ACTA ENDOCRINOLOGICA (BUC)

Context. Sleeve gastrectomy is an effective method for management of obesity. The Bariatric Analysis and Reporting Outcome System (BAROS) is a comprehensive and standard system for the assessment of outcomes of weight loss surgery. It is consisted of weight loss, changes in obesityrelated comorbidities and quality of life measurements. We investigated results of the sleeve gastrectomy based on the BAROS. Material and Methods. Outcomes of laparoscopic sleeve gastrectomy surgery was studied in 45 patients with obesity (11 male, 34 female), after 45 months in Turkey. Results. Total weight loss was 26.4±0.1% of body weight at 45 months. Weight regain was seen in 97.8% of the patients with an average 14.5 kg and 13.7% body mass index points. The surgery caused 76% decrease in incidence of obstructive sleep apnea, 73% decrease in type 2 diabetes, 63% decrease in hyperlipidemia and 62% decrease in hypertension. Significant improvement is observed in all quality-of-life parameters. The final score of the BAROS was 4.23±1.02. Conclusion. Based on BAROS, sleeve gastrectomy provides significant improvements in weight loss, incidence of medical comorbidities and quality of life after surgery. Future studies should address prevention of weight regain after the surgery.

Aims. We investigated the prevalence of micro and macro-vascular complications and how these patients perform with respect to current treatment goals. \r\nMethods. We performed a cross-sectional study in type 2 diabetes subjects treated with biguanides in monotherapy, attending a standard diabetes outpatient clinic during 2008-2009. We used the latest available visit at the Clinic for data regarding demographics, anthropometrics, biochemistry, micro and macrovascular complications of diabetes. \r\nResults. We investigated 814 subjects, 463 (56.9%) females, mean age 62.6?10.5 years, age at diabetes onset 60?10.4 years, and a disease duration at study inclusion 2.6?3.9 years. Only 5.2% of females and 17.7% (p<0.01) of males had a waist circumference <80/<94 cm and 40.4% of cases had a fasting plasma glucose <7.21 mmol/l. The therapeutic target for blood pressure was achieved in 14.7% of cases for systolic blood pressure (<130 mmHg) and 29.6% for diastolic blood pressure (<80 mmHg). \r\nConclusion. Individuals with type 2 diabetes treated with biguanides in monotherapy are poorly controlled, have a high prevalence of metabolic syndrome components as well as micro and macrovascular complications.

Newborn screening of phenylketonuria (PKU) is performed in many countries, including Romania, in addition to screening for congenital hypothyroidism. Patients affected by PKU require frequent measurements of phenylalanine (Phe) level in blood plasma. Such a determination is important not only in early diagnostic, but also in monitoring the treatment of PKU to maintain phenylalaninemia within limits that will not affect the brain. A simple, highly sensitive, accurate and rather inexpensive procedure for the simultaneous determination of Phe and Tyr plasma concentrations was previously described in this journal. The new procedure may be applied in many clinical laboratories, including those with no previous experience in diagnosis of inherited amino acid metabolic disorders. In this way the major public health problems linked to PKU not being detected in the first weeks of life (including the burden of institutionalized children with preventable mental retardation) may be avoided.

Objective. We aimed to investigate the prevalence of obesity and visceral obesity (VO) within children living on the small Greek island of Tinos and their associated factors. Methods. Three hundred and fifty two healthy children and pre-adolescents (54% boys) attending the primary schools of Tinos island were evaluated, aged (mean±SD) 8.53±1.72 years (range 6-11), from which 286 (81.25%) were of Greek origin and 65 (18.46%) foreign immigrants. Body weight, height and waist circumference (WC) were measured, plus BMI and WC percentiles were calculated. Children with WC > 90th percentile were categorized as having VO. Results. Among our patients, 235 (66.76%) were of normal weight, 88 (25%) overweight and 29 (8.2%) obese. Obese children, as opposed to their normal weight counterparts, were more likely to be of younger age (p=0.009). VO was found in 65 (18.47%) children, with a higher prevalence among the obese than overweight ones (96.43% vs. 42%, p<0.001). There was no difference in the prevalence of VO between children and pre-adolescents. However, foreign immigrants had lower frequency of overweight and obese children (p=0.026) and less viscerally obese children (9.09% vs. 20.63%, p=0.018) than the Greek participants. Conclusions. The prevalence of childhood obesity in rural Tinos was 8.24%, which was lower than the reported national prevalence of obesity in Greece, whilst almost all of the obese and 42% of the overweight children presented VO. The low prevalence of childhood obesity and VO on this small island could possibly be attributed to a more healthy diet and natural way of life.

