RESUMO
Non-alcoholic fatty liver disease (NAFLD) is commonly associated with obesity, metabolic syndrome, and type 2 diabetes. NAFLD is also seen in patients with endocrinopathies. However, the relationship between endocrine diseases and the development of NAFLD is not well known. In this study, we set out to determine whether liver fat content (LFC) was associated with IGF1 levels in people with pituitary diseases (PD). Eighty-nine patients with pituitary diseases and 74 healthy controls were included in this study. LFC was measured using MRI. Hepatic steatosis was defined as LFC>5.5%. Patients with PD were older, and had a higher BMI than healthy controls. LFC was significantly higher in people with PD than in controls (6.5% vs. 3.2%; p<0.001). LFC was negatively associated with the IGF1 level. The prevalence of steatosis was higher in PD patients than in controls (36.3% vs. 14.8%; p=0.002). In multivariate analysis, which included patients and controls, the predictive variables for steatosis were age, BMI and IGF1 levels, whereas the presence of pituitary diseases and gender were not associated with steatosis. Our data showed that LFC was strongly associated with IGF1 levels. These results suggest that steatosis associated with PD is probably a consequence of a low IGF1 level in these patients.
Assuntos
Biomarcadores/sangue , Índice de Massa Corporal , Fator de Crescimento Insulin-Like I/análise , Gordura Intra-Abdominal/fisiopatologia , Hepatopatia Gordurosa não Alcoólica/patologia , Doenças da Hipófise/complicações , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/sangue , Hepatopatia Gordurosa não Alcoólica/etiologia , Estudos ProspectivosRESUMO
OBJECTIVE: High-density lipoprotein (HDL) from nondiabetic patients with metabolic syndrome (MetS) displays abnormalities in their lipidome, such as triglyceride enrichment and sphingosine-1-phosphate depletion. We hypothesized that these abnormalities could impair the ability of HDL to stimulate endothelial nitric oxide synthase (eNOS). APPROACH AND RESULTS: Compared with HDL from control subjects, HDL from normoglycemic patients with MetS was 39% richer in triglycerides (P<0.01) and 15% poorer in sphingosine-1-phosphate (P<0.05; n=23 in each group). eNOS activity, assessed by the conversion of L-[3H]arginine to L-[3H]citrulline, was 69% lower in human umbilical vein endothelial cells incubated with HDL from MetS patients than in cells incubated with HDL from controls (P<0.0001). In addition, the activating phosphorylation of eNOS at serine (Ser) 1177 and of Akt (protein kinase B) at Ser473 was 37% (P<0.001) and 39% (P<0.05) lower, respectively, with HDL from MetS patients. Sphingosine-1-phosphate enrichment of HDL from MetS patients restored their ability to stimulate eNOS activity (P<0.05), in relation with a significant increase in eNOS phosphorylation at Ser1177 (P<0.05) and in Akt phosphorylation at Ser473 (P=0.05). By contrast, triglyceride enrichment of HDL from control subjects did not modify eNOS activity (P=0.90) and phosphorylation at Ser1177 (P=0.87). CONCLUSIONS: We provide evidence that the activation of eNOS by HDL is decreased in MetS patients before the appearance of diabetes mellitus and that sphingosine-1-phosphate depletion of HDL is the main factor responsible for this defect. This has important consequences on the impairment of HDL functionality and antiatherogenic properties in these patients.
Assuntos
Diabetes Mellitus/enzimologia , Células Endoteliais da Veia Umbilical Humana/enzimologia , Lipoproteínas HDL/sangue , Lisofosfolipídeos/sangue , Síndrome Metabólica/enzimologia , Óxido Nítrico Sintase Tipo III/metabolismo , Esfingosina/análogos & derivados , Adulto , Idoso , Estudos de Casos e Controles , Células Cultivadas , Diabetes Mellitus/sangue , Diabetes Mellitus/diagnóstico , Progressão da Doença , Ativação Enzimática , Feminino , Humanos , Masculino , Síndrome Metabólica/sangue , Síndrome Metabólica/diagnóstico , Pessoa de Meia-Idade , Fosforilação , Proteínas Proto-Oncogênicas c-akt/metabolismo , Esfingosina/sangueRESUMO
OBJECTIVE: In clinical practice, thyroid nodules are typically visually evaluated by expert physicians using 2D ultrasound images. Based on their assessment, a fine needle aspiration (FNA) may be recommended. However, visually classifying thyroid nodules from ultrasound images may lead to unnecessary fine needle aspirations for patients. The aim of this study is to develop an automatic thyroid ultrasound image classification system to prevent unnecessary FNAs. METHODS: An automatic computer-aided artificial intelligence system is proposed for classifying thyroid nodules using a fine-tuned deep learning model based on the DenseNet architecture, which incorporates an attention module. The dataset comprises 591 thyroid nodule images categorized based on the Bethesda score. Thyroid nodules are classified as either requiring FNA or not. The challenges encountered in this task include managing variability in image quality, addressing the presence of artifacts in ultrasound image datasets, tackling class imbalance, and ensuring model interpretability. We employed techniques such as data augmentation, class weighting, and gradient-weighted class activation maps (Grad-CAM) to enhance model performance and provide insights into decision making. RESULTS: Our approach achieved excellent results with an average accuracy of 0.94, F1-score of 0.93, and sensitivity of 0.96. The use of Grad-CAM gives insights on the decision making and then reinforce the reliability of the binary classification for the end-user perspective. CONCLUSIONS: We propose a deep learning architecture that effectively classifies thyroid nodules as requiring FNA or not from ultrasound images. Despite challenges related to image variability, class imbalance, and interpretability, our method demonstrated a high classification accuracy with minimal false negatives, showing its potential to reduce unnecessary FNAs in clinical settings.
