Heterogeneous natural history of Addison’s disease: mineralocorticoid deficiency may predominate

Autoimmune Addison’s disease (AAD) is defined as primary adrenal insufficiency due to immune-mediated destruction of the adrenal cortex. This destruction of steroid-producing cells has historically been thought of as an irreversible process, with linear progression from an ACTH-driven compensated phase to overt adrenal insufficie ncy requiring lifelong glucocorticoid replacement. However, a growing body of evidence suggests that this process may be more heterogeneous than previously thought, with potential for complete or partial recovery of glucocorticoid secretion. Although patients with persistent mineralocorticoid deficiency despite preserved or recovered glucocorticoid function are anecdotally mentioned, few well-documented cases have been reported to date. We present three patients in the United Kingdom who further challenge the long-standing hypothesis that AAD is a progressive, irreversible disease process. We describe one patient with a 4-year history of mineralocorticoid-only Addison’s disease, a patient with spontaneous recovery of adrenal function and one patient with clinical features of adrenal insufficiency despite significant residual cortisol function. All three patients show varying degrees of mineralocorticoid deficiency, suggesting that recovery of zona fasciculata function in the adrenal cortex may occur independently to that of the zona glomerulosa. We outline the current evidence for heterogeneity in the natural history of AAD and discuss possible mechanisms for the recovery of adrenal function

Gas-Bearing Early-Type Dwarf Galaxies in Virgo: Evidence for Recent Accretion

We investigate the dwarf (M_B> -16) galaxies in the Virgo cluster in the radio, optical, and ultraviolet regimes. Of the 365 galaxies in this sample, 80 have been detected in HI by the Arecibo Legacy Fast ALFA survey. These detections include 12 early-type dwarfs which have HI and stellar masses similar to the cluster dwarf irregulars and BCDs. In this sample of 12, half have star-formation properties similar to late type dwarfs, while the other half are quiescent like typical early-type dwarfs. We also discuss three possible mechanisms for their evolution: that they are infalling field galaxies that have been or are currently being evolved by the cluster, that they are stripped objects whose gas is recycled, and that the observed HI has been recently reaccreted. Evolution by the cluster adequately explains the star-forming half of the sample, but the quiescent class of early-type dwarfs is most consistent with having recently reaccreted their gas.Comment: 18 pages, 9 figure

Electronic structure of tetra(4-aminophenyl)porphyrin studied by photoemission, UV–Vis spectroscopy and density functional theory

The valence and conduction bands of a thin film of tetra(4-aminophenyl)porphyrin (TAPP) are investi-gated by direct and inverse photoemission as well as by comparison to density functional theory (DFT)calculations. By projecting the electronic eigenfunctions onto the molecular framework it was possibleto interpret the origin of each spectroscopic feature. Although the majority of the photoemission spec-trum is attributed to the unsubstituted tetraphenylporphyrin (TPP) parent molecule, several featuresare clearly due to the amino substitution. Substitution also has important consequences for the energypositions of the frontier orbitals and therefore on the low-energy electronic excitations. The measuredelectronic transport energy gap (Eg= 1.85 eV) between the highest occupied molecular orbital (HOMO)and lowest unoccupied (LUMO) in TAPP is found to be significantly reduced with respect to TPP. More-over, an increased energy separation between the two highest occupied states (HOMO and HOMO−1) isfound both experimentally and by DFT calculations. Such evidence is attributed to an increased HOMOorbital destabilization due to an enhanced electron-donor character of the phenyl substituents uponamino functionalization. Finally, the above findings together with further time-dependent DFT calcula-tions are used to interpret the effect of the amino groups on the UV–Vis absorption spectrum, namely anoverall red-shift of the spectrum and remarkable intensity changes within the Q band.© 2017 Elsevier B.V

