Burden of Comorbidities and Concomitant Medications and Their Associated Costs in Patients with Gastroenteropancreatic or Lung Neuroendocrine Tumors: Analysis of US Administrative Data

INTRODUCTION

This study investigated the burden of comorbidities and concomitant non-cancer medications and their cost in patients with neuroendocrine tumors (NETs).

METHODS

Adults with gastroenteropancreatic (GEP)-NETs and lung-NETs, with or without carcinoid syndrome (CS), who initiated first-line NET treatment (index date) with a somatostatin analog or telotristat and had ≥ 1 inpatient or ≥ 2 distinct outpatient claims (study period January 1, 2016-December 31, 2022) were identified from the US MarketScan database and matched (age, sex, insurance type) with up to four adults without cancer (reference group). At 0-90 and 91-180 days post-index, medication counts (generalized linear model, GLM), medication frequency distributions (chi-squared test), and medication costs in USD (two-part model: logit model and GLM for the first and second parts, respectively) were assessed. Frequencies of comorbidities of interest (≥ 1 diagnosis claim) in the 6 months post-index were calculated.

RESULTS

A total of 662 patients with GEP-NETs (279 with CS) and 84 with lung-NETs (30 with CS) were included. Irrespective of CS status, mean medication counts in the 0-90 and 91-180 days post-index was 1.5-1.8 times higher for GEP-NETs (p < 0.001) and 1.6-1.9 times higher for lung-NETs (p < 0.005) than reference groups. Medications most frequently prescribed for both NET groups were oral cardiovascular, central nervous system, and gastrointestinal agents. The most common comorbidities of interest in patients with NETs (vs reference groups) were hypertension (GEP-NETs: 68.7% vs 55.0%; lung-NETs: 73.8% vs 58.3%) and type 2 diabetes (GEP-NETs: 35.5% vs 24.1%; lung-NETs: 50.0% vs 28.3%). Excluding anticancer medications, mean per-patient-per-month medication costs (vs reference groups) were $276-811 (vs $176-349) and $390-647 (vs $210-$302) for 0-90 days and 91-180 days post-index, respectively.

CONCLUSION

Compared with people without cancer, patients with NETs had a higher prevalence of comorbidities and concomitant medication use, which was associated with a greater economic burden.

Measurement of thiol/disulfide homeostasis and ischemic modified albumin levels in patients with uterine leiomyomas

OBJECTIVE

The aim is to contrast the serum levels of thiol-disulfide homeostasis and ischemic modified albumin between patients with leiomyoma and healthy individuals and to assess the impact of oxidative stress on the etiopathogenesis of leiomyoma.

METHODS

In this prospective case-control study, a total of 154 participants were included, consisting of 77 cases diagnosed with leiomyoma and 77 healthy individuals without leiomyoma. The demographic characteristics and ultrasonographic findings of the participants were recorded, and parameters such as albumin, ischemia-modified albumin, and thiol-disulfide homeostasis were evaluated. The results obtained from the analyses were compared between the two groups.

RESULTS

No significant differences were observed in the demographic characteristics between the groups. A significant difference was observed between the leiomyoma and control groups regarding serum albumin parameters, serum ischemic modified albumin, and serum dynamic thiol-disulfide parameters (P < 0.001). No significant difference was found in the ratios of disulfide/total thiol, disulfide/native thiol, native thiol/total thiol (P > 0.05).

CONCLUSION

There was a notable contrast in the levels of albumin, ischemic modified albumin, albumin/ischemic modified albumin ratio, total thiol, native thiol, and disulfide between individuals with uterine leiomyomas and healthy individuals in the control group. Oxidative stress is believed to play a causative role in the etiopathogenesis of uterine leiomyomas.

Advances in incretin therapies for targeting cardiovascular disease in diabetes

The global prevalence of obesity is skyrocketing at an alarming rate, with recent data estimating that one-in-eight people are now living with the disease. Obesity is a chronic metabolic disorder that shares underlying pathophysiology with other metabolically-linked diseases such as type 2 diabetes mellitus, cardiovascular disease and diabetic cardiomyopathy. There is a distinct correlation between type 2 diabetes status and the likelihood of heart failure. Of note, there is an apparent sexual dimorphism, with women disproportionately affected with respect to the degree of severity of the cardiac phenotype of diabetic cardiomyopathy that results from diabetes. The current pharmacotherapies available for the attenuation of hyperglycaemia in type 2 diabetes are not always effective, and have varying degrees of efficacy in the setting of heart failure. Insulin can worsen heart failure prognosis whereas metformin, sodium-glucose cotransporter 2 inhibitors (SGLT2i) and more recently, glucagon-like peptide-1 receptor agonists (GLP-1RAs), have demonstrated cardioprotection with their administration. This review will highlight the advancement of incretin therapies for individuals with diabetes and heart failure and explore newly-reported evidence of the clinical usefulness of GLP-1R agonists in this distinct phenotype of heart failure.

Mechanistic insights into impaired β-oxidation and its role in mitochondrial dysfunction: A comprehensive review

Mitochondria, also known as the powerhouse of cells, have an important role in cellular metabolism and energy production. However, during Mitochondrial Dysfunction (MD), it is known to generate reactive oxidative species and induce cellular apoptosis. A number of research findings have linked MD to various diseases, highlighting its critical role in maintaining health and contributing to disease development. In this regard, recent research has revealed that disruptions in lipid metabolism, especially in fatty acid oxidation, are significant contributors to MD. However, the precise mechanisms by which these defects lead to disease remain poorly understood. This review explores how disruptions in lipid metabolism are responsible for triggering oxidative stress, inflammation, and cellular damage, leading to impaired mitochondrial function. By examining specific fatty acid oxidation disorders, such as carnitine palmitoyltransferase deficiency, medium-chain acyl-CoA dehydrogenase deficiency, and very long-chain acyl-CoA dehydrogenase deficiency, this review aims to uncover the underlying molecular pathways connecting lipid metabolism to mitochondrial dysfunction. Furthermore, MD is a common underlying mechanism in a wide array of diseases, including neurodegenerative disorders and metabolic syndromes. Understanding the mechanisms behind mitochondrial malfunction may aid in the development of tailored therapies to restore mitochondrial health and treat intricate health conditions.

A FRET-based competitive binding assay using coumestrol and the ligand-binding domain of human estrogen receptor alpha tagged with mTurquoise2 efficiently expressed in E. coli with ethanol

The estrogen receptor (ER) is a nuclear receptor and one of the most extensively researched targets in the study of endocrine-disrupting chemicals (EDCs). Many biosensors and bioassays for estrogenic EDCs use the ligand-binding domain of human ERα (LBD-hERα) as a biological recognition element. However, the LBD-hERα is poorly stable and difficult to produce as a functional LBD-hERα in the E. coli expression system. In this study, we efficiently expressed the functional LBD-hERα tagged with the cyan fluorescent protein, mTurquoise2 (LBD-hERα-mTq2) by the addition of ethanol (3 %) to E. coli suspension during protein expression (> 40 times more compared to without ethanol). We found that ethanol not only promoted the proper folding of LBD-hERα-mTq2, but also prevented the proteolysis of poorly folded recombinant proteins. We established a FRET-based binding assay between a fluorescent estrogen, coumestrol, and the LBD-hERα-mTq2, in which the formation of the complex exhibits a significant degree of FRET. A subsequent competitive binding assay with diethylstilbestrol demonstrates that our system successfully functions as a simple and reliable bioassay to detect estrogenic EDCs.

Silver spoons, reproduction, and growth catch-up in eastern Grey kangaroos

Early growth and environmental conditions can shape life-history trajectories. Long-lived iteroparous species with indeterminate growth face growth-reproduction trade-offs for most of their lives. Poor early conditions can delay primiparity and restrict growth, potentially compensated for by faster growth later in life, at the cost of reduced reproduction. We explored the variation in age at primiparity and early reproduction in eastern Grey kangaroos, based upon 13 yr of monitoring about 100 known-age females. We then examined associations between early reproduction, later reproduction, and lifetime growth. We used a modified von Bertalanffy growth function to model the indeterminate growth of females and to test the effects of early reproduction on lifetime growth. Favorable environmental conditions, large size, and condition as a subadult led to earlier reproduction and higher reproductive success at ages 3 to 5. As females aged, size and condition had diminishing effects on reproductive success. Females with greater early-adulthood reproduction had slightly higher reproduction later in life. We did not detect a growth cost of early reproduction. Large females in good condition favored early reproduction over growth, while those with poor early growth exhibited growth catch-up at the cost of reproduction both early and later in life. As reported for other long-lived iteroparous species with indeterminate growth, female kangaroos prioritize growth over reproduction for much of their lifespan. Eastern Gray kangaroos show heterogeneity in early growth and reproductive strategies. Early primiparity and reproduction are constrained by body condition, size, and environmental conditions when females are pre-reproductive subadults.

Tanycyte proliferation and migration through the sonic hedgehog pathway restores hypothalamic function after ischemic injury

Tanycytes, a distinct type of glial cell within the hypothalamus, will be investigated in this study to elucidate the intrinsic mechanisms by which they facilitate the restoration of hypothalamic function. We injected endothelin 1 (ET-1) into the third ventricle to establish an ischemic hypothalamic injury model. Nestin CreERT2 and Rosa26R-CAG:tdTomato mice were crossbred, and viral tracing was used to label and track tanycytes. Functional changes in these cells were observed with calcium imaging. Alterations in tanycytes were assessed with single-cell and transcriptomic sequencing analyses. The involvement of specific pathways was confirmed via intraperitoneal injection of N-acetyl cysteine (NAC) and cycloheximide. Following ischemic injury to the hypothalamus in mice, acute weight loss and impaired activity of Agrp neurons were observed, both of which recovered within 7 days. The fate of tanycytes was traced in Nestin-CreERT2: Rosa26R-CAG:Tdtomato mice to confirm their proliferation and migration after hypothalamic injury. Calcium imaging indicated that these proliferating and migrating cells participated in signal transduction, thereby reconstructing the regulatory network of tanycytes. The analysis of single-cell data on postnatal days 8 and 45 identified CDK1 as a marker of proliferative tanycytes. The roles of ROS and the Shh pathway in the proliferation and migration of tanycytes were validated via the intraperitoneal injection of NAC and cycloheximide inhibitors. After inducing ischemic injury to the arcuate nucleus of the hypothalamus, Agrp neuronal activity declined, accompanied by ROS fluctuations within tanycytes. Activation of the Shh pathway prompts the transition of tanycytes from a quiescent state to a proliferative state, thereby leading to their migration to the arcuate nucleus. This process re-establishes the regulatory network of tanycytes and restores metabolic balance. This finding may provide an important target for promoting the recovery of hypothalamic function.

