Cardiovascular features of possible autonomous cortisol secretion in patients with adrenal incidentalomas

Background: Low-grade incomplete post-dexamethasone cortisol suppression in patients with adrenal incidentalomas – recently defined as possible autonomous cortisol secretion (pACS) – has been associated with increased cardiovascular events and mortality. However, prospective studies documenting cardiac abnormalities in these patients are lacking. Subjects and methods: Between July 2016 and September 2017, 71 consecutive patients with adrenal lesions were prospectively screened for hypercortisolism by dexamethasone suppression test (NCT 02611258). Complete anthropometric, metabolic and hormonal parameters were recorded along with full cardiac ultrasound assessment and noninvasive measurement of arterial stiffness. All patients underwent chemical-shift magnetic resonance imaging to characterize the lesions. Cardiovascular outcomes were recorded in blind. Results: According to post-dexamethasone suppression cortisol values (post-DST), 34 patients had pACS and 37 nonfunctioning adenomas (NFA). The two groups were similar in sex, BMI, age distribution, cardiovascular risk factors and comorbidities. Left ventricular mass index (LVMIBSA) was increased in pACS compared to NFA (P=0.006) and mildly correlated to the post-DST cortisol level (rho=0.347; P=0.004). The post-DST cortisol levels explained up to 13.7% of LVMIBSAvariance (P=0.002). Compared to NFA, patients with pACS had a higher prevalence of diastolic dysfunction (35.1% vs 82.6%; P=0.001) and worse arterial stiffness assessed by pulse wave velocity (P=0.033). Conclusions: In apparently asymptomatic patients, mild autonomous cortisol secretion can sustain early cardiac and vascular remodeling, independently of other risk factors. The morphological and functional cardiovascular changes observed in pACS underline the need for further studies to correctly define the long-term management of this relatively common condition

Intelligent devices for process and quality control in a zero-defect production approach

Il lavoro di ricerca rientra nel contesto del progetto europeo GO0DMAN, uno dei progetti di ricerca promossi dalla Commissione europea per sviluppare un approccio “Zero-Defect Manufacturing” nei processi di produzione industriale, che integri “smart online inspection tools” a livello locale e un monitoraggio in tempo reale mediato da un sistema basato su agenti e big data analisi a livello globale. L'attività di ricerca è focalizzata sullo sviluppo di “smart online inspection tools” per due casi di utilizzo industriale: produzione di automobili e produzione di forni professionali. Il problema affrontato è la valutazione di quantità dimensionali, denominate gap e flush (spazi tra le diverse superfici rispettivamente nella direzione tangente e ortogonale), che devono essere conformi a valori predeterminati. Il gap e il flush possono essere misurati in diverse fasi lungo la linea di produzione e in diversi punti di misura, con diverse combinazioni di materiali. Lo strumento di misura realizzato affronta anche il problema di supervisionare l'operatore nell’attività di misurazione. Infatti, attualmente, i controlli dimensionali sul prodotto assemblato vengono eseguiti manualmente. L'intera funzionalità del sistema di misura è stata poi quindi integrata e dimostrata nell'architettura GO0DMAN. È stata infine effettuata una valutazione dell'incertezza di misura del dispositivo sia in condizioni di laboratorio che in linea così come uno studio della ripetibilità e della riproducibilità per convalidare la sua funzionalità con diversi operatori. Lo “smart online inspection tool” sviluppato per la produzione professionale di forni integra anche un sensore a ultrasuoni per prove di perdite di aria e / o vapore. Infatti, un altro parametro che influenza la qualità del prodotto finale è la presenza di perdite dalla porta del forno anteriore dovute ad esempio a guarnizioni difettose. Attualmente, il rilevamento delle perdite viene effettuato manualmente da un operatore durante il test funzionale del forno. L'integrazione di due misure in un unico dispositivo consente di correlare entrambi i parametri, che sono coinvolti nella tenuta della porta e nelle prestazioni funzionali del forno.The research work is within the context of the European project GO0DMAN, one of the research projects promoted by the European Commission to develop a Zero-Defect-Manufacturing approach in production processes integrating smart online inspection tools at local level and a real-time monitoring mediated by an Agent-based system and a big data analysis at global level. The research activity is focused on the development of smart online inspection tools for two industrial use cases: cars production and professional ovens production. The problem addressed is the assessment of the dimensional quantities, named gaps and flushes (spaces between different surfaces in the tangent and orthogonal directions respectively), which must be compliant to pre-determined values. Gap and flush can be measured in different stages along the production line and in different measurement points, with different material combinations. The inspection tool realized addresses also the problem of keeping the operator in the measurement loop. Indeed, currently, dimensional checks on the assembled product are made manually by the operator. The whole inspection system functionality has then been integrated and proved in the GO0DMAN architecture. An evaluation of the measurement uncertainty of the device has been assessed both in laboratory conditions and in-line and a study of the repeatability and the reproducibility has been set up to validate its functionality by different operators. The smart online inspection tool developed for the professional ovens production integrates also an ultrasound sensor for air and/or steam leakage tests. Indeed, another parameter affecting the final product quality is the presence of leaks from the front oven door due for example to faulty seals. Currently, leakage detection is made manually by an operator during the functional test of the oven. Furthermore, the integration of two inspections in a unique device allows to correlate both parameters, which are involved in the door tightness and the oven functional performances