Background. Repeated implantation failure (RIF) is the most important problem in assisted reproductive technologies (ART). In the process of embryo implantation, accurate function of progesterone through progesterone receptors (PR) is crucial for establishment of a receptive endometrium. FKBP51 and FKBP52 are two co-chaperones acting as negative and positive regulators of PR function, respectively. Studies have shown that any deficiencies in expression of PR or its co-chaperones causes reproductive disorders. Materials and Methods. In this study we evaluated the PR protein expression by immunohistochemistry and expression of PR, FKBP51, FKBP52 genes by quantitative real-time PCR in endometrial tissue of normal and RIF women during the window of implantation. Results. Immunohistochemical studies showed that the PR protein expression in stromal cells is significantly higher in the endometrium of normal women than RIF women (P< 0.001). In addition, a significantly lower PR and FKBP52 gene expression was observed in endometrial tissue of RIF women compared to normal women (P< 0.001 and P< 0.001, respectively), whereas there was no significant difference in PR protein in epithelial cells (P= 0.3) and FKBP51 gene expression between the two groups (P= 0.6). Conclusion. The results indicate that altered expression of PR protein in stromal compartment and gene expression of PR and FKBP52 gene in endometrial tissue can be related to endometrial receptivity defects and occurrence of RIF.

Introduction. Considering the very important role of adiponectin and leptin in\r\natherogenesis, it is important to study their relationship with other important factors in\r\nestablishing the cardiometabolic risk: hyperglycemia and serum lipids.\r\nPatients and Methods. There were studied 79 subjects (s), aged 59? 9 years, divided\r\ninto 3 groups according to body mass index (BMI): group I with BMI<25 kg/m2 - 19 s,\r\ngroup II with BMI 25-30 kg/m2 - 30s, and group III with BMI >30 kg/m2 - 30 s. In all\r\nsubjects the plasmatic levels of adiponectin, leptin and other cardiometabolic risk factors:\r\nblood glucose, total cholesterol, triglycerides, high density cholesterol, low density\r\ncholesterol were measured.\r\nResults. Considering the values of adiponectin and leptin in the three groups,\r\nadiponectin was significantly increased (14355?9120.40 vs 5889.167?6278.963 ng/mL,\r\np=0.015) and leptin significantly decreased (7212?7428.45 vs 9235.81?10988.66 pg/mL,\r\np=0.03), in group I in comparison with group II+III. Adiponectin and leptin were not\r\nsignificantly different in subjects with fasting glucose less or more than 110 mg/dL and the\r\nsame insignificant difference was registered for both adipokines between diabetic and non\r\ndiabetic subjects. Considering the plasma lipid fractions, it was registered an inverse\r\nsignificant correlation between adiponectin and total cholesterol, respectively LDL\r\ncholesterol, and a positive correlation with HDL cholesterol; leptin was inversely correlated\r\nwith HDL cholesterol, but not with LDL cholesterol or total cholesterol.\r\nConclusion. In the present study, the plasmatic values of adipokines (adiponectin and\r\nleptin) were correlated only to the BMI values (obesity) and respectively to the lipidic\r\nfractions. No correlation was registered with diabetes or impaired fasting glucose.

