Assessing Nutritional Status in Gastric Cancer Patients after Total versus Subtotal Gastrectomy: Cross-Sectional Study

Gastric cancer (GC) remains a significant global health concern, ranking as the third leading cause of cancer-related deaths. Malnutrition is common in GC patients and can negatively impact prognosis and quality of life. Understanding nutritional issues and their management is crucial for improving patient outcomes. This cross-sectional study included 51 GC patients who underwent curative surgery, either total or subtotal gastrectomy. Various nutritional assessments were conducted, including anthropometric measurements, laboratory tests, and scoring systems such as Eastern Cooperative Oncology Group/World Health Organization Performance Status (ECOG/WHO PS), Observer-Reported Dysphagia (ORD), Nutritional Risk Screening-2002 (NRS-2002), Patient-Generated Subjective Global Assessment (PG-SGA), and Simplified Nutritional Appetite Questionnaire (SNAQ). Serum carcinoembryonic antigen (CEA) levels were significantly higher in the subtotal gastrectomy group. Nutritional assessments indicated a higher risk of malnutrition in patients who underwent total gastrectomy, as evidenced by higher scores on ORD, NRS-2002, and PG-SGA. While total gastrectomy was associated with a higher risk of malnutrition, no single nutritional parameter emerged as a strong predictor of surgical approach. PG-SGA predominantly identified malnutrition, with its occurrence linked to demographic factors such as female gender and age exceeding 65 years.

Using the IUCN Environmental Impact Classification for Alien Taxa to inform decision-making

The Environmental Impact Classification for Alien Taxa (EICAT) is an important tool for biological invasion policy and management and has been adopted as an International Union for Conservation of Nature (IUCN) standard to measure the severity of environmental impacts caused by organisms living outside their native ranges. EICAT has already been incorporated into some national and local decision-making procedures, making it a particularly relevant resource for addressing the impact of non-native species. Recently, some of the underlying conceptual principles of EICAT, particularly those related to the use of the precautionary approach, have been challenged. Although still relatively new, guidelines for the application and interpretation of EICAT will be periodically revisited by the IUCN community, based on scientific evidence, to improve the process. Some of the criticisms recently raised are based on subjectively selected assumptions that cannot be generalized and may harm global efforts to manage biological invasions. EICAT adopts a precautionary principle by considering a species' impact history elsewhere because some taxa have traits that can make them inherently more harmful. Furthermore, non-native species are often important drivers of biodiversity loss even in the presence of other pressures. Ignoring the precautionary principle when tackling the impacts of non-native species has led to devastating consequences for human well-being, biodiversity, and ecosystems, as well as poor management outcomes, and thus to significant economic costs. EICAT is a relevant tool because it supports prioritization and management of non-native species and meeting and monitoring progress toward the Kunming-Montreal Global Biodiversity Framework (GBF) Target 6.

Development and application of a second-generation multilingual tool for invasion risk screening of non-native terrestrial plants

Under the increasing threat to native ecosystems posed by non-native species invasions, there is an urgent need for decision support tools that can more effectively identify non-native species likely to become invasive. As part of the screening (first step) component in non-native species risk analysis, decision support tools have been developed for aquatic and terrestrial organisms. Amongst these tools is the Weed Risk Assessment (WRA) for screening non-native plants. The WRA has provided the foundations for developing the first-generation WRA-type Invasiveness Screening Kit (ISK) tools applicable to a range of aquatic species, and more recently for the second-generation ISK tools applicable to all aquatic organisms (including plants) and terrestrial animals. Given the most extensive usage of the latter toolkits, this study describes the development and application of the Terrestrial Plant Species Invasiveness Screening Kit (TPS-ISK). As a second-generation ISK tool, the TPS-ISK is a multilingual turnkey application that provides several advantages relative to the WRA: (i) compliance with the minimum standards against which a protocol should be evaluated for invasion process and management approaches; (ii) enhanced questionnaire comprehensiveness including a climate change component; (iii) provision of a level of confidence; (iv) error-free computation of risk scores; (v) multilingual support; (vi) possibility for across-study comparisons of screening outcomes; (vii) a powerful graphical user interface; (viii) seamless software deployment and accessibility with improved data exchange. The TPS-ISK successfully risk-ranked five representative sample species for the main taxonomic groups supported by the tool and ten angiosperms previously screened with the WRA for Turkey. The almost 20-year continuous development and evolution of the ISK tools, as opposed to the WRA, closely meet the increasing demand by scientists and decision-makers for a reliable, comprehensive, updatable and easily deployable decision support tool. For terrestrial plant screening, these requirements are therefore met by the newly developed TPS-ISK.

Preptin: A New Bone Metabolic Parameter?

Preptin is a 34-aminoacid peptide derived from the E-peptide of pro-insulin-like growth factor 2 (pro-IGF2) that is co-secreted with insulin and upregulates glucose-mediated insulin secretion. High serum preptin levels were described in conditions associated with insulin resistance, such as polycystic ovary syndrome and type 2 diabetes mellitus (T2M). Insulin and also IGF2 are known to be anabolic bone hormones. The "sweet bone" in T2M usually associates increased density, but altered microarchitecture. Therefore, preptin was proposed to be one of the energy regulatory hormones that positively impacts bone health. Experimental data demonstrate a beneficial impact of preptin upon the osteoblasts. Preptin also appears to regulate osteocalcin secretion, which in turn regulates insulin sensitivity. Preptin is greatly influenced by the glucose tolerance status and the level of physical exercise, both influencing the bone mass. Clinical studies describe low serum preptin concentrations in osteoporosis in both men and women, therefore opening the way towards considering preptin a potential bone anabolic therapy. The current review addresses the relationship between preptin and bone mass and metabolism in the experimental and clinical setting, also considering the effects of preptin on carbohydrate metabolism and the pancreatic-bone loop.

Thyroid, Gonadal and Adrenal Dysfunction in Kidney Transplant Recipients: A Review for the Clinician

While chronic kidney disease-associated mineral and bone disorders (CKD-MBD) prevail in the endocrinological assessment of CKD patients, other endocrine abnormalities are usually overlooked. CKD is associated with significant thyroid, adrenal and gonadal dysfunction, while persistent and de novo endocrinological abnormalities are frequent among kidney transplant recipients (KTR). Low T3 levels prior to transplantation may help identify those at risk for delayed graft function and are often found in KTR. Thyroid surveillance after kidney transplantation should be considered due to structural anomalies that may occur. Despite the rapid recovery of gonadal hormonal secretion after renal transplantation, fertility is not completely restored. Testosterone may improve anemia and general symptoms in KTR with persistent hypogonadism. Female KTR may still experience abnormal uterine bleeding, for which estroprogestative administration may be beneficial. Glucocorticoid administration suppresses the hypothalamic-pituitary-adrenal axis in KTR, leading to metabolic syndrome. Patients should be informed about signs and symptoms of hypoadrenalism that may occur after glucocorticoid withdrawal, prompting adrenal function assessment. Clinicians should be more aware of the endocrine abnormalities experienced by their KTR patients, as these may significantly impact the quality of life. In clinical practice, awareness of the specific endocrine dysfunctions experienced by KTR patients ensures the correct management of these complications in a multidisciplinary team, while avoiding unnecessary treatment.

