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1.
Ann Otol Rhinol Laryngol ; 129(1): 70-77, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31510765

RESUMO

OBJECTIVE: Prediction and early intervention for hypocalcemia following parathyroidectomy and total thyroidectomy can decrease hospital cost and prevent severe hypocalcemia-related complications. This study aims to predict the severity of hypocalcemia after parathyroidectomy or thyroidectomy and to stratify patients into groups with different levels of risk for developing severe hypocalcemia, so that higher risk patients may be monitored more closely and receive earlier interventions. METHODS: This was a retrospective cohort study of 100 patients with primary hyperparathyroidism who underwent parathyroidectomy as the primary treatment modality at a tertiary care hospital. Clinical information, including demographic information, perioperative PTH and calcium levels, vitamin D levels, weight of the pathologic glands removed, gland pathology, and re-admission rates, were retrieved. Statistical analysis was performed to analyze the association between collected variables and percentage of calcium drop following parathyroidectomy with statistical significant set at P-values <0.05. RESULTS: Age, sex, and vitamin D level provided very minimal information to quantify risks of postoperative hypocalcemia. The percentage of decrease from preoperative PTH level to the lowest PTH level after the removal of the abnormal gland(s) is the most significant predicting factor for the severity of postoperative hypocalcemia. There is a mathematic regressional correlation between them. A formula was generated to quantify this linear relationship between them, and the nadir calcium can be calculated as Canadir=Capreop*[1-0.35*(PTHpreop-PTHintraop)2PTHpreop2], where Canadir = the lowest postoperative calcium level, and PTHintraop = PTH level 15 minutes after removal of the abnormal gland, with the value of R2 > 0.7. The formula has been tested primarily in our patient population with good reliability. CONCLUSIONS: The highest preoperative, lowest postoperative, and change in PTH level can help us reliably calculate the trend of postoperative calcium level. Decision to pursue early interventions can be made based on the calculated result from the formula we obtained.


Assuntos
Hiperparatireoidismo Primário/cirurgia , Hipocalcemia/epidemiologia , Paratireoidectomia , Complicações Pós-Operatórias/epidemiologia , Adenoma/sangue , Adenoma/patologia , Adenoma/cirurgia , Adulto , Fatores Etários , Feminino , Humanos , Hiperparatireoidismo Primário/sangue , Hipocalcemia/sangue , Hipocalcemia/terapia , Período Intraoperatório , Magnésio/sangue , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Hormônio Paratireóideo/sangue , Neoplasias das Paratireoides/sangue , Neoplasias das Paratireoides/patologia , Neoplasias das Paratireoides/cirurgia , Complicações Pós-Operatórias/sangue , Período Pós-Operatório , Período Pré-Operatório , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Tireoidectomia , Carga Tumoral , Vitamina D/sangue
2.
Clin Biochem ; 74: 60-68, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31669510

RESUMO

BACKGROUND: Colorectal cancer (CRC) is one of the most common cancers worldwide, and emerging lines of evidence have implicated circular RNAs (circRNAs), a novel class of endogenous noncoding RNAs, in CRC development. However, whether plasma circRNAs might be novel diagnostic biomarkers for CRC remains unclear. METHODS: We investigated the plasma levels of selected circRNAs by quantitative real-time PCR (qRT-PCR). The presence of the candidate circRNAs was confirmed through RNase R assays, qRT-PCR and DNA sequencing, and their diagnostic value was evaluated using a receiver operating characteristic (ROC) curve. RESULTS: The plasma levels of three circRNAs (circ-CCDC66, circ-ABCC1 and circ-STIL) were significantly decreased in CRC patients (n = 45) compared with healthy controls (n = 61). The ROC curve analysis showed that the area under the ROC curve (AUC) of the three-circRNA panel was 0.780, which is higher than that of traditional protein biomarkers, such as carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9). Combining the circRNA panel with CEA and CA19-9 might improve the ability to diagnose CRC (AUC = 0.855). In addition, the plasma circ-ABCC1 level was related to tumor growth and progression, and the plasma circ-CCDC66 and circ-ABCC1 levels were decreased in precursor lesions of CRC, including colon adenomas and adenomatous polyps. More importantly, circ-CCDC66 and circ-STIL were found to be useful for diagnosing early-stage CRC, and the three-circRNA panel improved the ability to diagnose CEA-negative and CA19-9-negative CRC. CONCLUSION: Our study provides the first identification of a panel of three plasma circRNAs that could serve as a novel and independent diagnostic biomarker for CRC.


Assuntos
Biomarcadores Tumorais/sangue , Neoplasias Colorretais/sangue , Neoplasias Colorretais/diagnóstico , /sangue , Adenoma/sangue , Pólipos Adenomatosos/sangue , Idoso , Antígenos Glicosídicos Associados a Tumores/sangue , Biomarcadores Tumorais/genética , Antígeno Carcinoembrionário/sangue , Estudos de Coortes , Neoplasias do Colo/sangue , Detecção Precoce de Câncer , Feminino , Humanos , Modelos Logísticos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Curva ROC , Reação em Cadeia da Polimerase em Tempo Real , Análise de Sequência de DNA
3.
Am Surg ; 85(9): 939-943, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31638503

