic Control in Adults with Type 2 Diabetes. Bexagliflozin 作为饮食和运动的辅助疗法,改善 2 型糖尿病成人的血糖控制。
Pub Date : 2024-04-01 Epub Date: 2023-12-19 DOI: 10.17925/EE.2024.20.1.6
Panagiotis Stachteas, Dimitrios Patoulias, Djordje S Popovic, Polyxeni Athanasiadou, Nikolaos Fragakis

Type 2 diabetes (T2D) is one of the leading causes of morbidity and mortality worldwide. Currently, over 10.5% of the adult population has been diagnosed with T2D, and almost 12% of total health expenditure is spent exclusively on T2D management globally. Sodium-glucose cotransporter-2 inhibitors are a relatively new class of oral antidiabetic agents that act by inhibiting renal sodium and glucose reabsorption. Except for their glucose-l owering effects, they have been associated with a more significant weight loss and blood pressure reduction and a lower risk of hypoglycaemia than other commonly prescribed antidiabetic drugs. On 20 January 2023, bexagliflozin became the fifth orally administered sodium-glucose transporter 2 inhibitor to be approved by the US Food and Drug Administration for the treatment of T2D as an adjunct therapy to diet and exercise in the USA after dapagliflozin, canagliflozin, empagliflozin and ertugliflozin. This review aims to discuss the current evidence on the efficacy and safety of bexagliflozin, which provides an important alternative treatment option for patients with T2D.

2 型糖尿病(T2D)是全球发病和死亡的主要原因之一。目前,超过 10.5% 的成年人被诊断患有 T2D,全球近 12% 的医疗总支出专门用于 T2D 的治疗。钠-葡萄糖共转运体-2 抑制剂是一类相对较新的口服抗糖尿病药物,通过抑制肾脏对钠和葡萄糖的重吸收发挥作用。除降糖作用外,与其他常用抗糖尿病药物相比,它们还具有更显著的减轻体重、降低血压和降低低血糖风险的作用。2023 年 1 月 20 日,bexagliflozin 成为继 dapagliflozin、canagliflozin、empagliflozin 和 ertugliflozin 之后,美国食品药品管理局批准的第五种口服钠-葡萄糖转运体 2 抑制剂,用于治疗 T2D,作为饮食和运动的辅助疗法。本综述旨在讨论有关贝沙格列净疗效和安全性的现有证据,贝沙格列净为 T2D 患者提供了另一种重要的治疗选择。
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引用次数: 0
Obesity and Oral Health: The Link Between Adipokines and Periodontitis. 肥胖与口腔健康:脂肪因子与牙周炎之间的联系
Pub Date : 2024-04-01 Epub Date: 2024-01-25 DOI: 10.17925/EE.2024.20.1.7
Ana Checa-Ros, Wei-Chung Hsueh, Belén Merck, Henry González-Torres, Valmore Bermúdez, Luis D'Marco

Periodontitis is a chronic inflammatory disease of the periodontium, or the supportive tissues around the tooth. This disease has been related to different risk factors, such as the presence of plaque and calculus, tobacco smoking, low socioeconomic status, and the immune state of the host. Importantly, the chronic inflammatory environment generated by periodontitis may lead to tooth loss and diverse systemic complications, such as cardiovascular disease, osteoarthritis and metabolic disease. Recent investigations have supported the role of obesity as a risk factor for periodontitis. Furthermore, studies have found obesity to compromise healing after periodontal therapy; however, the mechanisms underlying this association are not well understood. Proteins called 'adipokines' could be the factor linking obesity to periodontitis. Adipokines are bioactive molecules with hormonal properties and a structure similar to cytokines produced by the adipose tissue. Although adipokines have both pro-and anti-inflammatory effects, the shift towards pro-inflammatory actions occurs when the adipose tissue becomes pathological, as observe in the progression of conditions such as obesity or adiposopathy. This article reviews the role of adipokines in the pathophysiology and progression of periodontitis by focusing on their impact on inflammation and the molecular mechanisms through which adipokines contribute to the onset and development of periodontitis.

牙周炎是牙周或牙齿周围支持组织的一种慢性炎症性疾病。这种疾病与不同的风险因素有关,如牙菌斑和牙结石的存在、吸烟、社会经济地位低下以及宿主的免疫状态。重要的是,牙周炎产生的慢性炎症环境可能导致牙齿脱落和多种全身并发症,如心血管疾病、骨关节炎和代谢性疾病。最近的研究支持肥胖是牙周炎的一个风险因素。此外,研究还发现肥胖会影响牙周治疗后的愈合;然而,这种关联的机制还不十分清楚。被称为 "脂肪因子 "的蛋白质可能是肥胖与牙周炎的关联因素。脂肪因子是一种生物活性分子,具有荷尔蒙特性,结构类似于由脂肪组织产生的细胞因子。虽然脂肪因子既有促炎作用也有抗炎作用,但当脂肪组织发生病变时,脂肪因子的作用就会转向促炎作用,这一点在肥胖症或脂肪病等疾病的发展过程中可以观察到。本文回顾了脂肪因子在牙周炎的病理生理学和发展过程中的作用,重点探讨了脂肪因子对炎症的影响以及脂肪因子导致牙周炎发生和发展的分子机制。
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引用次数: 0
Insights into the Feasibility and Acceptability of a Mobile Insulin Titration Application in Clinical Practice and Its Effects on Diabetes Outcomes. 洞察移动胰岛素滴定应用程序在临床实践中的可行性和可接受性及其对糖尿病结果的影响。
Pub Date : 2024-04-01 Epub Date: 2024-02-29 DOI: 10.17925/EE.2024.20.1.10
Jodi S Krall, Jason M Ng, Neha Mehrotra, Kristine Ruppert, Linda M Siminerio

