ABSTRACT Objective: To explore the diagnostic value of the TUIAS (SW_TH01/II) computer-aided diagnosis (CAD) software system for the ultrasound Thyroid Imaging Reporting and Data System (TI-RADS) features in thyroid nodules. Materials and methods: This retrospective study enrolled patients with thyroid nodules in Shanghai East Hospital between January 2017 and October 2021. The novel CAD software (SW_TH01/II) and three sonographers performed a qualitative analysis of the ultrasound TI-RADS features in aspect ratio, margin irregularity, margin smoothness, calcification, and echogenicity of the thyroid nodules. Results: A total of 225 patients were enrolled. The accuracy, sensitivity, and specificity of the CAD software in “aspect ratio” were 95.6%, 96.2%, and 95.4%, in “margin irregularity” were 90.7%, 90.5%, and 90.9%, in “margin smoothness” were 85.8%, 88.5%, and 83.0%, in “calcification” were 83.6%, 81.7%, and 82.0%, in “homogeneity” were 88.9%, 90.6%, and 82.2%, in “major echo” were 85.3%, 88.0%, and 85.4%, and in “contains very hypoechoic echo” were 92.0%, 90.0%, and 92.4%. The analysis time of the CAD software was significantly shorter than for the sonographers (2.7 ± 1.6 vs. 29.7 ± 12.7 s, P < 0.001). Conclusion: The CAD system achieved high accuracy in describing thyroid nodule features. It might assist in clinical thyroid nodule analysis. Objective SW_TH01/II SWTH01II SWTHII SW TH01 II TH (SW_TH01/II computeraided computer aided (CAD TIRADS TI RADS (TI-RADS methods 201 2021 ratio irregularity smoothness calcification Results 22 sensitivity 956 95 6 95.6% 962 96 2 96.2% 954 4 95.4% 907 90 7 90.7% 905 5 90.5% 909 9 90.9% 858 85 8 85.8% 885 88 88.5% 830 83 0 83.0% “calcification 836 83.6% 817 81 81.7% 820 82 82.0% homogeneity “homogeneity 889 88.9% 906 90.6% 822 82.2% major echo 853 3 85.3% 880 88.0% 854 85.4% contains 920 92 92.0% 900 90.0% 924 92.4% 2.7 27 (2. 16 1 1. vs 297 29 29. 127 12 12. s 0.001. 0001 0.001 . 001 0.001) Conclusion SWTH TH0 20 202 95.6 96.2 95.4 90.7 90.5 90.9 85.8 88.5 83.0 83.6 81.7 82.0 88.9 90.6 82.2 85.3 88.0 85.4 92.0 90.0 92.4 2. (2 000 0.00 00 95. 96. 90. 85. 88. 83. 81. 82. 92. ( 0.0 0.

ABSTRACT FGF21 is a hormone produced primarily by the liver with several metabolic functions, such as induction of heat production, control of glucose homeostasis, and regulation of blood lipid levels. Due to these actions, several laboratories have developed FGF21 analogs to treat patients with metabolic disorders such as obesity and diabetes. Here, we performed a systematic review and meta-analysis of randomized controlled trials that used FGF21 analogs and analyzed metabolic outcomes. Our search yielded 236 articles, and we included eight randomized clinical trials in the meta-analysis. The use of FGF21 analogs exhibited no effect on fasting blood glucose, glycated hemoglobin, HOMA index, blood free fatty acids or systolic blood pressure. However, the treatment significantly reduced fasting insulinemia, body weight and total cholesterolemia. None of the included studies were at high risk of bias. The quality of the evidence ranged from moderate to very low, especially due to imprecision and indirection issues. These results indicate that FGF21 analogs can potentially treat metabolic syndrome. However, more clinical trials are needed to increase the quality of evidence and confirm the effects seen thus far. FGF FGF2 functions production homeostasis levels actions diabetes Here metaanalysis meta analysis outcomes 23 articles metaanalysis. analysis. hemoglobin index pressure However insulinemia cholesterolemia bias low issues syndrome far 2

ABSTRACT Objective: To study associations between polymorphisms in the angiotensin converting enzyme (ACE I/D), actinin 3 (ACTN3 R577X) and paraoxonase 1 (PON1 T(-107)C) genes and chronic diseases (diabetes and hypertension) in women. Materials and methods: Genomic DNA was extracted from saliva samples of 78 women between 18 and 59 years old used for genetic polymorphism screening. Biochemical data were collected from the medical records in Basic Health Units from Southern Brazil. Questionnaires about food consumption, physical activity level and socioeconomic status were applied. Results: The XX genotype of ACTN3 was associated with low HDL levels and high triglycerides, total cholesterol and glucose levels. Additionally, high triglycerides and LDL levels were observed in carriers of the TT genotype of PON1, and lower total cholesterol