More than a Bit of Fun: The Multiple Outcomes of a Bioblitz

Bioblitzes are a popular approach to engage people and collect biodiversity data. Despite this, few studies have actually evaluated the multiple outcomes of bioblitz activities. We used a systematic review, an analysis of data from more than 1000 bioblitzes, and a detailed analysis of one specific bioblitz to inform our inquiry. We evaluated five possible bioblitz outcomes, which were creating a species inventory, engaging people in biological recording, enhancing learning about nature, discovering a species new to an area, and promoting an organization. We conclude that bioblitzes are diverse but overall effective at their aims and have advantages over unstructured biodiversity recording. We demonstrate for the first time that bioblitzes increase the recording activity of the participants for several months after the event. In addition, we provide evidence that bioblitzes are effective at bringing people and organizations together to build communities of professionals and amateurs, critical for conserving and protecting biodiversity.

More than a Bit of Fun: The Multiple Outcomes of a Bioblitz

Bioblitzes are a popular approach to engage people and collect biodiversity data. Despite this, few studies have actually evaluated the multiple outcomes of bioblitz activities. We used a systematic review, an analysis of data from more than 1000 bioblitzes, and a detailed analysis of one specific bioblitz to inform our inquiry. We evaluated five possible bioblitz outcomes, which were creating a species inventory, engaging people in biological recording, enhancing learning about nature, discovering a species new to an area, and promoting an organization. We conclude that bioblitzes are diverse but overall effective at their aims and have advantages over unstructured biodiversity recording. We demonstrate for the first time that bioblitzes increase the recording activity of the participants for several months after the event. In addition, we provide evidence that bioblitzes are effective at bringing people and organizations together to build communities of professionals and amateurs, critical for conserving and protecting biodiversity.

Artificial Neural Network Models for Accurate Predictions of Fat-Free and Fat Masses, Using Easy-to-Measure Anthropometric Parameters

Abdominal fat and fat-free masses report a close association with cardiometabolic risks, therefore this specific body compartment presents more interest than whole-body masses. This research aimed to develop accurate algorithms that predict body masses and specifically trunk fat and fat-free masses from easy to measure parameters in any setting. The study included 104 apparently healthy subjects, but with a higher-than-normal percent of adiposity or waist circumference. Multiple linear regression (MLR) and artificial neural network (ANN) models were built for predicting abdominal fat and fat-free masses in patients with relatively low cardiometabolic risks. The data were divided into training, validation and test sets, and this process was repeated 20 times per each model to reduce the bias of data division on model accuracy. The best performance models used a maximum number of five anthropometric inputs, with higher R² values for ANN models than for MLR models (R² = 0.96-0.98 vs. R² = 0.80-0.94, p = 0.006). The root mean square error (RMSE) for all predicted parameters was significantly lower for ANN models than for MLR models, suggesting a higher accuracy for ANN models. From all body masses predicted, trunk fat mass and fat-free mass registered the best performance with ANN, allowing a possible error of 1.84 kg for predicting the correct trunk fat mass and 1.48 kg for predicting the correct trunk fat-free mass. The developed algorithms represent cost-effective prediction tools for the most relevant adipose and lean tissues involved in the physiopathology of cardiometabolic risks.

Local conditions matter: Minimal and variable effects of soil disturbance on microbial communities and functions in European vineyards

Soil tillage or herbicide applications are commonly used in agriculture for weed control. These measures may also represent a disturbance for soil microbial communities and their functions. However, the generality of response patterns of microbial communities and functions to disturbance have rarely been studied at large geographical scales. We investigated how a soil disturbance gradient (low, intermediate, high), realized by either tillage or herbicide application, affects diversity and composition of soil bacterial and fungal communities as well as soil functions in vineyards across five European countries. Microbial alpha-diversity metrics responded to soil disturbance sporadically, but inconsistently across countries. Increasing soil disturbance changed soil microbial community composition at the European level. However, the effects of soil disturbance on the variation of microbial communities were smaller compared to the effects of location and soil covariates. Microbial respiration was consistently impaired by soil disturbance, while effects on decomposition of organic substrates were inconsistent and showed positive and negative responses depending on the respective country. Therefore, we conclude that it is difficult to extrapolate results from one locality to others because microbial communities and environmental conditions vary strongly over larger geographical scales.

SHOX Deletion and Idiopathic Short Stature: What Does the Clinician Need to Know? Case Series Report

Children diagnosticated with idiopathic short stature (ISS) are probably, in most cases, underdiagnosticated. The genetic causes of ISS may be mutations of genes involved in local regulation of the growth plate or genes involved in the GH-IGF1 axis physiology. We present a kindred of five children evaluated for short stature or low normal stature, initially diagnosticated as idiopathic short stature, familial short stature, or being small for gestational age. Clinical signs suggestive of SHOX deletion screening in a child with short stature are low arm span/height ratio, increased sitting height/height ratio, BMI > 50% percentile, Madelung deformity, cubitus valgus, bowing and shortening of the forearm, dislocation of the ulna (at the elbow), and the appearance of muscular hypertrophy. Radiological characteristics suggestive of SHOX deficiency are triangularisation of the distal radial epiphysis, an enlarged diaphysis of the radius plus bowing of the radius, the convexity of the distal radial metaphysis, short fourth and fifth metacarpals, pyramidalization of the carpal row. Treatment with rGH is approved for children with SHOX gene deficiency and short stature. This kindred is an example that familial short stature, idiopathic short stature, and short stature due to a small gestational age are not final diagnoses. Complex investigations are necessary to identify the precise cause, leading to optimal clinical management. Treatment with rGH is an option for some of them; for others, it has no therapeutic response and, in some cases, is even harmful.

The Importance of HDL-Cholesterol and Fat-Free Percentage as Protective Markers in Risk Factor Hierarchy for Patients with Metabolic Syndrome

This research focused on establishing a hierarchy concerning the influence of various biological markers and body composition parameters on preventing, diagnosing and managing Metabolic Syndrome (MetS). Our cross-sectional cohort study included 104 subjects without any atherosclerotic antecedent pathology, organized in two groups (with and without MetS). All participants underwent clinical and anthropometric measurements, DEXA investigation and blood tests for all MetS criteria, together with adiponectin, leptin, insulin, uric acid and CRP. Based on mathematical logic, we calculated a normalized sensitivity score to compare the predictive power of biomarkers and parameters associated with MetS, upon the prevalence of MetS. Patients with MetS report higher levels of uric acid (p = 0.02), CRP (p = 0.012) and lower levels of adiponectin (p = 0.025) than patients without MetS. The top three biological markers with the highest predictive power of the prevalence of the disease are HDL, insulin, and adiponectin:leptin ratio, and the top three body composition parameters are trunk fat-free percentage, waist-height ratio and trunk fat percentage. Their high sensitivity scores differentiate them from all the other markers analysed in the study. Our findings report relevant scores for estimating the importance of cardiometabolic risks in the prevalence of MetS. The high rank of protective markers, HDL and trunk fat-free percentage, suggest that positive effects have a stronger association with the prevalence of MetS, than negative ones do. Therefore, this risk stratification study provides important support for prevention and management programs regarding MetS.