Moderate intensity continuous training, combined moderate-intensity continuous training vs combined high-intensity interval training in adults with hypertension: Randomized controlled trial

BACKGROUND AND PURPOSE

Despite all efforts to treat hypertension, it is still responsible for 10.8 million deaths annually. The aim of this study was to compare the effects of continuous moderate-intensity training, strength training combined with continuous moderate-intensity training and strength training combined with high-intensity interval training in adults with high blood pressure.

METHODS

A 12-week randomized control trial was performed. A total of 100 volunteers, 51 women and 49 men with hypertension participated. The sample was randomly assigned into three intervention groups and one control group.

RESULTS

All intervention groups significantly improved their hemodynamic parameters, body composition, lipid profile, glucose, and physical fitness as compared to the control group. Both combined training groups showed greater improvements than the moderate-intensity continuous training group. However, the strength group combined with the moderate-intensity continuous group showed the greatest benefits in systolic, diastolic and mean arterial pressure, of -13.4 mmHg, -6.8 mmHg and -8.9 mmHg respectively, abdominal circumference, upper and lower limb strength and VO₂peak, versus the continuous moderate-intensity group; it also achieved greater reductions in systolic and mean blood pressure, up to -6.8 mmHg and 4.3 mmHg respectively, than the strength group combined with the high intensity interval group.

CONCLUSION

Performing a strength training program combined with continuous moderate intensity training, 2 days per week for 12 weeks, produces significant improvements in cardiometabolic biomarkers, body composition, and physical condition of adults with hypertension, with these adaptations being superior to those produced by continuous moderate-intensity training and strength training combined with high-intensity intervallic training.

Understanding the potential contribution of polygenic risk scores to the prediction of gestational and type 2 diabetes in women from British Pakistani and Bangladeshi groups: a cohort study in Genes and Health

Background

British Pakistani and Bangladeshi (BPB) women have disproportionately high rates of gestational diabetes mellitus (GDM), with prevalence estimates up to three times higher than in the general population. They are also at increased risk of progressing to type 2 diabetes, leading to significant health complications. Despite this, predictive models tailored to this high-risk, yet understudied group are lacking.

Objective

To investigate whether combining genetic and traditional clinical data improves risk prediction of GDM and progression to type 2 diabetes among BPB women. We hypothesized that incorporating polygenic risk scores (PRS) would enhance the predictive accuracy of existing models.

Study Design

An observational cohort study utilizing the Genes & Health dataset, which includes comprehensive electronic health records. Women who gave birth between 2000 and 2023, both with and without a history of GDM, were included. Controls were defined as women without a GDM diagnosis during this period but who had a birth record. A total of 117 type 2 diabetes or GDM PRS were tested to determine the optimal PRS based on predictive performance metrics. The best-performing PRS was integrated with clinical variables for statistical analyses, including descriptive statistics, chi-square tests, logistic regression, and receiver operating characteristic curve analysis.

Results

Of 13,489 women with birth records, 10,931 were included in the analysis, with 29.3% developing GDM. Women with GDM were older (mean age 31.7 years, P<.001) and had a higher BMI (mean 28.4 kg/m2, P<.001) compared to controls. The optimal PRS demonstrated a strong association with GDM risk; women in the highest PRS decile had significantly increased odds of developing GDM (OR 5.66, 95% CI [4.59, 7.01], P=3.62×10-58). Furthermore, the risk of converting from GDM to type 2 diabetes was 30% in the highest PRS decile, compared to 19% among all GDM cases and 11% in the lowest decile. Incorporating genetic risk factors with clinical data improved the C-statistic for predicting type 2 diabetes following GDM from 0.62 to 0.67 (P=4.58×10-6), indicating better model discrimination.

Conclusion

The integration of genetic assessment with traditional clinical factors significantly enhances risk prediction for BPB women at high risk of developing type 2 diabetes after GDM. These findings support the implementation of targeted interventions and personalized monitoring strategies in this high-risk population. Future research should focus on validating these predictive models in external cohorts and exploring their integration into clinical practice to improve health outcomes.

Advances in targeted liquid chromatography-tandem mass spectrometry methods for endocannabinoid and N-acylethanolamine quantification in biological matrices: A systematic review

Liquid chromatography paired with tandem mass spectrometry (LC-MS/MS) is the gold standard in measurement of endocannabinoid concentrations in biomatrices. We conducted a systematic review of literature to identify advances in targeted LC-MS/MS methods in the period 2017-2024. We found that LC-MS/MS methods for endocannabinoid quantification are relatively consistent both across time and across biomatrices. Recent advances have primarily been in three areas: (1) sample preparation techniques, specific to the chosen biomatrix; (2) the range of biomatrices tested, recently favoring blood matrices; and (3) the breadth of endocannabinoid and endocannabinoid-like analytes incorporated into assays. This review provides a summary of the recent literature and a guide for researchers looking to establish the best methods for quantifying endocannabinoids in a range of biomatrices.

SET-binding protein 1 (SETBP1) suppresses cell proliferation in estrogen receptor-positive breast cancer

BACKGROUND

The single-nucleotide polymorphism rs6507583 at the promoter of SET-binding protein 1 (SETBP1) was implicated in estrogen receptor (ER)-positive breast carcinogenesis. Here, we evaluated the clinical and biological relevance of SETBP1 expression in ER-positive breast cancer (BC).

METHODS

The associations between SETBP1 expression and clinical outcomes in BC patients were analyzed in independent cohorts. The localizations of SETBP1 expression in BC tissues were observed by immunohistochemical staining. Pathway analyses were conducted using TCGA dataset. In vitro proliferation assay, protein phosphatase 2A (PP2A) activity assay, and gene expression analysis were performed in SETBP1-knockdown ER-positive BC cells. We investigated the factors influencing SETBP1 mRNA expression using TCGA dataset. rs6507583 presence and SETBP1 mRNA expression in 11 mammary cell lines and 56 BC tissue samples were examined by target sequencing and RT-qPCR, respectively.

RESULTS

SETBP1 was downregulated in BC cells compared with normal ductal epithelial cells. Low SETBP1 mRNA expression was an independent prognostic factor for poor recurrence-free survival. Pathway analyses revealed an inverse relationship between decreased SETBP1 expression and the expression of E2F, MYC, and G2M checkpoint target genes in BC tissues. SETBP1 knockdown promoted proliferation, inhibition of PP2A activity, and phosphorylation of MAPK in ER-positive BC. Low SETBP1 expression was influenced by high SETBP1 promoter methylation and DNA copy number SETBP1 deletion. SETBP1 expression with rs6507583 was lower than without rs6507583 in BC.

CONCLUSIONS

We demonstrated that low SETBP1 expression could be a poor prognostic biomarker that promotes ER-positive BC proliferation, possibly via phosphorylation of MAPK.

Sex Differences in Obesity and Its Treatment

PURPOSE OF REVIEW

Researchers and clinicians have increasingly recognized the importance of investigating and considering sex differences in obesity treatment. In this narrative review, we first summarized sex differences in select obesity-related conditions that have been the focus of studies of second-generation anti-obesity medications (i.e., semaglutide and tirzepatide) including type 2 diabetes, obstructive sleep apnea, knee osteoarthritis, and heart failure. We next described sex differences related to obesity treatments with a focus on the second-generation anti-obesity medications, semaglutide and tirzepatide.

RECENT FINDINGS

Type 2 diabetes, obstructive sleep apnea, knee osteoarthritis, and heart failure demonstrated sex-specific pathways influenced by factors such as hormones and body composition. Lifestyle modification, on average, resulted in larger weight losses in males. In contrast, second-generation AOMs produced higher mean weight losses among females. Females reported more adverse events (e.g., nausea, vomiting) with second-generation anti-obesity medications. The few studies that have performed analyses of changes in obesity-related comorbidities stratified by sex have shown consistent improvements between males and females in heart failure and cardiovascular outcomes. Studies are needed to evaluate the effect of sex on the efficacy of anti-obesity medications including on mental health, investigate the mechanisms underlying these effects, and develop interventions to improve the availability and access of these medications.

Association of neurodegeneration, cognitive impairment, and short stature in Down syndrome; Could proinflammatory cytokines be the common factor?

Down syndrome (DS), caused by an extra copy of chromosome 21, is the most prevalent chromosomal disorder. It leads to various complications including, cardiac and endocrine dysfunctions, impairment of the immune system, growth retardation, and certain neurological conditions. Stunted growth in this population might be linked to an increased risk of a variety of co-occurring conditions, particularly neurological disorders. Studies indicate that the levels of neurodegeneration and neuroinflammation markers are higher in shorter children with DS. The disruption of insulin-like growth factor 1 (IGF1) signalling pathway due to the overexpression of proinflammatory cytokine genes could help establish a connection between short stature and neurodegeneration in DS. These cytokines disrupt the production of IGF1 in the liver, thereby inhibiting IGF1 from promoting bone and brain growth. Additionally, elevated cytokines levels impair the production of sex hormones by affecting the gonadal axis, further exacerbating the aforementioned conditions. The group of GnRH neurons responsible for cognitive functions is also impaired in DS, and treatment with GnRH agonists has demonstrated improvements in cognition. Although GnRH agonists can delay the fusion of growth plates by inhibiting pulsatile GnRH secretion, they may also lead to cognitive impairments. Hypothyroidism, the most prevalent endocrine complication of DS, can also contribute to both cognitive impairment and short stature. In conclusion, the increase of proinflammatory cytokines, through various mechanisms, can play a significant role in the development of both cognitive impairments and short stature in DS.