RESUMO
Introduction Diabetes and pre-diabetes are highly prevalent in patients with a history of acute coronary syndrome. This is why screening for glucose metabolism disorders is recommended in patients following an acute coronary syndrome. The aim of our study was to determine whether glycated haemoglobin alone compared with the oral glucose tolerance test could allow effective screening for glucose metabolism disorders in acute coronary syndrome patients undergoing cardiac rehabilitation. Patients and methods Among 347 patients with a recent history of acute coronary syndrome enrolled in our cardiac rehabilitation centre, 267 patients without previously known diabetes were recruited for this prospective study with performance of both oral glucose tolerance test and glycated haemoglobin measurement. The patients were divided into three groups: newly diagnosed diabetes mellitus, pre-diabetes and normoglycaemia according to the oral glucose tolerance test and glycated haemoglobin results. The results obtained with glycated haemoglobin were compared with those obtained with the oral glucose tolerance test, considered as the reference. Results For the diagnosis of diabetes, glycated haemoglobin had a sensitivity of 72% and a specificity of 100%. Positive and negative predictive values were high at 100% and 96%, respectively. However, for the diagnosis of pre-diabetes the sensitivity of glycated haemoglobin was low at 64% as were the specificity (53%) and the positive predictive values (37%). Glycated haemoglobin overdiagnosed pre-diabetes (52% vs 30%, p < 0.0001). For the diagnosis of normoglycaemia, the sensitivity of glycated haemoglobin was also low (48%). Conclusion According to our study, glycated haemoglobin has low sensitivity and specificity for the detection of pre-diabetes in patients with coronary disease enrolled in cardiac rehabilitation, and glycated haemoglobin over-diagnoses pre-diabetes in comparison with the oral glucose tolerance test.
Assuntos
Síndrome Coronariana Aguda/reabilitação , Glicemia/metabolismo , Transtornos do Metabolismo de Glucose/diagnóstico , Hemoglobinas Glicadas/metabolismo , Programas de Rastreamento/métodos , Síndrome Coronariana Aguda/epidemiologia , Síndrome Coronariana Aguda/etiologia , Feminino , França , Transtornos do Metabolismo de Glucose/complicações , Transtornos do Metabolismo de Glucose/epidemiologia , Teste de Tolerância a Glucose/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Reprodutibilidade dos TestesRESUMO
OBJECTIVE: Phospholipids and sphingolipids play a critical role in the protective effects of HDL against atherosclerosis. These properties are impaired in patients with metabolic syndrome, before the development of diabetes. We thus investigated whether HDL from patients with metabolic syndrome but normal fasting glycaemia present abnormalities in their sphingophospholipid profile. METHODS: Using liquid chromatography/tandem mass spectrometry, we quantified the different species of the main phospholipids and sphingolipids in the HDL2 and HDL3 from 26 obese patients with metabolic syndrome but normal fasting glycaemia and 50 controls. RESULTS: Phosphatidylcholines, when expressed as the relative amount compared with total phospholipids and sphingolipids, were similar in both HDL2 and HDL3 in the two groups. Lysophosphatidylcholines were 41% (p = 0.0002) and 86% (p < 0.0001) higher in HDL2 and HDL3, respectively, from patients with metabolic syndrome than in those from controls. Phosphatidylinositols were also higher in HDL2 and HDL3 (respectively, +60 and + 103% (p < 0.0001)). In contrast, both HDL2 and HDL3 from patients with metabolic syndrome showed lower proportions of phosphatidylethanolamine-based plasmalogens (respectively -78 and -73%, p < 0.0001), phosphatidylcholine-based plasmalogens (respectively -44 and -53%, p < 0.0001), d18:1-sphingosine-1-phosphate (respectively -52 and -38%, p < 0.0001) and sphingomyelins (respectively -19% (p < 0.0001) and -24% (p = 0.0006)), than did controls. Moreover, we observed a decrease in C18:2 fatty acid-containing phospholipids and an increase in C20:4 fatty acid-containing phospholipids. CONCLUSION: The sphingophospholipidome of HDL from normoglycaemic obese patients with metabolic syndrome is profoundly modified, before the dysregulation of glycaemia. Most of the changes observed have pejorative effect in terms of vascular protection.