Development and application of a multilingual electronic decision-support tool for risk screening non-native terrestrial animals under current and future climate conditions

Electronic decision-support tools are becoming an essential component of government strategies to tackle non-native species invasions. This study describes the development and application of a multilingual electronic decision-support tool for screening terrestrial animals under current and future climate conditions: the Terrestrial Animal Species Invasiveness Screening Kit (TAS-ISK). As an adaptation of the widely employed Aquatic Species Invasiveness Screening Kit (AS-ISK), the TAS-ISK question template inherits from the original Weed Risk Assessment (WRA) and related WRA-type toolkits and complies with the ‘minimum requirements’ for use with the recent European Regulation on invasive alien species of concern. The TAS-ISK consists of 49 basic questions on the species’ biogeographical/historical traits and its biological/ecological interactions, and of 6 additional questions to predict how climate change is likely to influence the risks of introduction, establishment, dispersal and impact of the screened species. Following a description of the main features of this decision-support tool as a turnkey software application and of its graphical user interface with support for 32 languages, sample screenings are provided in different risk assessment areas for one representative species of each of the main taxonomic groups of terrestrial animals supported by the toolkit: mammals, birds, reptiles, amphibians, annelids, insects, molluscs, nematodes, and platyhelminths. The highest-scoring species were the red earthworm Lumbricus rubellus for the Aegean region of Turkey and the New Zealand flatworm Arthurdendyus triangulatus for Croatia. It is anticipated that adoption of this toolkit will mirror that of the worldwide employed AS-ISK, hence allowing to share information and inform decisions for the prevention of entry and/or dispersal of (high-risk) non-native terrestrial animal species – a crucial step to implement early-stage control and eradication measures as part of rapid-response strategies to counteract biological invasions.

Corrigenda: Sirbu C, Miu IV, Gavrilidis AA, Gradinaru SR, Niculae IM, Preda C, Oprea A, Urziceanu M, Camen-Comanescu P, Nagoda E, Sirbu IM, Memedemin D, Anastasiu P (2022) Distribution and pathways of introduction of invasive alien plant species in Romania. NeoBiota 75: 1–21. https://doi.org/10.3897/neobiota.75.84684

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Identifying, reducing, and communicating uncertainty in community science: a focus on alien species

Community science (also often referred to as citizen science) provides a unique opportunity to address questions beyond the scope of other research methods whilst simultaneously engaging communities in the scientific process. This leads to broad educational benefits, empowers people, and can increase public awareness of societally relevant issues such as the biodiversity crisis. As such, community science has become a favourable framework for researching alien species where data on the presence, absence, abundance, phenology, and impact of species is important in informing management decisions. However, uncertainties arising at different stages can limit the interpretation of data and lead to projects failing to achieve their intended outcomes. Focusing on alien species centered community science projects, we identified key research questions and the relevant uncertainties that arise during the process of developing the study design, for example, when collecting the data and during the statistical analyses. Additionally, we assessed uncertainties from a linguistic perspective, and how the communication stages among project coordinators, participants and other stakeholders can alter the way in which information may be interpreted. We discuss existing methods for reducing uncertainty and suggest further solutions to improve data reliability. Further, we make suggestions to reduce the uncertainties that emerge at each project step and provide guidance and recommendations that can be readily applied in practice. Reducing uncertainties is essential and necessary to strengthen the scientific and community outcomes of community science, which is of particular importance to ensure the success of projects aimed at detecting novel alien species and monitoring their dynamics across space and time.

Distribution and pathways of introduction of invasive alien plant species in Romania

Biological invasions are one of the main drivers of modern human-induced species losses. Research on the distribution of alien species and their pathways of introduction is essential for understanding and tackling the invasion process. A comprehensive overview on invasive alien plant (IAP) species in Romania is lacking. With this paper, we aim to contribute to filling this gap and to provide a visualization of national patterns regarding plant species invasions, geographical origins and pathways of introductions. Based on plant species occurrence records in the published literature and herbaria we compiled a national database of 102 invasive and potentially invasive alien plant species. We georeferenced 42776 IAP species occurrences and performed an analysis of their spatial patterns. The spatial analyses revealed a biased sampling, with clear hotspots of increased sampling efforts around urban areas. We used chord diagrams to visualize the pathway of introduction and geographical origins of the IAP species, which revealed that species in Romania originate mainly in North and Central America, while the dominant pathway of plant introduction was horticulture. Our results provide an important baseline in drafting management and action plans, as invasive alien plant species represent a priority for the European Union through the Biodiversity Strategy for 2030, and a good starting point for various analyses as the database is further developed and regularly updated.

Management of malignant struma ovarii: is aggressive therapy justified? Case report and literature review

Background

Struma ovarii (SO) is a rare ovarian teratoma containing predominantly thyroid tissue. In rare situations SO may develop malignancy. Most cases of malignant struma ovarii (MSO) are diagnosed after surgical removal, based on histopathological examination. There are still controversies regarding the extent of surgery and postoperative management in MSO, due to its unpredictable behavior, possible risk of metastasis and relatively high rate of recurrence.

Case Presentation

We present the case of a patient diagnosed with a right ovarian cyst discovered incidentally during routine ultrasound examination. Its rapid growth and pelvic MRI raised the suspicion of a neoplastic process. She underwent total hysterectomy and bilateral adnexectomy. The anatomopathological diagnosis was MSO with follicular variant of papillary thyroid carcinoma. Prophylactic total thyroidectomy was performed, followed by radioactive iodine ablation (RAI), and suppressive therapy with levothyroxine. At 1 year follow-up, the patient was disease free.

Conclusions

Even if latest literature reports consider that completion of local surgery with total thyroidectomy and RAI might be too aggressive in cases of MSO without extraovarian extension, in our case it was decided to follow the protocol for primary thyroid carcinoma, in order to reduce the recurrence risk.

Vineyard Management and Its Impacts on Soil Biodiversity, Functions, and Ecosystem Services

Healthy soils form the basis of sustainable viticulture, where soil characteristics have a direct impact on wine quantity and quality. Soil not only provides water and nutrients to vines, but is also a living medium containing micro- and macroorganisms that perform many ecological functions and provide ecosystem services. These organisms are involved in many processes, from decomposing organic matter to providing minerals to vine roots. They also control diseases, pests, and weeds, in addition to improving the soil structure in terms of its capacity to retain water and nutrients. Related to decomposition processes, the carbon content of vineyard soils influences fertility, erosion and biogeochemical cycles, with significant implications for the global climate. However, common agricultural practices represent strong threats to biodiversity and associated ecosystem services provided by vineyard soils. As consumers increasingly consider environmental aspects in their purchase decisions, winegrowers have to adapt their vineyard management strategies, raising the demand for sustainable pest- and weed-control methods. This article presents a comprehensive review of the impacts of vineyard practices on the soil ecosystem, biodiversity, and biodiversity-based ecosystem services, and provides future prospects for sustainable viticulture.

Metabolic Phenotypes—The Game Changer in Quality of Life of Obese Patients?