RESUMO

Reoperative parathyroid surgery (REOPS) is often associated with lower cure rates and greater risk of nerve injury and hypoparathyroidism. The aim of this study was to evaluate cure rates, pathology, complications, and the efficacy of preoperative localization in patients requiring REOPS. Between 1992 and 2017, 2491 consecutive patients underwent parathyroidectomy for primary hyperparathyroidism. With Institutional Review Board approval, our prospectively collected parathyroidectomy outcomes database was queried for operative findings, outcomes, pathology, and localization methodology. Three hundred forty-six patients had REOPS (111 men/32% and 235 women/68%), with an overall cure rate of 91 per cent and a mean follow-up of 1.9 ± 0.7 years. The average preoperative serum calcium and parathyroid hormone were 11 ± 1 mg/dL and 373 ± 796 pg/mL, respectively. Normalization of intraoperative parathyroid hormone occurred in 248 patients and it was predictive of cure in 98.8 per cent of patients. A single adenoma was resected in 253 patients (75%), and the superior gland location was most common at 57 per cent. Ectopic glands were identified in only 33 patients. When preoperative imaging localized a lesion, a tumor was identified in that location in 75.4 per cent of sestamibi or SPECT/CT scans, 57.8 per cent of CT, 61.2 per cent of MRI, and 46.2 per cent of US. When at least two imaging modalities were concordant, sensitivity improved to 91.6 per cent (P < 0.001). Complication rates of permanent hypoparathyroidism and recurrent nerve palsy occurred in 0.03 per cent of patients. REOP for recurrent or persistent primary hyperparathyroidism has a cure rate of 91 per cent. Most missed parathyroid tumors are in the neck, and multimodal imaging improves preoperative localization and success.


Assuntos
Adenoma/cirurgia , Hiperparatireoidismo Primário/cirurgia , Neoplasias das Paratireoides/cirurgia , Paratireoidectomia/métodos , Reoperação , Adenoma/sangue , Adenoma/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cálcio/sangue , Feminino , Seguimentos , Humanos , Hiperparatireoidismo Primário/sangue , Hiperparatireoidismo Primário/diagnóstico por imagem , Hipoparatireoidismo , Masculino , Pessoa de Meia-Idade , Paralisia , Hormônio Paratireóideo/sangue , Neoplasias das Paratireoides/sangue , Neoplasias das Paratireoides/diagnóstico por imagem , Paratireoidectomia/efeitos adversos , Complicações Pós-Operatórias , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Tecnécio Tc 99m Sestamibi , Adulto Jovem
4.
Medicine (Baltimore) ; 98(26): e16148, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31261542

RESUMO

Non-functioning pituitary adenomas (NFPAs) are the most common pituitary tumors, and some exhibit locally invasive or even clinically aggressive behavior. Circular RNAs (circRNAs) are a reinvented class of non-coding RNAs that play important roles in tumor initiation and progression.CircRNA microarray assays were performed in 4 invasive and 4 non-invasive NFPAs, and 4 typically differential expression circRNAs were selected for validation using quantitative reverse transcription-polymerase chain reaction. The diagnostic and prognostic values of tested cirRNAs were further evaluated. Bioinformatics analysis and a literature review of potential miRNAs targets involved in pituitary tumor invasion were performed.A specific circRNA expression profile was detected between invasive and non-invasive NFPAs, including 91 upregulated and 61 downregulated circRNAs in invasive tumors. The dysregulation of the 4 circRNAs has been confirmed. The expression of hsa_circRNA_102597, a downregulated circRNA, was significantly correlated with tumor diameter (P < .05) and Knosp grade (P < .01). Hsa_circRNA_102597 alone or in combined with Ki-67 index was able to accurately differentiate invasive from non-invasive NFPAs as well as predict tumor progression/recurrence. Fourteen aberrantly expressed circRNAs might be involved in the invasiveness of pituitary adenomas via seven predicted potential miRNA targets.CircRNAs are participated in pituitary tumor invasion, and may be used as novel diagnostic and prognostic biomarkers in NFPAs.


Assuntos
Adenoma/sangue , Invasividade Neoplásica/diagnóstico , Neoplasias Hipofisárias/sangue , RNA/sangue , Adolescente , Adulto , Idoso , Biomarcadores Tumorais/sangue , Biologia Computacional , Regulação para Baixo , Feminino , Regulação Neoplásica da Expressão Gênica , Humanos , Masculino , Análise em Microsséries , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase em Tempo Real
5.
World Neurosurg ; 130: e765-e774, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31295602

RESUMO

OBJECTIVE: Plurihormonal pituitary adenomas (PPAs) have recently been divided into 2 subtypes: pituitary specific transcription factor 1-positive plurihormonal pituitary adenomas (PIT-1+ PPAs) and plurihormonal adenomas with unusual immunohistochemical combinations (PAwUIC). The purpose of this study was to review patients with PPAs, elucidate their clinicopathologic characteristics, and present the surgical results. METHODS: Records were analyzed for 665 patients who underwent endoscopic endonasal transsphenoidal surgery for pituitary adenomas between 2007 and 2018. Data were reviewed for 27 patients who met the definition of PPAs and delineated regarding clinical, radiologic, pathologic features, and surgical outcomes. RESULTS: Of the 27 patients, 18 had PAwUIC, and 9 patients were diagnosed with PIT-1+ PPAs. Twenty-four patients (88.8%) had macroadenomas, including 6 giant adenomas (≥4 cm) (22.2%). Cavernous sinus invasion was found in 12 patients (44.4%). Pathologic examinations showed high aggressivity in nearly half of the patients. Most patients with PAwUIC (77.8%) had features of nonfunctioning pituitary adenomas, and only 4 had features of hormone-secreting pituitary adenomas. Gross total resection rates were 57.1% for PAwUIC and 77.8% for PIT-1+ PPAs. The remission rate for hormone-secreting pituitary adenomas was 100% in this case series. Mean follow-up was 74.4 ± 33 months (range, 6-121 months) for overall groups. CONCLUSIONS: To our knowledge, this is the first study to describe the clinicopathologic features of newly classified PPAs, which are characterized by aggressive behavior with higher values of percentage of cavernous sinus invasion. Relevant pathologic diagnosis of PPAs is crucial for appropriate management and follow-up.


