Components of metabolic syndrome in the first trimester of pregnancy as predictors of adverse perinatal outcome

Objectives: It is the prospective observational study aimed at early prediction of pregnancy complications in women with symptoms of MS. Material and methods: 124 Caucasian women in singleton pregnancies 11th to the 13th wks 6 days of gestation with MS criteria compared to 30 healthy controls. Perinatal maternal and fetal results were analyzed. Results: Increased in the MS group were: age (32.9 y vs. 28.6 y; p = 0,00), weight 11 to 13 + 6 weeks of gestation (79.0 kg vs. 59.7 kg; p = 0.00), BMI (29 kg/m2 vs. 21.6 kg/m2; p = 0.00), waist–hip ratio (WHR) (0.9 vs. 0.8; p = 0.00). Maternal serum parameters were higher in the MS group: LDL-cholesterol (124.1 vs. 109.6 mg/dL; p = 0.02), t-PA (2556.8 vs. 1949.5 pg/mL; p < 0.00), GGTP (16.8 vs. 13.3 IU/L; p = 0.02) and lower values for: adiponectin (6.4 vs. 7.5 μg/mL; p = 0.01), SHBG (273.4 vs. 338.4 nmol/L; p = 0.001). MS group neonates higher body weight (3594.4 vs. 3312.2 g; p = 0.01), significantly frequent macrosomic neo­nates (> 4000 g) (20.9% vs. 6.6%; p = 0.042), GDM (12% vs. 0; p = 0.019). Conclusions: Higher E-selectin serum concentration, GGTP and lower SHBG in first trimester are additionally to fasting maternal glucose, higher BMI and maternal age predictive for GDM. Higher E-selectin, fasting glucose, increased BMI and lower adiponectin serum concentration in first trimester are significant predictors of fetal macrosomia. Maternal BMI > 24.5 kg/m2 is the best predictor of increased risk of fetal macrosomia and gestational diabetes mellitus

Ocena czterech wariantów klasyfikacji TIRADS w grupie pacjentów z wolem guzkowym — badanie wstępne

Purpose The goal this study was to evaluate the utility of four variants of the Thyroid Imaging Reporting and Data System (TIRADS) in the differentiation of focal lesions in individuals with multinodular goiter.   Materials and Methods The study was approved by the Local Bioethical Committee. Each patient gave informed consent before enrolment. A total of 163 nodules in 124 patients with multinodular goiter were evaluated by ultrasound. B-mode and PD imaging and strain elastography were performed. Archived images were evaluated via retrospective analysis using four different proposed TIRADS classifications   Results Sensitivity and specificity of the Horvath, Park, Kwak, and Russ classifications were 0.625 and 0.769, 0.813 and 0.864, 0.938 and 0.667, and 0.875 and 0.293, respectively. Positive and negative predictive values were 0.227 and 0.95, 0.394 and 0.977, 0.234 and 0.99, and 0.119 and 0.956, respectively. Receive operating characteristic analysis suggests that the best differentiation potential was demonstrated by the Kwak classification with an area under the curve (AUC) of 0.896, followed by the Park (AUC = 0.872), Horvath (AUC = 0.774), and Russ (AUC = 0.729) classifications.   Conclusion The TIRADS classification proposed by Kwak can be a useful tool in daily practice for the evaluation of thyroid cancer in individuals with multinodular goiter, particularly for selecting cases that require biopsy, which may improve and simplify clinical decision making. To adopt a definitive, comprehensive variant of the TIRADS classification with potential for universal, practical application, further prospective studies that include improvement of the lexicon and evaluation of the full spectrum of thyroid malignancy are warranted.Wstęp: Celem tej pracy była ocena przydatności 4 wariantów systemu raportowania badań ultrasonograficznych tarczycy (TIRADS) do różnicowania zmian ogniskowych u pacjentów z wolem guzkowym. Materiał i metody: Badanie było zatwierdzone przez właściwą komisję bioetyczną. Każdy pacjent wyraził świadomą zgodę przed przy­stąpieniem do badania. W badaniu ultrasononograficznym analizowano 163 zmiany ogniskowe u 124 pacjentów z wolem guzowatym. Wykonano obrazowanie w skali szarości, z dopplerem mocy oraz elastografię odkształceń względnych. Zarchiwizowane obrazy zostały poddane analizie retrospektywnej z zastosowaniem 4 wariantów klasyfikacji TIRADS. Wyniki: Czułość i swoistość klasyfikacji Horvath, Park, Kwak i Russ wyniosły odpowiednio 0,625 i 0,769, 0,813 i 0,864, 0,938 i 0,667 oraz 0,875 i 0,293. Dodatnie i ujemne wartości predykcyjne wynosiły odpowiednio 0,227 i 0,95, 0,394 i 0,977, 0,234 i 0,99 oraz 0,119 i 0,956. Analiza ROC sugeruje, że najlepszy potencjał w różnicowaniu prezentuje wariant Kwak z polem pod krzywą (AUC) of 0,896, następnie Park (AUC = 0,872), Horvath (AUC = 0,774) i Russ (AUC = 0,729). Wnioski: Klasyfikacja TIRADS proponowana przez Kwaka może być przydatnym narzędziem w codziennej praktyce oceny pod kątem raka tarczycy u pacjentów z wolem guzkowym, szczególnie do wyselekcjonowania przypadków wymagających biopsji, co może polepszyć i uprościć podjęcie decyzji klinicznej. Wskazane są dalsze badania prospektywne, obejmujące ulepszenie leksykonu i ocenę pełnego spektrum guzów złośliwych tarczycy, aby ostatecznie przyjąć optymalny wariant klasyfikacji TIRADS, co zapewne umożliwi jej uniwersalne praktyczne zastosowanie