Background: The present study aimed to investigate the association of obesity phenotypes and quality of life (QoL) scales and their relationship with fat mass (FM) parameters. Methods: This study categorized 104 subjects into 4 obesity phenotypes based on BMI and metabolic syndrome status: metabolically healthy obese (MHO), metabolically unhealthy obese (MUO), metabolically healthy non-obese (MHNO), and metabolically unhealthy non-obese (MUNO). Body composition was measured by dual-energy X-ray absorptiometry (DEXA) and metabolic profile was characterized by blood samples. All subjects completed the SF-36 item Short Form Health Survey Questionnaire. Results: Comparing the four obesity phenotypes, significant results were reported for Bodily Pain between MHNO/MUNO (p = 0.034), for Vitality between MHO/MUO (p = 0.024), and for Mental Component Score between MHO/MUO (p = 0.026) and MUO/MUNO (p = 0.003). A more thorough inside-groups analysis yielded a positive and moderate to high correlation between FM parameters and QoL scales in MHO and MHNO, while a negative and weak to moderate correlation was observed in MUO and MUNO. Conclusion: This study reported an inverse U-shaped relationship between FM and QoL in obesity phenotypes, suggesting that metabolic status is a key factor involved in modulating QoL and therefore challenging the idea of obesity as a main driver of low QoL. We recommend the inclusion of FM percentage in the definition of obesity phenotypes in future research, to better evaluate QoL of obesity phenotypes.

From chronic pruritus to neuroendocrine tumor: A case report

Chronic pruritus is a major and distressing symptom of many diseases of dermatological, neurological, psychogenic or systemic origin. This chronic itch could be a presenting sign of malignancy; therefore, paraneoplastic pruritus has also been associated with neuroendocrine tumors (NETs). This article focuses on a patient presenting with chronic pruritus for the past 12 months and who received numerous treatment schemes with very poor clinical improvement, that presented in the hospital for worsening of the chronic pruritus associated with skin rash and significant weight loss (approximately 6 kg over a 2-month period). The laboratory tests showed iron deficiency anemia, eosinophilia and negative tumor markers. In order to investigate the hypoanabolic and anemic syndromes, upper gastrointestinal endoscopy and colonoscopy, which showed no lesions or tumors, were employed. Skin biopsy was performed and antihistaminic and local steroid treatment was initiated. The patient's status worsened within a week and the patient was started on systemic steroid treatment with poor results. Computer tomography was performed to identify any tumor(s) located either in the pelvis or abdomen. A lesion was found in the terminal ileum, identified as a hypervascularized associating bulky lymphadenopathy. The patient was transferred to the surgical ward where right hemicolectomy with manual ileotransverse anastomosis L-L was performed. The histopathological result confirmed NET G2. The patient clinically improved, the skin lesions resolved and the itchiness disappeared. The general status improved significantly. NET G2 diagnosing was possible due to the atypic paraneoplastic sign: chronic pruritus. This case study highlights the association between itch and malignancy and presents an atypical way of NET presentation when all tumor markers remain negative.

Silent pheochromocytoma and paraganglioma: Systematic review and proposed definitions for standardized terminology

Pheochromocytomas and paragangliomas (PPGLs) are rare neuroendocrine tumors with heterogeneous clinical presentations and potential lethal outcomes. The diagnosis is based on clinical suspicion, biochemical testing, imaging and histopathological confirmation. Increasingly widespread use of imaging studies and surveillance of patients at risk of PPGL due to a hereditary background or a previous tumor is leading to the diagnosis of these tumors at an early stage. This has resulted in an increasing use of the term "silent" PPGL. This term and other variants are now commonly found in the literature without any clear or unified definition. Among the various terms, "clinically silent" is often used to describe the lack of signs and symptoms associated with catecholamine excess. Confusion arises when these and other terms are used to define the tumors according to their ability to synthesize and/or release catecholamines in relation to biochemical test results. In such cases the term "silent" and other variants are often inappropriately and misleadingly used. In the present analysis we provide an overview of the literature and propose standardized terminology in an attempt at harmonization to facilitate scientific communication.

Cortisol Reactivity to a Digital Version of Trier Social Stress Test and Eating Behavior in Non-Overweight and Overweight Adolescents: A Pilot Study

(1) Background: In the present pilot study, we examined the response of cortisol to a digital version of the Trier Social Stress Test (TSST) and corresponding eating preferences in non-overweight and overweight adolescents. (2) Methods: The experimental study group included 35 adolescents aged 15.7 ± 0.5 years (16 boys and 19 girls). The participants were split into two groups: non-overweight (N = 24) and overweight (N = 11), according to the Body Mass Index (BMI). We induced acute stress in all participants, using a digital version of the Trier Social Stress Test (TSST), with three different digital tasks. We measured salivary cortisol before the test (T0), during the stress induction by digital tasks (T5, T10, T15), and 25 min after the stress test (T40). The Health Behavior in School-Aged Children Questionnaire (HBSC) was administered to assess the influence of stress on eating behavior: the consumption of fruit, vegetables, sweets, and soft drinks and the frequency of snacks. (3) Results: Among the entire group of adolescents, we observed a significant difference between the sexes in terms of cortisol response, girls being predominantly hyperreactive (13 girls compared to 5 boys, p = 0.03). In overweight adolescents, the cortisol reactivity was lower in boys and higher in girls (p = 0.05). The overweight hyperreactive adolescents, as compared to the hyporeactive ones, had a higher frequency of daily consumption of sweets (25% vs. 0%) and soft drink (25% vs. 0). (4) Conclusions: The individual patterns of cortisol reactivity to laboratory-induced stress could be associated with an increased risk of unhealthy eating behavior in adolescents.

A global-scale screening of non-native aquatic organisms to identify potentially invasive species under current and future climate conditions

The threat posed by invasive non-native species worldwide requires a global approach to identify which introduced species are likely to pose an elevated risk of impact to native species and ecosystems. To inform policy, stakeholders and management decisions on global threats to aquatic ecosystems, 195 assessors representing 120 risk assessment areas across all six inhabited continents screened 819 non-native species from 15 groups of aquatic organisms (freshwater, brackish, marine plants and animals) using the Aquatic Species Invasiveness Screening Kit. This multi-lingual decision-support tool for the risk screening of aquatic organisms provides assessors with risk scores for a species under current and future climate change conditions that, following a statistically based calibration, permits the accurate classification of species into high-, medium- and low-risk categories under current and predicted climate conditions. The 1730 screenings undertaken encompassed wide geographical areas (regions, political entities, parts thereof, water bodies, river basins, lake drainage basins, and marine regions), which permitted thresholds to be identified for almost all aquatic organismal groups screened as well as for tropical, temperate and continental climate classes, and for tropical and temperate marine ecoregions. In total, 33 species were identified as posing a 'very high risk' of being or becoming invasive, and the scores of several of these species under current climate increased under future climate conditions, primarily due to their wide thermal tolerances. The risk thresholds determined for taxonomic groups and climate zones provide a basis against which area-specific or climate-based calibrated thresholds may be interpreted. In turn, the risk rankings help decision-makers identify which species require an immediate 'rapid' management action (e.g. eradication, control) to avoid or mitigate adverse impacts, which require a full risk assessment, and which are to be restricted or banned with regard to importation and/or sale as ornamental or aquarium/fishery enhancement.

Bone mineral density predictors in long-standing type 1 and type 2 diabetes mellitus

BACKGROUND

Despite the increased fracture risk, bone mineral density (BMD) is variable in type 1 (T1D) and type 2 (T2D) diabetes mellitus. We aimed at comparing independent BMD predictors in T1D, T2D and control subjects, respectively.