levels were associated to the CC genotype. As expected, women with diabetes/hypertense had increased body weight, BMI (p = 0.02), waist circumference (p = 0.01), body fat percentage, blood pressure (p = 0.02), cholesterol, triglycerides (p = 0.02), and blood glucose (p = 0.01), when compared to the control group. Conclusion: Both ACTN3 R577X and PON1 T(-107)C polymorphisms are associated with nutritional status and blood glucose and lipid levels in women with diabetes/hypertense. These results contribute to genetic knowledge about predisposition to obesity-related diseases. Objective ACE I/D, ID I/D , I D I/D) ACTN (ACTN RX R X PON (PON T107C TC T 107 C diabetes hypertension methods 7 5 screening Brazil consumption applied Results Additionally expected diabeteshypertense hypertense weight p 0.02, 002 0.02 0 02 0.02) 0.01, 001 0.01 01 0.01) percentage group Conclusion obesityrelated obesity related 10 00 0.0 0.

ABSTRACT Bisphosphonates (BPs) are medications widely used in clinical practice to treat osteoporosis and reduce fragility fractures. Its beneficial effects on bone tissue have been consolidated in the literature for the last decades. They have a high affinity for bone hydroxyapatite crystals, and most bisphosphonates remain on the bone surface for a long period of time. Benefits of long-term use of BPs: Large and important trials (Fracture Intervention Trial Long-term Extension and Health Outcomes and Reduced Incidence with Zoledronic acid Once Yearly-Pivotal Fracture Trial) with extended use of alendronate (up to 10 years) and zoledronate (up to 6 years) evidenced significant gain of bone mineral density (BMD) and vertebral fracture risk reduction. Risks of long-term use of BPs: The extended use of antiresorptive therapy has drawn attention to two extremely rare, although severe, adverse events. That is, atypical femoral fracture and medication-related osteonecrosis of the jaw are more common in patients with high cumulative doses and longer duration of therapy. BPs have demonstrated safety and effectiveness throughout the years and evidenced increased BMD and reduced fracture risks, resulting in reduced morbimortality, and improved quality of life. These benefits overweight the risks of rare adverse events. (BPs fractures decades crystals time longterm term Longterm Long YearlyPivotal Yearly Pivotal up 1 (BMD reduction severe events is medicationrelated medication related morbimortality life

ABSTRACT Objective: COVID-19 is a multisystem immunoinflammatory disorder, and the hypothalamo–pituitary-adrenal (HPA) axis may be affected by SARS-CoV-2 as well as by steroid treatment during the illness. Information on the HPA axis after recovering from COVID-19, especially in those treated with steroids, is sparse. Hence, this study was performed to evaluate the hypothalamo-pituitary-adrenal axis during the post-COVID-19 period in patients treated with steroids during the illness. Subject and methods: This prospective study involved 60 patients aged 18-60 years who had recovered from moderate or severe COVID-19 and had received steroid treatment during the illness. The HPA axis was assessed with a low-dose (1 mcg) adrenocorticotropic hormone stimulation test at 3, 6 and 9 months in the post-COVID period. Results: The HPA axis was suppressed in 31.66% of the patients at 3 months and 5% at 6 months; however, all patients recovered at 9 months. Cumulative steroid use during the illness was inversely correlated with stimulated cortisol at 3 months in the post-COVID period. Fatigue was present in 58.33% of the patients at 3 months and was more prevalent in those with HPA axis suppression. Conclusion: Nearly one-third of the patients with moderate to severe COVID-19 who were treated with steroids had suppressed HPA axis at 3 months, with gradual recovery over a period of 9 months. Cumulative steroid equivalent dose, but not disease severity, was predictive of HPA axis suppression at 3 months. Objective COVID19 COVID 19 COVID-1 disorder hypothalamo–pituitaryadrenal hypothalamopituitaryadrenal hypothalamo–pituitary adrenal hypothalamo pituitary (HPA SARSCoV2 SARSCoV SARS CoV 2 SARS-CoV- COVID19, 19, sparse Hence postCOVID19 postCOVID post post-COVID-1 methods 1860 18 18-6 lowdose low dose 1 ( mcg Results 3166 31 66 31.66 5 however 5833 58 33 58.33 Conclusion onethird one third severity COVID1 COVID- pituitaryadrenal hypothalamopituitary SARS-CoV postCOVID1 post-COVID- 186 18- 316 31.6 583 58.3 31. 58.

