ACTA ENDOCRINOLOGICA (BUC)

Objective. to investigate the factors associated with postprandial glucose excursions in\r\npatients with type 2 diabetes.\r\nResearch Design and Methods. A complete medical history and physical examination\r\nwere assessed in 118 consecutive patients with type 2 diabetes attending the Diabetes\r\nOutpatient Clinic, Cluj-Napoca. Blood samples were collected in fasting state, and HbA1c\r\nand lipid profile were assessed. A six points blood glucose profile measured by patients at\r\nhome was performed. To determine variables associated with higher postprandial glycemic\r\nlevels, factor analysis followed by linear regression model was performed.\r\nResults. The study group had a median age of 59.2 years, 43.4% were females. The\r\nmedian duration of diabetes was 5 years. By factor analysis we have extracted 4 factors that\r\nexplained 75.6% of the variance of postprandial glycemia: factor 1 with positive loadings of\r\ntotal cholesterol and LDL cholesterol, factor 2 with positive loadings of body mass index\r\nand waist circumference, factor 3 with positive loadings of diabetes duration and age, factor\r\n4 with positive loadings of triglycerides and glycosylated hemoglobin (HbA1c). After\r\nadjustment for the sex and treatment, only factor 2 and factor 4 remained significantly associated\r\nwith postprandial glycemic values (p=0.003 and p<0.001), indicating that the postprandial\r\nglycemia is best predicted by a multiple regression that included body mass index, waist\r\ncircumference, tryglicerides and HbA1c as independent variables (r=0.54, p<0.001).\r\nConclusion. The results of our study shows that low body mass index and waist\r\ncircumference, high triglycerides and HbA1c levels are independently associated with\r\npostprandial glucose excursions.

Context. Detection of parathyroid incidentalomas (PTIs) by ultrasonography (US) generally depends on clinical experience and it can be usually confused with perithyroidal lymph nodes. Objective. We aimed to evaluate the role of US for the detection of PTIs and define clinicopathologic features of PTIs detected during routine neck US. Design. In this retrospective study, we studied PTIs in a multidisciplinary clinical approach of nuclear medicine and general surgery clinics. Subjects and Methods. US indications and reports of 41275 were reviewed retrospectively. Of these patients, PTI was suspected in 66 (0.16%) patients. Those with a pathology-confirmed diagnosis after surgery formed Group PCD and those without a pathology-confirmed diagnosis and operation Group NPCD. These groups were compared statistically according to demographic data, laboratory tests, imaging results and postoperative findings. Results. The diagnosis of PTI was confirmed pathologically in 31 operated patients. Other pathologies rather than PTI on US were multinodular goiter, thyroiditis, thyroid nodule and perithyroidal lymph node. PTH and calcium levels were significantly higher in PCD Group;anti- TPO and anti-TG levels were significantly higher in NPCD Group. Conclusions. Lesions suspected of PTI on US should be followed-up with further evaluation by laboratory tests and imaging methods and a multidisciplinary working environment should be established.

Objective. We aimed to examine the auxological findings of girls diagnosed with idiopathic central precocious puberty (CPP) at the end of the GnRHa treatment and to investigate the effect of related factors on the height gain of those patients. Design. Single-center, descriptive, cross-sectional retrospective study. Method. A total of 43 patients who were diagnosed with idiopathic CPP and treated with GnRHa between 2012 - 2021 were included in to the study. Results. A decline in height standard deviation score (SDS) from 1.20 ± 0.14 to 1.02 ± 0.06 during the therapy was observed (P<0.001). The bone age/chronological age ratio was decreased and predictive adult height was increased at the end of the therapy (P<0.001; P=0.001). Both the rates of being overweight and obesity were increased (38.6% to 50% and 9% to 15.9%) when the treatment onset compared to the end of therapy. At the end of the treatment, the mean body mass index (BMI) SDS of the overweight patients was still higher compared to the normal-weight group (P<0.001). Conclusion. We observed a positive effect of GnRHa therapy on height potential. An increase in BMI during the therapy has been also demonstrated especially in subjects who were overweight before treatment.

Background. Recent experimental data show that increased plasma adiponectin in chronic kidney disease could be a response to inflammation.\r\nObjective. To identify factors influencing adiponectinemia in patients with type 2 diabetes (T2DM) and microalbuminuria or low grade proteinuria.\r\nDesign. 32 patients with urinary albumin excretion rate (UAER)> 30 mg/g creatinine but without significant proteinuria (< trace COMBUR) were included and compared to 59 normalbuminuric T2DM controls. History, anthropometric measurements, laboratory analysis, total plasma adiponectin were obtained.\r\nResults. In our patients with UAER of 273.51?57.26 mg/g creatinine and estimated glomerular filtration rate (eGFR) 64.92?4.56 mL/min, in simple regression, adiponectinemia\r\ncorrelates inversely to eGFR (p=0.02, r= -0.38), triglyceridemia (p=0.03, r=-0.37) and hemoglobin\r\n(Hb -p= 0.01, r=-0.45) and positively to HDL cholesterol (p=0.001, r=0.54) and UAER (p<0.0001, r=0.71); the two latter parameters remain significant in multiple regression. In controls, adiponectinemia correlates inversely to age (p=0.04, r=-0.26) and BMI (p=0.04, r=-0.24); these and UAER predict adiponectinemia in multiple regression. 11 patients have UAE superior to 300 mg/g creatinine and 21 are strictly microalbuminuric (mean UAER 653.16?97.02 and 83.68?10.28mg albumin/g creatinine respectively). In microalbuminuric patients serum C reactive protein (CRP) correlates positively (p=0.0008, r=0.68) and Hb negatively (p=0.04, r=-0.41) to adiponectinemia; in multiple regression adiponectinemia only depends on CRP. In proteinuric patients CRP and\r\nglycated Hb correlate to adiponectinemia in stepwise multiple regression.\r\nConclusion. Adiponectinemia is mainly predicted by UAER in our cohort whereas it depends on age and BMI in normalbuminuric T2DM controls; in strictly microalbuminuric\r\npatients CRP is a major predictor of adiponectinemia.

