Towards Home-Based Diabetic Foot Ulcer Monitoring: A Systematic Review.

It is considered that 1 in 10 adults worldwide have diabetes. Diabetic foot ulcers are some of the most common complications of diabetes, and they are associated with a high risk of lower-limb amputation and, as a result, reduced life expectancy. Timely detection and periodic ulcer monitoring can considerably decrease amputation rates. Recent research has demonstrated that computer vision can be used to identify foot ulcers and perform non-contact telemetry by using ulcer and tissue area segmentation. However, the applications are limited to controlled lighting conditions, and expert knowledge is required for dataset annotation. This paper reviews the latest publications on the use of artificial intelligence for ulcer area detection and segmentation. The PRISMA methodology was used to search for and select articles, and the selected articles were reviewed to collect quantitative and qualitative data. Qualitative data were used to describe the methodologies used in individual studies, while quantitative data were used for generalization in terms of dataset preparation and feature extraction. Publicly available datasets were accounted for, and methods for preprocessing, augmentation, and feature extraction were evaluated. It was concluded that public datasets can be used to form a bigger, more diverse datasets, and the prospects of wider image preprocessing and the adoption of augmentation require further research.

Corrigendum to "Factors Associated with the Prevalence of Thyroid Nodules and Goiter in Middle-Aged Euthyroid Subjects".

[This corrects the article DOI: 10.1155/2017/8401518.].

Effects of 28 Days of Oral Dimethandrolone Undecanoate in Healthy Men: A Prototype Male Pill.

Context: Dimethandrolone (DMA) has androgenic and progestational activity. Single oral doses of DMA undecanoate (DMAU) were well tolerated and reversibly suppressed serum LH and testosterone (T) in men. Objective: Assess safety, tolerability, pharmacokinetics (PK), and pharmacodynamics (PD) of oral DMAU. Design: Double-blind, randomized, placebo-controlled study. Setting: Two academic medical centers. Participants: Healthy men (18 to 50 years). Interventions: One hundred men received DMAU [0, 100, 200, or 400 mg, formulated in castor oil/benzyl benzoate (C) or powder (P)] for 28 days. Subjects underwent 24-hour PK sampling on days 1 and 28 and twice weekly ambulatory visits throughout treatment. Main Outcome Measures: Primary outcomes were safety and tolerability parameters (vitals, laboratory data, mood, and sexual function scores) and adverse events. Secondary outcomes were drug PK profiles and PD effects (serum LH, FSH, and sex hormones). Results: Eighty-two subjects completed the study and were included in the analysis. There were no serious adverse events. No clinically significant changes developed in safety laboratory parameters. A significant dose effect was seen for weight, hematocrit, high-density lipoprotein cholesterol, corrected QT interval, and sexual desire. Serum 24-hour average concentrations of DMAU and DMA showed dose-related increases (P < 0.001). All six subjects in the P400 group and 12 of 13 subjects in the C400 group achieved marked suppression of LH and FSH (<1.0 IU/L) and serum T (<50 ng/dL). Conclusions: Daily oral administration of DMAU for 28 days in healthy men is well tolerated. Doses of ≥200 mg markedly suppress serum T, LH, and FSH. These results support further testing of DMAU as a male contraceptive.

Unrecognised cardiovascular disease in type 2 diabetes: is it time to act earlier?

Cardiovascular disease (CVD) is the most significant prognostic factor in individuals with type 2 diabetes (T2D). However, a significant number of individuals may develop CVD that does not present with the classic angina-related or heart failure symptoms. In these cases, CVD may seem to be 'silent' or 'asymptomatic', but may be more accurately characterised as unrecognised diabetic cardiac impairment. An initial step to raise awareness of unrecognised CVD in individuals with T2D would be to reach a consensus regarding the terminology used to describe this phenomenon. By standardising the terminologies, and agreeing on the implementation of an efficient screening program, it is anticipated that patients will receive an earlier diagnosis and appropriate and timely treatment. Given the availability of anti-diabetic medications that have been shown to concomitantly reduce CV risk and mortality, it is imperative to improve early identification and initiate treatment as soon as possible in order to enable as many patients with T2D as possible to benefit.

Factors Associated with the Prevalence of Thyroid Nodules and Goiter in Middle-Aged Euthyroid Subjects.

The aim of the present study was to determine associations of thyroid hormone levels and different metabolic parameters and anthropometric measurements with volume of nodular and nonnodular thyroid as well as with prevalence of goiter and thyroid nodules in middle-aged euthyroid subjects. Methods. The study consisted of 317 euthyroid subjects aged 48-49 from the Kaunas Cardiovascular Risk Cohort study. Thyroid-stimulating hormone (TSH), free thyroxine (FT4), and antithyroid peroxidase antibody (ATPO) levels, as well as anthropometric and metabolic parameters and smoking information, were evaluated. Results. In subjects with and without thyroid nodules, thyroid volume correlated with components of metabolic syndrome, body mass index (BMI), smoking, and TSH levels. In the nonnodular thyroid group, thyroid volume was also positively related to serum insulin and HOMA-IR, whereas a negative correlation between thyroid volume and leptin was identified in the nodular thyroid group. The goiter was identified in 12.3% of subjects. Female gender, thyroid nodules, smoking, BMI, and levels of TSH were independent predictors for goiter. Thyroid nodules were found in 31.2% of participants. Female gender, higher TSH levels, and thyroid volume were independent risk factors for thyroid nodules. Conclusions. Female gender, thyroid nodules, smoking, BMI, and TSH levels were identified as potential predictors of goiter. Female gender, TSH levels, and thyroid volume predicted the presence of thyroid nodules.