ABSTRACT Objective: Congenital hypopituitarism (CH) is a rare disease characterized by one or more hormone deficiencies of the pituitary gland. To date, many genes have been associated with CH. In this study, we identified the allelic variant spectrum of 11 causative genes in Turkish patients with CH. Materials and methods: This study included 47 patients [21 girls (44.6%) and 26 boys (55.4%)] from 45 families. To identify the genetic etiology, we screened 11 candidate genes associated with CH using next-generation sequencing. To confirm and detect the status of the specific familial variant in relatives, Sanger sequencing was also performed. Results: We identified 12 possible pathogenic variants in GHRHR, GH1, GLI2, PROP-1, POU1F1, and LHX4 in 11 patients (23.4%), of which six were novel variants: two in GHRHR, two in POU1F1, one in GLI2, and one in LHX4. In all patients, these variants were most frequently found in GLI2, followed by PROP-1 and GHRHR. Conclusion: Genetic causes were determined in only 23.4% of all patients with CH and 63% of molecularly diagnosed patients (7/11) from consanguineous families. Despite advances in genetics, we were unable to identify the genetic etiology of most patients with CH, suggesting the effect of unknown genes or environmental factors. More genetic studies are necessary to understand the etiology of CH. Objective (CH gland date 1 methods 4 21 [2 44.6% 446 44 6 (44.6% 2 55.4% 554 55 (55.4%) families nextgeneration next generation relatives performed Results GHRHR GH1 GH GLI2 GLI PROP1, PROP1 PROP 1, POU1F1 POUF POU F LHX 23.4%, 234 , 23 (23.4%) PROP- Conclusion 23.4 63 7/11 711 7 (7/11 genetics factors [ 44.6 (44.6 55.4 5 (55.4% POU1F (23.4% 23. 7/1 71 (7/1 44. (44. 55. (55.4 (23.4 7/ (7/ (44 (55. (23. (7 (4 (55 (23 ( (5 (2

ABSTRACT Objective: To investigate nonalcoholic fatty liver disease (NAFLD), nonalcoholic steatohepatitis (NASH) and hepatic fibrosis in biopsies of people with obesity who underwent bariatric surgery and examine the possible association of different variables with a diagnosis of NAFLD and NASH. Materials and methods: Epidemiological, clinical and laboratory data from 574 individuals with obesity of both genders seen by the same physician between 2003 and 2009 who had a liver biopsy during bariatric surgery were examined. Results: Of the 437 patients included, 39.8% had some degree of liver fibrosis, 95% had a histologic diagnosis of NAFLD, and the risk factors were age ≥ 28 years and Homeostatic Model Assessment (HOMA) ≥ 2.5 (p = 0.001 and p = 0.016, respectively). In the NAFLD group, NASH was present in 26% of patients and the associated factors were aspartate aminotransferase and alanine aminotransferase index (AST/ALT) > 1, high-density lipoprotein cholesterol (HDL-c) < 40 mg/dL, total cholesterol (TC) ≥ 200 mg/dL, gamma-glutamyl transferase (GGT) > 38 U/L and triglycerides (TG) levels > 150 mg/dL. The independent risk factors were low HDL-c, elevated AST/ALT and high TG. Conclusion: The variables associated with a diagnosis of NAFLD were HOMA ≥ 2.5 and age ≥ 28 years. NASH was associated with low HDL-c, high TG and AST/ALT ≤ 1. Objective , (NAFLD) (NASH methods Epidemiological 57 examined Results 43 included 398 39 8 39.8 95 2 (HOMA 25 5 2. 0001 0 001 0.00 0016 016 0.016 respectively. respectively . respectively) group 26 ASTALT AST ALT (AST/ALT 1 highdensity density HDLc HDL c (HDL-c 4 mgdL mg dL mg/dL TC (TC 20 gammaglutamyl gamma glutamyl GGT (GGT 3 UL U L (TG 15 HDLc, c, HDL-c Conclusion (NAFLD 39. 9 000 00 0.0 01 0.01 0.

