Jupiter Science Enabled by ESA's Jupiter Icy Moons Explorer.

ESA's Jupiter Icy Moons Explorer (JUICE) will provide a detailed investigation of the Jovian system in the 2030s, combining a suite of state-of-the-art instruments with an orbital tour tailored to maximise observing opportunities. We review the Jupiter science enabled by the JUICE mission, building on the legacy of discoveries from the Galileo, Cassini, and Juno missions, alongside ground- and space-based observatories. We focus on remote sensing of the climate, meteorology, and chemistry of the atmosphere and auroras from the cloud-forming weather layer, through the upper troposphere, into the stratosphere and ionosphere. The Jupiter orbital tour provides a wealth of opportunities for atmospheric and auroral science: global perspectives with its near-equatorial and inclined phases, sampling all phase angles from dayside to nightside, and investigating phenomena evolving on timescales from minutes to months. The remote sensing payload spans far-UV spectroscopy (50-210 nm), visible imaging (340-1080 nm), visible/near-infrared spectroscopy (0.49-5.56 µm), and sub-millimetre sounding (near 530-625 GHz and 1067-1275 GHz). This is coupled to radio, stellar, and solar occultation opportunities to explore the atmosphere at high vertical resolution; and radio and plasma wave measurements of electric discharges in the Jovian atmosphere and auroras. Cross-disciplinary scientific investigations enable JUICE to explore coupling processes in giant planet atmospheres, to show how the atmosphere is connected to (i) the deep circulation and composition of the hydrogen-dominated interior; and (ii) to the currents and charged particle environments of the external magnetosphere. JUICE will provide a comprehensive characterisation of the atmosphere and auroras of this archetypal giant planet.

Corticotroph cell hyperplasia as a rare cause of ACTH-dependent Cushing syndrome.

OBJECTIVE: Our aim was to characterise a cohort of patients with Cushing's disease (CD) who did not present pituitary adenoma in magnetic resonance imaging (MRI), needing a catheterisation of the inferior petrosal sinus (CIPS), and to study the pathological findings of the pituitary gland in these subjects after transsphenoidal surgery in order to establish the aetiology of CD. Furthermore, we evaluated possible differences in the features of the diagnosis between hyperplasia and adenoma. SUBJECTS AND METHODS: We included 16 subjects. 17 CIPS were done. Hormonal parameters were measured using standard methods. A microscopic histochemical study following standard procedures and immunohistochemical analysis was performed. The diagnostic criteria for adenoma and hyperplasia were based on the WHO classification. RESULTS: One patient was excluded for presenting an ACTH-producing bronchial neuroendocrine tumour. The 15 subjects with CD have a positive CIPS test indicating hypophyseal ACTH production. After transsphenoidal surgery, 12 patients showed a microadenoma and three (20%) a corticotroph cell hyperplasia. We found four recurrences after the transsphenoidal surgery (26%), with a mean time for recurrence of 105 months. We found that recurrence was more frequent in subjects with hyperplasia, and in those subjects with lower right/left ACTH ratio. CONCLUSION: Our study, which was focused on patients with CD with no pituitary adenoma detected by MRI and a positive CRH test after CIPS, has found that 20% showed corticotroph cell hyperplasia as the cause of CD. Right/left ACTH ratio after CIPS was useful to differentiate adenoma from hyperplasia. This finding may have important prognostic and treatment implications. More studies are necessary to confirm our result.

Study of abnormal adrenal receptors in subjects with ACTH-independent Cushing's syndrome and nodular adrenal hyperplasia. / Estudio de receptor anómalo suprarrenal en sujetos con síndrome de Cushing ACTH-independiente e hiperplasia nodular suprarrenal.