Różnicowanie zmian ogniskowych w wolu guzkowym tarczycy z zastosowaniem nowych technik ultrasonograficznych — doniesienia wstępne

  Introduction: To evaluate the relative value of technical ultrasound advances in differentiation of thyroid nodules in multinodular goitre. Material and methods: The study included patients with multinodular goitre, who were referred for thyroidectomy. Ultrasound evaluation of suspicious nodules was performed with: improved B-mode (spatial compound imaging and differential tissue harmonics), dedicated mapping of microcalcifications, mapping of the nodule vessels, and strain elastography evaluated qualitatively and semi quantitatively. Results: A total of 163 nodules in 124 patients with multinodular goitre were evaluated (147 benign and 16 cancers). Improved B-mode imaging was: 76.76% sensitive and 62.5% specific with AUC 0.740. Differentiating B-mode features were: shape — taller than wide OR 15.8, markedly hypoechoic OR 14.7, absence of cystic areas OR 6.6, absence of halo OR 5.0, and blurred/microlobulated margins OR 3.7. Addition of MicroPure imaging was 80.28% sensitive and 68.75% specific with AUC 0.771. MicroPure alone, power Doppler, and strain elastography were not statistically significant. Conclusions: Among singular modes of ultrasound imaging, only improved B-mode imaging proved to have a significant role in differentiation of thyroid nodules in multinodular goitre. Additional gain was seen with the addition to B-mode of the mapping of microcalcifications with MicroPure imaging. Power Doppler and strain elastography did not prove to be useful techniques in multinodular goitre. (Endokrynol Pol 2016; 67 (2): 157–165)    Wstęp: Celem pracy była ocena względnej wartości nowych technik ultrasonograficznych w różnicowaniu zmian ogniskowych w wolu guzkowym. Materiał i metody: Grupa badana obejmowała chorych z wolem guzkowym przed planowaną tyreoidektomią. Protokół badania ultrasonograficznego obejmował: B-mode z użyciem obrazowania złożonego przestrzennie oraz tkankowego obrazowania harmonicznego, mapowanie mikrozwapnień, mapowanie naczyń oraz elastogafię odkształceń względnych (ocena jakościowa i półilościowa). Wyniki: Oceniono w sumie 163 zmiany ogniskowe u 124 pacjentów (147 zmian łagodnych i 16 raków). Czułość, swoistość i AUC dla B-mode z użyciem obrazowania złożonego przestrzennie oraz tkankowego obrazowania harmonicznego wynosiły odpowiednio 76,76%, 62,5% oraz 0,740. Wśród ocenionych cech obrazowania B-mode różnicującymi okazały się być: kształt (zmian wyższa niż szersza OR 15,8), bardzo niska echogeniczność OR 14,7, brak zwyrodnień płynowych OR 6,6, brak otoczki halo OR 5,0 oraz zatarte/zrazikowe granice OR 3,7. Wzbogacenie obrazowania B-mode o obrazowanie Micropure zwiększyło czułość 80,28% i swoistość 68,75%, AUC 0,771. Obrazowanie Micropure, Power Doppler oraz elastografia odkształceń względnych jako samodzielne metody okazały się być nie istotne statystycznie w różnicowaniu zmian łagodnych i złośliwych. Wnioski: Wśród pojedynczych metod ultrasonograficznych jedynie wzbogacone obrazowanie B-mode okazało się być istotne w różnicowaniu zmian ogniskowych w wolu guzkowym tarczycy. Dodatkowym zyskiem było dołączenie do oceny B-mode mapowanie mikrozwapnień z zastosowaniem techniki Micropure. Power Doppler oraz elastografia odkształceń względnych okazały się być nieprzydatne w różnicowaniu zmian ogniskowych w wolu guzkowym tarczycy. (Endokrynol Pol 2016; 67 (2): 157–165)