ABSTRACT Objective: Nonalcoholic fatty liver disease (NAFLD) is a chronic liver disease and a growing global epidemic. In NAFLD, liver fat surpasses 5% of hepatocytes without the secondary causes of lipid accumulation or excessive alcohol consumption. Given the link between NAFLD and insulin resistance, the possible association between the rs2854744 (−202 G>T) promoter polymorphism of insulin-like growth factor binding protein 3 (IGFBP3) gene and NAFLD was investigated in this study. Materials and methods: In this genetic case-control association study, the IGFBP3 rs2854744 genotypes of 315 unrelated individuals, including 156 patients with biopsy-proven NAFLD and 159 controls, were determined using polymerase chain reaction/restriction fragment length polymorphism analyses. Results: The “GT+TT” genotype of the IGFBP3 rs2854744 polymorphism, compared with the “GG” genotype, was associated with a 2.7-fold increased risk of NAFLD after adjustment for confounding factors (P = 0.009; odds ratio [OR] = 2.71; 95% confidence interval [CI] = 1.19-3.18). Additionally, the IGFBP3 rs2854744 “T” allele, in comparison with the “G” allele, was significantly overrepresented in NAFLD patients than the controls (P = 0.008; OR = 1.85; 95%CI = 1.23-2.94). Conclusion: Our findings first indicated that the IGFBP3 rs2854744 “GT+TT” genotype is a marker of increased NAFLD susceptibility; however, it needs to be supported by further investigations in other populations. Objective (NAFLD epidemic 5 consumption resistance rs rs285474 −202 202 (−20 G>T GT G T insulinlike like IGFBP (IGFBP3 study methods casecontrol case control 31 individuals 15 biopsyproven biopsy proven reactionrestriction reaction restriction analyses Results GT+TT GTTT TT “GT+TT GG “GG 2.7fold 27fold fold 2.7 2 7 P 0.009 0009 0 009 [OR 2.71 271 71 95 CI [CI 1.193.18. 119318 1.19 3.18 . 1 19 18 1.19-3.18) Additionally “T allele “G 0.008 0008 008 1.85 185 85 95CI 1.232.94. 123294 1.23 2.94 23 94 1.23-2.94) Conclusion susceptibility however populations rs28547 −20 20 (−2 (IGFBP 7fold 27 2. 0.00 000 00 9 193 1.193.18 11931 119 1.1 318 3.1 1.19-3.18 1.8 8 232 1.232.94 12329 123 1.2 294 2.9 1.23-2.94 rs2854 −2 (− 0.0 1.193.1 1193 11 1. 3. 1.19-3.1 1.232.9 1232 12 29 1.23-2.9 rs285 − ( 0. 1.193. 1.19-3. 1.232. 1.23-2. rs28 1.193 1.19-3 1.232 1.23-2 rs2 1.19- 1.23-

ABSTRACT Objective: Despite a favorable prognosis, some patients with papillary thyroid carcinoma (PTC) develop recurrence. The objective of this study was to examine the impact of the combination of initial American Thyroid Association (ATA) risk stratification with serum level of postoperative stimulated thyroglobulin (s-Tg) in predicting recurrence in patients with PTC and compare the results with an assessment of response to initial therapy (dynamic risk stratification). Subjects and methods: We retrospectively analyzed 1,611 patients who had undergone total thyroidectomy for PTC, followed in most cases (87.3%) by radioactive iodine (RAI) administration. Clinicopathological features and s-Tg levels obtained 3 months postoperatively were evaluated. The patients were stratified according to ATA risk categories. Nonstimulated thyroglobulin levels and imaging studies obtained during the first year of follow-up were used to restage the patients based on response to initial therapy. Results: After a mean follow-up of 61.5 months (range 12-246 months), tumor recurrence was diagnosed in 99 (6.1%) patients. According to ATA risk, recurrence was identified in 2.3% of the low-risk, 9% of the intermediate-risk, and 25% of the high-risk patients (p < 0.001). Using a receiver operating characteristic curve approach, a postoperative s-Tg level of 10 ng/mL emerged as the ideal cutoff value, with positive and negative predictive values of 24% and 97.8%, respectively (p < 0.001). Patients with