Introduction: Insulin therapy is most effective if patients learn how to properly adjust insulin to achieve glycaemic targets. There is a need for methods and tools that can assist these processes in clinical practice. The purpose of this feasibility study was to evaluate an approach to support insulin dose adjustment in individual patients using a mobile titration application (app). Methods: A cohort of adults (N=36) with type 2 diabetes with suboptimal glycaemia who were starting basal insulin self-titration were trained by a diabetes care and education specialist to use a mobile titration app to guide adjusting insulin doses. Glycaemia, diabetes distress and patient and provider satisfaction were assessed during the first 3 months after initiating basal insulin titration using the mobile app. Results: Mean haemoglobin type A1c (HbA1c) was significantly reduced by an average of 2.1 ± 2.2% from baseline to 3 months (p<0.001). Diabetes distress significantly decreased from baseline to follow-up with scores going down (or improving) across all scales. Both patients and providers reported high levels of satisfaction and positive experiences. Conclusion: The model offers a promising solution to streamline insulin dosage adjustments to achieve specific clinical and self-management goals with high expectations for long-term benefits and warrants further investigation.

简介:如果患者学会如何正确调整胰岛素以达到血糖目标,胰岛素治疗就能发挥最大功效。在临床实践中,需要能辅助这些过程的方法和工具。本可行性研究旨在评估一种使用移动滴定应用程序(App)支持个体患者调整胰岛素剂量的方法。研究方法由糖尿病护理和教育专家对开始自行滴注基础胰岛素的 2 型糖尿病成人患者(36 人)进行培训,让他们使用手机滴注应用程序指导调整胰岛素剂量。在开始使用手机应用滴定基础胰岛素后的头 3 个月,对血糖、糖尿病困扰以及患者和医疗服务提供者的满意度进行了评估。结果显示从基线到 3 个月期间,平均血红蛋白 A1c(HbA1c)平均显著降低了 2.1 ± 2.2%(p 结论:该模型为简化胰岛素剂量管理提供了一种有前途的解决方案:该模型为简化胰岛素剂量调整以实现特定的临床和自我管理目标提供了一种很有前景的解决方案,具有很高的长期效益预期,值得进一步研究。
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引用次数: 0
Metabolic Dysfunction-associated Fatty Liver Disease: An Urgent Call for Global Action. 代谢功能障碍相关性脂肪肝:全球行动的紧急呼吁》。
Pub Date : 2024-04-01 Epub Date: 2023-11-08 DOI: 10.17925/EE.2023.20.1.1
Cornelius J Fernandez, Lakshmi Nagendra, Joseph M Pappachan

There has been an exponential increase in the global prevalence of fatty liver disease in recent years in association with the obesity pandemic worldwide. 'Metabolic dysfunction-associated fatty liver disease', the new terminology adopted by an international panel of experts in 2020 to largely replace the old term 'non-alcoholic fatty liver disease', has now been accepted by most hepatologists and diabetologists across the globe. The term metabolic dysfunction-associated fatty liver disease was created to better reflect the metabolicand liver-specific manifestations and complications of fatty liver disease. It is important to disseminate our current understanding of this enigmatic disease among the global scientific fraternity. Recent publications, including articles from the latest issue of Endocrinology & Metabolism Clinics of North America, are attempting to fill this knowledge gap.

近年来,随着肥胖症在全球的流行,全球脂肪肝发病率呈指数级增长。代谢功能障碍相关性脂肪肝 "是一个国际专家小组于 2020 年采用的新术语,在很大程度上取代了旧术语 "非酒精性脂肪肝",现已被全球大多数肝病学家和糖尿病学家所接受。代谢功能障碍相关性脂肪肝这一术语的出现,更好地反映了脂肪肝的代谢和肝脏特异性表现及并发症。向全球科学界传播我们目前对这一神秘疾病的理解非常重要。最近的出版物,包括最新一期《北美内分泌与代谢临床》(Endocrinology & Metabolism Clinics of North America)上的文章,都在试图填补这一知识空白。
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引用次数: 0
Fezolinetant: A Potential Treatment for Moderate to Severe Vasomotor Symptoms of Menopause. 非索内酯:治疗中度至重度更年期血管运动症状的潜在疗法。
Pub Date : 2023-11-01 Epub Date: 2023-06-15 DOI: 10.17925/EE.2023.19.2.13
Barbara DePree

