Immunohistochemical Glucagon-like Peptide-1 Receptor Expression in Human Insulinomas

Insulinomas are rare functional pancreatic neuroendocrine tumours, which metastasize in 10% of cases. As predicting the prognosis can be challenging, there is a need for the determination of clinicopathological factors associated with metastatic potential. The aim of this study is to evaluate the glucagon-like peptide-1 receptor (GLP-1R) expression in insulinomas and to analyse its association with clinicopathological features and patient outcome. This retrospective study involves pancreatic tumour tissue samples from fifty-two insulinoma patients. After histological re-evaluation, formalin-fixed paraffin-embedded tissue samples were processed into tissue microarrays and stained immunohistochemically with a monoclonal GLP-1R antibody. Forty-eight of the forty-nine (98%) non-metastatic tumours expressed GLP-1R, while one non-metastatic, multiple endocrine neoplasia type 1 (MEN1)-related tumour and all three of the metastatic tumours lacked GLP-1R expression. The lack of GLP-1R expression was associated with impaired overall survival, larger tumour diameter, higher Ki-67 PI and weaker insulin staining. Somatostatin receptor 1-5 expression did not differ between GLP-1R-positive and GLP-1R-negative insulinomas. In conclusion, the lack of GLP-1R expression is associated with metastatic disease and impaired survival in insulinoma patients. Thus, GLP-1R expression could be a useful biomarker in estimating the metastatic potential of the tumour and the prognosis of surgically treated patients.

Unilateral Cleft Lip and Palate Has Asymmetry of Bony Orbits: A Retrospective Study

Facial asymmetry is common in unilateral clefts. Since virtual surgical planning (VSP) is becoming more common and automated segmentation is utilized more often, the position and asymmetry of the orbits can affect the design outcome. The aim of this study is to evaluate whether non-syndromic unilateral cleft lip and palate (UCLP) patients requiring orthognathic surgery have asymmetry of the bony orbits. Retrospectively, we analyzed the preoperative cone-beam computed tomography (CBCT) or computed tomography (CT) data of UCLP (n = 15) patients scheduled for a Le Fort 1 (n = 10) or bimaxillary osteotomy (n = 5) with VSP at the Cleft Palate and Craniofacial Center, Helsinki University Hospital. The width, height, and depth of the bony orbit and the distance between the sella turcica and infraorbital canal were measured. A volumetric analysis of the orbits was also performed. The measurements were tested for distribution, and the cleft side and the contralateral side were compared statistically with a two-sided paired t-test. To assess asymmetry in the non-cleft population, we performed the same measurements of skeletal class III patients undergoing orthognathic surgery at Päijät-Häme Central Hospital (n = 16). The volume of bony orbit was statistically significantly smaller (p = 0.014), the distance from the infraorbital canal to sella turcica was shorter (p = 0.019), and the anatomical location of the orbit was more medio-posterior on the cleft side than on the contralateral side. The non-cleft group showed no statistically significant asymmetry in any measurements. According to these preliminary results, UCLP patients undergoing orthognathic surgery show asymmetry of the bony orbit not seen in skeletal class III patients without a cleft. This should be considered in VSP for the correction of maxillary hypoplasia and facial asymmetry in patients with UCLP.