Assuntos
Adenoma/diagnóstico por imagem , Adenoma/cirurgia , Procedimentos Neurocirúrgicos/métodos , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/cirurgia , Adenoma/sangue , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Hipofisárias/sangue , Estudos Retrospectivos , Resultado do Tratamento
6.
J Steroid Biochem Mol Biol ; 192: 105410, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31201926

RESUMO

CONTEXT: Cushing's syndrome is caused by increased exposure to cortisol. Discrimination of different causes of endogenous hypercortisolism can make a diagnostic dilemma. PATIENTS AND METHODS: In serum samples from patients with Cushing's syndrome (47 with Cushing's disease, 6 with ectopic ACTH-dependent Cushing's syndrome, 16 with adrenal adenoma, 7 bilateral adrenal hyperplasia (BMAH) with overt Cushing's syndrome, 42 controls from the general population) using novel method based on gas chromatography-tandem mass spectrometry (GC-MS/MS) we measured 94 serum steroids to search for steroid fingerprint of each subtype. RESULTS: Patients with Cushing's disease and ectopic ACTH producing tumors showed elevated levels of androgens and their metabolites when compared with healthy controls. Mineralocorticoid precursors were also elevated in ectopic ACTH syndrome. The levels of androgens were decreased in adrenal adenomas and BMAH. ROC analysis showed 100% sensitivity and 93.6% specificity for 11ß-hydroxyepiandrosterone sulfate for discrimination of Cushing's disease from ectopic ACTH secretion. We didn't find any significant (p < 0.05) difference in steroids that would discriminate BMAH from unilateral adenomas causing Cushing's syndrome. CONCLUSION: Various causes of Cushing's syndrome show particular steroid fingerprints that can be used to discriminate and may help to achieve appropriate clinical diagnosis.


Assuntos
Síndrome de ACTH Ectópico/diagnóstico , Adenoma/diagnóstico , Hiperplasia Suprarrenal Congênita/diagnóstico , Hormônio Adrenocorticotrópico/sangue , Síndrome de Cushing/diagnóstico , Transtorno 46,XY do Desenvolvimento Sexual/diagnóstico , Hidrocortisona/sangue , Esteroides/sangue , Síndrome de ACTH Ectópico/sangue , Adenoma/sangue , Hiperplasia Suprarrenal Congênita/sangue , Adulto , Idoso , Biomarcadores/sangue , Estudos de Casos e Controles , Síndrome de Cushing/sangue , Transtorno 46,XY do Desenvolvimento Sexual/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico
7.
World J Gastroenterol ; 25(17): 2099-2109, 2019 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-31114136

RESUMO

BACKGROUND: The methylated septin 9 (mSEPT9) assay was the first blood-based test approved by the United States Food and Drug Administration as a colorectal screening test. However, the diagnostic and prognostic role of preoperative mSEPT9 for colorectal cancer (CRC) in Chinese patients is still unknown. AIM: To improve the understanding of diagnostic and prognostic factors, serum mSEPT9 was detected in Chinese CRC patients. METHODS: A retrospective analysis of 354 cases, of which 300 had CRC and 54 were normal, was performed in China. Patients' characteristics, treatments, and laboratory data, including age, the date of surgery, Union for International Cancer Control (UICC) stages, distant metastasis (M), and so on, were collected. Methylation levels of SEPT9 were quantified by quantitative, methylation-specific polymerase chain reaction before surgery. In addition, the effects of mSEPT9 on the occurrence and prognosis of 330 CRC cases from The Cancer Genome Atlas (TCGA) database were evaluated using bioinformatics analyses. Potential prognostic factors for overall survival (OS) and progression-free survival (PFS) were evaluated by Kaplan-Meier univariate analysis. RESULTS: In Chinese CRC patients, positive mSEPT9 was strongly associated with advanced UICC stages, deeper invasion by the primary tumor, and more distant metastasis. Methylation levels of SEPT9 were stage-dependent and showed a stepwise increase in UICC stages (I-IV), primary tumor categories (T1-T4), regional node categories (N0-N2), and distant metastasis categories (M0-M1). The patients with positive mSEPT9 showed a tendency toward lower PFS. After analyzing TCGA clinical data, the high mSEPT9 group was found to be obviously correlated only with more distant metastasis. The patients with high mSEPT9 levels showed a tendency toward lower OS. Besides, nine meaningful mSEPT9 sites were found to provide guidance for the follow-up studies. CONCLUSION: MSEPT9 analysis may add valuable information to current tumor staging. Serum mSEPT9 in Chinese CRC patients appears to offer promising novel prognostic markers and might be considered for monitoring CRC recurrence.