Elastografia fali poprzecznej guzów nadnerczy jest możliwa do wykonania i może pomóc w różnicowaniu zmian litych z torbielowatymi — doniesienie wstępne

Introduction: The aim of this study was to evaluate the feasibility and usefulness of supersonic shear wave elastography (SSWE) in the diagnosis of nonmalignant adrenal masses.Material and methods: 13 patients with a total number of 16 adrenal masses were enrolled in the study. In each case, both conventional ultrasound imaging and SSWE for stiffness assessment were performed. The final diagnosis was based on CT, MRI, biochemical studies, surgery or more than one year of follow up.Results: The final diagnosis: nodular hyperplasia in six masses, six adenomas, three cysts, and one myelolipoma. All solid adrenal masses presented the elastography signal in contrast to cystic lesions that were devoid of it, as shear waves do not propagate through fluids.Conclusions: SSWE is a feasible technique that can be applied during ultrasound of the abdomen and retroperitoneum. SSWE presents potential for the differentiation of solid and cystic adrenal lesions. Further large scale studies evaluating the possibility of differentiation of adrenal and other retroperitoneal masses with SSWE are warranted. (Endokrynol Pol 2014; 65 (2): 119–124)Wstęp: Celem badania była ocena wykonalności i przydatności naddźwiękowej elastografii fali poprzecznej (SSWE) w diagnostyce łagodnych zmian ogniskowych nadnerczy.Materiał i metody: U 13 pacjentów wykonano badania ultrasonograficzne, oceniając 16 zmian ogniskowych nadnerczy z oceną ich spoistości z wykorzystaniem naddźwiękowej elastografii fali poprzecznej. Ostateczne rozpoznanie ustalono na podstawie wyników badań CT i MR, badań biochemicznych, operacji lub monitorowania ponad rok.Wyniki: Ostateczne rozpoznania: 6 zmian o typie guzkowego rozrostu kory nadnercza, 6 gruczolaków, 3 torbiele, 1 myelolipoma. Sygnał elastograficzny zarejestrowano we wszystkich litych guzach nadnerczy w przeciwieństwie do zmian torbielowatych, które nie wykazywały sygnału elastograficznego, zgodnie z zasadą, że fale poprzeczne nie rozchodzą się w płynach.Wnioski: Badanie z użyciem SSWE jest możliwe do wykonania i może być zastosowane w trakcie badań ultrasonograficznych jamy brzusznej i przestrzeni zaotrzewnowej. Metoda ta wykazała potencjał dla różnicowania litych i torbielowatych zmian ogniskowych nadnerczy. Uzasadnione są dalsze szerokie badania oceniające możliwość różnicowania guzów nadnerczy i innych zmian ogniskowych przestrzeni zaotrzewnowej. (Endokrynol Pol 2014; 65 (2): 119–124

