Low frequency of AIP mutations in patients with young-onset sporadic pituitary macroadenomas

PURPOSE

Mutations in the aryl hydrocarbon receptor interacting protein (AIP) gene cause familial isolated pituitary adenomas (FIPA). AIP mutations have also been found in patients with apparently sporadic pituitary adenomas, particularly in young patients with large adenomas. The aim of this study was to determine the frequency of AIP germline mutations in patients with young-onset sporadic pituitary macroadenomas.

METHODS

The AIP gene was sequenced in 218 Portuguese patients with sporadic pituitary macroadenomas diagnosed before the age of 40 years.

RESULTS

Heterozygous rare sequence variants in AIP were identified in 18 (8.3%) patients. However, only four (1.8%) patients had pathogenic or likely pathogenic variants. These consisted of two already known mutations (p.Arg81* and p.Leu115Trpfs*41) and two novel mutations (p.Glu246*, p.Ser53Thrfs*36). All four patients had GH-secreting adenomas diagnosed between the ages of 14 and 25 years. The frequency of AIP pathogenic or likely pathogenic variants in patients under the age of 30 and 18 years was 3.4% and 5.0%, respectively.

CONCLUSION

The frequency of AIP mutations in this cohort was lower than in other studies. Previous reports may have overestimated the contribution of AIP mutations due to the inclusion of genetic variants of uncertain significance. The identification of novel AIP mutations expands the known spectrum of genetic causes of pituitary adenomas and may help understand the role of AIP mutations in the molecular mechanisms underlying pituitary tumorigenesis.

Thermal Performance of Multifunctional Facade Solution Containing Phase Change Materials: Experimental and Numerical Analysis

This work focuses on the development and analysis of a new multifunctional facade panel incorporating PCM in foam layers. The thermal performance was analysed recurring to a hotbox heat flux meter method to determine the thermal transmittance (U-value) and the main findings are presented. The experimental setup was based on the steady-state approach, using climatic chambers, assuring a stable thermal environment. Even small fractions of PCM achieved a small reduction in thermal amplitude. Numerical simulations using Ansys Fluent were developed to evaluate the performance of PCM use over a wide range of temperature boundary conditions and operating modes. These numerical models were calibrated and validated using the results of experimental tests, achieving a correlation factor of 0.9674, and, thus, accurately representing a real-world scenario. The decrement factor (f) was used to analyse the data. It was identified that the efficiency of the panel and size of the optimum region increased with the PCM fraction growth. The results showed the significant potential of the multi-layered panel, with the thermal regulator effect of the PCM incorporated, on indoor space temperature so as to reach good thermal comfort levels. The efficiency of the panel can be improved by nearly 50% depending on the input boundary conditions. The efficiency of the panel and the size of the optimum region increase with growth in the PCM fraction. The simulated behaviour was at an optimum when the input mean temperature was 20 °C for a room temperature of between 18-20 °C.

The influence of simultaneous pancreas-kidney transplantation on the evolution of diabetic foot lesions and peripheral arterial disease

PURPOSE

Simultaneous pancreas-kidney transplantation (SPKT) remains the best treatment option in patients with type 1 diabetes and chronic kidney failure. There are only a few studies addressing the potential ischemic deterioration of peripheral arterial disease (PAD) due to blood diverting from the iliac artery to the kidney graft. We aimed to evaluate diabetic foot lesions and PAD evolution in SPKT recipients and investigate if they are more frequent in ipsilateral lower limb of kidney graft.

METHODS

We developed a retrospective cohort, including patients submitted to SPKT in our tertiary center, between 2000 and 2017. Diabetic foot lesions and PAD frequencies were compared in the period before and after transplantation.

RESULTS

Two hundred and eleven patients were included, 50.2% (n = 106) female, with a median age at transplantation of 35 years (IQR 9). After a median follow-up period of 10 years (IQR 7), patient, kidney, and pancreatic graft survival were 90.5% (n = 191), 83.4% (n = 176), and 74.9% (n = 158), respectively. Before transplant, 2.8% (n = 6) had PAD and 5.3% (n = 11) had history of foot lesions. In post-transplant period, 17.1% (n = 36) patients presented PAD and 25.6% (n = 54) developed diabetic foot ulcers, 47.6% (n = 35) of which in the ipsilateral and 53.3% (n = 40) in the contralateral lower limb of the kidney graft (p = 0.48). Nine patients (4.3%) underwent major lower limb amputation, 3 (30%) ipsilateral and 7 (70%) contralateral to the kidney graft (p = 0.29).