Differential Effects of Retinol-Binding Protein 3 and Anti-VEGF Antibodies on Retinal Dysfunctions in Diabetic Retinopathy

Anti-vascular endothelial growth factor (anti-VEGF) therapies are effective treatment for severe diabetic retinopathy (DR) and macular edema, but a significant subset of people had inadequate response to anti-VEGF intervention. Because elevation or overexpression of retinol binding protein 3 (RBP3) decreases risks for retinal pathologies and progression to severe DR, we compared the therapeutic profiles of RBP3 and anti-VEGF antibody to normalize retinal dysfunctions induced by diabetes. Intravitreous injection of recombinant human RBP3 (rhRBP3) and anti-VEGF antibody (namely, bevacizumab) inhibited retinal vascular permeability in Lewis rats induced by VEGF-A or after 2 months of diabetes induced by streptozotocin, in parallel with reductions of retinal VEGF and VEGF receptor 2 expressions and tyrosine phosphorylation of VEGF receptor. Only rhRBP3 ameliorated diabetes-induced reduction of neural retinal function, measured by electroretinogram. Furthermore, rhRBP3 reduced retinal expressions of inflammatory cytokines (TNF-α and IL-6) in retinal pigmented epithelial and Müller cells exposed to hyperglycemia. Metabolic studies, using a Seahorse flux analyzer, showed only rhRBP3 normalized retinal glycolytic rates in diabetic rats. Thus, both intravitreous anti-VEGF antibody and RBP3 injections normalized retinal vascular dysfunctions caused by diabetes. Only RBP3 targeted both neural and vascular retina to reduce glycolytic rates, reverse neural-retinal dysfunctions, and reduce inflammatory cytokines induced by diabetes, to delay early changes of DR.

ARTICLE HIGHLIGHTS

Cannabidiol oil delays pancreatic islet dysfunction in Wistar rats under hypercaloric diet

Hypercaloric diet (HCD) intake can lead to metabolic alterations, such as metabolic syndrome and type-2 diabetes mellitus. Phytocannabinoid cannabidiol (CBD) is a GPR55 receptor antagonist involved in insulin secretion and other functions in pancreatic islet. The therapeutic use of CBD has been suggested for diabetes, but little is known regarding its effects on pancreatic islet physiology. Our aim was to evaluate the effects of CBD oil on pancreatic islets, from Wistar rats under HCD. Male rats were divided in 4 groups: Normal diet vehicle-treated (control) and CBD-treated group. Rats under HCD were subdivided in treated with vehicle (HCD) and with CBD oil administered 21 mg/Kg orally, 0.5 ml in 3 days per week; controls received coconut oil as vehicle. Body weight, food intake, and water consumption were recorded. After 20 weeks, glucose tolerance curve was performed; serum insulin was determined by ELISA, and pancreas was removed for histological and gene expression analysis for insulin, glucagon, PDX-1, MafA and GPR55 receptor. CBD treatment reduced body weight and food intake but increased fluid consumption, independently of diets. In control group, CBD did not alter blood glucose and serum insulin, but modified expression for GPR55 receptor, glucagon, insulin and MafA. Rats under HCD and treated with CBD decreased glycaemia, insulinaemia, islets relative area, GPR55-positive cells, PDX-1 and MafA gene expression, meanwhile insulin and glucagon expression was increased. In conclusion, CBD ameliorated HCD effects through changes in insulin, glucagon and GPR55 receptor expressions. We assume CBD interacts with other receptors beside GPR55.

Mechanisms of Impaired Wound Healing in Type 2 Diabetes: The Role of Epigenetic Factors

Despite decades of research, impaired extremity wound healing in type 2 diabetes remains a significant driver of patient morbidity, mortality, and health care costs. Advances in surgical and medical therapies, including the advent of endovascular interventions for peripheral artery disease and topical therapies developed to promote wound healing, have not reduced the frequency of lower leg amputations for nonhealing wounds in type 2 diabetes. This brief report is aimed at reviewing the roles of various cell types in tissue repair and summarizing the known dysfunctions of these cell types in diabetic foot ulcers. Recent advances in our understanding of the epigenetic regulation in immune cells identified to be altered in type 2 diabetes are summarized, and particular attention is paid to the developing research defining the epigenetic regulation of structural cells, including keratinocytes, fibroblasts, and endothelial cells. Gaps in knowledge are highlighted, and potential future directions are suggested based on the current state of the field.

Hecate-FSHβ33-53C/S lytic peptide conjugate selectively kills targeted follicle stimulating hormone receptor (FSHR)-positive cancer cells

BACKGROUND

The follicle stimulating hormone (FSH) receptor (FSHR), is expressed primarily in the gonads, also found in ovarian and prostate cancers, and in tumor vessel endothelial cells. We investigated the potential of a targeted cytotoxic approach using Hecate-FSHβ, a conjugate derived from a lytic peptide Hecate, an analog of bee venom melittin, and the β subunit of FSH, to selectively eliminate FSHR-positive cancer cells.

METHODS

Hecate-FSHβ-mediated cytotoxicity was tested in human granulosa tumor cell line KGN, human embryonic kidney HEK-293 cell line stably transfected with human FSHR cDNA (HEK293-FSHR) and mock-transfected HEK-293 cells as FSHR-negative control cells. Tested variant Hecate-FSHβ33-53C/S with cysteine residues replaced by serine, was evaluated for its cytotoxicity towards FSHR-positive cells.

RESULTS

Hecate-FSHβ33-53C/S demonstrated the highest specific cytotoxicity towards FSHR-positive cells (KGN and HEK293-FSHR vs. control). In competition studies, cotreatment with recombinant human FSH (rhFSH) reduced the cytotoxic effect of the conjugate on these cells, highlighting FSHR specificity. In xenograft models of HEK293-FSHR, Hecate-FSHβ33-53C/S alone or in combination with a gonadotropin releasing hormone (GnRH) antagonist (Cetrorelix, CTX) significantly inhibited tumor growth. No synergistic effect was observed with co-administered Hecate-FSHβ33-53C/S and CTX. Hecate-FSHβ33-53C/S induced necrosis in tumor cells, whereas CTX triggered apoptosis. Hecate-FSHβ33-53C/S did not produce any side effects. CTX treatment caused increased spleen size and inhibited spermatogenesis, leading to reduced testis weight, which aligns with expected gonadal effects.

CONCLUSIONS

Hecate-FSHβ33-53C/S is highly effective in selectively targeting and killing FSHR-expressing cancer cells, with minimal side effects, suggesting its potential as a therapeutic option for cancers expressing FSH receptors.

Evaluating primary amenorrhea in the primary care setting

ABSTRACT

Primary amenorrhea is the absence of menarche by age 15 years. Though not as common as secondary amenorrhea, primary care providers must know how to assess primary amenorrhea. Evaluation includes a thorough health history, physical exam, lab evaluation, and, in some cases, imaging. Primary amenorrhea has three broad causes: genetic, hormonal, and anatomic.

Panenteric Transit Times and Contractile Activity in Diabetic Gastroenteropathy

Background/Aims

Panenteric gastrointestinal dysmotility in diabetic gastroenteropathy remains incompletely understood. We aim to (1) compare gastrointestinal transit times, contractile activity, and pH levels between individuals with and without diabetic gastroenteropathy and (2) investigate associations between symptoms and contractile activity.

Methods

We compared 37 healthy individuals to 68 individuals with diabetic gastroenteropathy. Gastrointestinal segmental transit times, contractile activity, and pH were measured with SmartPill. The Gastroparesis Cardinal Symptom Index and the Gastrointestinal Symptom Rating Scale were used to evaluate symptoms.

Results

Compared to controls, individuals with diabetic gastroenteropathy had prolonged median gastric emptying time (3.3 [IQR, 2.5-4.4] vs 2.5 [IQR, 1.9-3.6] hours, P = 0.023), antroduodenal transition time (23 [IQR, 8-52] vs 11 [IQR, 2-25] minutes, P = 0.015), colonic transit times (36.0 [IQR, 17.3-53.5) vs 20.8 [IQR, 14.0-28.8] hours, P = 0.004), and whole-gut transit time (46.1 [IQR, 24.3-72.9] vs 28.7 [IQR, 22.0-42.7] hours, P = 0.002). The diabetes group had lower antral contraction frequency (1.5 [IQR, 0.9-2.1] vs 2.5 [IQR, 1.5-3.9] contractions per minute, P = 0.004) and sum of amplitudes (1941 [1377-2763] vs 2975 [1734-5337] mmHg, P = 0.004). In contrast, the diabetes group had higher colonic sum of amplitudes and area under the contraction curve. The antral contraction frequency was unassociated with gastrointestinal symptoms. Still, the overall stomach contraction frequency increased by 30% (P < 0.001) and 15% (P = 0.003) in individuals with diabetes for each incremental increase in nausea and reflux scores, respectively.

Conclusions

Gastrointestinal transit times, as well as antral and colonic contractile activity, differed between individuals with diabetic gastroenteropathy and controls. The overall gastric contraction frequency was associated with symptom severity.

Hepatitis B Virus Disrupts the Blood-Testis Barrier via the Induction of mTOR-Dependent Autophagy in Sertoli Cells

Hepatitis B virus (HBV) is one of the most serious public health threats worldwide. HBV is not only able to pass through the blood-testis barrier (BTB); It can also cause impairment of male fertility. However, the mechanisms involved in this process remain unknown. In this study, we showed that HBV can establish persistent infection in human and mouse testes. Persistent HBV infection triggers inflammatory cell invasion, testes immune homeostasis imbalance, and the disruption of the BTB formed by inter-Sertoli cells. HBV mainly persisted in the Sertoli cells and could induce the autophagy of Sertoli cells by HBV X protein (HBx), a major regulatory protein of HBV. Data indicated that the mTOR signal pathway-mediated autophagy plays a pivotal role in HBV-induced BTB damage. Autophagy inhibitor 3-MA and mTOR activator MHY1485 could ameliorate HBV-induced autophagy and BTB damage. These findings demonstrated that the mTOR-mediated excessive autophagy of Sertoli cells induced by HBx could be one of the pathological mechanisms responsible for the fertility decline caused by HBV infection.