Sleep disturbances in progressive supranuclear palsy syndrome (PSPS) and corticobasal syndrome (CBS)

Introduction. Progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS) are clinical manifestations of tauopathies. They are commonly associated with rapid motor and cognitive deterioration. Sleep disturbances are less frequently described as a feature of these diseases, though they are reported among 50-75% of PSP patients. State of the art. Apart from various clinical manifestations, sleep abnormalities in PSP and CBS seem to be a factor enhancing pathogenesis as well its consequences. Multiple researchers have looked into the issue of whether the complexity of sleep disturbances in PSP and CBS could be linked to atrophic changes within structures crucial for daytime regulation, coexisting pathologies, or other less explored mechanisms. Clinical significance. Among sleep abnormalities in PSP and CBS have been reported excessive daytime sleepiness, night-time insomnia, reduction of total sleep time, more pronounced sleep fragmentation, restless leg syndrome (RLS), agrypnia excitata, periodic limb movements, sleep respiratory disturbances, rapid-eye movement behaviour disorder, and others. Future directions. The aim of this review was to elaborate upon the significance of sleep abnormalities in tauopathic parkinsonian syndromes, and to determine their usefulness in differential diagnosis with synucleinopathic parkinsonian syndromes. Extended analyses of sleep disturbances may provide a different perspective on atypical parkinsonisms

Could hyperlipidemia be a risk factor for corticobasal syndrome? — a pilot study

Introduction. Corticobasal syndrome (CBS) is a specific clinical manifestation shared by multiple pathologies. The exact mechanism of this phenomenon remains unclear. Differential diagnosis of CBS in everyday clinical practice is challenging, as this syndrome can overlap with other entities, especially progressive supranuclear palsy Richardson-Steele phenotype (PSP-RS). Several papers have suggested a possible role of vascular pathology as a linking factor in the pathogenesis of CBS based on different neuropathologies. This paper analyses differences in the occurrence of the most common vascular risk factors such as hypertension and lipid profile with respect to dietary habits among patients who fulfill the diagnostic criteria for probable/possible CBS and PSP-RS. Material and methods. Seventy (70) patients in total were included in the study. Exclusion criteria comprised hydrocephalus, stroke in the past, the presence of marked vascular changes in white matter defined as the presence of vascular change ≥ 1 mm in 3T MRI, medical history of hyperlipidemia or the use of drugs that could impact upon lipid metabolism before the initiation of the neurodegenerative disease, and neoplastic focuses in the central nervous system. Patients with diabetes, or with BMI exceeding 18–25, or who were smokers, or who were affected by chronic stress were also excluded. Data was analysed statistically using the Shapiro-Wilk test, the U Mann-Whitney test for group comparison, and a Bonferroni correction to control the false discovery rate (FDR). Results. Our obtained results indicated a statistically significantly higher level of total cholesterol in the CBS group (p = 0.0039) without a correlation with dietary habits. Conclusions and clinical implications. The results obtained in our study may suggest a possible role of vascular pathology in CBS development. This issue requires further research

Role of orexin in pathogenesis of neurodegenerative parkinsonisms

Introduction. The pathogenesis of parkinsonisms is not fully understood. Among possible factors which may influence the course of neurodegenerative diseases, endocrine abnormalities may be interpreted as having been underevaluated.State of the art. Growing interest is associated with the role of neuropeptides such as orexin. Orexin is a neuropeptide produced by orexigenic neurons in the lateral parts of the hypothalamus and is linked with excitement, wakefulness and appetite. An extended analysis of this neuropeptide might answer whether changes in the metabolism of orexin is more likely to be a cause or a consequence of neurodegeneration.Clinical significance. Orexin is a neuropeptide produced by orexigenic neurons in the lateral parts of the hypothalamus and is linked with excitement, wakefulness and appetite. The aim of this study was to discuss the role of this factor and its abnormalities in the pathogenesis and course of parkinsonian syndrome.Future directions. Understanding the role of orexin in these diseases may be interpreted as an important feature in evolving therapeutical methods. Further evaluation based on larger groups of patients is required