Objective. Few prognostic analyses have been conducted for papillary thyroid cancer (PTC) patients with preablative stimulated Tg >10 ng/mL. We investigated the therapeutic responses and prognosis of these patients after the initial radioiodine (RAI) therapy. Methods. We retrospectively assessed 256 patients with PTC who underwent RAI remnant ablation after total thyroidectomy, and all presTg levels were >10 ng/mL. We assessed therapeutic responses and influencing factors 6–12 months after the initial RAI therapy. The Kaplan-Meier method was used to analyze progression-free survival (PFS). Results. After initial RAI therapy, excellent (ER), indeterminate (IDR), biochemically incomplete (BIR), and structurally incomplete (SIR) responses were identified in 5.1% (13/256), 22.6% (58/256), 46.9% (120/256), and 25.4% (65/256) of the patients, respectively. Among them, incomplete response (IR [BIR+SIR]), accounting for 72.3% of the responses. Univariate and multivariate analyses showed that presTg (OR=1.047, 95% CI 1.027– 1.066, p=0.000), sex (OR=3.356, 95% CI 1.613–6.986, p=0.001), and tumor size (OR=1.431, 95% CI 1.050–1.951, p=0.023) were independent risk factors for IR. ROC analysis identified presTg levels and tumor size cutoffs of 24.4 mg/ mL and 2.3 cm, respectively, for predicting IR. The PFS was significantly shorter in the SIR group than in the ER, IDR, and BIR groups (p=0.020). At the last follow-up, the number of patients with SIR decreased significantly (65 to 44 cases). Conclusions. PresTg level, tumor size, and male sex were predictive of IR, and patients with initial SIR showed the poorest prognosis. Individualized interventions can improve the prognosis of patients with an initial SIR.

Context. Endothelial dysfunction and diabetic cardiomyopathy are critical complications of diabetes. Gallic acid (GA) plays a significant role in cardiovascular disorders resulted from diabetes. In addition, increased plasma miR-24, miR-126 associated with endothelial dysfunction. Aim. The current study was designed to assess the effects of GA on plasma miR-24, miR-126 levels in the diabetic rats. Animals and Methods. Adult male Sprague-Dawley rats were divided into three groups (n=8): control (C), diabetic (D) and diabetic group treated with GA (D+G, 25 mg/kg, by gavage) for eight weeks. The blood glucose level, body weight, lipid profile, blood pressure, plasma miR-24 and miR-126 levels, antioxidant and inflammatory biomarkers were measured. Results. The plasma levels of miR-24, miR-126, body weight, high-density lipoprotein cholesterol (HDL-c), total anti-oxidant capacity (TAC) and the systolic blood pressure significantly reduced and blood glucose, total cholesterol (TC), triglycerides (TG), very low-density lipoprotein cholesterol (VLDL-c), malondialdehyde (MDA), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α) and low-density lipoprotein cholesterol (LDL-c) significantly elevated among the diabetic rats compared with the control group. However, GA restored body weight, blood pressure, TC, TG, VLDL-c, TNF-α, miR- 126, blood glucose, HDL-c, MDA, TAC, miR-24 and IL-6 among the GA treated rats compared with the diabetic group. Conclusion. GA improves inflammation, oxidative stress and hypotension result from diabetes. These protective effects are probably mediated via increasing plasma miR-24 and miR-126 levels.