METHODS

Cross-sectional case-control study enrolling 30 T1D, 39 T2D and 69 age, sex and body mass index (BMI) - matched controls that underwent clinical examination, dual-energy X-ray absorptiometry (BMD at the lumbar spine and femoral neck) and serum determination of HbA1c and parameters of calcium and phosphate metabolism.

RESULTS

T2D patients had similar BMD compared to T1D individuals (after adjusting for age, BMI and disease duration) and to matched controls, respectively. In multiple regression analysis, diabetes duration - but not HbA1c- negatively predicted femoral neck BMD in T1D (β= -0.39, p = 0.014), while BMI was a positive predictor for lumbar spine (β = 0.46, p = 0.006) and femoral neck BMD (β = 0.44, p = 0.007) in T2D, besides gender influence. Age negatively predicted BMD in controls, but not in patients with diabetes.

CONCLUSIONS

Long-standing diabetes and female gender particularly increase the risk for low bone mass in T1D. An increased body weight partially hinders BMD loss in T2D. The impact of age appears to be surpassed by that of other bone regulating factors in both T1D and T2D patients.

Deep Learning Application for Analyzing of Constituents and Their Correlations in the Interpretations of Medical Images

The need for time and attention, given by the doctor to the patient, due to the increased volume of medical data to be interpreted and filtered for diagnostic and therapeutic purposes has encouraged the development of the option to support, constructively and effectively, deep learning models. Deep learning (DL) has experienced an exponential development in recent years, with a major impact on interpretations of the medical image. This has influenced the development, diversification and increase of the quality of scientific data, the development of knowledge construction methods and the improvement of DL models used in medical applications. All research papers focus on description, highlighting, classification of one of the constituent elements of deep learning models (DL), used in the interpretation of medical images and do not provide a unified picture of the importance and impact of each constituent in the performance of DL models. The novelty in our paper consists primarily in the unitary approach, of the constituent elements of DL models, namely, data, tools used by DL architectures or specifically constructed DL architecture combinations and highlighting their "key" features, for completion of tasks in current applications in the interpretation of medical images. The use of "key" characteristics specific to each constituent of DL models and the correct determination of their correlations, may be the subject of future research, with the aim of increasing the performance of DL models in the interpretation of medical images.

Updated Incidence of Thyroid Cancer in the North East Region of Romania after 35 Years of Chernobyl Fallout. Is There a Link between?

Thyroid cancer (TC) represents a worldwide problem, the consistent growth of the incidence increment issues about management of risk factors and curative treatment. Updated statistical data are not complete in the North East region of Romania and need to be improved. Therefore, through this study, we aim to renew the existing data on thyroid cancer. We conducted a retrospective study covering a period of 10 years. Data were collected from a hospital information system (InfoWorld) between 2009 and 2019. Patients' age groups were stratified in relation with the age at the moment of the Chernobyl event. A database was obtained (Microsoft Excel) and statistical correlations were applied. In the studied period, 1159 patients were diagnosed: 968 females and 191 males, distributed by region, with the highest addressability in Iasi (529), followed by neighboring counties. Age distribution displayed that most of the thyroid cancers were in the range 4060 years old (50.94%), followed by 60-80 years old (32.41%). Most patients were diagnosed with papillary carcinoma 63.10%, then follicular 14.7%, medullary 6.74% and undifferentiated 1.02%. Romania was in the vicinity of the radioactive cloud at Chernobyl fallout, so we must deliberate whether the increased incidence of thyroid cancer in the age group 40-60 years is associated with radiogenicity (iodine 131) given the fact that over has 35 years and the half-life of other radioisotopes like Caesium-137 and Strontium -90 is completed.

New insights into the metabolic-bone crosstalk in active acromegaly

INTRODUCTION

Body composition (BC) and adipokines share bone active properties and display an altered profile in acromegaly. The fibroblast growth factor 23 (FGF23)/α-Klotho system, also involved in bone metabolism, is upregulated in growth hormone (GH) excess states. Hence, we aimed to investigate their impact on bone in active acromegaly, compared to controls.

MATERIAL AND METHODS

BC, bone mineral density (BMD) (via dual X-ray absorptiometry), serum adipokines (leptin, adiponectin, resistin), parathyroid hormone (PTH), FGF23, α-Klotho, and osteocalcin were assessed in a cross-sectional study enrolling 35 patients with active acromegaly (Acro), compared to 35 sex, age, and body mass index (BMI) one-to-one matched healthy controls (CTL).

RESULTS

The Acro group had higher bone density scores (p < 0.05), lower visceral fat depots (p = 0.011), and lower serum leptin (p < 0.001) but elevated adiponectin (p < 0.001) and resistin (p = 0.001) concentrations when compared to the CTL group. α-Klotho was not related to the GH/IGF1 axis in the Acro group. Resistin was higher in both diabetic and non-diabetic Acro compared to CTL (p < 0.05). Age and BC were the main independent BMD predictors in regression analysis in both groups, while IGF1 was a positive predictor of osteocalcin levels in the Acro (β = 0.48, p = 0.006). The correlations between adipokines, the FGF23/α-Klotho system, and bone parameters, respectively, were lost after adjusting for age and BC.

CONCLUSIONS

Age and BC were the main independent BMD predictors in the acromegalic patients with active disease, while IGF1 was independently associated with serum osteocalcin concentrations. The role of α-Klotho in evaluating acromegaly and the associated osteopathy in the long-term appears to be limited. Our study is among the first to report significant serum resistin changes in patients with active acromegaly, opening new insights in the GH-mediated insulin resistance. The GH-resistin relationship merits further investigations.

Pregnancy-related reference intervals for serum thyrotropin based on real-life clinical data

AIM

During pregnancy, thyroid homeostasis is physiologically modified, leading to altered levels of thyrotropin (TSH): hence, the adoption of pregnancy-related, population- and method-specific reference ranges is recommended. This monocentric and retrospective study was conducted to establish local pregnancy-related reference intervals for serum TSH in singleton pregnant women using real-life clinical data.

METHODS

We included women who measured serum TSH during pregnancy at our Laboratory over six years, excluding pregnant women with current or past history of thyroid disease, pituitary or autoimmune diseases, use of medications known to influence thyroid function, multiple and/or pathological pregnancies, BMI >30 Kg/m².

RESULTS

We retrieved a total of 3744 TSH results. Reference limits (90% confidence intervals) for TSH (in mIU/L) are: first trimester 0.09 (0.06-0.12) - 3.16 (3.05-3.29); second trimester 0.25 (0.11-0.30) - 3.55 (3.34-3.73); third trimester 0.42 (0.15-0.48) - 3.93 (3.80-4.08).

CONCLUSION

In conclusion, real-life clinical data could be used to establish or verify local reference intervals for TSH in pregnant women: this may reduce the risk of misclassification of pregnant women undergoing thyroid function testing.

Balancing orbital volume reduction and redistribution for a tailored surgical treatment in Graves' ophthalmopathy

Aim

The purpose of this study is to share our experience on the use of different orbital decompression techniques, as well as the principles followed for deciding the most case-appropriate procedure that ensured the most favorable outcomes.

Methods

We reviewed the Graves’ ophthalmopathy cases operated over the course of 14 years, regarding the presenting signs, the imaging evaluation, the degree of exophthalmos, the type of surgical orbital decompression performed, and the postoperative outcomes.