Assuntos
Biomarcadores Tumorais/metabolismo , Neoplasias Colorretais/diagnóstico , Septinas/metabolismo , Adenoma/sangue , Adenoma/diagnóstico , Adenoma/cirurgia , Idoso , China , Neoplasias Colorretais/sangue , Neoplasias Colorretais/cirurgia , Biologia Computacional , Metilação de DNA , Detecção Precoce de Câncer , Feminino , Perfilação da Expressão Gênica , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Período Pré-Operatório , Prognóstico , Estudos Retrospectivos
8.
Clin Lab ; 65(5)2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31115212

RESUMO

BACKGROUND: Colorectal cancer (CRC) is one of the most common malignancies and a major cause of cancer-related death worldwide. Fecal occult blood tests (FOBT) are non-invasive colorectal cancer screening tests. In recent years plasma microRNAs (miRNAs) have shown great potential in early non-invasive cancer detection. METHODS: FOBT (immunochemical) and a panel of 12 plasma miRNAs were tested in two independent groups: 57 CRC patients and 125 neoplasm free controls, in addition to 58 advanced adenoma patients and 67 neoplasm free controls. miRNA levels were assessed by quantitative real-time polymerase chain reaction (qRT-PCR). RESULTS: Plasma levels of 7 miRNAs (miR-18a, miR-20a, miR-21, miR-92a, miR-133a, miR-143, miR-145) differed significantly between CRC patients and neoplasm free controls. miRNA plasma levels did not differ between advanced adenoma patients and controls. For 7 dysregulated miRNAs in CRC patients, AUCs ranged from 0.585 to 0.632 for CRC detection, in comparison to an AUC of 0.857 for iFOBT. The combination of miR-133a and iFOBT achieved a higher AUC (0.894) than iFOBT alone. At 97.8% specificity, miRNAs showed much lower sensitivities than iFOBT, but the miRNA panel and iFOBT in combination detected CRC with a higher sensitivity than iFOBT alone. CONCLUSIONS: The diagnostic performance of miRNAs was poorer than iFOBT. Nevertheless, plasma miRNA profiles offer an innovative non-invasive approach for early CRC detection. The potential advantage of combining plasma miRNA profiles with iFOBT needs to be further studied in a larger cohort of patients.


Assuntos
Adenoma/sangue , Biomarcadores Tumorais/sangue , Neoplasias Colorretais/sangue , Detecção Precoce de Câncer/métodos , MicroRNAs/sangue , Sangue Oculto , Adenoma/diagnóstico , Adenoma/genética , Adulto , Idoso , Biomarcadores Tumorais/genética , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/genética , Feminino , Perfilação da Expressão Gênica , Regulação Neoplásica da Expressão Gênica , Humanos , Masculino , MicroRNAs/genética , Pessoa de Meia-Idade , Sensibilidade e Especificidade
9.
Arch Endocrinol Metab ; 63(2): 157-166, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30916168

RESUMO

OBJECTIVES: Our study aimed to investigate the associations of glucose tolerance status with insulin-like growth factor-I (IGF-I) and other clinical laboratory parameters of acromegalic patients before and after the patients underwent transsphenoidal adenomectomy (TSA) by conducting a single-center, retrospective study. SUBJECTS AND METHODS: A total of 218 patients with acromegaly who had undergone TSA as the first treatment were retrospectively analyzed. Serum IGF-I, growth hormone (GH) and glucose levels were measured before and after surgery. RESULTS: The follow-up levels for random GH, GH nadir, and the percentage of the upper limit of normal IGF-I (%ULN IGF-I) were decreased significantly. The percentages of normal (39.0%), early carbohydrate metabolism disorders (33.0%) and diabetes mellitus (28.0%) changed to 70.2%, 16.5% and 13.3%, respectively, after TSA. %ULN IGF-I at baseline was higher in the diabetes mellitus (DM) group than in the normal glucose tolerance group and impaired glucose tolerance (IGT) /impaired fasting glucose (IFG) groups before TSA, and the DM group exhibited a greater reduction in %ULN IGF-I value after surgery. The follow-up %ULN IGF-I value after surgery was significantly lower in the improved group, and Pearson's correlation analysis revealed that the reductions in %ULN IGF-I corresponded with the reductions in glucose level. CONCLUSION: This study examined the largest reported sample with complete preoperative and follow-up data. The results suggest that the age- and sex-adjusted IGF-I level, which reflects altered glucose metabolism, and the change of it are associated with improved glucose tolerance in acromegalic patients both before and after TSA.


Assuntos
Acromegalia/sangue , Adenoma/cirurgia , Intolerância à Glucose/sangue , Adenoma Hipofisário Secretor de Hormônio do Crescimento/cirurgia , Fator de Crescimento Insulin-Like I/análise , Adenoma/sangue , Adulto , Glicemia/análise , Diabetes Mellitus/sangue , Feminino , Seguimentos , Adenoma Hipofisário Secretor de Hormônio do Crescimento/sangue , Hormônio do Crescimento Humano/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Período Pré-Operatório , Estudos Retrospectivos , Resultado do Tratamento
10.
J Med Case Rep ; 13(1): 85, 2019 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-30862315

RESUMO

INTRODUCTION: Clinically silent somatotroph adenoma is characterized by elevated serum growth hormone but without the clinical symptoms of acromegaly, and it is considered rare. The natural history is not well understood, progress to symptomatic is uncertain, and treatment strategy has not been established. CASE PRESENTATION: The first patient was a 48-year-old-Asian woman who presented with serum growth hormone 6.99 ng/ml and insulin-like growth factor 1 of 476 ng/ml, but no characteristic features of acromegaly. Five years after initial diagnosis, she presented with acromegalic facial appearance. Transsphenoidal surgery achieved gross total removal and endocrinological remission. The second patient was a 40-year-old-Asian woman who presented with serum growth hormone 31.14 ng/ml and insulin-like growth factor 1 of 709.6 ng/ml, but no characteristic features of acromegaly. Three years after initial diagnosis, she presented with acromegalic facial appearance. Transsphenoidal surgery achieved gross total removal and endocrinological remission. The third patient was a 64-year-old-Asian woman who presented with serum growth hormone 6.0 ng/ml and insulin-like growth factor 1 of 341 ng/ml, but no characteristic features of acromegaly. Eight months after initial diagnosis, hand enlargement was detected. Transsphenoidal surgery achieved gross total removal and endocrinological remission. CONCLUSION: Due to its potential for evolving to symptomatic disease, the risks of surgery and observation for patients with somatotroph adenoma should be carefully compared from the viewpoint of better health outcome.