INTRODUCTION: ACTH-independent Cushing's Syndrome (AICS) accounts for 15-20% of cases of Cushing's syndrome, with <1% due to abnormal receptors. Our aim is to study the presence of abnormal receptors in subjects diagnosed with AICS with nodular adrenal hyperplasia in a 14-year period (2002-2016), as well as its clinical-biological and evolutive characteristics. MATERIAL AND METHODS: A multicentre descriptive study of a 15-case series of AICS with nodular adrenal hyperplasia (study period: 2002-2016). In these cases, abnormal receptor screening was performed by means of stimulation tests, with a plasma cortisol increase of ≥ 25% from baseline being considered pathologic. RESULTS: Of the 15 cases, 13 were female, with a mean age at diagnosis of 56.8 years. In 12 of the 15 cases studied, positivity was detected with stimulation tests, and, of them, 25% were positive for the meal test, 58.3% for posture walking test, 33.3% for desmopressin; 25% for terlipressin; 33.3% for GnRH; 25% for LH and 50% for metoclopramide. Regarding treatment, bilateral adrenalectomy was performed in 16.7% and unilateral adrenalectomy in 41.7%. The rest continue under observation with periodic follow-up (41.7%). CONCLUSIONS: In most of the cases studied with AICS and nodular adrenal hyperplasia (80%), an abnormal cortisol response is detected due to the presence of abnormal receptors. The test with the highest percentage of positivity was the postural walking test (58.3%).

Diagnosing insulin resistance by simple quantitative methods in subjects with normal glucose metabolism.

OBJECTIVE: To identify a reliable yet simple indirect method for detection of insulin resistance (IR). RESEARCH DESIGN AND METHODS: A total of 65 subjects (44 men and 21 women aged 30-60 years) were selected by a simple random sampling method. Inclusion criteria were voluntary participation from staff and hospital personnel, absence of abnormal glucose tolerance, and normal results of lipid profile and basic blood chemistry. A blood sample was taken after a 12-h overnight fast to determine plasma lipid, glucose, and insulin levels. An intravenous glucose tolerance test with administration of insulin after 20 min and extraction of multiple blood samples for glucose and insulin measurements and calculation of the minimal model approximation of the metabolism of glucose (MMAMG) S(i) value were performed. Three indirect indexes used to predict insulin sensitivity or IR were calculated, and metabolic syndrome was diagnosed using the Adult Treatment Panel III (ATP III) criteria. All results were correlated with those of the MMAMG. RESULTS: The 75th percentile value as the cutoff point to define IR corresponded with a fasting plasma glucose level of 12 mU/l, a homeostasis model assessment of 2.6, a 25th percentile for S(i) value of 21, and QUICKI (quantitative insulin sensitivity check index) and McAuley indexes of 0.33 and 5.8, respectively. The S(i) index correlated (P < 0.001) with all the indirect indexes and parameters of the metabolic syndrome. CONCLUSIONS: When compared with the S(i) index, the most sensitive and specific indirect method was the score proposed by McAuley et al. (specificity 0.91, sensitivity 0.75, 9.2 probability ratio of a positive test), followed by the existence of metabolic syndrome (specificity 0.91, sensitivity 0.66, 7.8 probability ratio of a positive test).

Abdominal obesity, insulin resistance, and metabolic syndrome in a southern European population.

BACKGROUND: Our objective was to investigate the relationship between abdominal obesity (AO), as measured by waist circumference (WC), insulin resistance (IR), and components of the metabolic syndrome (MS). METHODS: A cross-sectional study was carried out with 283 subjects (130 males and 153 females aged 25-65 years) from a primary care outpatient clinic in Valencia (Spain) over a period of 1 year. Body mass index (BMI), waist circumference (WC), blood pressure (BP), total cholesterol, triglycerides, HDL-C, glucose, and insulin were measured by standard methods. IR was defined as HOMA-IR equal to or greater than 3.8. RESULTS: The prevalence of IR was 39.6%. Subjects were divided into groups according to WC. A 'normal' WC was defined as below 88 cm in women and below 102 cm in men; 'AO' was defined as a WC equal to or above 88 cm in women and equal to or above 102 cm in men. The prevalence of IR was 31.7% in the group with normal WC and 54.6% in the AO group (P<0.001). The percentage of subjects with the MS (high BP, dyslipemia or abnormal glucose tolerance) significantly increased (P<0.001) in subjects with AO (48.4 vs. 18.8% in normal WC subjects). AO is an indicator of IR with an odds ratio of 2.59 (95% CI 1.55-4.29). CONCLUSIONS: AO, expressed as WC, appears to be a good indicator of risk for IR and the MS, particularly in non-obese subjects (BMI<30). The main independent parameters of risk for IR are WC and TG, whereas those for the MS are IR, WC, and age.

Metabolic effects of regular physical exercise in healthy population.

