Visceral adiposity index and DHEAS are useful markers of diabetes risk in women with polycystic ovary syndrome

Objective: On the basis of the known diabetes risk in polycystic ovary syndrome (PCOS), recent guidelines of the Endocrine Society recommend the use of an oral glucose tolerance test (OGTT) to screen for impaired glucose tolerance (IGT) and type 2 diabetes (T2DM) in all women with PCOS. However, given the high prevalence of PCOS, OGTTwould have ahigh cost-benefit ratio. In this study, we identified, through a receiver operating characteristic analysis, simple predictive markers of the composite endpoint (impaired fasting glucose (IFG) or IGT or IFGCIGT or T2DM) in women with PCOS according to the Rotterdam criteria.Design: We conducted a cross-sectional study of 241 women with PCOS in a university hospital setting.Methods: Clinical, anthropometric, and metabolic (including OGTT) parameters were evaluated. The homeostasis model assessment of insulin resistance (HOMA2-IR), the Matsuda index of insulin sensitivity, and the oral dispositional index and visceral adiposity index (VAI) were determined.Results: Out of 241 women included in this study, 28 (11.6%) had an IFG, 13 (5.4%) had IGT, four (1.7%) had IFGCIGT, and four (1.7%) had T2DM. Among the anthropometric variables examined, the VAI had a significantly higher C-statistic compared with BMI (0.760 (95% CI: 0.70-0.81) vs 0.613 (95% CI: 0.54-0.67); PZ0.014) and waist circumference (0.760 (95% CI: 0.70-0.81) vs 0.619 (95% CI: 0.55-0.68); PZ0.028). Among all the hormonal and metabolic serum variables examined, DHEAS showed the highest C-statistic (0.720 (95% CI: 0.65-0.77); P<0.001).Conclusions: In addition to fasting glucose, the VAI and DHEAS may be considered useful tools for prescreening in all women with PCOS without the classical risk factors for diabetes

TOpic: rare and special cases, the real "Strange cases"

Introduction: The bladder hernia represents approximately 1-3% of all inguinal hernias, where patients aged more than 50 years have a higher incidence (10%). Many factors contribute to the development of a bladder hernia, including the presence of a urinary outlet obstruction causing chronic bladder distention, the loss of bladder tone, pericystitis, the perivesical bladder fat protrusion and the obesity

La FR.E.M.S. (FRequency modulated ElectroMagnetic neural Stimulation): una nuova prospettiva terapeutica per la neuropatia diabetica dolorosa degli arti inferiori

The FR.E.M.S. therapy represents an useful therapeutic remedy for the symptomatic management of the diabetic patients with a painful sensitive neuropathy

Poor diagnostic value of the euglycemic-hyperinsulinemic clamp in the clinical assessment of insulin resistant women with PCOS.

Insulin resistance (IR) per se and/or the ensuing compensatory hyperinsulinism, have been always considered as a key point in the pathogenesis of PCOS. Aim of our study was to evaluate which of these two aspects plays a key role in the pathogenesis of PCOS. Using a cross-sectional study design, 15 PCOS (Rotterdam criteria) and 16 age/BMI-matched control women (with suspect of IR) underwent clinical measures of IR after a 3-month withdrawal of insulin sensitizers and oral contraceptive pills. In an academic clinic setting, average glucose infusion rate (M-value) (during an euglycaemic–hyperinsulinaemic clamp), AUCinsulin and AUCglucose (during an Oral Glucose tolerance Test), HOMA-IR, ISI-Matsuda, Oral Dispositional Index (DIo) and Visceral Adiposity Index (VAI) were investigated. The prevalence of IR (according the M-value cut-off of 4.7 mg/Kg/min proposed by Bergman et al.) in the two groups was comparable: 14/16 (87.5%) for control women and 15/15 (100%) for PCOS women (p=0.484). No significant differences were observed between the two groups for M-value (p=0.540), VAI (p=0.406) and DIo (p= 0.813). Women with PCOS showed significantly higher levels of fasting insulin [median (IQR): 22 (19-37) vs. 13.55 (10.25-18.67) mU/ml; p<0.001], 30’ after OGTT insulin [96 (66-230) vs. 48 (26.25-83.25) mU/ml; p=0.003] and consequently significant differences in derived indexes (HOMA-IR, ISI-Matsuda, AUCinsulin). Furthermore, by performing a Kruskal-Wallis test between the four Rotterdam-PCOS phenotypes, the complete phenotype showed significantly higher levels of VAI (p=0.007). Our study suggests that for the assessment of IR in PCOS, the gold standard euglycemic-hyperinsulinemic clamp, an expensive method requiring an experienced operator to manage the technical difficulties, has also the limitation that utilizes steady-state insulin levels that may be supraphysiological. This finding may be explained in the reversal of normal portal to peripheral insulin gradient. Thus, the glucose clamp may not accurately reflect the ovarian insulin action under physiological conditions, nor gives us information about the compensatory hyperinsulinism. In non-diabetic women with PCOS, a dynamic test, such as OGTT (in particular the initial phase of stimulated insulin secretion), provides more useful information than the gold standard glucose Clamp