Assuntos
Acromegalia/etiologia , Adenoma/complicações , Adenoma Hipofisário Secretor de Hormônio do Crescimento/complicações , Adenoma/sangue , Adenoma/cirurgia , Adulto , Doenças Assintomáticas , Biomarcadores/sangue , Feminino , Adenoma Hipofisário Secretor de Hormônio do Crescimento/sangue , Adenoma Hipofisário Secretor de Hormônio do Crescimento/cirurgia , Hormônio do Crescimento Humano/sangue , Humanos , Fator de Crescimento Insulin-Like I/análise , Pessoa de Meia-Idade
11.
Neurosurgery ; 84(3): 616-623, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30767017

RESUMO

BACKGROUND: Accurate assessment of the need for glucocorticoid therapy is essential after transsphenoidal surgery (TSS) for pituitary tumors. Agreement on the best test to use in the early postoperative setting is lacking. OBJECTIVE: To examine recovery room (RR) cortisol as a predictor of long-term need for glucocorticoids. METHODS: We conducted a retrospective cohort study of 149 patients who underwent TSS for pituitary tumors between January 2007 and December 2014. Pathological tumor diagnoses were confirmed. Endocrinologists assessed the need for glucocorticoid supplementation within 6 to 8 wk after TSS. We extracted data on preoperative, RR, and day 1 to 3 post-TSS morning serum cortisol (MSC). We reported areas under the receiver operating characteristic curve (AUC) and diagnostic measures for different cortisol measures. We also conducted a logistic regression to identify the most predictive variables. RESULTS: Eighteen patients required glucocorticoid supplementation at follow-up. RR cortisol was the most accurate measurement in the early postoperative period (AUC [95% confidence interval (CI)], .92 [.85-.99]; P < .001), followed by day 1, 2, and 3 post-TSS MSC, respectively. A threshold RR cortisol of 744.0 nmol/L (26.97 µg/dL) had 90.9% sensitivity and 73.7% specificity for detecting patients in the hypocortisolism group, while 757.5 nmol/L (27.46 µg/dL) had 100% and 70.0%, respectively. The logistic regression identified RR cortisol as the sole significant predictor (odds ratio [CI], .36[.18-.71] for every 100 nmol/L increase; P = .0033). CONCLUSION: The RR cortisol is accurate in predicting long-term glucocorticoid supplementation and may be the best early postoperative measure. Future larger studies should validate these findings and derive optimal RR cortisol threshold values.


Assuntos
Adenoma/sangue , Glucocorticoides/administração & dosagem , Hidrocortisona/sangue , Neoplasias Hipofisárias/sangue , Sala de Recuperação/tendências , Adenoma/tratamento farmacológico , Adenoma/cirurgia , Adulto , Idoso , Biomarcadores/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Hipofisárias/tratamento farmacológico , Neoplasias Hipofisárias/cirurgia , Valor Preditivo dos Testes , Estudos Retrospectivos , Seio Esfenoidal/cirurgia
12.
Expert Rev Endocrinol Metab ; 14(1): 35-42, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30595057

RESUMO

INTRODUCTION: Acromegaly requires a multimodal treatment approach that includes surgery by an expert pituitary neurosurgeon, pharmacological treatment with one or more of the available drugs and radiation therapy. These treatment alternatives are not mutually exclusive but rather complement each other when properly indicated in the individual patient. In this review, we summarize and analyze the available data concerning the choice of the surgical approach (microscopy vs. endoscopy) and the interactions between medical treatment with somatostatin analogs and pituitary surgery. AREAS COVERED: Technical aspects, complications and outcome of transsphenoidal surgery (TSS); Advantages and disadvantages of the microscopic and endoscopic approaches; Safety and efficacy of somatostatin analogs (SSA); Primary pharmacological therapy versus primary TSS; Benefits of the preoperative treatment with SSA; and the effect of surgical tumor debulking in the therapeutic response to SSA. EXPERT COMMENTARY: Continuing efforts at improving surgical techniques and at generating more efficacious pharmacological therapies for acromegaly are likely to improve the outcome of these patients. However, an integral approach of the patient aimed not only at achieving biochemical criteria of cure but also at treating the individual comorbidities is mandatory to improve the quality of life of these patients and to reduce their mortality rate.


Assuntos
Acromegalia/tratamento farmacológico , Acromegalia/cirurgia , Terapia Combinada/efeitos adversos , Somatostatina/análogos & derivados , Acromegalia/sangue , Acromegalia/radioterapia , Adenoma/sangue , Adenoma/tratamento farmacológico , Adenoma/radioterapia , Adenoma/cirurgia , Terapia Combinada/métodos , Procedimentos Cirúrgicos de Citorredução/efeitos adversos , Procedimentos Cirúrgicos de Citorredução/métodos , Endoscopia/efeitos adversos , Hormônio do Crescimento Humano/sangue , Humanos , Peptídeos Cíclicos/uso terapêutico , Neoplasias Hipofisárias/sangue , Neoplasias Hipofisárias/tratamento farmacológico , Neoplasias Hipofisárias/radioterapia , Neoplasias Hipofisárias/cirurgia , Cuidados Pré-Operatórios , Qualidade de Vida , Somatostatina/uso terapêutico , Resultado do Tratamento
13.
Oncol Rep ; 41(1): 113-124, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30542712