CONCLUSIONS

Diabetic foot lesions were not more frequent in the ipsilateral lower limb of the kidney graft, therefore downgrading the 'steal syndrome' role in these patients.

Zap1 is required for Candida glabrata response to fluconazole

The increasing prevalence of fluconazole-resistant clinical isolates of Candida spp. strongly hinders the widespread use of the drug. To tackle this problem, great efforts have been made to fully understand the fungal response to fluconazole. In this work, we show that the role of Zap1 in Candida glabrata goes beyond regulating yeast adaptation to zinc deficiency. In line with our previous observation that deletion of ZAP1 makes yeast cells more sensitive to fluconazole, we found that the mutant CgΔzap1 accumulates higher levels of the drug, which correlates well with its lower levels of ergosterol. Surprisingly, Zap1 is a negative regulator of the drug efflux transporter gene CDR1 and of its regulator, PDR1. The apparent paradox of drug accumulation in cells where genes encoding transporters relevant for drug extrusion are being overexpressed led us to postulate that their activity could be impaired. In agreement, Zap1-depleted cells present, in addition to decreased ergosterol levels, an altered composition of membrane phospholipids, which together should impact membrane function and impair the detoxification of fluconazole. Overall, our study brings to light Zap1 as an important hub in Candida glabrata response to fluconazole.

Erratum to "Gastroenteropancreatic Neuroendocrine Neoplasia Characterization in Portugal: Results from the NETs Study Group of the Portuguese Society of Endocrinology, Diabetes and Metabolism"

[This corrects the article DOI: 10.1155/2019/4518742.].

Gastroenteropancreatic Neuroendocrine Neoplasia Characterization in Portugal: Results from the NETs Study Group of the Portuguese Society of Endocrinology, Diabetes and Metabolism

BACKGROUND

The incidence of gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) has been increasing in the last five decades, but there is no large-scale data regarding these tumours in Portugal. We conducted a cross-sectional, multicentric study in main Portuguese centers to evaluate the clinical, pathological, and therapeutic profile of GEP-NENs.

METHODS

From November, 2012, to July, 2014, data from 293 patients diagnosed with GEP-NENs from 15 centers in Portugal was collected and registered in an online electronic platform.

RESULTS

Median age at diagnosis was 56.5 (range: 15-87) years with a preponderance of females (54.6%). The most frequent primary sites were the pancreas (31.1%), jejunum-ileum (24.2%), stomach (13.7%), and rectum (8.5%). Data regarding hormonal status was not available in most patients (82.3%). Stratified by the tumour grade (WHO 2010 classification), we observed 64.0% of NET G1, 24.7% of NET G2, and 11.3% of NEC. Poorly differentiated tumours occurred mainly in older patients (p = 0.017), were larger (p < 0.001), and presented more vascular (p = 0.004) and lymphatic (p = 0.001) invasion. At the time of diagnosis, 44.4% of GEP-NENs presented metastatic disease. Surgery (79.6%) and somatostatin analogues (30.7%) were the most frequently used therapies of GEP-NENs with reported grading.

CONCLUSION

In general, Portuguese patients with GEP-NENs presented similar characteristics to other populations described in the literature. This cross-sectional study represents the first step to establish a national database of GEP-NENs that may aid in understanding the clinical and epidemiological features of these tumours in Portugal.

The Magnetic Levator Prosthesis for Temporary Management of Severe Blepharoptosis: Initial Safety and Efficacy

Purpose

We further optimized and evaluated the safety of the magnetic levator prosthesis (MLP) for temporary management of severe blepharoptosis, and compared efficacy and comfort against the ptosis crutch.

Methods

The interpalpebral fissure (IPF) of participants (n = 12) with ptosis was measured during attempted eyelid opening, volitional closing, and spontaneous closing with no device, ptosis crutch, or the MLP. A 10-point scale documented comfort. Additionally, a 20 minute and then 1 week trial of the MLP was offered. Safety measures were skin erythema rating, change in visual acuity, and change in corneal staining.