PPARα regulates ER-lipid droplet protein Calsyntenin-3β to promote ketogenesis in hepatocytes

Ketogenesis requires fatty acid flux from intracellular (lipid droplets) and extrahepatic (adipose tissue) lipid stores to hepatocyte mitochondria. However, whether interorganelle contact sites regulate this process is unknown. Recent studies have revealed a role for Calsyntenin-3β (CLSTN3β), an endoplasmic reticulum-lipid droplet contact site protein, in the control of lipid utilization in adipose tissue. Here, we show that Clstn3b expression is induced in the liver by the nuclear receptor PPARα in settings of high lipid utilization, including fasting and ketogenic diet feeding. Hepatocyte-specific loss of CLSTN3β in mice impairs ketogenesis independent of changes in PPARα activation. Conversely, hepatic overexpression of CLSTN3β promotes ketogenesis in mice. Mechanistically, CLSTN3β affects LD-mitochondria crosstalk, as evidenced by changes in fatty acid oxidation, lipid-dependent mitochondrial respiration, and the mitochondrial integrated stress response. These findings define a function for CLSTN3β-dependent membrane contacts in hepatic lipid utilization and ketogenesis.

MOB1 deletion in murine mature adipocytes ameliorates obesity and diabetes

There is currently a global epidemic of obesity and obesity-related diseases such as type 2 diabetes due to decreased physical activity, excessive food intake, and/or genetic predisposition. The Hippo-YAP1 pathway has attracted attention as a potential therapeutic target because YAP1/TAZ activation in murine immature adipocytes in vitro suppresses their differentiation by inhibiting PPARγ activity. However, the role of YAP1 activation in mature adipocytes in vivo remains unclear. MOB1, whose expression is increased in obesity, is the hub of the Hippo core molecule complex and negatively regulates YAP1/TAZ activation. Therefore, we generated aMob1DKO mutant mice, which feature deficiency of Mob1a/b specifically in mature adipocytes. Compared to controls, aMob1DKO mice subjected to a high-fat diet showed beneficial changes consistent with resistance to diet-induced obesity. The mutants exhibited increases in basal lipolysis, "beiging," and energy expenditure, as well as suppression of ROS production and inflammation in white adipose tissue. Insulin sensitivity and glucose tolerance were improved, and ectopic fat accumulation was reduced. Most of these changes were dependent on the YAP1 activation observed in mature white adipose tissue of aMob1DKO mice. FGF21, which improves lipid metabolism, was upregulated directly via YAP1 activation, and many of the phenotypes seen in aMob1DKO mice were also dependent on FGF21. Thus, the aMob1DKO mouse is an interesting model for the study of the metabolic effects of diet-induced obesity and protection against diabetes. Our work suggests that a YAP1-FGF21 axis exists in adipocytes that may be a potential therapeutic target for obesity.

Prevalence and impact of metabolically healthy obesity on cardiovascular outcomes in postmenopausal women and disparities: An age-matched study

BACKGROUND

There is widespread debate about the impact of metabolically healthy obesity (MHO) on cardiovascular outcomes. However, studies have not exclusively examined the impact of MHO on cardiovascular outcomes in the postmenopausal population.

AIM

To explore the prevalence of MHO and its relationship with hospitalization outcomes, including major adverse cardiac or cerebrovascular events (MACCE), in postmenopausal women.

METHODS

We extracted data from the National Inpatient Sample 2020 database using International Classification of Disease, Tenth Revision, Clinical Modification codes for all admissions of postmenopausal women. We excluded patients with diabetes, hypertension, and hyperlipidemia to obtain metabolically healthy patients and then identified patients with obesity to create obese and non-obese cohorts. We used a 1:1 propensity score matching method to match patients with and without MHO based on age, and then we did a multivariable regression analysis for in-hospital MACCE.

RESULTS

In 2020, 1304185 metabolically healthy postmenopausal women were admitted; 148250 (11.4%) had MHO. After propensity score matching for age, a statistically significant difference was observed in overall MACCE [odds ratio (OR): 1.08, 95% confidence interval (CI): 1.01-1.16, P = 0.028] among MHO and non-MHO cohorts, especially in patients of African-American ethnicity (OR: 1.23, 95%CI: 1.01-1.49, P = 0.035) and the lowermost income quartile (OR: 1.24, 95%CI: 1.06-1.44, P = 0.007).

CONCLUSION

Postmenopausal patients with MHO are at risk of MACCE, especially black patients and those with lower incomes. Larger prospective studies can demystify MHO’s impact on cardiovascular outcomes among postmenopausal women.

Modeling diabetic cardiomyopathy using human cardiac organoids: Effects of high glucose and lipid conditions

Diabetic cardiomyopathy (DCM) is a complex metabolic disorder resulting from chronic hyperglycemia and lipid toxicity, which leads to cardiac dysfunction, fibrosis, inflammation, and mitochondrial impairment. Traditional two-dimensional (2D) cell cultures and animal models have limitations in replicating human cardiac physiology and pathophysiology. In this study, we successfully developed a three-dimensional (3D) model of DCM using cardiac organoids generated from human induced pluripotent stem cells (hiPSCs). These organoids were treated with varying concentrations of glucose and sodium palmitate to mimic the high-glucose and high-lipid environment associated with diabetes. At lower concentrations, glucose and sodium palmitate enhanced cell viability, while higher concentrations induced significant cardiotoxic effects, including apoptosis, oxidative stress, and mitochondrial dysfunction. The cardiac organoids also exhibited increased expression of cardiac injury markers, fibrosis-related genes, and inflammatory cytokines under high-glucose and high-lipid conditions. Treatment with metformin, a widely used antidiabetic drug, mitigated these adverse effects, indicating the model's potential for drug testing and evaluation. Our findings demonstrate that this human-derived 3D cardiac organoid model provides a more physiologically relevant platform for studying DCM and can effectively complement traditional models. This model holds promise for advancing the understanding of diabetic heart disease and for assessing the efficacy of potential therapeutic interventions.

Toxicological insights into graphene family materials: Cytochrome P450 modulation and cellular stress in liver cells

Graphene family materials (GFM), including pristine graphene (GN), graphene oxide (GO), and nano-sized graphene oxide (nGO), are increasingly utilized across industrial, environmental, and biomedical domains. Despite their potential benefits, the hazardous effects of GFM, particularly on liver xenobiotic-metabolizing enzymes and cellular functions, are not fully understood. Cytochrome P450 (CYP) are enzymes conserved across species, which play a crucial role in the metabolism of xenobiotics, drugs, environmental pollutants, and endogenous compounds, are key to understanding the biotransformation and detoxification processes impacted by GFM. This study investigates the effects of GFMs on CYP enzymes (CYP1A2, CYP2D6, CYP3A4) in a recombinant CYP system and HepG2 liver cells, alongside an assessment of cellular stress responses. In HepG2 cells, GFMs induced oxidative stress, mitochondrial depolarization, and cytotoxicity, with GN causing the most pronounced effects. GO exhibited the strongest inhibition of CYP enzymatic activity, particularly CYP1A2, in a dose-dependent manner in a recombinant CYP system. None of the tested nanomaterials significantly altered CYP expression, except for nGO, where a slight increase in CYP3A4 protein expression was observed. These findings highlight the significant influence of GFM physicochemical properties on their hazardous potential, especially their ability to disrupt metabolic processes and induce cellular stress. This study emphasizes the critical need for evaluating the safety of GFM in light of their widespread application and potential environmental and human health implications.

Study on the spectrum-effect correlation of phytoestrogenic activity of total flavonoids from Cynomorii Herba

ETHNOPHARMACOLOGICAL RELEVANCE

Cynomorii Herba (CH), a traditional Chinese medicine, contains total flavonoids with potential phytoestrogenic activity, but the specific active components and mechanisms of action remain unclear.

AIM OF THE STUDY

To investigate the active components and mechanisms responsible for the phytoestrogenic activity of Cynomorii Herba Total Flavonoids (CHTF).

MATERIALS AND METHODS

A comprehensive fingerprint analysis of CHTF from 12 different regions was conducted using ultra-performance liquid chromatography-mass spectrometry (UPLC-MS) technology. A spectrum-effect relationship model was established using grey relational analysis (GRA) and artificial neural network (ANN) methods, correlating the fingerprint peaks of CHTF with three pharmacological indicators: uterine index, MCF-7 cell proliferation rate, and estradiol (E2) content. Ultimately, molecular docking techniques were employed to verify the binding affinity of key flavonoid compounds to estrogen receptors (ER).

RESULTS

The sample from Alxa Left Banner (AQ), showed the strongest activity. A comprehensive analysis identified 16 key components closely related to phytoestrogenic activity, with (+)-catechin, procyanidin C1, and (-)-epicatechin being the main active constituents. Molecular docking studies showed that these compounds have good binding affinity to ERα and ERβ, confirming them as the main active substances responsible for the phytoestrogenic activity of CHTF.

CONCLUSION

CHTF exhibits significant phytoestrogenic activity by mediating ER, and CHTF from different regions shows various degrees of phytoestrogenic activity. There are 9 flavonoid and 7 non-flavonoid compounds in CHTF responsible for its phytoestrogenic activity.

Association Between Carotid Intima-Media Thickness and Novel Lipid Parameters in Hypertensive Patients

INTRODUCTION

Carotid Intima-Media Thickness (IMT) is a marker of subclinical atherosclerosis and cardiovascular risk. Dyslipidemia is a well-established risk factor for atherosclerosis and novel lipid parameters have recently emerged.

AIM

The aim of our study was to assess the association between IMT and novel lipid parameters in hypertensive patients.

METHODS

We analyzed the IMT of 848 hypertensive patients followed at the Hypertension Unit of San Gerardo Hospital (Monza, Italy). Classic (total, HDL, LDL and non-HDL cholesterol and triglycerides) and novel indices (non-HDL/HDL, LDL/HDL, total cholesterol/HDL, log triglycerides/HDL and triglycerides-glycemia index) were measured and calculated.

