Are glucose and insulin levels at all time points during OGTT a reliable marker of diabetes mellitus risk in pediatric obesity?

PURPOSE: Childhood overweight and obesity associated with insulin resistance and metabolic syndrome represent the new global pandemic and the main causative factors for dysglycemia, prediabetes, and Type 2 Diabetes Mellitus (T2DM). Predictors, such as HOMA-IR, HOMA-ß%, and QUICKI lack specific reference values in children. OGTT is a gold standard for glycometabolic assessment. Recently, a glycemic level higher than 155 mg/dl at + 60' after glucose ingestion has been defined as a risk factor for T2DM in obese adolescents. We aim to analyze and correlate fasting insulin-resistance markers with OGTT results in overweight/obese children and adolescents. METHODS: We retrospectively evaluated glucose and insulin values during a 2-h OGTT every 30 min in 236 overweight/obese patients. Glucose values and insulin sum during OGTT were compared to glycometabolic indexes and different cut-off values for insulin sum. RESULTS: A 1-h glucose > 155 mg/dl and insulin sum > 535 microU/ml at all times during OGTT are the best predictors of diabetes risk in obese youths. A1-h glucose > 155 mg/dl is significantly associated with HbA1c > 5.7%, while no association was observed between HbA1c > 5.7% and glucose levels at baseline and 2 h. The ability of the standardized HOMA-IR to predict the prediabetes status is clearly lower than the total insulin sum at OGTT. CONCLUSION: Our study demonstrates that also 1-h post-OGTT glucose, together with HbA1c, is an effective diabetes predictor.

Sellar and parasellar lesions in the transition age: a retrospective Italian multi-centre study.

BACKGROUND: Sellar/parasellar lesions have been studied in the adult and paediatric age range, but during the transition age their epidemiology, clinical manifestations, management and treatment outcomes have been poorly investigated. MATERIALS AND METHODS: An Italian multicentre cohort study, in which hospital records of patients with diagnosis of sellar/parasellar lesions during the transition age and young adulthood (15-25 years), were reviewed in terms of prevalence, clinical and hormonal features at diagnosis, and outcomes where available. Both pituitary neuroendocrine tumours (pituitary tumours, Group A) and non-endocrine lesions (Group B) were included. RESULTS: Among Group A (n = 170, 46.5% macroadenomas), the most frequent were prolactin and GH-secreting tumours, with a female predominance. Among Group B (n = 28), germinomas and Rathke cells cysts were the most common. In Group A, the most frequent hormonal deficiency was gonadal dysfunction. Galactorrhoea and amenorrhoea were relatively common in female patients with prolactinomas. Pre-surgical diabetes insipidus was only seen in Group B, in which also hormone deficiencies were more frequent and numerous. Larger lesions were more likely to be seen in Group B. Patients in Group B were more frequently male, younger, and leaner than those of Group A, whereas at last follow-up they showed more obesity and dyslipidaemia. In our cohort, the percentage of patients with at least one pituitary deficiency increased slightly after surgery. CONCLUSIONS: The management of sellar/parasellar lesions is challenging in the transition age, requiring an integrated and multidisciplinary approach. Hormone and metabolic disorders can occur many years after treatment, therefore long-term follow-up is mandatory.

High dose craniospinal irradiation as independent risk factor of permanent alopecia in childhood medulloblastoma survivors: cohort study and literature review.

PURPOSE: Our aim was to determine the main risk factors related to the occurrence of permanent alopecia in childhood medulloblastoma (MB) survivors. METHODS: We retrospectively analyzed the clinical features of all consecutive MB survivors treated at our institute. We divided the patients into 3 groups depending on the craniospinal irradiation (CSI) dose received and defined permanent alopecia first in terms of the skin region affected (whole scalp and nape region), then on the basis of the toxicity degree (G). Any relationship between permanent alopecia and other characteristics was investigated by a univariate and multivariate analysis and Odds ratio (OR) with confidence interval (CI) was reported. RESULTS: We included 41 patients with a mean10-year follow-up. High dose CSI resulted as an independent factor leading to permanent hair loss in both groups: alopecia of the whole scalp (G1 p-value 0.030, G2 p-value 0.003) and of the nape region (G1 p-value 0.038, G2 p-value 0.006). The posterior cranial fossa (PCF) boost volume and dose were not significant factors at multivariate analysis neither in permanent hair loss of the whole scalp nor only in the nuchal region. CONCLUSION: In pediatric patients with MB, the development of permanent alopecia seems to depend only on the CSI dose ≥ 36 Gy. Acute damage to the hair follicle is dose dependent, but in terms of late side effects, constant and homogeneous daily irradiation of a large volume may have a stronger effect than a higher but focal dose of radiotherapy.

Broadband performance of superdirective delay-and-sum beamformers steered to end-fire.