Associations between risk factors in childhood (12-13 years) and adulthood (48-49 years) and subclinical atherosclerosis: the Kaunas Cardiovascular Risk Cohort Study.

BACKGROUND: The data on the childhood determinants of adult cardiovascular disease (CVD) are lacking in populations of Eastern Europe that are characterised by substantially high CVD mortality. From a public health perspective, it is important to identify high-risk individuals as early as possible in order to have the greatest benefit of preventive interventions. The aim of this study was to evaluate the associations of childhood and adulthood traditional risk factors with subclinical atherosclerosis and arterial stiffness in a Lithuanian cohort followed up for 35 years. METHODS: The study cohort consisted of 380 adults aged 48-49 from Kaunas Cardiovascular Risk Cohort study, who were followed up since childhood (12-13 years). The baseline survey (1977) included blood pressure (BP) and anthropometric measurements and sexual maturity scale. In the follow-up survey (2012), BP, anthropometric and lipids measurements, interview about smoking, measurement of carotid intima-media thickness (IMT) and determination of pulse wave velocity (PWV) were performed. Two types of general linear models were applied to test the associations of childhood and adulthood risk factors with IMT and PWV. Model 1 included only childhood variables. In model 2, adulthood variables were added to childhood variables. RESULTS: In linear regression model with childhood variables childhood systolic BP (ß = 0.014; p = 0.016) and BMI (ß = 0.006; p = 0.003) were directly associated with IMT only in women. When adulthood variables were included into regression model, the association between childhood systolic BP and IMT remained significant (ß = 0.013; p = 0.021), while childhood BMI was not associated with IMT (ß = 0.003; p = 0.143). Additionally, association of adult smoking and IMT was found in women (ß = 0.033; p = 0.018). IMT of men was directly related to adult systolic BP (ß = 0.022; p = 0.018) and inversely to HDL cholesterol level (ß = -0.044; p = 0.021). PWV was directly associated only with adult systolic BP in both genders (ß = 0.729 for men and ß = 0.476 for women; p = 0.001). CONCLUSIONS: Sex differences in the associations between childhood and adulthood risk factors and subclinical atherosclerosis were found. The results of the study support efforts to reduce conventional risk factors both in childhood and adulthood for the primary prevention of atherosclerosis.

The effect of physiotherapy in addition to testosterone replacement therapy on the efficiency of the motor system in men with hypogonadism.

BACKGROUND AND OBJECTIVE: The aim of this study was to analyze whether the addition of physiotherapy to testosterone replacement therapy provides added benefit in improving functional capacity of the motor system in men with hypogonadism. MATERIAL AND METHODS: The study involved 3 groups of subjects: group 1, healthy men (n=20); group 2, men with hypogonadism who underwent testosterone replacement therapy with physiotherapy (TRT+PT) (n=8); and group 3, men with hypogonadism who underwent testosterone replacement therapy alone (TRT) (n=10). Physical activity (International Physical Activity Questionnaire [IPAQ]) and body composition (X-SCAN analysis) were analyzed; the vertical jump test (Leonardo Mechanography®) was applied. RESULTS: The application of testosterone replacement therapy together with physiotherapy for 6 months significantly increased the maximum and relative power of jump in the subjects in the TRT+PT group; however, in the TRT group, no statistically significant difference was observed. The maximum jump height for the subjects in the TRT+PT group significantly increased 6 months after the intervention; however, in the TRT group, this index remained unaltered. The lean body mass of the subjects in the TRT+PT group increased (P<0.05); however, in the TRT group, it did not change. The relative fat body mass in the TRT+PT group decreased significantly (P<0.05), but, in the TRT group, it had a tendency to increase, though insignificantly. CONCLUSIONS: Our results suggest that the application of testosterone replacement therapy together with physiotherapy (1 hour twice weekly) in men with hypogonadism may lead to earlier and better results in comparison with testosterone replacement therapy applied alone.

[An update on multiple insulin injection therapy in type 1 and 2 diabetes]. / Intensyviosios insulinoterapijos naujoves gydant 1 ir 2 tipo cukrini diabeta.

Achieving and maintaining glycemic control (glycated hemoglobin--HbA(1c)< or =7.0% according to American Diabetes Association and < or =6.5% according to International Diabetes Federation) is the primary goal in treating diabetes, which lowers the risk for diabetes-related complications. Insulin therapy is essential for type 1 diabetes treatment. Insulin therapy in type 2 diabetes is initiated when glycemic control is inadequate despite the combination of antihyperglycemic drugs. The type of insulin therapy is selected according to the patient's lifestyle and needs. Multiple insulin injection therapy and premixed insulin therapy are usually administered. In multiple insulin injection therapy, basal insulin is administered one or two times a day, and regular human insulin or rapid-acting insulin analog is administered with each meal. The duration of action of regular insulin is 6-8 hours; therefore, the risk for postprandial hypoglycemia is increased. The action of novel insulin analogs (rapid- and long-acting) closely mimics physiological insulin secretion. Three rapid-acting insulin analogs are currently available: insulin lispro, insulin aspart, and insulin glulisine. Insulin glulisine is the most recently approved rapid-acting insulin analog. It is safe, flexible, and effective in achieving target postprandial glycemic control. Moreover, the pharmacokinetics of insulin glulisine does not depend on the amount of subcutaneous fat. Basal insulins include intermediate-acting human insulins (neutral protamine Hagedorn) and long-acting insulin analogs (insulin glargine, insulin detemir). The latter are the optimal choice covering basal insulin requirement. Compared to neutral protamine Hagedorn insulin, long-acting insulin analogs have no pronounced concentration peak and reduce nocturnal hypoglycemia risk and weight gain.