AIM: To assess the effect of moderate regular aerobic physical activity not associated to body weight changes on insulin resistance and the associated metabolic changes in general population. SUBJECTS AND METHODS: A cross-sectional, observational study in an adult population (n=101 subjects aged 30-70 years) with no personal history of disease and with stable weight in the three months prior to the study. The group with regular exercise performed 30-60 minutes of moderate regular physical exercise 5 days per week (7.5-15 hours MET per week), while a control group performed no regular physical exercise and had a sedentary lifestyle. Subjects were age- and sex-matched. Lipids, lipoproteins, and HOMA index were measured using standard methods. RESULTS: The group with regular physical activity consisted of 48 subjects (21 male/27 female), while the group with no regular physical activity included 53 subjects (31 male/22 female). No significant differences were found between the groups in age, sex, BMI, waist circumference, and blood pressure. Significant differences were found between the groups in fasting serum triglyceride, HDL-C, and apoB levels. Fasting plasma insulin levels (12.1 ± 4.13 vs 14.9 ± 4.8 mU/L, P= .004) and HOMA index (2.8 ± 1.1 vs 3.5 ± 4.1, P= .001) were significantly lower in the group with regular physical activity as compared to the sedentary group. Prevalence rates of metabolic syndrome were 20.7% and 45.8% (P=.01) in the regular physical activity and sedentary groups respectively. CONCLUSION: Moderate regular physical activity is associated to higher insulin sensitivity, an improved lipid profile, and a decrease in components of metabolic syndrome with no change in weight or BMI.

[Correlation between plasma concentrations of homocysteine and diabetic polyneuropathy evaluated with the Semmes-Weinstein monofilament test in patients with type 2 diabetes mellitus]. / Correlación entre las concentraciones plasmáticas de homocisteína y la polineuropatía diabética evaluada con la prueba del monofilamento de Semmes-Weinstein en pacientes con diabetes tipo 2.

BACKGROUND AND OBJECTIVE: Few modifiable risk factors are known to be associated with the presence and progression of diabetic polyneuropathy (DPN). MATERIAL AND METHOD: We have analyzed in 405 type 2 diabetic (T2DM) subjects (169 women) the association of plasma homocysteine with the presence of DPN measured with the Semmes-Weinstein (SW) monofilament test. A score below 4 was considered an altered SW monofilament test. Plasma homocysteine, vitamin B12 and folic acid were measured using standard procedures (ELISA). RESULTS: Patients with T2DM with altered SW test have significantly higher age, evolution of disease, HbA1c and lower creatinine clearance values. In addition, plasma homocysteine values were independently and significantly higher in T2DM with DPN measured as altered SW test (13.64 ± 4.93 vs. 12.22 ± 4.48 µmol/l, P<.01) with similar vitamin B12 and folic acid values comparing the 2 groups. CONCLUSION: Plasma homocysteine and HbA1c values are the 2 modifiable biological factors associated with the presence of DPN evaluated as an altered SW monofilament test in T2DM subjects.

[Subclinical carotid atherosclerosis in patients with familial combined hyperlipidemia. Two years follow-up after treatment with high doses of atorvastatin]. / Arteriosclerosis carotídea subclínica en pacientes con hiperlipidemia familiar combinada. Evolución tras dos años de tratamiento con dosis altas de atorvastatina.

BACKGROUND AND OBJECTIVE: Familial combined hyperlipidemia (FCH) is a genetic model of atherogenic dyslipidemia with insulin resistance and early coronary disease. Our objective was to evaluate the presence of carotid alterations as a marker of systemic atherosclerosis in subjects with FCH and assess the effect of 80 mg of atorvastatin per day in carotid plaque thickness after 2 years. SUBJECTS AND METHODS: 100 non diabetic subjects with FCH in primary prevention were consecutively included. Clinical and biochemical parameters and carotid ultrasonography were performed. Subjects with carotid plaque started treatment with 80 mg of atorvastatin per day for 2 years. RESULTS: 29% of subjects had carotid plaques. We did not find significant differences in any of the parameters between subjects with presence or absence of carotid plaques. Twenty subjects with carotid plaques accepted/agreed to participate in the interventional study. Two years follow-up showed a significant reduction in LDLc (30%) and carotid plaque thickness (10%). CONCLUSION: Carotid ultrasonography is useful to detect subclinical atherosclerosis in high risk cardiovascular patients such as subjects with FCH. Treatment with high doses of atorvastatin induces the regression of carotid plaque thickness after 2 years follow-up. Our results suggest that intensive treatment with atorvastatin could be useful to reduce the development of cardiovascular disease in this group of patients.