Context. The 131I activity for treating Graves’ disease (GD) is usually determined based on physician’s experience. Objective. This study aimed to design an empirical method that was not only personalized and quantitative, but also simple, convenient, and easy to grasp. Subjects and Methods. The study population comprised patients with GD, selected between May 2013 and May 2016, who received 131I therapy in the Outpatient Department of Shanghai Ninth People’s Hospital. The firstvisit patients of physician 1 were placed in the traditional group: the activity of 131I (mCi) was calculated using the routine formula: [empirical activity (0.07–0.12 mCi/g) × thyroid mass]/[24-h thyroid 131I uptake]. The first-visit patients of physician 2 were placed in the personalized group. The activity of 131I (mCi) was calculated in two steps. First, the initial activity was calculated: 0.1 mCi/g × thyroid mass (g), and then a personalized and quantitative calibration table of 131I activity was used to obtain a final 131I activity. The cure rate with a single activity of 131I was recorded 1 year later. Results. The traditional and personalized groups included 241 and 282 patients, respectively. Interestingly, the personalized group achieved a higher cure rate [86.5% (244/282) versus 73.4% (177/241), P = 0.000] with a relatively higher 131I activity for the first treatment [8.7 (7, 3.5-30) mCi versus 6.7(6, 2.5-30) mCi, P = 0.000] compared with the traditional group, while the incidence rate of permanent hypothyroidism was not significantly different between the two groups (P = 0.175). Conclusion. The empirical method designed in this study was reliable.

Aims. To investigate the effect of sulphonylurea (SU) treatment on all-cause and cardiovascular mortality as compared with metformin (MET), when used in combination with insulin (INS) in type 2 diabetes. Methods. All type 2 diabetes patients aged ≥40 years were included at their first prescription of INS+MET or INS+SU, during 2001-2008. They were considered at risk until death or December 31st, 2011. Mortality rates were calculated per 1000 person-years. Crude and adjusted rate ratios (RR) were calculated using time dependent analysis with INS+MET as reference. Results. There were 7122 patients (60.8% women) included in the analysis, with a mean age at baseline of 62.0±9.9 years. During the 11 years of study, patients on INS+MET contributed 13620 person-years and 330 deaths (mortality rate 24, CI95% 22-27), while those on INS+SU contributed 8720 person-years and 393 deaths (mortality rate 45, CI95% 41-50). Adjusted all-cause mortality RR were: SU 1.6 (CI95% 1.21-2.11, p<0.001), glimepiride 1.18 (CI95% 0.73-1.91, p=0.51), gliclazide 1.78 (CI95% 1.07-2.95, p=0.024), glibenclamide 1.66 (CI95% 0.71-3.88, p=0.23), glipizide 1.24 (CI95% 0.68-2.27, p=0.49), and gliquidonum 2.32 (CI95% 1.54-3.50, p=0.001). Conclusions. When combined with insulin as dual therapy, patients treated with SU were at increased mortality risk as compared with insulin + MET.

ntroduction. Childhood obesity is a public health problem characterized by early insulin resistance (IR), inflammation, and oxidative stress. The presence of an uninterrupted low-grade inflammatory state impairs metabolic and cardiovascular health. The population is particularly susceptible to develop metabolic disorders related to increased body fat. Methods. Eighty-three adolescents were recruited and grouped according to HOMA-IR and BMI in either with or without IR and obese or normal-weight respectively. Anthropometric, biochemical, immunological and hormonal variables were determined. Transverse Analytical Study. Results. Obesity, dyslipidemia, IL-6, and C-reactive protein were significantly higher in the IR group than in the non-IR group. Obese adolescents showed increased insulin levels, HOMA-IR, inflammatory markers, and triglycerides; while having lower HDL-C, and adiponectin when compared to normal-weight adolescents. As expected, obesity-related anthropometric markers positively correlated with IR and inflammatory markers while negatively correlated with adiponectin levels. Conclusions. Early IR, subclinical inflammation, dyslipidemia, and hypoadiponectinemia characterize obesity in adolescents. These factors may increase the risk of future coronary heart disease (CHD) and diabetes mellitus development (DM) in early adulthood.

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