Results

All 42 patients identified presented with proptosis, with 92.8% cases of bilateral proptosis. The main addressing concern was functional in 54.8% cases and aesthetic in 45.2% patients. CT was used for the preoperative evaluation in all cases. In total, 81 orbits were operated. The orbital decompression surgery involved only the orbital fat in 7.4% of orbits and associated fat and bone decompression in the other 92.6% of orbits. The postoperative results were favorable in all cases regarding both appearance and function, with minimal postoperative complications.

Conclusion

The adequate selection of the most suitable procedure based on the characteristics of each case is the prerequisite for a successful surgery. We found that the association of fat and bone decompression of various extents is most permissive in tailoring the degree of decompression to the existing requirements.

Thyrotoxic Periodic Paralysis-A Misleading Challenge in the Emergency Department

Despite its' life-threatening potential due to cardiac severe dysrhythmia in the context of severe hypokalemia, thyrotoxic periodic paralysis (TPP) often goes unrecognized. Although classically confined to young Asian men, it can occur irrespective of age, sex, and race. We report a short series of three cases of TPP as first presentation of Graves' disease in a young Caucasian male and in two Caucasian elderly and middle-aged women, respectively. The first patient developed malignant ventricular arrhythmias due to severe hypokalemia and was defibrillated, with recovery after prompt potassium correction and administration of antithyroid agents and propranolol. The other two cases developed persistent hypokalemia despite adequate potassium chloride (KCl) repletion, with slow recovery of motor deficit and serum potassium normalization up to day 5. In the first case, long-term euthyroid state was achieved via total thyroidectomy due to the presence of a suspicious nodule that proved to be malignant. In the other two cases, medical treatment was the choice of therapy for thyrotoxicosis. None experienced recurrent TPP. Thyroid hormone evaluation is mandatory in the presence of hypokalemic paralysis, even in the absence of clinical signs of thyrotoxicosis. If TPP is confirmed, initial therapy should comprise antithyroid drugs and propranolol, besides hypokalemia correction.

FGF23 Beyond the Kidney: A New Bone Mass Regulator in the General Population

Clinical studies investigating the relationship between fibroblast growth factor 23 (FGF23) and bone mass are controversial, especially in the healthy renal population. Our study is one of the forefronts investigating the relationship between FGF23 and bone mass parameters in the general population, according to age, sex, menopausal, and nutritional status. Cross-sectional study enrolling 123 volunteers between 20-80 years of age without primary osteoporosis under treatment nor secondary osteoporosis, where bone mass (bone mineral density-BMD, bone mineral content-BMC; assessed by Dual X-Ray Absorptiometry-DXA), body composition (DXA evaluation), and also the serum levels of FGF23, parathormone (PTH), 25(OH)D, bone resorption marker C-terminal telopeptide of type I collagen (CTx) and leptin were determined. FGF23 was negatively and independently associated with BMD and/or BMC in all groups. FGF23 contributed to up to 10% (p <0.05) of femoral neck BMD variance in postmenopausal women, but was not an accurate discriminator of normal versus low bone mass (AUC=0.622±0.076). FGF23 did not correlate with 25(OH)D, CTx, body weight, body composition parameters or leptin. FGF23 was independently associated with PTH in premenopausal women and men only. FGF23 was negatively associated with bone mass parameters in both sexes, but was not a fine discriminator between normal bone mass and osteopenia/osteoporosis. The mechanism through which FGF23 acts upon the bone seems independent of the nutritional status, requiring further investigation.

Persistent severe hyperkalemia following surgical treatment of aldosterone-producing adenoma

Primary aldosteronism is one of the most common causes of secondary hypertension. This condition is characterized by autonomous hypersecretion of aldosterone which produces sodium retention and potassium excretion, resulting in high blood pressure and potential hypokalemia. Transient postoperative hyporeninemic hypoaldosteronism with an increased risk of hyperkalemia may occur in some patients. We report the case of a 63-year-old patient with persistent hypokalemia, periodic paralysis, and refractory hypertension who was diagnosed with primary hyperaldosteronism due to elevated aldosterone, undetectable plasmatic renin concentration, and the presence of a left adrenal mass. One month after the surgery, the patient was admitted with signs of severe hyperkalemia (8 mmol/L) and worsened renal function, thus requiring hemodialysis. Fluid resuscitation, loop diuretic, and sodium bicarbonate treatment decreased his potassium. Zona glomerulosa insufficiency was confirmed by hormonal tests which exposed low aldosterone–renin axis. The fludrocortisone treatment was initiated and maintained, with consequent potassium and creatinine stabilization. Old age, long duration of hypertension, impaired renal function, severe hypokalemia before surgery, and large size of the aldosterone-producing adenoma are important risk factors for serious potassium imbalance after removal of the adenoma. We have to consider monitoring the patients after surgery for primary hyperaldosteronism in order to prevent severe hyperkalemia; therefore, postoperative immediate follow-up (arterial pressure, potassium, and renal function) is mandatory.

Reactive Arthritis The Reiter-Fiessinger-Leroy Syndrome

The role of creating the expression of reactive arthritis rests with AHO in 1973, which defines reactive arthritis as an acute, unsupportive, sterile inflammatory arthropathy, arising from infections located at a distance in people with a certain genetic predisposition; the disease is systemic and, despite its name, is not limited to the joints. Reactive arthritis (RA), included in Reiter syndrome (with the classic triad of urethritis, conjunctivitis and arthritis), is a non-suppurative inflammatory joint pathology, with a minimal autoimmune component, which it is installed following intestinal or urogenital infections, mainly in people with genetic predisposition. Reactive arthritis is a form of arthritis that affects the joints, urethra, eyes and membranes and sometimes the skin and mucous membranes. This condition is also called Reiter`s syndrome, although this name only indicates a subtype. Reactive arthritis is a seronegative spondyloarthropathy, which brings together a group of disorders that cause inflammation in the body, especially in the spine - such as ankylosing spondylitis, and in the legs. The study covers a number of 20 patients (11 men, 9 women) admitted to the Rheumatology Service of the Clinical Recovery Hospital, between 2010 and 2011, aged over 20, who were diagnosed with reactive arthritis. The existence of a structural similarity between the etiological agent and the HLA-B27 molecule determines either the recognition of the disease-causing germ as a self, so that no immune response will be initiated against it and the antigen will be able to trigger the disease, or the recognition of the germ as nonself, with the triggering of an immune response aimed at both itself and against the HLA-B27 molecule carrying cells of similar structure. Reactive arthritis (RA), included in the Reiter syndrome (with the classic triad of urethritis, conjunctivitis and arthritis), is a non-suppurative inflammatory joint pathology, with a minimal autoimmune component, which is installed as a result of intestinal or urogenital infections, mainly in people with genetic predisposition.

INSIGHTS ON AROMATASE IMMUNOHISTOCHEMISTRY: VARIATIONS BETWEEN INTRINSIC MOLECULAR SUBTYPES OF BREAST CANCERS

Context

Aromatase is a key enzyme in local estrogen production by androgen conversion, especially in women post-menopause. There have been controversies concerning aromatase localization in breast carcinomas and its association with current histopathological variables.