low to intermediate ATA risk with postoperative s-Tg levels < 10 ng/mL and excellent response to treatment had a very low recurrence rate (<0.8%). In contrast, higher recurrence rates were observed in intermediate-risk to high-risk patients with postoperative s-Tg ≥ 10 ng/mL and indeterminate response (25%) and in those with incomplete response regardless of ATA category or postoperative s-Tg value (38.5-87.5%). Using proportion of variance explained (PVE), the predicted recurrence using the ATA initial risk assessment alone was 12.7% and increased to 29.9% when postoperative s-Tg was added to the logistic regression model and 49.1% with dynamic risk stratification. Conclusions: The combination of ATA staging system and postoperative s-Tg can better predict the risk of PTC recurrence. Initial risk estimates can be refined based on dynamic risk assessment following response to therapy, thus providing a useful guide for follow-up recommendations. Objective prognosis (PTC (ATA sTg s Tg (s-Tg . stratification) methods 1611 1 611 1,61 87.3% 873 87 (87.3% RAI (RAI administration evaluated categories followup follow up Results 615 61 5 61. range 12246 12 246 12-24 months, , months) 9 6.1% 6 (6.1% 23 2 2.3 lowrisk, lowrisk low-risk intermediaterisk, intermediaterisk 25 highrisk high p 0.001. 0001 0.001 0 001 0.001) approach ngmL ng mL 24 978 97 8 97.8% <0.8%. 08 <0.8% (<0.8%) contrast (25% 38.587.5%. 385875 38.5 87.5% 38 (38.5-87.5%) PVE, PVE (PVE) 127 7 12.7 299 29 29.9 491 49 49.1 Conclusions recommendations 161 1,6 87.3 (87.3 1224 12-2 6.1 (6.1 2. 000 0.00 00 97.8 <0.8 (<0.8% (25 587 38.587.5% 38587 385 38. 875 87.5 (38.5-87.5% (PVE 12. 29. 4 49. 16 1, 87. (87. 122 12- 6. (6. 0.0 97. <0. (<0.8 (2 58 38.587.5 3858 (38.5-87.5 (87 (6 0. <0 (<0. ( 38.587. (38.5-87. (8 (<0 38.587 (38.5-87 (< 38.58 (38.5-8 (38.5- (38.5 (38. (38 (3

ABSTRACT Objective: Despite its recognized importance, primary hyperaldosteronism (PHA) remains an underdiagnosed condition in clinical practice. The objective of the present study was to evaluate PHA screening practices by general practitioners and specialists in endocrinology and cardiology. Subjects and methods: This cross-sectional, observational study invited physicians to respond voluntarily to an online survey. The survey collected the respondents’ sociodemographic data and answers to five hypothetical clinical cases meeting Endocrine Society criteria for PHA screening. Results: In all, 126 physicians responded to the online survey. Endocrinologists were the specialists who most often chose PHA screening, although the screening rates were overall low, ranging from 36.5% to 92.9%, depending on the case and the respondents’ specialty. The survey also assessed the reasons for not choosing PHA screening, which included limited availability of tests within the public health services, interference of antihypertensive medications on hormone levels, and failure to identify the screening indication. Being an endocrinologist was an independent predictor for choosing PHA screening for the patients in Cases #1 and #5 (p = 0.001 and p = 0.002, respectively). Conclusion: Endocrinologists were the specialists who most often chose PHA screening, although the screening rates were overall low among all specialists. These findings highlight a need for continuing medical education programs addressing PHA screening and making the diagnosis of PHA more present in the daily clinical practice of physicians treating patients with hypertension. Objective importance (PHA cardiology methods crosssectional, crosssectional cross sectional, sectional cross-sectional respondents Results 12 365 36 5 36.5 929 92 9 92.9% specialty services levels indication 1 # 0001 0 001 0.00 0002 002 0.002 respectively. respectively . respectively) Conclusion hypertension 3 36. 92.9 000 00 0.0 92. 0.