Performance variability of radiomics machine learning models for the detection of clinically significant prostate cancer in heterogeneous MRI datasets

Background: Radiomics promises to enhance the discriminative performance for clinically significant prostate cancer (csPCa), but still lacks validation in real-life scenarios. This study investigates the classification performance and robustness of machine learning radiomics models in heterogeneous MRI datasets to characterize suspicious prostate lesions for non-invasive prediction of prostate cancer (PCa) aggressiveness compared to conventional imaging biomarkers. Methods: A total of 142 patients with clinical suspicion of PCa underwent 1.5T or 3T biparametric MRI (7 scanner types, 14 institutions) and exhibited suspicious lesions [prostate Imaging Reporting and Data System (PI-RADS) score >= 3] in peripheral or transitional zones. Whole-gland and index-lesion segmentations were performed semi-automatically. A total of 1,482 quantitative morphologic, shape, texture, and intensity-based radiomics features were extracted from T2-weighted and apparent diffusion coefficient (ADC)-images and assessed using random forest and logistic regression models. Five-fold cross-validation performance in terms of area under the ROC curve was compared to mean ADC (mADC), PI-RADS and prostate-specific antigen density (PSAD). Bias mitigation techniques targeting the high-dimensional feature space and inherent class imbalance were applied and robustness of results was systematically evaluated. Results: Trained models showed mean area under the curves (AUCs) ranging from 0.78 to 0.83 in csPCa classification. Despite using mitigation techniques, high performance variability of results could be demonstrated. Trained models achieved on average numerically higher classification performance compared to clinical parameters PI-RADS (AUC =0.78), mADC (AUC =0.71) and PSAD (AUC =0.63). Conclusions: Radiomics models' classification performance of csPCa was numerically but not significantly higher than PI-RADS scoring. Overall, clinical applicability in heterogeneous MRI datasets is limited because of high variability of results. Performance variability, robustness and reproducibility of radiomics-based measures should be addressed more transparently in future research to enable broad clinical application

Predicting Functional Recovery and Quality of Life in Older Patients Undergoing Colorectal Cancer Surgery: Real-World Data From the International GOSAFE Study

PURPOSE The GOSAFE study evaluates risk factors for failing to achieve good quality of life (QoL) and functional recovery (FR) in older patients undergoing surgery for colon and rectal cancer.METHODS Patients age 70 years and older undergoing major elective colorectal surgery were prospectively enrolled. Frailty assessment was performed and outcomes, including QoL (EQ-5D-3L) recorded (3/6 months postoperatively). Postoperative FR was defined as a combination of Activity of Daily Living &gt;= 5 + Timed Up &amp; Go test &lt;20 seconds + MiniCog &gt;2.RESULTS Prospective complete data were available for 625/646 consecutive patients (96.9%; 435 colon and 190 rectal cancer), 52.6% men, and median age was 79.0 years (IQR, 74.6-82.9 years). Surgery was minimally invasive in 73% of patients (321/435 colon; 135/190 rectum). At 3-6 months, 68.9%-70.3% patients experienced equal/better QoL (72.8%-72.9% colon, 60.1%-63.9% rectal cancer). At logistic regression analysis, preoperative Flemish Triage Risk Screening Tool &gt;= 2 (3-month odds ratio [OR], 1.68; 95% CI, 1.04 to 2.73; P = .034, 6-month OR, 1.71; 95% CI, 1.06 to 2.75; P = .027) and postoperative complications (3-month OR, 2.03; 95% CI, 1.20 to 3.42; P = .008, 6-month OR, 2.56; 95% CI, 1.15 to 5.68; P = .02) are associated with decreased QoL after colectomy. Eastern Collaborative Oncology Group performance status (ECOG PS) &gt;= 2 is a strong predictor of postoperative QoL decline in the rectal cancer subgroup (OR, 3.81; 95% CI, 1.45 to 9.92; P = .006). FR was reported by 254/323 (78.6%) patients with colon and 94/133 (70.6%) with rectal cancer. Charlson Age Comorbidity Index &gt;= 7 (OR, 2.59; 95% CI, 1.26 to 5.32; P = .009), ECOG &gt;= 2 (OR, 3.12; 95% CI, 1.36 to 7.20; P = .007 colon; OR, 4.61; 95% CI, 1.45 to 14.63; P = .009 rectal surgery), severe complications (OR, 17.33; 95% CI, 7.30 to 40.8; P &lt; .001), fTRST &gt;= 2 (OR, 2.71; 95% CI, 1.40 to 5.25; P = .003), and palliative surgery (OR, 4.11; 95% CI, 1.29 to 13.07; P = .017) are risk factors for not achieving FR.CONCLUSION The majority of older patients experience good QoL and stay independent after colorectal cancer surgery. Predictors for failing to achieve these essential outcomes are now defined to guide patients' and families' preoperative counseling