RESULTS

Univariable analyses showed a significant correlation between IMT and most lipid parameters. Multivariable linear regression with IMT as continuous dependent variable revealed a significant association with total cholesterol (β = 0.108, p = 0.001), LDL cholesterol (β = 0.119, p < 0.001), non-HDL cholesterol (β = 0.126, p < 0.001), non-HDL/HDL (β = 0.134, p < 0.001), LDL/HDL (β = 0.140, p < 0.001) and total cholesterol/HDL (β = 0.134, p < 0.001). Logistic multivariable regression with IMT categorized as ≥ or < 0.9 mm demonstrated a significant association with total cholesterol (OR = 1.100 per 10 mg/dL increase, p = 0.003), LDL cholesterol (OR = 1.130 per 10 mg/dL increase, p = 0.001), non-HDL cholesterol (OR = 1.110 per each unit increase, p = 0.001), non-HDL/HDL (OR = 1.368 per each unit increase, p = 0.002), LDL/HDL (OR = 1.583 per each unit increase, p = 0.001) and total cholesterol/HDL (OR = 1.368 per each unit increase, p = 0.002).

CONCLUSIONS

Carotid IMT is significantly associated with various lipid parameters, with the strongest association observed for non-HDL/HDL, LDL/HDL and total cholesterol/HDL.

Investigation of synergistic effects of silver nanoparticles with sorafenib on in vitro prostate and head and neck cancer models

Prostate cancer is one of the most common cancers in men and hypopharyngeal cancer is a rare aggressive malignant cancer. Since conventional cancer treatments have side effects, most of the current studies are directed towards finding innovative approaches in the diagnosis and treatment of cancer. In recent years, research has focussed on the anticancer properties of silver nanoparticles (AgNPs). The synergistic effects of AgNPs and sorafenib have been studied, however, their impacts on PC3 and FaDu cells have not been studied yet. In this study, AgNPs and sorafenib were applied individually and together to both cell types, their effects were examined at cellular and molecular levels. Cell viability was measured by CVDK-8 assay. Apoptosis was measured colorimetrically and changes in Caspase-3 levels were identified with western blot analysis. Cell viability in AgNPs and sorafenib individual groups was decreased concentration-dependent in both cells. AgNPs-Sorafenib combination was more effective in inhibiting the cell viability in FaDu cells compared to PC3 cells. According to Western blot analysis, a significant change in apoptosis was observed in the AgNPs and AgNPs-Sorafenib groups in FaDu cells, while not observed in the sorafenib group. The findings of this study will provide new perspectives on nanocarrier drug systems.

A host enzyme reduces metabolic dysfunction-associated steatotic liver disease (MASLD) by inactivating intestinal lipopolysaccharide

The incidence of metabolic dysfunction-associated steatotic liver disease (MASLD) has been increasing worldwide. Since gut-derived bacterial lipopolysaccharides (LPS) can travel via the portal vein to the liver and play an important role in producing hepatic pathology, it seemed possible that (1) LPS stimulates hepatic cells to accumulate lipid, and (2) inactivating LPS can be preventive. Acyloxyacyl hydrolase (AOAH), the eukaryotic lipase that inactivates LPS and oxidized phospholipids, is produced in the intestine, liver, and other organs. We fed mice either normal chow or a high-fat diet for 28 weeks and found that Aoah-/- mice accumulated more hepatic lipid than did Aoah+/+ mice. In young mice, before increased hepatic fat accumulation was observed, Aoah-/- mouse livers increased their abundance of sterol regulatory element-binding protein 1, and the expression of its target genes that promote fatty acid synthesis. Aoah-/- mice also increased hepatic expression of Cd36 and Fabp3, which mediate fatty acid uptake, and decreased expression of fatty acid-oxidation-related genes Acot2 and Ppara. Our results provide evidence that increasing AOAH abundance in the gut, bloodstream, and/or liver may be an effective strategy for preventing or treating MASLD.

Temporal Effects of a Viral Peptide on Glucose-Stimulated Insulin Secretion

Impaired glucose homeostasis, often attributed to the destruction of insulin-secreting pancreatic β-cells, results in Type 1 diabetes (T1D). While both genetic and environmental factors have been implicated in the onset of T1D, there is an increase in clinical observations of T1D resulting from or triggered by viral infections. Despite the increase mentioned above, mechanistic insights into viral-induced T1D onset remain scarce. The key question of how viral infections may impact insulin secretion, thereby affecting glucose-stimulated insulin secretion (GSIS), is still unanswered. In this work, we correlate GSIS and viral peptides for the first time. Using the Mouse Insulinoma 6 (MIN6) cell line as a model system for β cells, we studied pituitary adenylate cyclase-activating polypeptide (PACAP) potentiated GSIS. Specifically, we noted that two forms of PACAP, namely, PACAP38 (P38) and PACAP27 (P27) are important in GSIS. From proteomes of chikungunya and dengue viruses (CHIKV and DV, respectively) implicated in triggering T1D, we identified viral peptides that were similar (but not identical) to PACAP. We report that a peptide from CHIKV, termed as CV1, enhances insulin secretion in MIN6 cells along with P38; however, independent treatments with CV1 yield variable outcomes based on duration of incubation. While short-term treatment shows viral peptides outcompeting P38, leading to increased insulin secretion without cytotoxicity, there is a decrease in cell viability with longer incubations under some conditions. Remarkably, long-term CV1 incubation significantly reduces glucose sensitivity of and GSIS by MIN6 cells. We report the first experimental evidence linking viral peptides to GSIS (specifically PACAP-stimulated).

CT-derived adipose tissue characteristics and TAVI all-cause mortality and complications: a systematic review

Transcatheter Aortic Valve Implantation (TAVI) has revolutionized severe aortic stenosis treatment, but risk stratification remains challenging. This systematic review examined the association between computed tomography (CT)-derived adipose tissue parameters and TAVI outcomes. We searched major databases for studies on visceral (VAT), subcutaneous (SAT), and intramuscular (IMAT) adipose tissue parameters and post-TAVI outcomes. Fourteen studies (9692 patients) were included. Higher SAT area/volume was consistently associated with better survival (5 studies, HR range: 0.83-2.77, p < 0.05). Lower SAT and VAT density also correlated with better survival (5 and 4 studies, respectively, HR range: 1.31-1.46, p < 0.05). VAT area showed mixed results. A VAT:SAT ratio < 1 was associated with better cardiovascular outcomes in one study. Lower IMAT index correlated with shorter hospital stays in a single study. This review reveals complex relationships between adipose tissue parameters and TAVI outcomes. Lower adipose tissue density and higher subcutaneous adiposity were most consistently associated with better outcomes. These findings suggest that detailed analysis of adipose tissue characteristics may enhance risk stratification in TAVI candidates.

Advancements and limitations in traditional anti-cancer therapies: a comprehensive review of surgery, chemotherapy, radiation therapy, and hormonal therapy

Cancer remains a major global health challenge, consistently ranking as the second leading cause of mortality worldwide. Despite significant advancements in research and technology, the need to deepen our understanding of tumor biology and improve therapeutic strategies persists. This review focuses on the progress and challenges of four traditional cancer treatment modalities: surgery, chemotherapy, radiation therapy, and hormonal therapy. Surgery, the primary method for tumor removal, has evolved with the integration of fluorescence-based technology and robotic systems, enhancing precision and minimizing collateral damage. Radiation therapy has progressed with improved focus, intensity control, and 3D technology, refining both diagnosis and treatment. Chemotherapy has advanced from natural extracts to synthesized derivatives with amplified cytotoxicity against cancer cells. Hormonal therapy has emerged as a crucial strategy for hormone-dependent cancers, restraining growth or inducing regression. Despite these advancements, each approach faces ongoing challenges. Surgery struggles with complete tumor removal due to heterogeneity. Chemotherapy contends with drug resistance and side effects. Radiation therapy grapples with precision issues and limited access in some regions. Hormonal therapy faces resistance development and quality of life impacts. This study provides a comprehensive analysis of the evolution of these traditional anti-cancer therapies, offering insights into their progress and highlighting areas for future research. By examining these modalities, we aim to underscore their relevance in the current oncology landscape and identify opportunities for improvement in cancer treatment strategies.

The 15-Year Survival Advantage: Immune Resilience as a Salutogenic Force in Healthy Aging

Human aging presents an evolutionary paradox: while aging rates remain constant, healthspan and lifespan vary widely. We address this conundrum via salutogenesis-the active production of health-through immune resilience (IR), the capacity to resist disease despite aging and inflammation. Analyzing ~17,500 individuals across lifespan stages and inflammatory challenges, we identified a core salutogenic mechanism: IR centered on TCF7, a conserved transcription factor maintaining T-cell stemness and regenerative potential. IR integrates innate and adaptive immunity to counter three aging and mortality drivers: chronic inflammation (inflammaging), immune aging, and cellular senescence. By mitigating these aging mechanisms, IR confers survival advantages: At age 40, individuals with poor IR face a 9.7-fold higher mortality rate-a risk equivalent to that of 55.5-year-olds with optimal IR-resulting in a 15.5-year gap in survival. Optimal IR preserves youthful immune profiles at any age, enhances vaccine responses, and reduces burdens of cardiovascular disease, Alzheimer's, and serious infections. Two key salutogenic evolutionary themes emerge: first, female-predominant IR, including TCF7, likely reflects evolutionary pressures favoring reproductive success and caregiving; second, midlife (40-70 years) is a critical window where optimal IR reduces mortality by 69%. After age 70, mortality rates converge between resilient and non-resilient groups, reflecting biological limits on longevity extension. TNFα-blockers restore salutogenesis pathways, indicating IR delays aging-related processes rather than altering aging rates. By reframing aging as a salutogenic-pathogenic balance, we establish TCF7-centered IR as central to healthy longevity. Targeted midlife interventions to enhance IR offer actionable strategies to maximize healthspan before biological constraints limit benefits.