Results

The MLP and crutch opened the eye (IPF 11.2 and 9.3 mm), but the MLP allowed better volitional closure (IPF 1.0 vs. 4.9 mm, P = 0.009), but was no better in allowing spontaneous blink (IPF 7.5 vs. 7.7 mm, P = 0.722). Both devices were equally comfortable (both median 8/10 comfort, P = 0.46). With extended use, opening with the MLP showed IPF 9.24 mm at 20 minutes and 9.46 mm at 1 week, and volitional closure was IPF 0.95 and 0.52 mm, respectively. Closure on spontaneous blink improved with extended wear to IPF 5.14 and 5.18 mm, respectively (P = 0.002). Two participants exhibited moderate skin erythema and one had increased corneal staining without change in acuity.

Conclusions

The MLP is safe and feasible for temporary correction of severe ptosis.

Translational Relevance

First group data in patients showing successful reanimation of the eyelid with magnetic force.

The endocannabinoid anandamide impairs in vitro decidualization of human cells

Endocannabinoids (eCBs) are endogenous mediators that along with the cannabinoid receptors (CB1 and CB2), a membrane transporter and metabolic enzymes form the endocannabinoid system (ECS). Several eCBs have been discovered with emphasis on anandamide (AEA). They are involved in several biological processes such as energy balance, immune response and reproduction. Decidualization occurs during the secretory phase of human menstrual cycle, which involves proliferation and differentiation of endometrial stromal cells into decidual cells and is crucial for the establishment and progression of pregnancy. In this study, a telomerase-immortalized human endometrial stromal cell line (St-T1b) and non-differentiated primary cultures of human decidual fibroblasts from term placenta were used to characterize the ECS using immunoblotting and qRT-PCR techniques. It was shown that St-T1b cells express CB1, but not CB2, and that both receptors are expressed in HdF cells. Furthermore, the expression of fatty acid amide hydrolase (FAAH), the main degrading enzyme of AEA, increased during stromal cell differentiation. AEA inhibited cell proliferation, through deregulation of cell cycle progression and induced polyploidy. Moreover, through CB1 binding receptor, AEA also impaired cell differentiation. Therefore, AEA is proposed as a modulator of human decidualization. Our findings may provide wider implications, as deregulated levels of AEA, due to Cannabis sativa consumption or altered expression of the metabolic enzymes, may negatively regulate human endometrial stromal cell decidualization with an impact on human (in)fertility.Free Portuguese abstract: A Portuguese translation of this abstract is freely available at http://www.reproduction-online.org/content/152/4/351/suppl/DC1.

P5-09-01: Breast Cancer Annual Screening Program Núcleo Mama Porto Alegre (NMPOA): Imaging Results after Seven Years

Introduction: The NMPOA cohort started in 2004 with the purpose of testing a breast screening model for underserved women in limited resource countries. In the city of Porto Alegre (South Brazil with 1.5 million population), breast cancer incidence rate is 127/100.000 (Brazilian NCI,2010) with increasing mortality due to 45% of Stage III and IV and no public health care early detection program, it was mandatory to test the feasibility of an organized screening program for women with very low income and level of education (64% under 6 years of schooling). In this scenario, there was always a concern of over diagnosis that will increase costs (more biopsies and surgeries) and under diagnosis by the radiologists involved in the program. We present here the results of all breast biopsies performed in this period, and its correlation with the attributed BI-RADS classification in order to optimize care and costs. Also, this study has a long term proposal and other results have been published concerned to the baseline profile of the population (Cancer Epidemiol Biomarkers Prev. 2010 Oct;19(10):2673–9. Epub 2010 Aug 17).

Methods:Since April 2004, 5592 women from 40 to 69 years were enrolled in the program and underwent to clinical breast exam and annual mammography screening at NMPOA. Initially, lesions were classified as B1, B2 or B0. After complementary views or exams, B0 was classified as B3, B4 (A, B or C) or B5. B4 and B5 were considered positive tests and immediately submitted to biopsy (open surgical or ultrasound guided core biopsy). B3 was followed according to recommended in BI-RADS fourth edition, and subsequently classified as benign (annual follow up) or suspicious findings (biopsy performed). The evaluation included histological analysis of breast biopsy specimens by two independent pathologists. Predictive positive value (PPV), predictive negative value (PNV) and accuracy (Acc) were calculated.