RESUMO

Clinical non­functioning pituitary adenoma (NFPA) accounts for >30% of all pituitary adenomas, and the recurrence rate is notably high. The ability to predict tumour recurrence during initial surgery will aid in determining if adjunctive therapy is required to reduce recurrence. With the aim of developing a circular RNA (circRNA) signature to improve prognosis prediction in NFPA, the present study examined the circRNA expression profiles in 73 patients with NFPA from Beijing Tiantan Hospital using high­throughput RNA chip technology. The dataset was randomly separated into a training group and a test group using an R program. In the training group (n=37), a Cox proportional hazards regression model was used to analyse the genes associated with the recurrence and progression­free survival (PFS) of patients with NFPA. Meanwhile, a random survival forest algorithm, Kaplan­Meier and receiver operating characteristic curve (ROC) analyses were used to determine the multi­circRNA signature with the largest area under the ROC curve (AUROC) and verify its efficacy in the test group (n=36). In the training and test groups, the signatures of two circRNAs (hsa_circ_0000066 and hsa_circ_0069707) were specifically associated with the PFS of patients with NFPA (log­rank P<0.05). Furthermore, the two­circRNA signature had a high prediction accuracy for tumour recurrence, with an AUROC of 0.87 and 0.67 in the training and test groups, respectively; and the discriminative power of the signature was greater compared with that of age. The present study is the first to suggest a circRNA signature with a clinical application value for predicting recurrence/progression in patients with NFPA.


Assuntos
Adenoma/sangue , Recidiva Local de Neoplasia/diagnóstico , Neoplasias Hipofisárias/sangue , RNA/sangue , Adenoma/mortalidade , Adenoma/patologia , Adulto , Idoso , Progressão da Doença , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Sequência com Séries de Oligonucleotídeos , Neoplasias Hipofisárias/mortalidade , Neoplasias Hipofisárias/patologia , Valor Preditivo dos Testes , Prognóstico , Intervalo Livre de Progressão , Curva ROC , Análise de Sobrevida
14.
Acta Oncol ; 58(sup1): S42-S48, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30523734

RESUMO

BACKGROUND: Blood-based, cancer-associated biomarkers may detect subjects at risk of having neoplastic diseases. The aim of the present study was to evaluate whether elevated serological protein biomarker levels may identify adenoma patients, who are at increased risk of being diagnosed with subsequent primary malignancy. METHODS: Levels of CEA, CA19-9, TIMP-1 and YKL-40 were determined in blood samples collected prior to diagnostic bowel endoscopy due to symptoms of colorectal neoplasia. Follow-up time was ten years, and identified adenoma patients, who were diagnosed with subsequent primary intra- or extra-colonic malignant diseases. The biomarker levels were also determined in 400 subjects, who underwent diagnostic colonoscopy, had clean colorectum and were without apparent co-morbidity; these levels were used as reference levels. In the present study, biomarkers were interpreted as elevated when levels were above the reference intervals adjusting for age and gender. The 1-year and 5-years cumulative incidences were calculated. RESULTS: Primary malignancies were identified in 175 (19%) of the 923 subjects diagnosed with adenomas at the primary bowel endoscopy. In detail, 20 of the 175 subjects were diagnosed with colorectal cancer (CRC) and 155 subjects with extra-colonic cancers. Thirty patients were diagnosed with malignancy within the first year. Three groups were established: 0: no elevated biomarkers; 1: 1 of the 4 biomarkers elevated; and 2: ≥2 biomarkers elevated. The cumulative 5-years incidence of malignancy was: 0: 6.9%; 1: 11.8%; and 2: 17.5% (p = .0009). CONCLUSION: Elevated blood-based, cancer-associated protein biomarker levels in subjects diagnosed with adenomas at large bowel endoscopy identifies subjects at increased risk of being diagnosed with subsequent primary malignancy.


Assuntos
Adenoma/diagnóstico , Antígeno CA-19-9/sangue , Antígeno Carcinoembrionário/análise , Proteína 1 Semelhante à Quitinase-3/sangue , Neoplasias Colorretais/diagnóstico , Neoplasias Intestinais/diagnóstico , Inibidor Tecidual de Metaloproteinase-1/sangue , Adenoma/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/sangue , Neoplasias Colorretais/sangue , Neoplasias Colorretais/epidemiologia , Dinamarca/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Neoplasias Intestinais/sangue , Neoplasias Intestinais/epidemiologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Fatores de Risco , Adulto Jovem
15.
Gastroenterol Hepatol ; 42(4): 263-270, 2019 Apr.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30459060

RESUMO

Faecal immunochemical tests for haemoglobin (FIT), as an adjunct to clinical information, assist in the triage of patients presenting in primary care with lower abdominal symptoms. Controversy remains regarding whether and which qualitative and quantitative FIT can be used, which groups of patients would benefit most from FIT, whether FIT should be done in primary and/or secondary care, and how FIT should be incorporated into diagnostic pathways. Controversy also exists as to the optimum cut-off used for referral for colonoscopy. A single sample of faeces may be sufficient. Reporting of results requires consideration. FIT provide a good rule in test for colorectal cancer and a good rule out test for significant bowel disease, but robust safety-netting is required for patients with negative results and ongoing symptoms. Risk scoring models have been developed, but their value is unclear as yet. Further evaluation of these topics is required to inform good practice.