Management of Osteoporosis in Men: A Narrative Review

Male osteoporosis is a still largely underdiagnosed pathological condition. As a consequence, bone fragility in men remains undertreated mainly due to the low screening frequency and to controversies in the bone mineral density (BMD) testing standards. Up to the 40% of overall osteoporotic fractures affect men, in spite of the fact that women have a significant higher prevalence of osteoporosis. In addition, in males, hip fractures are associated with increased morbidity and mortality as compared to women. Importantly, male fractures occur about 10 years later in life than women, and, therefore, due to the advanced age, men may have more comorbidities and, consequently, their mortality is about twice the rate in women. Gender differences, which begin during puberty, lead to wider bones in males as compared with females. In men, follicle-stimulating hormones, testosterone, estrogens, and sex hormone-binding levels, together with genetic factors, interact in determining the peak of bone mass, BMD maintenance, and lifetime decrease. As compared with women, men are more frequently affected by secondary osteoporosis. Therefore, in all osteoporotic men, a complete clinical history should be collected and a careful physical examination should be done, in order to find clues of a possible underlying diseases and, ultimately, to guide laboratory testing. Currently, the pharmacological therapy of male osteoporosis includes aminobisphosphonates, denosumab, and teriparatide. Hypogonadal patients may be treated with testosterone replacement therapy. Given that the fractures related to mortality are higher in men than in women, treating male subjects with osteoporosis is of the utmost importance in clinical practice, as it may impact on mortality even more than in women

The complications of male hypogonadism: is it just a matter of low testosterone?

The history of diagnosing hypogonadism and hypotestosteronemia shows us the many steps that were necessary to achieve our current knowledge and the ability to improve these patients’ well-being. Moreover, so far, criteria for diagnosing hypotestosteronemia varies according to the underlying condition, and according to the consensus or guideline adopted. Furthermore, besides the many signs and symptoms, there are several complications associated with low testosterone levels such as osteoporosis, metabolic alterations, as well as cardiovascular disorders. However, data are often conflicting regarding the severity, timing or even the real clinical relevance of these complications, although these studies often lack essential information such as gonadotropin levels or the underlying cause of hypogonadism. The present review focus on the complications of male hypogonadism according to the cause of testosterone deficiency, highlighting the lack of information found in many studies investigating its effects. We thereby stress the necessity to always perform a complete evaluation of the type of hypogonadism (including at least gonadotropins and secondary causes) when investigating the effects of low testosterone levels

COLD GASS, an IRAM legacy survey of molecular gas in massive galaxies: I. Relations between H2, HI, stellar content and structural properties

We are conducting COLD GASS, a legacy survey for molecular gas in nearby galaxies. Using the IRAM 30m telescope, we measure the CO(1-0) line in a sample of ~350 nearby (D=100-200 Mpc), massive galaxies (log(M*/Msun)>10.0). The sample is selected purely according to stellar mass, and therefore provides an unbiased view of molecular gas in these systems. By combining the IRAM data with SDSS photometry and spectroscopy, GALEX imaging and high-quality Arecibo HI data, we investigate the partition of condensed baryons between stars, atomic gas and molecular gas in 0.1-10L* galaxies. In this paper, we present CO luminosities and molecular hydrogen masses for the first 222 galaxies. The overall CO detection rate is 54%, but our survey also uncovers the existence of sharp thresholds in galaxy structural parameters such as stellar mass surface density and concentration index, below which all galaxies have a measurable cold gas component but above which the detection rate of the CO line drops suddenly. The mean molecular gas fraction MH2/M* of the CO detections is 0.066+/-0.039, and this fraction does not depend on stellar mass, but is a strong function of NUV-r colour. Through stacking, we set a firm upper limit of MH2/M*=0.0016+/-0.0005 for red galaxies with NUV-r>5.0. The average molecular-to-atomic hydrogen ratio in present-day galaxies is 0.3, with significant scatter from one galaxy to the next. The existence of strong detection thresholds in both the HI and CO lines suggests that "quenching" processes have occurred in these systems. Intriguingly, atomic gas strongly dominates in the minority of galaxies with significant cold gas that lie above these thresholds. This suggests that some re-accretion of gas may still be possible following the quenching event.Comment: Accepted for publications in MNRAS. 32 pages, 25 figure

COLD GASS, an IRAM Legacy Survey of Molecular Gas in Massive Galaxies: II. The non-universality of the Molecular Gas Depletion Timescale