ABSTRACT Objective: The study aims to explore the relationship between lipoprotein lipase (LPL) variants and hyperlipidemic acute pancreatitis (HLAP) in the southeastern Chinese population. Subjects and methods: In total, 80 participants were involved in this study (54 patients with HLAP and 26 controls). All coding regions and intron-exon boundaries of the LPL gene were sequenced. The correlations between variants and phenotypes were also analysed. Results: The rate of rare LPL variants in the HLAP group is 14.81% (8 of 54), higher than in controls. Among the detected four variants (rs3735959, rs371282890, rs761886494 and rs761265900), the most common variant was rs371282890. Further analysis demonstrated that subjects with rs371282890 "GC" genotype had a 2.843-fold higher risk for HLAP (odds ratio [OR]: 2.843, 95% confidence interval [CI]: 1.119-7.225, p = 0.028) than subjects with the "CC" genotype. After adjusting for sex, the association remained significant (adjusted OR: 3.083, 95% CI: 1.208-7.869, p = 0.018). Subjects with rs371282890 "GC" genotype also exhibited significantly elevated total cholesterol, triglyceride and non-high-density lipoprotein cholesterol levels in all the participants and the HLAP group (p < 0.05). Conclusion: Detecting rare variants in LPL might be valuable for identifying higher-risk patients with HLAP and guiding future individualised therapeutic strategies. Objective (LPL (HLAP population methods 8 54 (5 2 controls . controls) intronexon intron exon sequenced analysed Results 1481 14 81 14.81 ( 54, , 54) rs3735959, rs3735959 rs (rs3735959 rs76188649 rs761265900, rs761265900 rs761265900) rs37128289 GC "GC 2.843fold 2843fold fold 2.843 843 odds OR [OR] 2843 95 CI [CI] 1.1197.225, 11197225 1.119 7.225, 1 119 7 225 1.119-7.225 0.028 0028 0 028 CC "CC sex adjusted 3083 3 083 3.083 1.2087.869, 12087869 1.208 7.869, 208 869 1.208-7.869 0.018. 0018 0.018 018 0.018) nonhighdensity non high density 0.05. 005 0.05 05 0.05) Conclusion higherrisk strategies 5 148 14.8 rs373595 (rs373595 rs7618864 rs76126590 rs3712828 843fold 2.84 84 [OR 284 9 [CI 1197 1.1197.225 1119722 1119 1.11 7225 7.225 11 22 1.119-7.22 0.02 002 02 308 08 3.08 2087 1.2087.869 1208786 1208 1.20 7869 7.869 20 86 1.208-7.86 001 0.01 01 00 0.0 14. rs37359 (rs37359 rs761886 rs7612659 rs371282 2.8 28 1.1197.22 111972 111 1.1 722 7.22 1.119-7.2 30 3.0 1.2087.86 120878 120 1.2 786 7.86 1.208-7.8 0. rs3735 (rs3735 rs76188 rs761265 rs37128 2. 1.1197.2 11197 1. 72 7.2 1.119-7. 3. 1.2087.8 12087 12 78 7.8 1.208-7. rs373 (rs373 rs7618 rs76126 rs3712 1.1197. 7. 1.119-7 1.2087. 1.208-7 rs37 (rs37 rs761 rs7612 rs371 1.1197 1.119- 1.2087 1.208- rs3 (rs3 rs76 (rs rs7

ABSTRACT Objective: To investigate the relationship between fasting blood glucose (FBG) and carotid intima-media thickness (IMT) in premenopausal and postmenopausal women. Subjects and methods: The study enrolled 2,959 women seen at the Maanshan People's Hospital of Anhui Province from December 2013 to December 2018. Carotid IMT was measured using Doppler ultrasound. Linear regression and R smoothing curves were used to analyze the relationship between blood glucose level and carotid IMT in the premenopausal and postmenopausal groups. Results: Postmenopausal compared with premenopausal women had higher mean IMT (mIMT; 0.81 ± 0.23 mm versus 0.70 ± 0.14 mm, respectively, p < 0.001) and maximum IMT (maxIMT; 0.86 ± 0.35 mm versus 0.74 ± 0.16 mm, respectively, p < 0.001) values. On