Falling through the cracks: unmet health service needs among people living with HIV in Atlanta, Georgia

Despite growing numbers of people living with HIV (PLWH), the landscape of related services is shrinking. This study investigated health and social service needs of men (N = 489) and women (N = 165) living with HIV in Atlanta, GA. Participants completed confidential measures asking about the health and social services they needed and accessed. Results showed an array of health and social service needs among PLWH; failure to access services was prevalent. Hunger was among the most common basic needs, reported by greater than 60% of men and women. For men, unmet service needs were associated with fewer years since testing positive for HIV, higher CD4+ T cell values, experiencing more stressors and depression, and greater quantity of alcohol use. For women, failure to access services was associated with experiencing depression and not receiving HIV medications. Providing basic services to PLWH remains a public health priority and a moral imperative.

Monthly unannounced pill counts for monitoring HIV treatment adherence: tests for self-monitoring and reactivity effects

BACKGROUND

Unannounced home-based pill counts conducted in person or on the telephone are reliable and valid for monitoring medication adherence. However, expecting to have one's pills counted, organizing medications for pill counts, and increased attention from the person conducting the pill counts may have reactive effects and inadvertently improve adherence. The current study determined whether monthly unannounced pill counts conducted by telephone influence adherence over time.

METHODS

Two prospective cohorts, one drawn from a social support condition in a behavioral intervention trial (n=186) and the other an observational study (n=187), were followed for 12 months and 8 months, respectively. Medication adherence was monitored using monthly unannounced pill counts conducted by telephone. In addition, blood plasma viral load was collected at the final pill count for the observational cohort.

RESULTS

Analyses did not indicate increases in medication adherence over time for antiretroviral or psychiatric medications among men, women, people with detectable and undetectable viral loads, and various medication regimens.

CONCLUSIONS

Unannounced pill counts conducted by telephone do not demonstrate reactivity effects and remain a viable, unobtrusive, objective method of monitoring medication adherence.

Metformin and atorvastatin combination further protect the liver in type 2 diabetes with hyperlipidaemia

BACKGROUND

non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes are associated with dyslipidaemia, inflammation and oxidative stress. However, the pathophysiology of NAFLD in type 2 diabetes with hyperlipidaemia is not fully known, as well as the utility of the commonly prescribed anti-diabetic and lipid-lowering drugs in ameliorating liver injury markers.

METHODS

hepatic complications of type 2 diabetes with hyperlipidaemia and the effects of atorvastatin and metformin, isolated and in association, in systemic and hepatic inflammatory and oxidative stress markers were tested using genetic type 2 diabetic Goto-Kakizaki rats fed with a high-fat diet.

RESULTS

the high-fat diet aggravated the overall metabolic state and the hepatic markers of injury. All treatments decreased fasting glycaemia, insulin resistance and free fatty acid levels. Combined treatment further decreased C-reactive protein (CRP), adiponectin, liver tumour necrosis factor-α (TNF-α) and interleukin-6 (IL-6), systemic and hepatic oxidative stress and portal inflammation.

CONCLUSIONS

our data provides evidence of a greater benefit with a combination of atorvastatin and metformin in improving liver injury in type 2 diabetes with hyperlipidaemia.

Health and treatment implications of food insufficiency among people living with HIV/AIDS, Atlanta, Georgia

HIV/AIDS is concentrated among the inner-city poor and poverty may directly interfere with HIV treatment. This study examined food insufficiency in relation to HIV-related health and treatment. A sample of 344 men and women living with HIV/AIDS in Atlanta, Georgia completed measures of food security, health, and HIV disease progression and treatment. HIV treatment adherence was monitored using unannounced pill counts. Results showed that half of people living with HIV/AIDS in this study lacked sufficient food, and food insufficiency was associated with multiple indicators of poor health, including higher HIV viral loads, lower CD4 cell counts, and poorer treatment adherence. Adjusted analyses showed that food insufficiency predicted HIV treatment non-adherence over and above years of education, employment status, income, housing, depression, social support, and non-alcohol substance use. Hunger and food insecurity are prevalent among people living with HIV/AIDS, and food insufficiency is closely related to multiple HIV-related health indicators, particularly medication adherence. Interventions that provide consistent and sustained meals to people living with HIV/AIDS are urgently needed.