The most common symptom of menopause is vasomotor symptoms (VMS), which occur in more than 80% of postmenopausal women. Furthermore, VMS are the manifestation of menopause for which women most commonly seek treatment, namely, to address their impacted quality of life, including sleep, and work-and non-work-related productivity. VMS vary in frequency, intensity and duration. Hormone therapy (HT) has been our most effective treatment for VMS and has been approved for this indication by the United States Food and Drug Administration (FDA). Despite being a safe and effective treatment option, many patients and providers are hesitant to consider HT. Moreover, HT is contraindicated for some women. While many over-the-counter and non-HT options are available, we lack data on the efficacy and safety of most of these. This has left a void for women. Fezolinetant was recently approved by the FDA for the treatment of moderate-to-severe VMS. So far, clinical trials have shown positive results in terms of safety and efficacy. Fezolinetant is a non-hormonal, neurokinin 3 receptor antagonist that works in the hypothalamus at the thermoregulatory centre. Blocking the non-hormonal neurokinin 3 receptor antagonist modulates hot flashes and night sweats. As early as 4 weeks from initiating fezolinetant, women experienced a statistically significant reduction of both severity and frequency of VMS per day, resulting in an improved quality of life.

更年期最常见的症状是血管运动症状(VMS),80% 以上的绝经后妇女都会出现这种症状。此外,更年期血管运动症状也是妇女最常寻求治疗的更年期表现,即解决她们受到影响的生活质量,包括睡眠、工作和非工作相关的工作效率。更年期综合症的频率、强度和持续时间各不相同。激素疗法(HT)一直是我们治疗VMS最有效的方法,并已被美国食品药品管理局(FDA)批准用于这一适应症。尽管激素治疗是一种安全有效的治疗方法,但许多患者和医疗服务提供者对激素治疗犹豫不决。此外,高催乳素对某些女性来说是禁忌症。虽然有许多非处方和非 HT 方案,但我们缺乏大多数方案的有效性和安全性数据。这给女性留下了空白。美国食品及药物管理局(FDA)最近批准了用于治疗中度至重度 VMS 的非索内酯(Fezolinetant)。到目前为止,临床试验在安全性和有效性方面都取得了积极的成果。Fezolinetant 是一种非激素类神经激肽 3 受体拮抗剂,作用于下丘脑的体温调节中枢。阻断非激素类神经激肽 3 受体拮抗剂可调节潮热和盗汗。在开始服用非佐林内酯 4 周后,妇女每天出现的 VMS 的严重程度和频率都有了统计学意义上的显著降低,从而提高了生活质量。
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引用次数: 0
Endocrine Hypertension: The Urgent Need for Greater Global Awareness. 内分泌高血压:提高全球认识的迫切需要。
Pub Date : 2023-11-01 Epub Date: 2023-10-20 DOI: 10.17925/EE.2023.19.2.11
Cornelius J Fernandez, Lakshmi Nagendra, Mohammed Alkhalifah, Joseph M Pappachan

Hypertension affects about 1.28 billion adults globally, and significantly increases the risk of chronic morbidity and mortality among sufferers. About 15% of these individuals have secondary hypertension, the majority of whom have dysfunction of one or more endocrine systems as the cause of hypertension. Although adrenal disorders are often identified as the cause of endocrine hypertension, extra-adrenal disease and pituitary disorders also can cause the disease. Timely diagnosis is of paramount importance, because of the potential for a surgical cure or optimal disease control with pharmacotherapy to prevent hypertensive complications. Even with its relatively high prevalence compared with many other chronic illnesses, the diagnosis of endocrine hypertension is often delayed or never made because of poor awareness about the disease among physicians. This review attempts to provide an overview of the disease, with some practical aspects of diagnosis and management of a few of the important disorders causing endocrine hypertension.

高血压影响着全球约 12.8 亿成年人,大大增加了患者的慢性发病率和死亡率。这些人中约有 15%患有继发性高血压,其中大多数人的高血压是由一种或多种内分泌系统功能失调引起的。虽然肾上腺疾病通常被认为是内分泌性高血压的病因,但肾上腺外疾病和垂体疾病也可导致该病。及时诊断至关重要,因为有可能通过手术治愈或通过药物治疗达到最佳的疾病控制效果,从而预防高血压并发症。尽管内分泌性高血压的发病率比许多其他慢性疾病都要高,但由于医生对该病的认识不足,内分泌性高血压的诊断往往被延误或从未确诊。本综述试图对该疾病进行概述,并对引起内分泌性高血压的几种重要疾病的诊断和管理提供一些实用的方法。
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引用次数: 0
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TouchREVIEWS in endocrinology
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