Material and Methods

Using polyclonal antibody immunohistochemistry we assessed (by intensity and percentage scores) the immunolocalization of aromatase in 70 tissue samples, and described particularities within the molecular subtypes of breast cancer.

Results

Aromatase was found in all tissue compartments: tumor (95.7%), stroma (58.6%) and adipose tissue (94.3%). Aromatase expression in tumor cells correlated inversely with tumor grading (p=-0.361, p=0.027), and positively with estrogen receptor status (ER, p=0.143, p<0.001). Dividing the study group by intrinsic subtypes, a strongly inversely association between tumor aromatase and grading (p=-0.486, p<0.001), and between stromal aromatase and Ki67-index (p=-0.448, p=0.048) was observed in luminal A breast cancer. Tumor aromatase and ER percentage scores had stronger correlations in luminal B HER2 negative (p=0.632, p=0.002), and positive (p=0.324, p=0.026) tumors. In contrast, in triple negative tumors, a positive association stromal aromatase and Ki67 index (p=-0.359, p=0.007) was observed.

Conclusion

Local aromatase was linked to better tumor differentiation and proliferation in luminal breast subtypes, and not in triple negative cases, suggesting a potential prognostic role of aromatase in breast carcinomas.

CBCT Evaluation of the Mandibular Bone Quality in Relation to Skeletal Status After Treatment with Strontium Renelate in Diabetic Patients

The aim of this study was to evaluate the diagnostic efficacy of the cone beam computed tomography (CBCT) - based mandibular indices and the CBCT mandibular bone density values and to determine whether they correlate with bone mineral density (BMD) of the lumbar spine (L1 - L4) and proximal left femur in patients with osteoporosis and diabetes mellitus, which were taken a treatment with strontium ranelate over a period of 6 months. The study included 20 osteoporosis patients and 40 diabetic patients (16 patients � type 1 diabetes mellitus and 24 patients � type 2 diabetes mellitus). In CBCT images, the radiomorphometric indices were measured in the right and left mandibles. The relationship between the CBCT measurements of the mandible and skeletal BMD was assessed. The present study showed that mandibular bone quality is closely correlated with the skeletal status of the patients with osteoporosis and diabetes mellitus which were in treatment with strontium ranelate for bone improving.

Coexistent papillary thyroid carcinoma diagnosed in surgically treated patients for primary versus secondary hyperparathyroidism: same incidence, different characteristics

BACKGROUND

The coexistence of hyperparathyroidism and thyroid cancer presents important diagnostic and management challenges. With minimally invasive parathyroid surgery trending, preoperative thyroid imaging becomes more important as concomitant thyroid and parathyroid lesions are reported. The aim of the study was to evaluate the rate of thyroid cancer in patients operated for either primary (PHPT) or secondary hyperparathyroidism (SHPT).

METHODS

Our retrospective study included PHPT and SHPT patients submitted to parathyroidectomy and, when indicated, concomitant thyroid surgery between 2010 and 2017.

RESULTS

Parathyroidectomy was performed in 217 patients: 140 (64.5%) for PHPT and 77 (35.5%) for SHPT. Concomitant thyroid surgery was performed in 75 patients with PHPT (53.6%), and 19 papillary thyroid carcinomas (PTC) were found, accounting for 13.6% from all cases with PHPT and 25.3% from PHPT cases with concomitant thyroid surgery. Thirty-one of operated SHPT patients (40.3%) also underwent thyroid surgery and 9 PTC cases were diagnosed (11.7% of all SHPT patients and 29% of patients with concomitant thyroid surgery). We found differences between PHPT and SHPT patients (p < 0.001) with respect to age (54.6 ± 13y versus 48.8 ± 12y), female-to-male ratio (8:1 versus ~ 1:1), surgical technique (single gland parathyroidectomy in 82.8% PHPT cases; versus subtotal parathyroidectomy in 85.7% SHPT cases) and presurgical PTH (357.51 ± 38.11 pg/ml versus 1020 ± 161.38 pg/ml). Morphopathological particularities, TNM classification and multifocality incidence of PTC were similar in the two groups. All PTC from patients with SHPT were thyroid microcarcinomas (TMC, i.e. tumors with a diameter smaller than 1 cm), whereas seven out of the 19 cases with PTC and PHPT were larger than 1 cm.

CONCLUSIONS

PTC was frequently and similarly associated with both PHPT and SHPT irrespective of presurgical PTH levels. Thyroid tumors above 1 cm were found only in patients with PHPT. Investigators should focus also on associated thyroid nodular pathology in patients with PHPT.

Antithrombotic Therapy in Patients with Stroke An observational study

Cerebrovascular disease is the second leading cause of death in developed countries after cardiovascular disease, with a prevalence of 794 percent of hundred thousand of people. Ischemic stroke (IS) remains an important public health issue of great importance in terms of its reality and the morbidity it implies, although the tendency is to reduce epidemiological indicators. In this paper we have updated informations on etiopathogenesis, epidemiology, pathological anatomy, clinical, laboratory and imaging investigations, differential diagnosis, evolution, complications, prophylaxis with antiplatelet treatment of patients with IS. IS remains an important public health issue of great importance in terms of its reality and the morbidity it implies, although the tendency is to reduce epidemiological indicators. Platelet function testing may potentially be useful in monitoring the biological effect of platelet antiaggregant medication. Aggregometry could provide personalized prognostic information and may thus become a useful tool in designing strategies for prevention and management of ischemic stroke.

Hypocalcemia after Thyroidectomy for Advanced Local Malignancies

Postoperative hypoparathyroidism is most commonly caused by the extirpation, injury or devascularisation of parathyroid glands. The aim of this study is to establish correlations between the advanced thyroid cancer staging, the appropriate individual treatment, the results obtained, the frequency and intensity of transient and/or permanent post-operative hypocalcemia. The present study can be continued with further researches in order to improve and develop surgical, oncological and endocrine management protocols for patients diagnosed with advanced thyroid cancer and also to avoid these relatively frequent and important complications.