Craniofacial Changes Among Children and Adolescents Submitted to Growth Hormone Therapy: A Systematic Review

The aim of this systematic review was to investigate the association between craniofacial changes and growth hormone (GH) therapy among children and adolescents with GH deficiency or idiopathic short stature (ISS). The PRISMA guideline was followed to carry out all stages of this review. An electronic search was conducted in seven databases, without year or language restrictions. The study selection was carried out in two stages by two calibrated examiners. Studies exploring craniofacial changes among children and adolescents with GH deficiency or ISS undergoing GH therapy were included. After data extraction, the risk of bias was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal tool and the RoB 2.0 Checklist. The certainty of the evidence was assessed using the GRADE tool. Among the 4494 identified citations, seven studies met the eligibility criteria. These studies evaluated the impact of GHs on cephalometric measurements and dental age. No differences between immediate and delayed treatments were found in maxillary and mandibular dimensions. All selected articles showed a low risk of bias. A low certainty of evidence was observed for all outcomes assessed. GH therapy appears to result in a small increase in mandibular dimensions, although without clinical significance characteristic of adverse effects. Clinical trials and long-term follow-up studies of these patients are needed to develop accurate recommendations regarding the effects of GHs in the craniofacial region. Growth hormone may result in a slight increase in mandibular and maxillary dimensions, without significant adverse effects to general health. Controlled intervention studies with long-term follow-up are needed to establish more precise recommendations. Trial Registration: PROSPERO database (https://www.crd.york.ac.uk/prospero/): CRD42024511329.

Towards a genetic obesity risk score in a single-center study of children and adolescents with obesity

The objective of this study was to identify clinical and/or metabolic predictive factors of genetic obesity. Subjects aged ≤ 18 years with obesity (BMI ≥ 97 th percentile) followed-up at the Paediatric Endocrinology Clinic of Maggiore Hospital in Novara, Italy were screened for genes associated with obesity by next-generation sequencing. Anamnestic, anthropometric, and biochemical data were collected, and parents completed two questionnaires, to screen for hyperphagia and daytime sleepiness, respectively. The study included 50 patients. Six genetic variants (6/50 patients,12%) were classified as pathogenic/likely pathogenic, three (3/50 patients,6%) as polygenic, and 16 (13/50 patients,26%) as variants of uncertain clinical significance (VUS). Eight patients carried > 1 variant. All pathogenic mutations were in genes implicated in the hypothalamic melanocortin pathway or responsible for syndromic obesity. All subjects with definitive genetic diagnosis developed obesity before five years of age. There were no statistically significant differences in auxological nor metabolic parameters between the three genetic patterns of absent genetic mutations, VUS, and pathogenic/likely pathogenic mutations. Finally, a Genetic Obesity Risk Score was developed using logistic regression analysis, selecting Hyperphagia Questionnaire score, age of onset of obesity, and family history as variables. Genetic screening of our cohort of children and adolescents with severe obesity revealed pathogenic/polygenic variants in 18% of cases, with PCSK1 the most frequently mutated gene and with a definitive genetic diagnosis in 3 patients. Identifying clinical, behavioral, and metabolic features predictive of genetic obesity would facilitate early diagnosis and tailored management.

Determination of Thyroid Hormones and 11 Metabolites in the Human Serum Using a Simple Derivatization Strategy and Analysis by Isotope-Dilution Liquid Chromatography Tandem Mass Spectrometry

Many analytical methods for thyroid hormone (TH) determination lack sensitivity and/or specificity. The thyroid hormone metabolites (THMs) are usually not measured at all. This study describes the development of sensitive high-throughput analytical methods for determining the total concentration and free fraction of TH and THM in the human serum. For the analysis of the TOTAL fraction, we employed protein precipitation and anionic exchanger solid-phase extraction. For the FREE fraction, ultrafiltration and salt-out liquid partitioning were used. Derivatization using dansyl chloride was employed to enhance the sensitivity of HPLC-ESI-MS/MS analysis. Both protocols were validated according to the European Analytical Guidelines (2002/657/EC). We obtained very good recoveries (73-115%) and precision. Interday coefficients of variation (CVs) for most of the analytes ranged from 1.2 to 16.4%. The sensitivity was excellent with detection limits in the sub ppt range for the majority of TH and THM. A significant enhancement in sensitivity (>10 fold) was achieved through derivatization. The applicability was proved on a set of samples from pregnant women enrolled in the CELSPAC cohort (n = 120). Our TH reference ranges are in good agreement with those reported in the literature. The methods also allowed us to quantify the levels of 11 THM, including some previously undetected THM in total and free fractions, and proved to be suitable for high-throughput routine TH and THM analyses. Our approach offers an important advancement in thyroid hormone analysis. To the best of our knowledge, it is for the first time that data for T1A and T2A as well as for free THM levels in the human serum are published in the literature. Moreover, our study also brings the first information about the levels of most of the THM in pregnant women.

Can Stem Cell Therapy Revolutionize Ocular Disease Treatment? A Critical Review of Preclinical and Clinical Advances

Stem cell therapy in regenerative medicine has a scope for treating ocular diseases. Stem cell therapy aims to repair damaged tissue and restore vision. The present review focuses on the advancements in stem cell therapies for ocular disorders, their mechanism of action, and clinical applications while addressing some outstanding challenges. Stem cells that include embryonic stem cells (ESCs), induced pluripotent stem cells (iPSCs), mesenchymal stem cells (MSCs), and retinal progenitor cells have regenerative potential for ocular repair. They differentiate into specialized ocular cell types, conduct neuroprotection, and modulate immune responses. It is emphasized in preclinical and clinical studies that stem cell therapy can treat corneal disorders such as limbal stem cell deficiency, retinal diseases like dry age macular degeneration and retinitis pigmentosa, and diabetic retinopathy. Various studies suggested that stem cells have considerable scope in glaucoma treatment by supporting retinal ganglion cell survival and optic nerve regeneration. Advanced approaches such as gene editing, organoid generation, and artificial intelligence enhance these therapies. Effective delivery to target areas, engraftment, orientation, and long-term survival of transplanted cells need optimization. Issues such as immune rejection and tumorigenicity must be addressed. This approach is further hindered by regulatory issues and overly complicated approval processes and trials. Ethical issues related to sourcing embryonic stem cells and patient consent complicate the issue. The cost of manufacturing stem cells and their accessibility are other factors posing potential barriers to widespread application. These regulatory, ethical, and economic issues must be tackled if stem cell treatments are to be made safe, accessible, and effective. Future studies will include refining therapeutic protocols, scaling manufacturing processes, and overcoming socio-economic barriers, eventually improving clinical outcomes.

The role of androgens and global and tissue-specific androgen receptor expression on body composition, exercise adaptation, and performance

Gonadal testosterone stimulates skeletal muscle anabolism and contributes to sexually differentiated adipose distribution through incompletely understood mechanisms. Observations in humans and animal models have indicated a major role for androgen receptor (AR) in mediating sex differences in body composition throughout the lifespan. Traditional surgical, genetic and pharmacological studies have tested systemic actions of circulating androgens, and more recent transgenic approaches have allowed for tests of AR gene function in specific androgen responsive niches contributing to body composition, including: skeletal muscle and surrounding interstitial cells, white and brown adipose, as well as trabecular and cortical bone. Less well understood is how these functions of gonadal androgens interact with exercise. Here, we summarize the understood mechanisms of action of AR and its interactions with exercise, specifically on outcomes of body composition and muscle function, and the global- and tissue-specific role of AR in regulating skeletal muscle, adipose, and bone morphology. Additionally, we describe the known effects of androgen and AR manipulation on female body composition, muscle morphology, and sport performance, while highlighting a need for greater inclusion of female subjects in human and animal muscle physiology and endocrinology research.

The Impact of Biological Sex And High-Fat High-Fructose Diet on Brain Dysfunction in an Animal Model of Sepsis

The aim of this study was to evaluate long-term inflammatory, biochemical and behavioral parameters in adult male and female Wistar rats submitted to a model of high-fat and high fructose diet and sepsis. In the study we used 8-month-old male and female rats. High-fat and high fructose diet was provided for 4 months, and sepsis was induced shortly afterwards. Behavioral tests were performed at 10, 30 and 60 days after sepsis induction, at 30- and 60-days metabolic parameters, leptin and cytokines (prefrontal cortex and hippocampus) were determined. High-fat and high-fructose diet was able to induce glucose intolerance. Sepsis favored anxious behavior at 10 days after sepsis, remaining at 30 days and with apparent improvement at 60 days in females and maintenance of behavior in males. Cognitive damage was observed both at 30 and 60 days in animals from both groups. Plasma metabolic parameters were elevated only males exposed to a high-fat high-fructose diet and submitted to CLP only at 30 days. Long-term brain inflammation was not consistently affected both by sex and high-fat and high fructose diet.The relationship between high-fat and high fructose diet, gender and sepsis is still contradictory, as are the mechanisms involved in this paradox. Models and analyses need to be standardized in order to better understand how this event occurs.

Anti-central fatigue effects of myelophil in 5-HTergic hyperactivity mice model

BACKGROUND

Myelophil is a standardized ethanol extract of Astragali Radix and Salviae Miltiorrhizae Radix, which has been developed based on clinical experience in traditional Korean medicine practices for patients with unexplained chronic fatigue, including myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Our previous studies demonstrated Myelophil's clinical efficacy in ME/CFS, as well as its brain-related activities in animal models. However, the underlying pharmacological mechanisms remain unclear. Recently, we identified serotonergic hyperactivity as a key pathophysiological factor in central fatigue, such as ME/CFS. Therefore, in the present study, we aimed to investigate the mechanisms by which Myelophil exerts its effects, particularly in the context of a 5-HTergic hyperactivity model.

METHOD

To verify the action mechanisms of Myelophil on serotonergic hyperactivity condition, we herein assessed its anti-central fatigue properties using a fluoxetine-treated mice model. Male C57BL/6 N mice (9 weeks old) were subjected to periodic intraperitoneal (IP) injections of fluoxetine for 4 weeks and the mice were simultaneously oral administered Myelophil (0, 50, or 100 mg/kg) or ascorbic acid (100 mg/kg).