Assuntos
Adenoma/sangue , Adenoma/diagnóstico , Neoplasias Colorretais/sangue , Neoplasias Colorretais/diagnóstico , Fezes/química , Hemoglobinas/análise , Doenças Inflamatórias Intestinais/sangue , Doenças Inflamatórias Intestinais/diagnóstico , Testes Hematológicos/métodos , Humanos , Imunoquímica , Guias de Prática Clínica como Assunto
16.
Pathol Oncol Res ; 25(1): 97-105, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28980150

RESUMO

MicroRNAs (miRNAs) have been found to play a critical role in colorectal adenoma-carcinoma sequence. MiRNA-specific high-throughput arrays became available to detect promising miRNA expression alterations even in biological fluids, such as plasma samples, where miRNAs are stable. The purpose of this study was to identify circulating miRNAs showing altered expression between normal colonic (N), tubular adenoma (ADT), tubulovillous adenoma (ADTV) and colorectal cancer (CRC) matched plasma and tissue samples. Sixteen peripheral plasma and matched tissue biopsy samples (N n = 4; ADT n = 4; ADTV n = 4; CRC n = 4) were selected, and total RNA including miRNA fraction was isolated. MiRNAs from plasma samples were extracted using QIAamp Circulating Nucleic Acid Kit (Qiagen). Matched tissue-plasma miRNA microarray experiments were conducted by GeneChip® miRNA 3.0 Array (Affymetrix). RT-qPCR (microRNA Ready-to-use PCR Human Panel I + II; Exiqon) was used for validation. Characteristic miRNA expression alterations were observed in comparison of AD and CRC groups (miR-149*, miR-3196, miR-4687) in plasma samples. In the N vs. CRC comparison, significant overexpression of miR-612, miR-1296, miR-933, miR-937 and miR-1207 was detected by RT-PCR (p < 0.05). Similar expression pattern of these miRNAs were observed using microarray in tissue pairs, as well. Although miRNAs were also found in circulatory system in a lower concentration compared to tissues, expression patterns slightly overlapped between tissue and plasma samples. Detected circulating miRNA alterations may originate not only from the primer tumor but from other cell types including immune cells.


Assuntos
Adenoma/genética , Biomarcadores Tumorais/genética , MicroRNA Circulante/genética , Neoplasias Colorretais/genética , Regulação Neoplásica da Expressão Gênica , Adenoma/sangue , Adenoma/patologia , Biomarcadores Tumorais/sangue , Estudos de Casos e Controles , MicroRNA Circulante/sangue , Neoplasias Colorretais/sangue , Neoplasias Colorretais/patologia , Progressão da Doença , Seguimentos , Perfilação da Expressão Gênica , Humanos , Prognóstico
17.
Clin Colorectal Cancer ; 18(1): e53-e60, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30366678

RESUMO

INTRODUCTION: Colorectal cancer is a major public health issue, with incidences continuing to rise owing to the growing and aging world population. Current screening strategies for colorectal cancer diagnosis suffer from various limitations, including invasiveness and poor uptake. Consequently, there is an unmet clinical need for a minimally invasive, sensitive, and specific method for detecting the presence of colorectal cancer and pre-malignant lesions. PATIENTS AND METHODS: An indirect enzyme-linked immunosorbent assay was used to measure the primary (IgM) and secondary (IgG) adaptive humoral immune responses to a panel of previously identified cancer antigens in the sera of normal and adenoma samples, and sera from patients with colorectal cancer. RESULTS: An optimal panel of 7 biomarkers capable of identifying patients with colorectal cancer as distinct from both normal and adenoma samples is identified. The cumulative sensitivity and specificity of the assay are 70.8% and 86.5%, respectively. The positive and negative predictive values of the cohort are 77.3% and 82.1%. This assay was not able to accurately discriminate between normal and adenoma samples. Patients whose serum was positive for the presence of anti-ICLN IgM autoantibodies had a significantly poorer 5-year survival than patients whose serum was negative (P = .004). CONCLUSION: This study describes a novel minimally invasive enzyme-linked immunosorbent assay-based method, capable of identifying patients with colorectal cancer as distinct from both normal and adenoma samples. Patients are likely to be far more amenable to a blood-based test such as the one described herein, rather than a fecal-based test, likely leading to increased patient uptake.


Assuntos
Adenoma/imunologia , Autoanticorpos/sangue , Biomarcadores Tumorais/sangue , Neoplasias Colorretais/imunologia , Imunoglobulina G/imunologia , Imunoglobulina M/imunologia , Adenoma/sangue , Adenoma/patologia , Idoso , Autoanticorpos/imunologia , Biomarcadores Tumorais/imunologia , Estudos de Casos e Controles , Estudos de Coortes , Neoplasias Colorretais/sangue , Neoplasias Colorretais/patologia , Ensaio de Imunoadsorção Enzimática , Feminino , Seguimentos , Humanos , Masculino , Prognóstico , Taxa de Sobrevida
18.
Mol Cell Biochem ; 454(1-2): 177-189, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30357530