Linear arrays steered to end-fire provide superdirective robust performance if a constraint is imposed on the white-noise gain. Filter-and-sum beamformers achieve the maximum constrained directivity by tuning their complex weights over the frequency. Delay-and-sum beamformers have simpler structures, but their weights are fixed and optimized at a given frequency. This letter investigates the constrained directivity provided over a broad band by different delay-and-sum techniques. Complex weights and analytic signals attain near-optimal broadband performance over four octaves. Oversteered arrays using real weights and signals were found to attain superdirective performance over approximately two octaves. Hearing aids and directional hydrophones are potential applications for the considered arrays.

Effect of serum on the mitochondrial active area on developmental days 1 to 4 in in vitro-produced bovine embryos.

Certain morphological changes at the subcellular level caused by the current techniques for in vitro embryo production seem to affect mitochondria. Many of these, including dysfunctional changes, have been associated with the presence of serum in the culture medium. Thus, the aim of the present work was to assess the mitochondrial dynamics occurring in embryos during the first 4 days of development, in order to analyze the most appropriate time for adding the serum. We used transmission electron microscopy (TEM) micrographs to calculate the embryo area occupied by the different morphological types of mitochondria, and analyzed them with Image Pro Plus analyzer. The results showed hooded mitochondria as the most representative type in 1- to 4-day-old embryos. Swollen, on-fusion, orthodox and vacuolated types were also present. When analyzed in embryos cultured without serum, the dynamics of the different mitochondrial types appeared to be similar, a fact that may provide evidence that the developmental changes control the mitochondrial dynamics, and that swollen mitochondria may not be completely inactive. In contrast, in culture medium supplemented with serum from estrous cows, we observed an increased area of hooded mitochondria by developmental day 4, a fact that may indicate an increased production of energy compared with previous days. According to these results, the bovine serum added to the culture medium seems not to be responsible for the functional changes in mitochondria.

A cytoplasmatic estrogen receptor related protein (ER-D5 Ag) in breast cancer.

A monoclonal antibody against an Estrogen Receptor Related Protein (EG-D5 AG by Amersham) was analyzed in evaluating hormone dependence in 188 breast cancers, in addition to current index of steroid receptors. The Authors observed that the concentration of this new Antigen is not related with PgR but with ER concentration. In fact, increasing the ER values, increases the concentration of ER-D5 Ag, showing a good correlation between these two tumoral markers. In regard to Progesterone Receptor ranges, the ER-D5+ves were equally distributed between PgR-ves and PgR+ves Our experience suggests the application of ER-D5 Ag as R-ves tumor screening marker and emphasizes the importance of a second level in determining therapy and prognosis in breast cancer.

Relationship between ER-EIA and ER-D5-Ag-IRMA in breast cancer.

There is an increasing interest in the predicting of sensitivity to endocrine treatment in breast cancer, because receptor-poor tumors respond to hormonal therapy like patients without estrogen receptors. The estrogen receptor related protein (ER-D5-Ag) could be an opportunity for a new approach to identify those patients who will respond. Monoclonal antibody against estrogen receptor related protein and monoclonal antibody against estrogen receptor (1) might provide an alternative immunological approach to the problem. 53 Pre-M and 135 Post-M breast cancer specimens were analysed in predicting hormonal sensitivity in negative receptor tumors through ER-EIA and ER-D5-Ag-IRMA. Pre-M ER-EIA - ve were 70.6% ER-D5 + ve and Post-M ER-EIA - ve were 36.5% ER-D5 + ve. The Authors analysed the predictive value of ER-D5 (90.46% in Post-M; 68.28% in Pre-M) in regard to action mechanism of the two methods.

A comparative analysis of multi-pulse techniques in contrast-enhanced ultrasound medical imaging.

One of the important issues in the field of ultrasound medical imaging using contrast agents is the development of techniques able to separate the response of the contrast media from that of the biological tissues. In the literature, one can find various solutions involving the use of multiple transmitted signals and the combination of related echoes. However, the quality of these techniques may be reduced due to some undesired effects that are seldom considered, despite the fact that they are always present in real systems. These effects are the signal distortions introduced by the hardware equipment, the thermal noise in the electronic circuitry, and body motion between successive pulses. In this paper we propose a simulation tool that will allow the calculation of the backscattered echo from a population of contrast agents immersed in a biological tissue, considering all the mentioned effects. With this tool, an assessment of the comparative robustness of three well-known multi-pulse techniques has been carried out under realistic working conditions and the performance of the three techniques has been evaluated in terms of contrast-to-tissue ratio and signal-to-noise ratio. The results show that the undesired effects have a strong impact on these techniques and that there are notable differences in their robustness. Finally, some suggestions on the choice of the particular technique to be applied are provided on the basis of the specific work conditions.