linear regression analysis, mIMT values increased with increasing FBG values when FBG level was ≤ 7 mmol/L, but no significance was found between FBG and maxIMT. After stratification by menopausal status, mIMT and maxIMT increased with increasing FBG when FBG was ≤ 7 mmol/L in the premenopausal group. In the postmenopausal group, mIMT and maxIMT increased with increasing FBG. After adjustment for covariate factors, the relationship between FBG and mIMT remained the same as before the adjustment, but when FBG was ≤ 11 mmol/L, the maxIMT increased with increasing FBG. In the stratification analysis, maxIMT increased with increasing FBG when FBG was ≤ 7 mmol/L in the premenopausal group, while both mIMT and maxIMT increased with increasing FBG when FBG was > 10 mmol/L in the postmenopausal group. Conclusion: Levels of FBG contributed more to increased IMT in postmenopausal than premenopausal women. The influence of FBG was greater on maxIMT than mIMT. Additionally, FBG was helpful in assessing focal thickening of the carotid intima. Objective (FBG intimamedia intima media (IMT methods 2959 2 959 2,95 Peoples People s 201 2018 ultrasound groups Results (mIMT 081 0 81 0.8 023 23 0.2 070 70 0.7 014 14 0.1 respectively 0.001 0001 001 (maxIMT 086 86 035 35 0.3 074 74 016 16 analysis mmolL mmol L status group factors 1 Conclusion Additionally 295 95 2,9 20 08 8 0. 02 07 01 0.00 000 00 03 3 29 9 2, 0.0

ABSTRACT Differentiated thyroid carcinoma (DTC) accounts for most cases of thyroid cancer, and the heterogeneity of DTC requires that management decisions be taken by a multidisciplinary team involving endocrinologists, head and neck surgeons, nuclear medicine physicians, pathologists, radiologists, radiation oncologists, and medical oncologists. It is important for nonspecialists to recognize and refer patients with DTC who will benefit from a specialized approach. Recent advances in knowledge and changes in management of DTC call for the need to raise awareness on the part of these nonspecialist physicians, including general endocrinologists and medical oncologists at large. We provide an overview of diagnostic and therapeutic principles in DTC, especially those that bear direct implication on day-to-day management of these patients by generalists. Patients with DTC may be broadly categorized as having localized, locally persistent/recurrent, or metastatic disease. Current recommendations for DTC include a three-tiered system that classifies patients with localized disease into low, intermediate, or high risk of persistent or recurrent disease. Risk stratification should be performed at baseline and repeated on an ongoing basis, depending on clinical evolution. One of the overarching goals in the management of DTC is the need to personalize treatment by tailoring its modality and intensity according to ongoing prognostic stratification, evolving knowledge about the disease, and patient characteristics and preference. In metastatic disease that is refractory to radioactive iodine, thyroid tumors are being reclassified into molecular subtypes that better reflect their biological properties and for which molecular alterations can be targeted with specific agents. (DTC cancer surgeons physicians pathologists radiologists approach large daytoday day generalists persistentrecurrent persistent/recurrent threetiered three tiered low intermediate basis evolution preference iodine agents