RESUMO

Colorectal cancer (CRC) is a major cause of death worldwide. Novel non-invasive, high diagnostic value screening test is urgently needed to improve survival rate, treatment and prognosis. Stable, small, circulating microRNA (miRNA) offers unique opportunities for the early diagnosis of several diseases. It acts as tumor oncogenes or suppressors and involve in cell death, survival, and metastasis. Communication between miRNA and carcinogenesis is critical but it still not clear and needs further investigation. The aim of our study is to evaluate the role of miR-210, miR-21, miR-126, as non-invasive diagnostic biomarkers for screening, early detection of CRC, studying their correlation with prognostic variables, and clarifying the roles of miRNAs on HIF-1α-VEGF signaling pathway. The expression of miR-210, miR-21 and miR-126 was performed using qRT-PCR in adenocarcinoma (no = 35), adenomas (no = 51), and neoplasm free controls (no = 101). Serum levels of VEGF and HIF-1α was determined by ELISA Kit. The results show that the expression of miR-210, miR-21, VEGF, HIF-1α was significantly up-regulated while that miRNA-126 was down-regulated in both adenocarcinoma and adenomas compared with controls (p < 0.001 for each). No significant difference was noted comparing patients with adenocarcinoma and adenomas. The three miRNAs correlated with VEGF, HIF-α. The miR-210 and miR-21 associated with TNM classification and clinical staging of adenocarcinoma (p < 0.001) and they show high diagnostic value with sensitivity and specificity 88.6%, 90.1% and 91.4%, 95.0% respectively. Our study revealed that circulating miR-210, miR-21 were up-regulated while miR-126 was down-regulated in CRC and adenomas patients, they all correlated with TNM staging and they had high diagnostic value. HIF-1α VEGF signaling pathways regulated by miRNAs played a role in colon cancer initiation. To the best of our knowledge, this is the first study of this miRNAs panel in CRC in our community. These data suggested that these biomarkers could be a potential novel, non-invasive marker for early diagnosis, screening and predicting prognosis of CRC. Understanding the molecular functions by which miRNAs affect cancer and understanding its roles in modulating the signaling output of VEGF might be fruitful in reducing the incidence and slowing the progression of this dark malignancy.


Assuntos
Neoplasias Colorretais/diagnóstico , MicroRNAs/sangue , Adenocarcinoma/sangue , Adenocarcinoma/diagnóstico , Adenocarcinoma/genética , Adenocarcinoma/metabolismo , Adenoma/sangue , Adenoma/diagnóstico , Adenoma/genética , Adenoma/metabolismo , Idoso , Biomarcadores Tumorais/sangue , Neoplasias Colorretais/sangue , Neoplasias Colorretais/genética , Neoplasias Colorretais/metabolismo , Diagnóstico Precoce , Feminino , Regulação Neoplásica da Expressão Gênica , Humanos , Subunidade alfa do Fator 1 Induzível por Hipóxia/sangue , Subunidade alfa do Fator 1 Induzível por Hipóxia/metabolismo , Masculino , MicroRNAs/genética , Pessoa de Meia-Idade , Prognóstico , Transdução de Sinais , Fator A de Crescimento do Endotélio Vascular/sangue , Fator A de Crescimento do Endotélio Vascular/metabolismo
19.
Epigenomics ; 10(12): 1569-1583, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30426784

RESUMO

AIM: To investigate the quantitative relationship between the positive detection rate (PDR) in colorectal tumor detection and the mSEPT9 level. MATERIALS & METHODS: The level of blood mSEPT9 in various colorectal diseases was quantified by the Epi proColon 2.0 assay. ΔΔCt values were calculated representing the mSEPT9 level. A total of 1347 subjects were recruited in this quantitative study. RESULTS: PDR or sensitivity was positively correlated with the progression of colorectal tumors and the mSEPT9 level in an exponential relationship. The mSEPT9 level of CRC exhibited a distinct pattern of distribution. Strong correlation was found between mSEPT9 level and PDR or sensitivity in various tumor differentiation, pathological types or metastasis. CONCLUSION: The quantitative profiling of blood mSEPT9 determines the detection performance on colorectal tumors.


Assuntos
Adenoma/sangue , Biomarcadores Tumorais/sangue , Pólipos do Colo/sangue , Neoplasias Colorretais/sangue , Metilação de DNA , Septinas/sangue , Adenoma/diagnóstico , Adenoma/genética , Idoso , Biomarcadores Tumorais/genética , Pólipos do Colo/diagnóstico , Pólipos do Colo/genética , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/genética , Detecção Precoce de Câncer , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Lesões Pré-Cancerosas/sangue , Lesões Pré-Cancerosas/diagnóstico , Lesões Pré-Cancerosas/genética , Sensibilidade e Especificidade , Septinas/genética
20.
Eur J Radiol ; 108: 184-188, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30396653

RESUMO

OBJECTIVE: To investigate whether lipid metabolism-related factors regulate unenhanced CT attenuation in adrenal adenoma (AA). MATERIALS AND METHODS: Thirty-six patients with surgically proven AAs were enrolled in this study. The patients' underlying diseases were the following: primary aldosteronism (n = 24), Cushing's syndrome (n = 8), subclinical Cushing's syndrome (n = 3) and non-functioning AA (n = 1). Unenhanced CT attenuation of AAs and liver was measured. Pathologically, clear cell ratio (CCR) constituting each AA was qualitatively assessed. Clinical data including tumor diameter, body mass index (BMI), hemoglobin A1c, triglyceride, total cholesterol, blood cortisol and plasma aldosterone levels were also obtained. Simple and multiple linear regression analyses were performed to evaluate the radiological and clinicopathological factors associated with CT attenuation of AAs for all patients and separately for 25 patients with primary aldosteronism or non-functioning AA. RESULTS: For all patients, there was a significant correlation between CT attenuation and each of CCR, BMI and blood cortisol levels (p < 0.05). For patients with primary aldosteronism or non-functioning AA, there was also a significant correlation between CT attenuation and CCR or BMI (p < 0.05). CONCLUSION: In addition to pathological factors, lipid-metabolism-related factors including BMI and blood cortisol levels can affect unenhanced CT attenuation of AA.


Assuntos
Adenoma/diagnóstico por imagem , Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Índice de Massa Corporal , Tomografia Computadorizada por Raios X/métodos , Adenoma/sangue , Adenoma/patologia , Neoplasias das Glândulas Suprarrenais/sangue , Neoplasias das Glândulas Suprarrenais/patologia , Glândulas Suprarrenais/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Hidrocortisona/sangue , Masculino , Pessoa de Meia-Idade , Adulto Jovem
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