Immunohistochemical somatostatin receptor expression in insulinomas

Insulinomas are rare pancreatic neuroendocrine tumours. Most patients can be cured with surgery, but patients with a metastatic disease show impaired survival. The aim of this study was to evaluate somatostatin receptor (SSTR) 1-5 expression in insulinomas and to correlate the expression profile with clinicopathological variables and with patient outcome. This retrospective study involved 52 insulinoma patients. After histological re-evaluation, formalin-fixed paraffin-embedded tissue samples were processed into tissue microarrays and stained immunohistochemically with monoclonal SSTR1-5 antibodies. All the 52 tumours (49 non-metastatic, 3 metastatic) expressed at least one SSTR subtype. SSTR2 was expressed most frequently (71%), followed by SSTR3 (33%), SSTR1 (27%), SSTR5 (6%) and SSTR4 (0%). SSTR3 expression was associated with a larger tumour size (median diameter 19 mm vs. 13 mm, p = 0.043), and SSTR3 and SSTR5 expression were associated with impaired overall survival [HR 3.532 (95% CI 1.106-11,277), p = 0.033, and HR 6.805 (95% CI 1.364-33.955), p = 0.019 respectively]. Most insulinomas express SSTR2, which may be utilized in diagnostic imaging, and in planning individualized treatment strategies for insulinoma patients. Further studies are needed to clarify the association between SSTR profile and overall survival.

Long-term morbidity and mortality in patients diagnosed with an insulinoma

OBJECTIVE

Insulinomas are rare functional pancreatic neuroendocrine tumours. As previous data on the long-term prognosis of insulinoma patients are scarce, we studied the morbidity and mortality in the Finnish insulinoma cohort.

DESIGN

Retrospective cohort study.

METHODS

Incidence of endocrine, cardiovascular, gastrointestinal and psychiatric disorders, and cancers was compared in all the patients diagnosed with an insulinoma in Finland during 1980-2010 (n = 79, including two patients with multiple endocrine neoplasia type 1 syndrome), vs 316 matched controls, using the Mantel-Haenszel method. Overall survival was analysed with Kaplan-Meier and Cox regression analyses.

RESULTS

The median length of follow-up was 10.7 years for the patients and 12.2 years for the controls. The long-term incidence of atrial fibrillation (rate ratio (RR): 2.07 (95% CI: 1.02-4.22)), intestinal obstruction (18.65 (2.09-166.86)), and possibly breast (4.46 (1.29-15.39) and kidney cancers (RR not applicable) was increased among insulinoma patients vs controls, P < 0.05 for all comparisons. Endocrine disorders and pancreatic diseases were more frequent in the patients during the first year after insulinoma diagnosis, but not later on. The survival of patients with a non-metastatic insulinoma (n = 70) was similar to that of controls, but for patients with distant metastases (n = 9), the survival was significantly impaired (median 3.4 years).

CONCLUSIONS

The long-term prognosis of patients with a non-metastatic insulinoma is similar to the general population, except for an increased incidence of atrial fibrillation, intestinal obstruction, and possibly breast and kidney cancers. These results need to be confirmed in future studies. Metastatic insulinomas entail a markedly decreased survival.

Long-term health-related quality of life in persons diagnosed with an insulinoma in Finland 1980-2010

OBJECTIVE

Insulinomas are rare pancreatic neoplasms, which can usually be cured by surgery. As the diagnostic delay is often long and the prolonged hyperinsulinemia may have long-term effects on health and the quality of life, we studied the long-term health-related quality of life (HRQoL) in insulinoma patients.

DESIGN, PATIENTS AND MEASUREMENTS

The HRQoL of adults diagnosed with an insulinoma in Finland in 1980-2010 was studied with the 15D instrument, and the results were compared to those of an age- and gender-matched sample of the general population. The minimum clinically important difference in the total 15D score has been defined as ±0.015. The clinical characteristics, details of insulinoma diagnosis and treatment, and the current health status of the subjects were examined to specify the possible determinants of long-term HRQoL.

RESULTS

Thirty-eight insulinoma patients participated in the HRQoL survey (response rate 75%). All had undergone surgery with a curative aim, a median of 13 (min 7, max 34) years before the survey. The insulinoma patients had a clinically importantly and statistically significantly better mean 15D score compared with the controls (0.930 ± 0.072 vs 0.903 ± 0.039, P = .046) and were significantly better off regarding mobility, usual activities and eating. Among the insulinoma patients, younger age at the time of survey, higher level of education and smaller number of chronic diseases were associated with better overall HRQoL.

CONCLUSIONS

In the long term, the overall HRQoL of insulinoma patients is slightly better than that of the general population.