ABSTRACT Objective: Both pulsatile gonadotropin-releasing hormone (GnRH) and combined gonadotropin therapy are effective to induce spermatogenesis in men with congenital hypogonadotropic hypogonadism (CHH). This study aimed to evaluate the effect of pulsatile GnRH therapy on spermatogenesis in male patients with CHH who had poor response to combined gonadotropin therapy. Materials and methods: Patients who had poor response to combined gonadotropin therapy ≥ 6 months were recruited and shifted to pulsatile GnRH therapy. The rate of successful spermatogenesis, the median time to achieve spermatogenesis, serum gonadotropins, testosterone, and testicular volume were used for data analysis. Results: A total of 28 CHH patients who had poor response to combined gonadotropin (HCG/HMG) therapy for 12.5 (6.0, 17.75) months were recruited and switched to pulsatile GnRH therapy for 10.0 (7.25, 16.0) months. Sperm was detected in 17/28 patients (60.7%). The mean time for the appearance of sperm in semen was 12.0 (7.5, 17.5) months. Compared to those who could not achieve spermatogenesis during pulsatile GnRH therapy, the successful group had a higher level of LH60min (4.32 vs. 1.10 IU/L, P = 0.043) and FSH60min (4.28 vs. 1.90 IU/L, P = 0.021). Testicular size increased during pulsatile GnRH therapy, compared to previous HCG/HMG therapy (P < 0.05). Conclusion: For CHH patients with prior poor response to one year of HCG/HMG therapy, switching to pulsatile GnRH therapy may induce spermatogenesis. Objective gonadotropinreleasing releasing (GnRH CHH. . (CHH) methods gonadotropins testosterone analysis Results 2 HCGHMG HCG HMG (HCG/HMG 125 12 5 12. 6.0, 60 0 (6.0 17.75 1775 17 75 100 10 10. 7.25, 725 7 25 (7.25 16.0 160 16 1728 17/2 60.7%. 607 60.7% (60.7%) 120 7.5, (7.5 17.5 175 LHmin LH min 4.32 432 4 32 (4.3 vs 110 1 1.1 IUL IU L IU/L 0.043 0043 043 FSHmin FSH 4.28 428 (4.2 190 90 1.9 0.021. 0021 0.021 021 0.021) 0.05. 005 0.05 05 0.05) Conclusion (CHH 6.0 (6. 17.7 177 7.25 72 (7.2 16. 172 17/ 60.7 (60.7% 7.5 (7. 17. 4.3 43 3 (4. 11 1. 0.04 004 04 4.2 42 19 9 002 0.02 02 00 0.0 6. (6 7.2 60. (60.7 7. (7 4. (4 0. ( (60. (60

SUMMARY Lipodystrophies are characterized by complete or selective loss of adipose tissue and can be acquired or inherited. Familial partial lipodystrophy (FPLD) is a hereditary lipodystrophy commonly caused by mutations in the LMNA gene. Herein, we report two cases of FPLD associated with podocytopathies. Patient 1 was diagnosed with FPLD associated with the heterozygous p.Arg482Trp variant in LMNA and had normal glucose tolerance and hyperinsulinemia. During follow-up, she developed nephrotic-range proteinuria. Renal biopsy was consistent with minimal change disease. Patient 2 was diagnosed with FPLD associated with a de novo heterozygous p.Arg349Trp variant in LMNA. Microalbuminuria progressed to macroalbuminuria within 6 years and to nephrotic range proteinuria in the last year. He remained without diabetes and with hyperinsulinemia. Renal biopsy revealed focal segmental glomerulosclerosis not otherwise specified. This report provides further evidence of variable features of lipodystrophy associated with LMNA variants and the importance of long-term follow-up with evaluation of kidney dysfunction. inherited (FPLD gene Herein podocytopathies pArg482Trp pArgTrp p Arg482Trp Arg Trp hyperinsulinemia followup, followup follow up, up nephroticrange disease pArg349Trp Arg349Trp year specified longterm long term dysfunction pArg ArgTrp