Objective. The mechanisms underlying the development of diabetic neuropathic pain (NeP) are still unknown. The aim of the study was to evaluate painful diabetic neuropathy in Type II diabetic patients with Leeds Assessment of Neuropathic Symptoms and Signs Scale (LANSS), thermal and vibratory Quantitative Sensory Testing (QST) and, EMG supported Diabetic Neuropathy Score (DNS) and to evaluate the differences in patients with and without neuropathic pain. Methods. Eighty three Type II diabetic patients (26 males, 57 females) were investigated. Patients with pain were assessed by the LANSS pain scale and a score of ≥12 was classified as NeP. All patients underwent nerve conduction studies (NCS) to obtain EMG supported diabetic neuropathy score (DNS). Cold and warm sensation thresholds and cold pain and heat pain thresholds were obtained for evaluation of A-delta and C type fibers. Vibratory perception thresholds were recorded for evaluation of thickly myelinated fibers. Results. The percentage of NeP (LANSS score ≥12) was 15.7 %. QST revealed significantly lower cold detection, higher warm detection and higher heat pain thresholds at the feet in patients with NeP compared with patients without NeP. Although small fiber dysfunction has been revealed in all patients with NeP, the percentages of the presence of small fiber neuropathy and EMG supported diabetic neuropathy were not significantly different among patients with NeP and without NeP. Conclusions. We concluded that QST is a useful and a noninvasive tool to detect small fiber dysfunction in Type II diabetic patients. QST revealed increased severity of small fiber dysfunction in patients with NeP. Although small fiber neuropathy has been revealed in all Type II diabetic patients with neuropathic pain the absence of pain does not predict preserved small fiber function.

Background. ThyPRO is a recently developed thyroid-specific quality of life (QoL) questionnaire applicable to patients with benign thyroid disorders(BTD). The aim of the present study was to translate ThyPRO and ThyPRO-39 into Romanian, and to evaluate reliability and cross-cultural validity. Methods. Standard methodology for translation and linguistic validation of patient-reported outcomes (PRO) was applied. The questionnaire was completed by 130 patients with benign thyroid diseases seen at Department of Endocrinology in the Emergency County Hospital, Tîrgu Mureș, Romania, between October 2015 and March 2016. Internal reliability of the Romanian version of the ThyPRO (ThyPROro) scales was assessed for multi-item scales using Cronbach’s alpha coefficient. An efficient method for testing cross-cultural validity is analysis of differential item functioning (DIF). Uniform DIF between the Romanian and the original Danish sample was investigated using ordinal logistic regression. The translation process proceeded without difficulties, and any disagreements were revised by one of the developers and the language coordinator. Results. Internal reliability for ThyPRO was satisfactory. Cronbach`s alpha coefficients for the 13 scales ranged from 0.78 to 0.93 for the ThyPROro and 0.78 to 0.87 for the ThyPROro-39. In the 85-item ThyPRO, nine instances of DIF were found. Most were minor, explaining <3% of the variation in scale score, but DIF in positively worded items were larger, with explained variance (R2’s) around 10-15%. Conclusion. The ThyPROro questionnaire is ready for assessment of health-related quality of life in Romanian patients with benign thyroid diseases.

Context. Understanding factors delaying recovery in thyrotoxicosis patients is crucial for optimizing treatment plan. Objective. This study aimed to identify predictive factors for the delayed thyroid function recovery in thyrotoxicosis patients. Design. The study is a retrospective review of medical records of adult thyrotoxicosis patients diagnosed at Kaohsiung Veterans General Hospital, Taiwan, from January 2014 to December 2021. The duration of follow-up for the main outcome was at least 18 months. Subjects and Methods. Patients newly diagnosed with thyrotoxicosis who were age > 18 years old, had a TSH level <0.1 μIU/mL, received CBZ or PTU treatment, and demonstrated a subsequent TSH increase to above 0.4 μIU/ mL, were included. Results. The study included 443 patients. The average time to achieve normalized TSH levels was 6.9 months. Key factors associated with delayed TSH normalization included higher body mass index (BMI) [odds ratio (OR) = 1.06, confidence interval (CI): 1.01–1.12], elevated serum free T4 levels (OR = 1.97; CI, 1.44–2.69), and treatment with propylthiouracil (OR = 2.66; CI, 1.33–5.32). In contrast, factors such as sex, age, season of diagnosis, and comorbidities did not significantly impact the rate of TSH normalization. Conclusion. The study highlights the importance of considering individual patient characteristics, such as BMI and initial free T4 levels, in thyrotoxicosis management. The findings suggest a potential preference for carbimazole over PTU in achieving faster TSH normalization. This research contributes to the understanding of thyrotoxicosis recovery and supports the need for personalized treatment approaches in clinical practice.

Background. The transport of gametes and embryos is facilitated by motile cilia lining the inside of the fallopian tube. Progesterone regulates ciliary beat frequency (CBF) through multiple types of progesterone receptors in the fallopian tube. Membrane progesterone receptors beta and gamma (mPRβ and mPRγ) are both expressed in the ciliated cell lining of the fallopian tubes of humans. This study aimed at exploring the mRNA expression of mPRβ and mPRγ in the fallopian tubes of women with ectopic pregnancy. Materials and Methods. In this Case control study, a quantitative reverse transcriptase polymerase chain reaction was performed to determine the mRNA expression of mPRβ and mPRγ in the fallopian tubes obtained from 12 women with ectopic pregnancies, 12 women with normal pregnancies, and 12 healthy nonpregnant women in the luteal phase of their menstrual cycle. Results. It was indicated that mPRβ and mPRγ were expressed in the fallopian tube of the three groups of participants. However, the expression of mPRβ and mPRγ mRNA in the fallopian tube of women with ectopic pregnancy was not significantly different from that of the nonpregnant and normal pregnant women. Conclusion. These results suggest that mPRs might play no role in etiology of ectopic pregnancies associated with disturbed progesterone signalling.