Characteristics and Outcomes of 79 Patients with an Insulinoma: A Nationwide Retrospective Study in Finland

OBJECTIVE

Insulinomas are rare pancreatic tumours. Population-based data on their incidence, clinical picture, diagnosis, and treatment are almost nonexistent. The aim of this study was to clarify these aspects in a nationwide cohort of insulinoma patients diagnosed during three decades.

DESIGN AND METHODS

Retrospective analysis on all adult patients diagnosed with insulinoma in Finland during 1980-2010.

RESULTS

Seventy-nine patients were diagnosed with insulinoma over the research period. The median follow-up from diagnosis to last control visit was one (min 0, max 31) year. The incidence increased from 0.5/million/year in the 1980s to 0.9/million/year in the 2000s (p = 0.002). The median diagnostic delay was 13 months and did not change over the study period. The mean age at diagnosis was 52 (SD 16) years. The overall imaging sensitivity improved from 39% in the 1980s to 98% in the 2000s (p < 0.001). Seventy-one (90%) of the patients underwent surgery with a curative aim, two (3%) had palliative surgery, and 6 (8%) were inoperable. There were no significant differences in the types of surgical procedures between the 1980s, 1990s, and 2000s; tumour enucleations comprised 43% of the operations, distal pancreatic resections 45%, and pancreaticoduodenectomies 12%, over the whole study period. Of the patients who underwent surgery with a curative aim, 89% had a full recovery. Postoperative complications occurred in half of the patients, but postoperative mortality was rare.

CONCLUSIONS

The incidence of insulinomas has increased during the past three decades. Despite the improved diagnostic options, diagnostic delay has remained unchanged. To shorten the delay, clinicians should be informed and alert to consider the possibility of hypoglycemia and insulinoma, when symptomatic attacks are investigated in different sectors of the healthcare system. Developing the surgical treatment is another major target, in order to lower the overall complication rate, without compromising the high cure rate of insulinomas.

Peripheral Vascular Restenosis: A Retrospective Study on the Use of Drug-Eluting Balloons in Native Arteries, Vein Grafts and Dialysis Accesses

Background and Aims:

The objective of this study is to analyze outcomes of the first experiences with drug-eluting balloons in native arteries, vein grafts, and vascular accesses. The study is also a pilot for our future prospective, randomized, and controlled studies regarding the use of drug-eluting balloons in the treatment of the stenosis in bypass vein graft and dialysis access.

Materials and Methods:

A total of 93 consecutive patients were retrospectively analyzed and in the end 81 were included in the study. Inclusion criteria included at least one previous percutaneous angioplasty to the same lesion. Patients were divided into three groups according to the anatomical site of the lesion: native lower limb artery, vein bypass graft, or vascular access. Time from the previous percutaneous angioplasty to the drug-eluting balloon was compared to the time from the drug-eluting balloon to endpoint in the same patient. Endpoints included any new revascularization of the target lesion, major amputation, or new vascular access.

Results:

The median time from the drug-eluting balloon to endpoint was significantly longer than the median time from the preceding percutaneous angioplasty to drug-eluting balloon in all three groups. This difference was clearest in native arteries and vein grafts, whereas the difference was smaller from the beginning and disappeared over time in the vascular access group. No significant differences were seen between the groups with regard to smoking, antiplatelet regime, diabetes, Rutherford classification, or sex.

Conclusion:

Although the setup of this study has several limitations, the results suggest that there could be benefit from drug-eluting balloons in peripheral lesions. Very little data have been published on the use of drug-eluting balloons in vein grafts and vascular accesses, and randomized and controlled prospective studies are needed to further investigate this field.