Evaluation of olive oil mill wastewater toxicity on the mitochondrial bioenergetics after treatment with Candida oleophila

In a previous work the ability of Candida oleophila to use phenolic compounds as sole carbon and energy source at high concentrations without an additional carbon source was reported. C. oleophila grown in bioreactor batch cultures in a diluted and sterilized olive oil mill wastewater (OMW) caused a significant decrease in the total tannins content but no significant alteration was observed in phenolic acid and fatty acid content. Both treated and untreated OMWs were tested to evaluate the capacity in interfering with mitochondrial bioenergetics. Mitochondrial respiration was not affected by treated OMW on the range of used concentrations, contrary to the untreated OMW. Furthermore, mitochondrial membrane potential and respiratory complexes were always significantly less affected by treated OMW in comparison with untreated OMW. However, supplementary treatment should be applied before OMW could be considered non-toxic.

Evaluation of olive oil mill wastewaters acute toxicity: a study on the mitochondrial bioenergetics

Acute toxicity of olive mill wastewaters (OMW), collected from a continuous olive mill, was evaluated in rat liver mitochondrial bioenergetics. Inhibition of respiratory activities in state 4, state 3, and uncoupled respiration are essentially mediated through partial inhibitions of mitochondrial complexes II and III. ATPase activity was considerably less depressed by OMW than ATP synthase activity (a difference of 42%). The inhibition observed on ATP synthase is mostly the result of an inhibition on the redox complexes. Ultimately, the OMW-induced loss of phosphorylation capacity was not only the result of a direct effect of OMW on the enzymatic complex (F(0)-F(1) ATPase), but also the result of a deleterious effect on the integrity of the mitochondrial membrane, which can promote an inhibition of the respiratory complexes and an increase of the proton permeability of the inner membrane.

Can we improve gait skills in chronic hemiplegics? A randomised control trial with gait trainer

AIM

Partial body weight support (PBWS) is an accepted treatment for hemiplegic patients. The aim of this study is to compare the efficiency of gait trainer with conventional treatment on the gait management after stroke.

METHODS

Forty chronic post-stroke hemiplegics were part of a prospective research. Inclusion criteria were: first ever stroke in a chronic stage with stabilised motor deficits; age >18 and <80 years; cognitive and communication skills to understand the treatment; absence of cardiac, psychological and orthopedic contraindications. Patients were randomised into two groups: the control group (CG) that used the Bobath method in 40 minutes sessions, 5 times a week, for 5 weeks, and the experimental group (EG) that used the gait trainer, for the same period of time and frequency. Assessment tools: Motricity Index (MI); Toulouse Motor Scale (TMS); modified Ashworth Spasticity Scale (mASS); Berg Balance Scale (BBS); Rivermead Mobility Index (RMI); Fugl-Meyer Stroke Scale (F-MSS); Functional Ambulation Category (FAC); Barthel Index (BI); 10 meters, time up and go (TUG), 6 minutes, and step tests. EG and CG did the assessments before treatment (T(0)), right after treatment (T(1)), and on follow-up, 3 months later (T(2)).

RESULTS

CG and EG were homogenous in all the variables at T(0). CG and EG showed improvement in almost all the assessment scales after treatment, although only some with relevant differences. EG showed statistically relevant improvement on T(1) and on T(2) in several of the assessment tools, whereas CG only showed statistically significant improvement after T(1) and only in some of the assessment tools.

CONCLUSIONS

Both groups of chronic hemiplegic patients improved after either PBWS with gait trainer or Bobath treatment. Only subjects undergoing PBWS with gait trainer maintained functional gain after 3 months.