Carbohydrate metabolism and lipid profile in patients with Parkinson’s disease with subthalamic deep brain stimulation

Aim of the study. Assessment of potential effect of subthalamic nucleus deep brain stimulation (STN-DBS) on glucose metabolism in patients with Parkinson’s disease (PD). Clinical rationale for the study. Although a valuable alternative to pharmacotherapy in advanced PD, STN-DBS is thought to negatively affect the cardiometabolic profile of patients (including body mass, lipid profile). Exacerbation of glucose metabolism dysregulation after DBS could therefore be assumed. Material and methods. Two groups of patients with Parkinson’s disease were included: 20 treated pharmacologically (PHT) and 20 newly qualified for STN-DBS (DBS) — with the first assessment prior to surgery, and the second 11 months after surgery on average. Body mass index (BMI), plasma concentrations of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol (HDL-C), triglycerides (TG) and glucose levels during a three-point oral glucose tolerance test were measured three times (median intervals between visits 12 and 14 months respectively). Results. Significant differences between the two groups were noted with respect to changes in BMI, and serum concentration of TG and HDL-C over the course of the study. In the DBS group, a significant increase in BMI (26.42 vs. 27.24 kg/m2, p = 0.03) and TG level (103.8 vs. 142.8 mg/dL, p < 0.001) with a simultaneous decrease in HDL-C level (54.4 vs. 46 mg/dL, p < 0.01) was observed. Mean glucose level after oral glucose administration was lower in the DBS than in the PHT group (147.4 vs. 120.2 mg/dL, p = 0.03 after one hour and 109.9 vs. 82.3 mg/dL, p < 0.01 after two hours) during the second visit. Also inter-visit changes in fasting glucose levels (8.4 mg/dL in the PHT group and –5.8 mg/dL in the DBS group, p = 0.02) differed over the study duration. Conclusions. Our observations are similar to previous ones indicating less favourable changes in BMI and some lipid fractions in patients treated surgically. Interestingly, such a trend was not observed for glucose metabolism parameters, suggesting that mechanisms other than simple body mass changes are involved in early biochemical changes after STN-DBS in PD patients. Clinical implications. The metabolic consequences of DBS require further investigation as an additional factor potentially affecting the outcome of therapy, and routine patient follow-up should not be limited to neurological and psychological assessments

Shear Wave Elastography May Add a New Dimension to Ultrasound Evaluation of Thyroid Nodules: Case Series with Comparative Evaluation

Although elastography can enhance the differential diagnosis of thyroid nodules, its diagnostic performance is not ideal at present. Further improvements in the technique and creation of robust diagnostic criteria are necessary. The purpose of this study was to compare the usefulness of strain elastography and a new generation of elasticity imaging called supersonic shear wave elastography (SSWE) in differential evaluation of thyroid nodules. Six thyroid nodules in 4 patients were studied. SSWE yielded 1 true-positive and 5 true-negative results. Strain elastography yielded 5 false-positive results and 1 false-negative result. A novel finding appreciated with SSWE, were punctate foci of increased stiffness corresponding to microcalcifications in 4 nodules, some not visible on B-mode ultrasound, as opposed to soft, colloid-inspissated areas visible on B-mode ultrasound in 2 nodules. This preliminary paper indicates that SSWE may outperform strain elastography in differentiation of thyroid nodules with regard to their stiffness. SSWE showed the possibility of differentiation of high echogenic foci into microcalcifications and inspissated colloid, adding a new dimension to thyroid elastography. Further multicenter large-scale studies of thyroid nodules evaluating different elastographic methods are warranted