Smart portable laser triangulation system for assessing gap and flush in car body assembly line

In this paper a smart portable laser triangulation system for assessing gap and flush in car parts coupling is presented. This system is designed to make it possible an accurate measurement by human operators along car-body assembly line. The device is integrated with additional sensors managing safety of operators and measurement uncertainty minimization. Moreover, it embeds Wi-Fi communication capabilities for autonomous data exchange with plant middleware infrastructure exploiting the OPC-UA framework

A Smartphone Integrated Hand-Held Gap and Flush Measurement System for in Line Quality Control of Car Body Assembly

This paper presents the design and the characterization of a portable laser triangulation measurement system for measuring gap and flush in the car body assembly process. Targeting Human in the Loop (HILT) operations in the manufacturing sector, and in line with the vision of human empowerment with Industry 4.0 technologies, the instrument embeds features to ease operators’ activity and compensate possible misuse that could affect the robustness and the quality of data acquired. The device is based on a smartphone integrated with a miniaturized laser triangulation system installed in a cover. The device embodies additional sensors and control systems in order to guarantee operators’ safety (switching on and off the laser line based on specific conditions), support operators during the measurement execution task, and optimize the image acquisition process for minimizing the uncertainty associated to the measurement. The smartphone performs on-board processing and allows Wi-Fi communication with the plant IT infrastructure. Compliance to Industry 4.0 requirements is guaranteed using OPC-UA (Open Platform Communications—Unified Architecture) communication protocol enabling the exchange of live data with the plant middleware. The smartphone provides also an advanced high-resolution color display and well proven and ergonomic human–machine interfaces, which have been fully exploited in the design. The paper introduces the system optical layout and then presents the algorithms implemented to realize the gap and flush measurement. The paper finally presents the calibration of the instrument and estimates its calibration uncertainty in laboratory conditions. Then it discusses how performance decays when the operator handles the instrument on a reference car body. Finally, it shows the analysis of uncertainty when the device is used on real car bodies of different colors in a production line. It is observed that the measurement uncertainty of the whole measurement chain (measurand + instrument + operator + uncontrolled environmental conditions) is larger than the instrument calibration uncertainty because the measurement process is affected by the operator and the variable conditions of the production line

Selenium Supplementation in Pregnant Women with Autoimmune Thyroiditis: A Practical Approach

Selenium (Se) is an essential trace element with antioxidant and anti-inflammatory properties and a pivotal role in thyroid metabolism. Ensuring a sufficient Se supply is possible via a balanced, wholesome diet; however, Se content in foods may be different throughout geographical areas. Se supplementation is expected to improve inflammatory status in patients with autoimmune thyroiditis, especially in those with high activity, and has been demonstrated as effective in reducing the thyroid peroxidase antibodies titer. Se status seems to affect thyroid function in pregnancy, which prompts the potential role of Se supplementation in such patients. Few clinical trials have investigated the effectiveness of Se supplementation in pregnant women with thyroiditis, and their results suggest the safety and effectiveness of this element in reducing autoantibody levels and preventing postpartum thyroiditis development, although limited. Hence, more robust evidence is needed to confirm these data. The current study aims to summarize published data on the relationship between Se and thyroid status in pregnant women with thyroiditis and the potential use of Se. Moreover, an algorithm for Se supplementation is proposed for pregnant women with thyroiditis to help endocrinologists in daily clinical practice to consider Se status

Sex-specific effects of daily tadalafil on diabetic heart kinetics in RECOGITO, a randomized, double-blind, placebo-controlled trial

: Cyclic GMP-phosphodiesterase type 5 (PDE5) inhibition has been shown to counteract maladaptive cardiac changes triggered by diabetes in some but not all studies. We performed a single-center, 20-week, double-blind, randomized, placebo-controlled trial (NCT01803828) to assess sex differences in cardiac remodeling after PDE5 inhibition in patients with diabetic cardiomyopathy. A total of 122 men and women (45 to 80 years) with long-duration (>3 years) and well-controlled type 2 diabetes mellitus (T2DM; HbA1c < 86 mmol/mol) were selected according to echocardiographic signs of cardiac remodeling. Patients were randomly assigned (1:1) to placebo or oral tadalafil (20 mg, once daily). The primary outcome was to evaluate sex differences in cardiac torsion change. Secondary outcomes were changes in cardiovascular, metabolic, immune, and renal function. At 20 weeks, the treatment-by-sex interaction documented an improvement in cardiac torsion (-3.40°, -5.96; -0.84, P = 0.011) and fiber shortening (-1.19%, -2.24; -0.14, P = 0.027) in men but not women. The primary outcome could not be explained by differences in cGMP concentrations or tadalafil pharmacodynamics. In both sexes, tadalafil improved hsa-miR-199-5p expression, biomarkers of cardiovascular remodeling, albuminuria, renal artery resistive index, and circulating Klotho concentrations. Immune cell profiling revealed an improvement in low-grade chronic inflammation: Classic CD14++CD16- monocytes reduced, and Tie2+ monocytes increased. Nine patients (14.5%) had minor adverse reactions after tadalafil administration. Continuous PDE5 inhibition could offer a strategy to target cardiorenal complications of T2DM, with sex- and tissue-specific responses. Further studies are needed to confirm Klotho and hsa-miR-199-5p as markers for T2DM complications