Aerobic characteristics, oxygen debt and blood lactate in speed endurance athletes during training

Aerobic characteristics, oxygen debt and blood lactate were analysed in 20 male speed endurance athletes (400 m sprinters and 400 m hurdlers). The subjects were tested three times; at the beginning of March, at the end of May and at the end of August. Aerobic and anaerobic threshold and maximal oxygen uptake measured on the treadmill decreased (p < 0.05-0.01) from the second test occasion to the third one. The anaerobic work test on the treadmill was a constant load test at 5.56 m.s-1 with a slope of 4 degrees. The time to exhaustion increased (p < 0.05) from the first test occasion (112 +/- 17 s) to the second one (136 +/- 35 s) and did not change in the last test (135 +/- 25 s). Following the anaerobic work test oxygen debt was measured during 20 minutes. The highest total oxygen debt values (144 +/- 19 ml.kg-1) were observed in the second test occasion. Peak blood lactate following the anaerobic work increased (p < 0.05) from the first test occasion to the second one and remained at the same level during the next three competitive months. The good speed endurance athletes differed from the poor counterparts in time to exhaustion (p < 0.01), in 100 m record time (p < 0.01) and in maximal oxygen uptake (p < 0.05). Our results suggest that aerobic characteristics decrease during the competitive period in speed endurance athletes. The anaerobic performance capacity including work time and peak blood lactate is at high level in the competitive period.(ABSTRACT TRUNCATED AT 250 WORDS)

Changes in running speed, blood lactic acid concentration and hormone balance during sprint training performed at an altitude of 1860 metres

The development of results of five national level sprinters (Group A) was followed up during a training period of two weeks at an altitude of 1860 m aiming at increase of strength and speed and after it. Changes in anaerobic capacity were monitored by making blood lactic acid determinations, and occurrence of any overstrain by serum testosterone, cortisol, growth hormone and SHBG (sex hormone binding globulin) determinations. A control group (Group B) trained simultaneously according to a similar programme at sea level. Maximal 150 m running speeds increased in Group A significantly during the two weeks at the altitude of 1860 m (p less than 0.001). No such increase was observable in Group B. Maximal 300 m running speeds and maximal lactic acid concentrations after running did not increase significantly in either group. Serum hormone levels did not change significantly either, in either group. Training at an altitude of 1860 m to increase strength and speed significantly improved results at the shorter distance of 150 m but had not significant effects on anaerobic capacity or on serum testosterone, cortisol, growth hormone or SHBG levels.

Physiological performance capacity in different prepubescent athletic groups

Endurance, strength and speed capacity were investigated among prepubescent male weight lifters (EL), endurance runners (ER) and sprint runners (SR). The subjects were selected by their coaches and all of them were classified as promising and successful junior athletes in the age groups of 10-13 years. Twelve boys belonged to athletic group (AG) and their performance capacity was compared to normally active control (C) boys (n = 9). Biological age was significantly (p less than 0.05) greater in AG (11.3 +/- 0.9 years) than in C (10.2 +/- 1.4 years) but in chronological age there was no difference between the groups. Maximal oxygen uptake was significantly (p less than 0.05) higher in AG (62.3 +/- 3.1 ml.kg-1.min-1) than in C (55.4 +/- 7.7 ml.kg-1.min-1). The endurance runners had the highest value (66.5 +/- 2.9 ml.kg-1.min-1). In anaerobic characteristics there were no significant differences. The rise of centre of gravity (0.26 +/- 0.03 m) of AG in a test for the best drop jump was clearly (p less than 0.05) higher than that (0.22 +/- 0.03 m) of C. The weight lifters and sprint runners were the best in the test for force production. AG had significantly (p less than 0.01) shorter choice reaction time (261 +/- 39 ms) than C (344 +/- 81 ms). Testosterone correlated with jump performances (p less than 0.05), biological age (p less than 0.01) and chronological age (p less than 0.001). Growth hormone correlated significantly only with biological age (p less than 0.05) and testosterone (p less than 0.001). In conclusion, endurance capacity (aerobic) and strength capacity were greater in the athletic group than in the control group and it was suggested that training background and more advanced biological maturation of the athletes affected especially their strength capacity. The parameters used in this investigation can be utilized for talent selection in sport.