RESULT

Four-week injection of fluoxetine notably increased serotonin (5-hydroxytryptamine, 5-HT) activity, as evidenced by immunofluorescence staining and Western blot assays in the raphe nuclei (RN), and induced central fatigue-like behaviors in the nest building test, wheel running test, rota-rod test, plantar test, and open field test. Meanwhile, Myelophil (100 mg/kg) administration significantly ameliorated those fatigue-related behaviors including pain sensitivity. Furthermore, the anti-fatigue effects of Myelophil were corroborated by changes in serotonin-related parameters (serotonin transporter; 5-HTT and vesicular monoamine transporter 2; VMAT2), as well as neurotrophic markers including c-Fos and brain-derived neurotrophic factor (BDNF) in the RN.

CONCLUSION

These results provide experimental evidence suggesting the potential mechanisms by which Myelophil may alleviate central fatigue associated with hyper-5-HTergic activity.

CLINICAL TRIAL NUMBER

Not applicable.

Unlocking Loop Geometric Remodeling Redirects Aldo-Keto Reductase from Substrate Promiscuity to 3-Keto-Deoxynivalenol Specificity

Aldo-keto reductase is responsible for the formation of nontoxic 3-epi-deoxynivalenol (3-epi-DON) from 3-keto-DON, which is an enzymatic detoxification manner to completely eliminate the toxicity of mycotoxin DON against health and environmental threats. Therefore, unlocking the facilitated substrate specificity of aldo-keto reductase for 3-keto-DON has become a critical challenge for advanced catalytic performance. In this endeavor, a loop-based engineering strategy was developed for aldo-keto reductase AKR13B3 from Devosia A6-243 to catalyze 3-keto-DON. A 31.9-fold switch from a disfavored substrate to the preferred one was produced along with a significant 37.9-fold increase in catalytic efficiency. Kinetic parameter determinations, structural analyses, and molecular simulations were employed to elucidate the molecular mechanisms underlying these enhancements in catalytic activity and substrate specificity. Overall, our work presents a feasible scheme for designing aldo-keto reductases with exceptional substrate specificity and catalytic activity, holding great promise for developing enzymatic detoxification agents.

Molecular characteristics of early- and late-onset ovarian cancer: insights from multidimensional evidence

BACKGROUND

Ovarian cancer (OC) is among the most lethal gynecologic malignancies, characterized by poor prognosis. While aging is a well-established risk factor, the underlying mechanisms distinguishing early- and late-onset ovarian cancer remain poorly understood.

METHODS

This study analyzed the global burden and age-related trends of ovarian cancer using the GBD database. A cut-off age of 55 years was used to differentiate between early and late onset ovarian cancer, and a Mendelian randomization method was also used to investigate the causal relationship between aging and ovarian cancer. Machine learning was applied to identify tumor-specific age-associated genes, followed by bioinformatics analyses and single-cell sequencing to explore the roles of these genes and immune profile alterations in ovarian cancer. Additionally, models were constructed, and drug sensitivity analyses performed to evaluate their potential as diagnostic markers or therapeutic targets.

RESULTS

Ovarian cancer incidence and mortality exhibit age-related trends, with telomere length positively associated with increased risk (OR = 1.27, 95% CI: 1.01-1.60, P = 3.90 × 10⁻2). Older patients with OC have a worse prognosis. PRKCD and UCP2 were significantly upregulated in ovarian cancer. PRKCD facilitates epithelial-mesenchymal transition (EMT), contributing to ovarian cancer progression, while UCP2 modulates ROS dynamics, influencing chemoresistance. Immune microenvironment analysis revealed differences between high- and low-expression groups, particularly in T cells, macrophages, and other immune cells. Both genes are sensitive to a varity of drugs, including dasatinib, fluvastatin, highlighting their potential as therapeutic targets.

CONCLUSION

Aging is a significant risk factor for ovarian cancer, with PRKCD and UCP2 closely linked to its onset and progression. These genes show promise as novel biomarkers and therapeutic targets for ovarian cancer.

Exacerbated hypercalcemia, nephrolithiasis, and renal impairment after vitamin D supplementation in granulomatous disease: a case report

BACKGROUND

The cosmetic industry is booming with unorthodox therapies aimed at improving the appearance of beauty and strength. One such therapy is self-administered, intramuscular injections of paraffin oil for the purpose of increasing presumed muscular size. Paraffin oil injections are becoming frequent among younger male individuals, who inject up to several liters in (primarily) the upper extremities. However, paraffin oil leads to the formation of granulomas, which are rich in macrophages with an upregulated extrarenal 1-hydroxylation. These macrophages will rapidly and unimpededly convert inactive vitamin D (25OHD2) to active vitamin D (1,25OH2D3), thereby causing significant hypercalcemia and derivative disease.

CASE PRESENTATION

In 2007, a Scandinavian male individual in his 20s had self-injected 1200 ml of paraffin oil into both biceps. Within 5 years, the oil had migrated and was then widely dispersed in his biceps and surrounding tissues, causing swelling and pain. By 2015, granulomas had formed at injection sites, and he was admitted to a hospital with severe hypercalcemia, which was managed with fluid therapy and slowly resolved. From 2015 to 2020, his calcium levels were intermittently elevated, and he experienced two episodes of nephrolithiasis requiring surgical intervention. In 2020, he was prescribed one dose oral vitamin D (6000 µg cholecalciferol) for suspected vitamin D deficiency based on a low serum 25OHD2. His episodic hypercalcemia increased, and he developed nephrolithiasis and exacerbated renal impairment.

CONCLUSION

Unlike most other patients with low 25(OH)D2, patients with granulomatous disease should not routinely receive vitamin D supplementation, as this may aggravate hypercalcemia and hypercalcuria, causing nephrolithiasis and renal impairment.

Uncovering therapeutic targets for Pre-eclampsia and pregnancy hypertension via multi-tissue data integration

BACKGROUND

Pre-eclampsia (PE) and pregnancy hypertension (PH) are common and serious complications during pregnancy, which can lead to maternal and fetal death in severe cases. Therefore, further research on the potential therapeutic targets of PE and PH is of great significance for developing new treatment strategies.

METHODS

This study used the summary data-based Mendelian randomization (SMR) method to analyze expression quantitative trait loci (eQTL) data from blood, aorta, and uterus with Genome-wide association studies (GWAS) data on PE and PH, exploring potential genetic loci involved in PE and PH. Since proteinuria is a clinical manifestation of PE, we also analyzed genes related to the kidney and PE. The HEIDI test was used for heterogeneity testing, and results were adjusted using FDR. The cis-eQTL data were obtained from the blood summary-level data of the eQTLGen Consortium and the aorta and uterus data from the V8 release of the GTEx eQTL summary data. The GWAS data for PE and PH were obtained from the FinnGen Documentation of R10 release. This study utilized the STROBE-MR checklist for reporting Mendelian Randomization (MR) studies.

RESULTS

This study identified several potential therapeutic targets by integrating eQTL data from blood, uterus, and aorta with GWAS data for PE and PH, as well as kidney eQTL data with GWAS data for PE. Additionally, the study discovered some genes with common roles in PE and PH, offering new insights into the shared pathological mechanisms of these two conditions. These findings not only provide new clues to the pathogenesis of PE and PH but also offer crucial foundational data for the development of future therapeutic strategies.

CONCLUSION

This study revealed multiple potential therapeutic targets for PE and PH, providing new insights for basic experimental research and clinical treatment to mitigate the severe consequences of PE and PH.

CLINICAL TRIAL NUMBER

Not applicable.

DNA methylation and 28 year incidence of two neuropathy phenotypes in type 1 diabetes: the Pittsburgh Epidemiology of Diabetes Complications cohort study

AIMS/HYPOTHESIS

Diabetic peripheral neuropathy (DPN) and neuropathic pain (NP) are common complications of type 1 diabetes that can greatly affect quality of life. Studying DNA methylation (DNAm) may help identify potential therapeutic targets; however, epigenome-wide association studies (EWAS) of DPN and NP are lacking. We thus performed prospective EWAS of 28 year DPN and NP incidence in the Pittsburgh Epidemiology of Diabetes Complications (EDC) study of childhood-onset (<17 years) type 1 diabetes.

METHODS

DPN was defined as two or more of the following criteria: symptoms consistent with DPN; decreased tendon reflexes; or abnormal sensory examination. NP was reported as burning, aching or stabbing pain in the feet during an EDC examination or on the Michigan Neuropathy Screening Instrument (MNSI). The time of the first available blood-derived DNA specimen collected between 1988-1998 was considered the analytic 'baseline' (mean age 27 years; diabetes duration 19 years). After quality control, DNAm (EPIC array) at 683,597 CpGs was analysed in Cox models for time-to-DPN in 282 individuals free of DPN at baseline and time to NP in 365 individuals free of NP at baseline. False discovery rate (FDR) <0.05 was considered statistically significant. We also identified differentially methylated regions (DMRs), functional interaction networks and genetic variants associated with DNAm (methylation quantitative trait loci [meQTLs]), and performed Mendelian randomisation (MR) to assess evidence of causality.

RESULTS

Over 28 years, 154 individuals (54.6%) developed DPN and 148 (40.5%) developed NP. Greater methylation at three CpGs was significantly associated (FDR≤0.05) with reduced hazard of DPN: cg06163904 (CHMP6); cg10835127 (CACNA1B); and cg18945945 (PKNOX1). CpG associations with DPN remained similar after adjustment for clinical risk factors. We identified 75 meQTLs for cg18945945 in the PKNOX1 region, 59 of which were validated in an external diabetes cohort. One-sample MR provided nominal evidence for a potentially causal association between cg18945945 and DPN (p=0.01). While no individual CpGs were significantly associated with NP, there were 49 NP-associated DMRs.

CONCLUSIONS/INTERPRETATION

Our study identified associations between DNAm and 28 year incidence of DPN and NP at several biologically plausible loci. Most notably, we identified a novel association between DNAm of PKNOX1 and future DPN, including evidence of a genetic influence on PKNOX1 methylation that was validated in an external diabetes cohort. PKNOX1 has previously been implicated in drug-induced neuropathy; our results provide strong evidence that epigenetic regulation of PKNOX1 may also play a functional role in the development of diabetic neuropathy. Our results suggest that epigenetic modification of the identified loci warrants further study to inform potential targets for prevention of DPN.