SAT-LB090 Osteoporosis in Menopausal Women with Autoimmune Thyroiditis

Introduction. Autoimmune thyroiditis may be an important factor that can affect bone quality. There seems to be a connection between systemic inflammation and impaired bone density. Disturbance in osteclastic activity in new bone formation might be a consequence of chronic inflammatory autoimmune disorders leading to osteopenia or osteoporosis. Aim. To estimate the prevalence of osteoporosis in menopausal women with autoimmune thyroiditis. Patients and method. Cross-sectional study of a tertiary endocrine center. 207 menopausal women diagnosed with autoimmune thyroiditis underwent a bone density scan: dual-energy x-ray absorptiometry (DEXA) along with phospho-calcic (Ca, P, PTH, vit D) and thyroid (TSH, TPO-Ab) profile. Results. The mean age of the patients was 63.24±9.33. According with medical history and treatment 91 (43.9%) patients presented hypothyroidism, 14 (6.8%) hyperthyroidism and 102 (49.3%) without known thyroid dysfunction at the moment of screening. After the DEXA scan 77 patients (37.1%) had a T-score< -2.5 SD, 120 (58%) T-score between -2.5 and -1 SD, and 10 patients (4.9%) a T-score> -1SD. In the group with osteoporotic women 32 (41.5%) had treatment with levothyroxine, 4 (5.2%) had treatment with methimazole and 41 (53.3%) no treatment. In the group with osteopenia 55 women (45.9%) had treatment with levothyroxine, 56 (46.6%) no treatment and 9 patients (7.5%) had treatment with methimazole. In the group with normal BMD 5 patients (50%) had no treatment, 4 (40%) had treatment with levothyroxine and only 1 (10%) was in treatment with methymazole. 193 patients (93.2%) presented normal thyroid function (TSH 0.27-4.20µUI/ml) and only 14 women with autoimmune thyroiditis presented abnormal TSH (6 with TSH> 10 and 8 TSH< 0.27 µUI/ml). All the 6 patients with high TSH were treated with levothyroxin and required an increase in levothyroxine dosage. Of the 8 patients with decreased TSH: 4 were treated with levothyroxin, 3 with methimazole and 1 with no treatment. All these patients required a change in dosage according with TSH values and clinical examination. Conclusions. In our study the prevalence of osteoporosis was 37.1%. The presence of autoimmune thyroiditis was associated with an increased risk of low bone density regardless the thyroid function. In a fairly equal number of cases 41.5% with substitutive treatment (for hypothyroidism) vs. 53.3% untreated (euthyroidism) the diagnosis of osteoporosis was made. From the clinical point of view our results shows the importance of screening for osteoporosis in menopausal women with autoimmune thyroiditis Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. Abstracts presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.

Consistency of impact assessment protocols for non-native species

Standardized tools are needed to identify and prioritize the most harmful non-native species (NNS). A plethora of assessment protocols have been developed to evaluate the current and potential impacts of non-native species, but consistency among them has received limited attention. To estimate the consistency across impact assessment protocols, 89 specialists in biological invasions used 11 protocols to screen 57 NNS (2614 assessments). We tested if the consistency in the impact scoring across assessors, quantified as the coefficient of variation (CV), was dependent on the characteristics of the protocol, the taxonomic group and the expertise of the assessor. Mean CV across assessors was 40%, with a maximum of 223%. CV was lower for protocols with a low number of score levels, which demanded high levels of expertise, and when the assessors had greater expertise on the assessed species. The similarity among protocols with respect to the final scores was higher when the protocols considered the same impact types. We conclude that all protocols led to considerable inconsistency among assessors. In order to improve consistency, we highlight the importance of selecting assessors with high expertise, providing clear guidelines and adequate training but also deriving final decisions collaboratively by consensus.

Particularities of Using Contrast Agents in Diagnosis of Stroke

Stroke is the first cause of disability, the second cause of dementia and the third cause of mortality in industrialized countries. Due to its increasing incidence, there is a need to study the possibilities of early prevention and diagnosis. Our study was conducted on a group of 165 selected patients diagnosed with different forms of ischemic strokes, aged between 25 and 50 years. We explored them using contrast injected MRI technique, to show the usefulness of this radiologic method and to propose a protocol for the investigation of clinically diagnosed patients with stroke. Contrast injected MRI is demonstrated to be a gold technique in exploring early cases of ischemic stroke with different anomalies. Special agents combined with this technique allows assessment of the functionality of the blood-brain barrier, revealing the real ischemic penumbra.

Developing a list of invasive alien species likely to threaten biodiversity and ecosystems in the European Union

The European Union (EU) has recently published its first list of invasive alien species (IAS) of EU concern to which current legislation must apply. The list comprises species known to pose great threats to biodiversity and needs to be maintained and updated. Horizon scanning is seen as critical to identify the most threatening potential IAS that do not yet occur in Europe to be subsequently risk assessed for future listing. Accordingly, we present a systematic consensus horizon scanning procedure to derive a ranked list of potential IAS likely to arrive, establish, spread and have an impact on biodiversity in the region over the next decade. The approach is unique in the continental scale examined, the breadth of taxonomic groups and environments considered, and the methods and data sources used. International experts were brought together to address five broad thematic groups of potential IAS. For each thematic group the experts first independently assembled lists of potential IAS not yet established in the EU but potentially threatening biodiversity if introduced. Experts were asked to score the species within their thematic group for their separate likelihoods of i) arrival, ii) establishment, iii) spread, and iv) magnitude of the potential negative impact on biodiversity within the EU. Experts then convened for a 2-day workshop applying consensus methods to compile a ranked list of potential IAS. From an initial working list of 329 species, a list of 66 species not yet established in the EU that were considered to be very high (8 species), high (40 species) or medium (18 species) risk species was derived. Here, we present these species highlighting the potential negative impacts and the most likely biogeographic regions to be affected by these potential IAS.

Executive functioning and quality of life in acromegaly

Introduction

Active acromegaly is a rare chronic endocrine disorder caused by excessive growth hormone (GH). Clinical studies suggest that cognitive performance is impaired in acromegaly – particularly executive function as well as short- and long-term memory. This study compared the quality of life (QoL) and executive functioning in acromegaly patients vs healthy controls.

Materials and methods

This was an observational case–control study on 38 subjects divided into 19 acromegaly patients and 19 matched controls. The groups were evaluated for QoL, attention, and executive function. All subjects completed Acromegaly Quality of Life Questionnaire (AcroQoL), Trail Making Test (parts A and B), Stroop, and phonemic fluency tests.

Results

Acromegaly patients had an AcroQoL global score that was significantly lower than controls. There were significant differences between the acromegaly group and the control group in terms of the physical effects (P=0.001) and appearance (P<0.001) but not for personal relationships (P=0.421). Acromegaly patients performed worse in the trail making test part B. They provided significantly fewer words than healthy subjects in phonemic fluency testing. Although patients performed generally worse than controls, no significant differences were noted in the trail making test part A, Stroop test, and the constrained phonemic fluency.

Conclusion

Acromegaly patients display worse executive functioning than healthy controls and have a decreased QoL.

CHANGES IN BONE MINERAL PARAMETERS AFTER SLEEVE GASTRECTOMY: RELATIONSHIP WITH GHRELIN AND PLASMA ADIPOKINE LEVELS

CONTEXT

Metabolic surgery is currently the most efficient treatment for obesity, but concern is raised about the possible long-term nutritional side effects. Bone metabolism is often adversely affected after surgery, but literature data are contradictory.

OBJECTIVE

The aim of this study was to evaluate the evolution of bone mass parameters in the first year after laparoscopic sleeve gastrectomy in relation to anthropometric and body composition parameters and specific hormones of obesity.

DESIGN

We conducted a prospective study on 75 patients with obesity that underwent metabolic surgery over a course of 18 months at our center, with a follow-up period of 12 months.

SUBJECTS AND METHODS

All patients underwent a complex preoperative assessment and were required to return for medical follow-up at 6 and 12 months after surgery. Each visit included anthropometric parameters, DEXA and determination of specific hormonal parameters.

RESULTS

We noticed a significant improvement in anthropometric and body composition parameters after surgery. The value of adiponectin presented a significant increase after surgery and leptin showed a significant decrease at 6 and 12 months postoperative; ghrelin level decreased postoperative compared to preoperative, but without statistical significance. We observed no reduction in BMD after surgery, but a significant improvement in BMC at 12 months after surgery compared to preoperative. Ghrelin negatively correlated to BMD preoperative.

CONCLUSIONS

Despite the significant alterations in anthropometric, body composition and hormonal parameters, we found no negative effect on BMD and BMC in our study population.