We study the relation between molecular gas and star formation in a volume-limited sample of 222 galaxies from the COLD GASS survey, with measurements of the CO(1-0) line from the IRAM 30m telescope. The galaxies are at redshifts 0.025<z<0.05 and have stellar masses in the range 10.0<log(M*/Msun)<11.5. The IRAM measurements are complemented by deep Arecibo HI observations and homogeneous SDSS and GALEX photometry. A reference sample that includes both UV and far-IR data is used to calibrate our estimates of star formation rates from the seven optical/UV bands. The mean molecular gas depletion timescale, tdep(H2), for all the galaxies in our sample is 1 Gyr, however tdep(H2) increases by a factor of 6 from a value of ~0.5 Gyr for galaxies with stellar masses of 10^10 Msun to ~3 Gyr for galaxies with masses of a few times 10^11 Msun. In contrast, the atomic gas depletion timescale remains contant at a value of around 3 Gyr. This implies that in high mass galaxies, molecular and atomic gas depletion timescales are comparable, but in low mass galaxies, molecular gas is being consumed much more quickly than atomic gas. The strongest dependences of tdep(H2) are on the stellar mass of the galaxy (parameterized as log tdep(H2)= (0.36+/-0.07)(log M* - 10.70)+(9.03+/-0.99)), and on the specific star formation rate. A single tdep(H2) versus sSFR relation is able to fit both "normal" star-forming galaxies in our COLD GASS sample, as well as more extreme starburst galaxies (LIRGs and ULIRGs), which have tdep(H2) < 10^8 yr. Normal galaxies at z=1-2 are displaced with respect to the local galaxy population in the tdep(H2) versus sSFR plane and have molecular gas depletion times that are a factor of 3-5 times longer at a given value of sSFR due to their significantly larger gas fractions.Comment: Accepted for publication in MNRAS. 19 pages, 11 figure

Molecular and atomic gas along and across the main sequence of star-forming galaxies

We use spectra from the ALFALFA, GASS and COLD GASS surveys to quantify variations in the mean atomic and molecular gas mass fractions throughout the SFR-M* plane and along the main sequence (MS) of star-forming galaxies. Although galaxies well below the MS tend to be undetected in the Arecibo and IRAM observations, reliable mean atomic and molecular gas fractions can be obtained through a spectral stacking technique. We find that the position of galaxies in the SFR-M* plane can be explained mostly by their global cold gas reservoirs as observed in the HI line, with in addition systematic variations in the molecular-to-atomic ratio and star formation efficiency. When looking at galaxies within +/-0.4 dex of the MS, we find that as stellar mass increases, both atomic and molecular gas mass fractions decrease, stellar bulges become more prominent, and the mean stellar ages increase. Both star formation efficiency and molecular-to-atomic ratios vary little for massive main sequence galaxies, indicating that the flattening of the MS is due to the global decrease of the cold gas reservoirs of galaxies rather than to bottlenecks in the process of converting cold atomic gas to stars.Comment: 9 pages, 6 figures. Accepted for publication in MNRA

Colorectal cancer after bariatric surgery (Cric-Abs 2020): Sicob (Italian society of obesity surgery) endorsed national survey

Background: The published colorectal cancer (CRC) outcomes after bariatric surgery (BS) are conflicting, with some anecdotal studies reporting increased risks. The present nationwide survey CRIC-ABS 2020 (Colo-Rectal Cancer Incidence-After Bariatric Surgery-2020), endorsed by the Italian Society of Obesity Surgery (SICOB), aims to report its incidence in Italy after BS, comparing the two commonest laparoscopic procedures—Sleeve Gastrectomy (SG) and Roux-en-Y gastric bypass (GBP). Methods: Two online questionnaires—first having 11 questions on SG/GBP frequency with a follow-up of 5–10 years, and the second containing 15 questions on CRC incidence and management, were administered to 53 referral bariatric, high volume centers. A standardized incidence ratio (SIR—a ratio of the observed number of cases to the expected number) with 95% confidence intervals (CI) was calculated along with CRC incidence risk computation for baseline characteristics. Results: Data for 20,571 patients from 34 (63%) centers between 2010 and 2015 were collected, of which 14,431 had SG (70%) and 6140 GBP (30%). 22 patients (0.10%, mean age = 53 ± 12 years, 13 males), SG: 12 and GBP: 10, developed CRC after 4.3 ± 2.3 years. Overall incidence was higher among males for both groups (SG: 0.15% vs 0.05%; GBP: 0.35% vs 0.09%) and the GBP cohort having slightly older patients. The right colon was most affected (n = 13) and SIR categorized/sex had fewer values < 1, except for GBP males (SIR = 1.07). Conclusion: Low CRC incidence after BS at 10 years (0.10%), and no difference between procedures was seen, suggesting that BS does not trigger the neoplasm development