Induction chemoradiotherapy and surgical resection for non-small cell lung carcinomas of the superior sulcus (pancoast tumors): Mature results of National Cancer Institute (INCa)-Brazil

17124

Background: The established treatment for T3 Pancoast tumors, radiation plus surgery, leads to a 50% R0 resection rate and a 30% 5 year survivals. T4 tumors are usually unresectable and incurable. Our group retrospectively analyzed the feasibility and efficacy of induction chemoradiotherapy plus surgery for T3 and T4 tumors. Methods: Eligible patients (pts) had biopsy proven, untreated, T3–4N0–1 Pancoast tumors. Induction therapy was cisplatin (50 mg/m2, days 1,8,29,36) and etoposide (50 mg/m2, days 1–5, 29–33) (PE) given concurrently with radiation (45 Gy, 25 daily fractions). Thoracotomy was done within 5 weeks of induction therapy for stable or responding disease. All pts were to receive postoperative chemotherapy (PE ×2). Median follow up was 19 months. Results: From 4/01–6/05, 13 eligible pts were enrolled: 6 men, 7 women, median age 53 years; 9 T3, 4 T4. All pts (100%) completed induction therapy. Grade 3–4 toxicities were neutropenia (n = 2), anemia (n = 1), fatigue (n = 1), esophagitis (n = 5). All pts had thoracotomy, 13 had R0 resection. Pathologic CR was found in 3 (23.1%), minimal microscopic disease in 1 (7.7%). Postoperative chemotherapy completed by only 1/13 pts. Median survival was not reached and Median Disease free (DFS) and 2 year overall survivals (OS) were 26 months (CI 95% 13.6–38.4) 67% for all pts, respectively. Relapse sites were brain only (n = 3) and local only (n = 1). Conclusion: This combined modality therapy was well tolerated and leads to high rates of complete resection, OS and local control that are strikingly better than with radiation and surgery. These results obtained in a population with T3 and T4 tumors reproduced those of the SWOG study in terms of resectability, safety and short-term survival Of note is the poor adherence to postoperative chemotherapy in this population.

No significant financial relationships to disclose.

Stress and burnout among Portuguese anaesthesiologists

BACKGROUND AND OBJECTIVE

Anaesthesiology is considered a stressful occupation. Our purpose was to assess stress and burnout among Portuguese anaesthesiologists.

METHODS

A cross-sectional survey based on an anonymous questionnaire was sent to all Portuguese anaesthesiologists registered by the Portuguese Medical Association. Data on patient characteristics and professional variables, perceived stress (Perceived Stress Scale), the subscale of work satisfaction of the Pressure Management Indicator scale, burnout (Maslach Burnout Inventory) and main stress factors were collected. The proportion of participation was 31.8%.

RESULTS

The average value of perceived stress scale was 24.0 (range: 0-56). Among the 263 anaesthesiologists, 57.9% experienced emotional exhaustion, 44.8% lack of personal accomplishment and 90.9% depersonalisation. Lack of personal accomplishment increased with number of children among women but not among men; depersonalisation was more frequent among anaesthesiologists working in community hospitals and anaesthesiologists with leadership functions experienced less professional stress.

CONCLUSION

There are stress conditions and burnout amongst Portuguese anaesthesiologists. The prevalence of depersonalisation was extremely high in the studied sample. Emotional exhaustion is partially explained by high perceived-stress and low satisfaction with organisation in the job according to Pressure Management Indicator scale.

[Iatrogenic traumatic lesions of femoral veins during varicose veins surgery]

Traumatic lesions of the femoral veins during varicose veins surgery are very uncommon and they raise several therapeutic difficulties. They occur in 1/1000 cases of varicose veins operated. The authors describe four cases of lesions of this type that were seen and treated for the last six years, probably because there was an increase in the number of varicose veins operated on in the Lisbon area. The authors discuss the surgical options and they concluded that these complications can be minimized with good anatomical and surgical skills, specially of the saphenous-femoral and saphenous-popliteal junctions.

[The production of a latex immunoglobulin conjugate for the diagnosis of Gardnerella vaginalis]

To obtain an anti-Gadnerella vaginalis latex globulin, specific immunosera to reference strain (ATCC 14018) and to a clinical isolation strain pool were produced. These immunosera were characterized using PAGE-SDS and immunoblotting where a close antigenic relation between the clinical isolation strains and the reference strain was observed. The latex globulin conjugates obtained from these 2 immunosera were evaluated in vitro with a resulting level of detection of 10 ufc/mL of Gardnerella vaginalis. These two conjugates were also evaluated in clinical samples and compared with the 6 vaginalis culture and the criteria considered for diagnosing bacterial vaginosis. The anti-strain pool (II) latex globulin conjugate turned out to be more sensitive and specific than anti-G. vaginalis ATCC strain (I) latex globulin.