Single-cell profiling in ovarian germ cell and sex cord-stromal tumours

BACKGROUND

The tumour microenvironment of rare ovarian germ cell tumours (OGCT) and sex-cord stromal tumours (SCST) remains unexplored. To better understand their immune and stromal landscape, we constructed a blueprint using single-cell RNA sequencing (scRNA-seq).

METHODS

We performed scRNA-seq of 66, 919 cells from twelve fresh tumour samples: seven adult granulosa cell tumour (aGSCT), one juvenile GSCT (jGSCT), one Sertoli-Leydig (SL) tumour, two immature teratoma (IT) and one dysgerminoma (DG). We characterised immune cell subtypes and fibroblasts based on their specific marker genes. Validation included combined positive score (CPS) of 46 OGCTs and 66 SCSTs, and bulk RNA sequencing (n = 32).

RESULTS

Cell clustering and annotation revealed a immune-activated microenvironment in DG, driven by PD-1- exhausted T cells, reflected in high CPS (≥10) and upregulated immune pathways. IT samples displayed no immunoreactive profile, consistent with a negative CPS. aGSCTs exhibited a fibroblast-enriched, immune-desert phenotype, with low T cell infiltration and increased immunosuppressive LYVE1 and CX3CR1+ macrophages, corresponding to negative CPS.

CONCLUSION

We constructed a detailed blueprint of the OGCT and SCSTs microenvironment of, elucidating potential modulators that shape their immune landscape. The immune-suppressive environment in aGSCTs likely limits immunotherapy response, as immunosuppressive macrophages inhibit T cell expansion along with EMT activation and fibroblast predominance.

Risk factors for unplanned 31-day readmission after surgery for colorectal cancer patients: a meta-analysis

BACKGROUND

The high incidence of unplanned readmissions within 31 days after colorectal cancer surgery remains a significant challenge. However, the identified risk factors for these readmissions are inconsistent across the literature. This study aims to perform a comprehensive meta-analysis to estimate the incidence of unplanned readmissions and systematically identify the factors associated with this risk, providing robust evidence for targeted interventions to reduce readmission rates.

METHODS

This study was conducted in accordance with the PRISMA guidelines. All study steps, including study selection, data extraction, and quality assessment, were independently performed by two authors, with any disagreements resolved through consultation with a third author. A comprehensive search for published studies was conducted across the following databases up to January 2025: VIP Journal Database, Wanfang Data, CNKI, SinoMed, PubMed, Embase, Web of Science, and the Cochrane Library. Statistical analyses were performed using RevMan 5.4 and Stata 17.0, with a p-value of less than 0.05 considered statistically significant.

RESULTS

This meta-analysis identified several significant risk factors associated with unplanned readmission during this period (P < 0.05), including age (OR = 1.13), postoperative complications (OR = 1.87), tumor stage (TNM ≥ III) (OR = 2.01), tumor site in the rectum (OR = 1.64), stoma creation (OR = 1.70), Complicated diabetes (OR = 1.56), Charlson Comorbidity Index (CCI) (OR = 1.27), blood transfusion (BT) (OR = 1.24), Length of hospital stay (LOS) (OR = 1.65), and surgical approach (OR = 1.22). Notably, female (OR = 0.85) was identified as a protective factor against unplanned readmission.

CONCLUSION

The unplanned readmission rate within 31 days after colorectal cancer surgery was 11.73%. Current evidence suggests that age, postoperative complications, TNM ≥ III, tumor site in the rectum, stoma creation, complicated diabetes, Charlson Comorbidity Index (CCI), blood transfusion (BT), length of hospital stay (LOS), and surgical approach are significant risk factors for unplanned readmission. Conversely, female has been identified as a protective factor. To mitigate these risks and reduce readmission rates, healthcare professionals should implement targeted educational and clinical interventions.

The Lebanese GRADE-based vitamin D guidelines: a paradigm for the MENA region

BACKGROUND

The Middle East and North Africa region are traditionally known as regions with a high prevalence of vitamin D deficiency. However, serum 25-hydroxyvitamin D (25OHD) levels seem to be increasing lately. We developed guidelines on the screening and supplementation of adult Lebanese patients with vitamin D. These guidelines address community-dwelling and institutionalized individuals.

METHODS

Our guideline panel consisted of clinical and methodology experts that formulated the guidelines questions. We conducted a systematic review to gather global data on fracture (CRD42019129540), regional data on vitamin D trials (CRD42014010488), and on patients' values and preferences (CRD42022320022). We also complemented the latter with results from a cross-sectional local study. We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to assess the quality and certainty of evidence, and to develop recommendations.

RESULTS

For community-dwelling and institutionalized Lebanese adult population, the panel suggests no screening for vitamin D deficiency, over screening for vitamin D deficiency (conditional recommendation, based on very low certainty evidence). For community-dwelling Lebanese adult population, the panel suggests no supplementation with calcium and vitamin D, over supplementation (conditional recommendation, based on moderate certainty evidence). For institutionalized Lebanese adult population, the panel suggests supplementation with calcium and vitamin D, over no supplementation (conditional recommendation, based on moderate certainty evidence). The guidelines also identify high-risk subgroups, more likely to benefit from screening and supplementation. In community dwelling and institutionalized Lebanese adult individuals, for whom there is a decision to supplement with calcium and vitamin D, the panel suggests supplementation with a daily vitamin D equivalent of 600-2000 IU, as compared to doses higher than 2000 IU (conditional recommendation, very low certainty evidence).

CONCLUSION

The Lebanese GRADE-based vitamin D guidelines recommend against population screening and vitamin D supplementation. Subgroups at high risk are identified. The guidelines take into account contextual factors, and allow their adoption or adaptation in countries in the region.

Association between the glucose pattern in oral glucose tolerance test and adverse pregnancy outcomes among non-diabetic women

BACKGROUND

This study aimed to explore whether the patterns of the oral glucose tolerance test (OGTT) could function as a predictive factor for adverse pregnancy outcomes in pregnant women without gestational diabetes mellitus (GDM).

METHODS

A retrospective cohort study was carried out, involving a total of 23,577 pregnant women. The participants were classified into three groups according to the area under the curve (AUC) of the OGTT performed between 24 and 28 weeks of gestation. Based on the tertiles of the AUC-OGTT magnitude, three distinct glucose patterns were identified: small AUC (SA) with an AUC-OGTT ≤ 12.26, medium AUC (MA) with an AUC-OGTT between 12.26 and 13.81, and large AUC (LA) with an AUC-OGTT > 13.81. Logistic regression analysis was utilized to assess the association between different AUC-OGTT patterns and the risk of adverse pregnancy outcomes.

RESULTS

The incidence of adverse pregnancy outcomes, including preeclampsia, preterm birth, macrosomia, and cesarean delivery, showed a progressive increase from the SA to the MA to the LA pattern. A positive dose-response relationship was observed between the AUC-OGTT and adverse pregnancy outcomes. In the logistic regression analysis, with the SA pattern as the reference, the MA pattern was associated with a higher risk of macrosomia and cesarean delivery (both P < 0.001). Even after adjusting for potential covariates, the relative risks for these outcomes were 1.34 (95% CI: 1.14, 1.56) and 1.09 (95% CI: 1.01, 1.16), respectively (both P < 0.05). Additionally, the LA pattern was associated with a higher risk of preeclampsia, preterm birth, macrosomia, and cesarean delivery (all P < 0.01). After adjusting for potential covariates, the relative risks for preterm birth, macrosomia, and cesarean delivery were 1.20 (95% CI: 1.03, 1.41), 1.68 (95% CI: 1.44, 1.95), and 1.15 (95% CI: 1.07, 1.23), respectively (all P < 0.05). Moreover, these risks differed according to maternal age and preconception body mass index (BMI).

CONCLUSIONS

The present study highlights the relationship between OGTT patterns and adverse pregnancy outcomes in Chinese women without GDM. Identifying the MA and LA patterns as unfavorable factors for adverse pregnancy outcomes can provide crucial information for clinicians to develop personalized risk assessment and intervention strategies, which may contribute to improving pregnancy outcomes.

Growth characteristics of children with 21-hydroxylase deficiency and the value of steroid hormones in height assessment

BACKGROUND

Impaired height is a common complication of 21-hydroxylase deficiency (21OHD), yet sensitive monitoring indicators remain limited. This study aims to elucidate growth characteristics and identify effective monitoring parameters for 21OHD children.

METHODS

Cross-sectional data from 111 patients were categorized into four groups based on age and developmental stage: 0 - 2 years, 2 years old to pre-pubertal initiation, puberty initiation to pre-epiphyseal closure, and post-epiphyseal closure, named groups A to D, respectively. Each group was further stratified by phenotype and sex. Height standard deviation scores (HSDS), corrected for bone age (BA) and target height (HSDS - THSDS, HBASDS - THSDS), were calculated. Steroid hormone levels and hydrocortisone (HC) doses were analyzed using statistical models to identify factors influencing height.

RESULTS

The medians of HSDS - THSDS were > 0 in all subgroups of Group A. The medians of HBASDS - THSDS were < 0 in all subgroups of Group B, and 17-hydroxyprogesterone (17OHP) and HC dose significantly positively influenced BA advancement. BA of patients in Group C was older than the calendar age(CA), while the medians of HBASDS - THSDS in all subgroups except the non-classic females were all < 0, and 17OHP, 21-deoxycortisol(21DOF), and 11-oxy-androgen were significant influencing factors. The medians of final height (FHSDS - THSDS) of all subgroups in Group D were < 0, males with classic 21OHD significantly lower than females.

CONCLUSIONS

21OHD children exhibit accelerated bone maturation as early as childhood, worsening during adolescence, leading to severely impaired growth potential and final height. 17OHP, 21DOF, and 11-oxy-androgens are promising biomarkers for evaluating growth and bone maturity.