Ectopic Cushing's Syndrome Unveiling a Metastatic Parotid Carcinoma

Introduction. Adrenocorticotropic hormone (ACTH) ectopic production is a rare cause of Cushing syndrome (CS). The most commonly associated tumours are small-cell lung carcinoma along with bronchial and thymic carcinoids. To date, only 5 cases have been published in the literature featuring ectopic ACTH secretion from metastatic acinic cell carcinoma (ACC) of the parotid gland. We hereby describe a very uncommon case of ectopic CS (ECS) unveiling a metastatic parotid ACC. Case Presentation. A 46-year-old man with hypertension and dyslipidemia diagnosed 4-months before, as well as new-onset diabetes mellitus unveiled 1-month earlier, was referred to emergency department for hypokalemia. Hormonal study and dynamic biochemical tests performed indicated ECS. Imaging and cytological findings pointed toward a likely primary right parotid malignancy with liver metastases. Somatostatin receptor scintigraphy has shown an increased uptake in the parotid gland and mild expression in liver metastasis. The patient underwent right parotidectomy, and histopathologic examination confirmed ACC. Meanwhile, hypercortisolism was managed with metyrapone, ketoconazole, and lanreotide. Despite chemotherapy onset, a rapid disease progression and clinical course deterioration was observed. Conclusion. The present report highlights a rare ECS, exposing a metastatic parotid ACC, with an aggressive and challenging clinical course, representing the first case whose diagnosis of ECS came prior to ACC

Long-Term weight loss and metabolic syndrome remission after bariatric surgery: The effect of sex, age, metabolic parameters and surgical technique-a 4-year follow-up study

Introduction: Bariatric surgery is an effective treatment for morbid obesity and its metabolic related comorbidities. However, the literature reports inconsistent results regarding weight loss (WL) and the resolution of comorbidities associated with obesity. Objective: We aim to evaluate long-Term differences in WL between different surgical techniques and the impact of each surgical technique on metabolic parameters (type 2 diabetes mellitus [T2DM], dyslipidemia,hypertension, and metabolic syndrome). We also aim to evaluate the effect of baseline clinical characteristics in WL and in the evolution of metabolic syndrome (MetS) components. Our hypothesis is that different types of surgery have different effects on WL and the prevalence of comorbidities over time. Methods: We retrospectively evaluated WL and metabolic parameter remission (T2DM, dyslipidemia, hypertension, and MetS) during 4 years in 1,837 morbidly obese patients (females, 85%; age, 42.5 ± 10.6 years; BMI, 44.0 ± 5.8) who underwent bariatric surgery (Roux-en-Y gastric bypass [RYGB], laparoscopic sleeve gastrectomy [LSG], and laparoscopic adjustable gastric band [LAGB]). Results: The mean percentage of WL for RYGB, LSG, and LAGB was, respectively, 32.9 ± 8.7, 29.8 ± 9.8, and 16.2 ± 9.6 at 12 months and 30.6 ± 9.1, 22.7 ± 10.0, and 15.8 ± 10.8 at 48 months (p < 0.001), even after adjustment for baseline weight, BMI, age, and sex (p < 0.001). Women had more WL during the first 36 months (p = 0.013 and 0.007 at 12 and 36 months, respectively) and older patients had less WL compared to younger ones (p <0.001), except at 48 months. Patients with T2DM had less WL than those without diabetes after adjustment (sex, age, and surgical technique) during the same period. Patients with hypertension had less WL at 12 months (p = 0.009) and MetS at 24 months (p = 0.020) compared to those without these comorbidities. There was no significant difference regarding the presence of dyslipidemia in WL. The RYGB group showed better results for MetS resolution. Conclusion:During the 4-year follow-up, RYGB was the surgical procedure that caused the highest WL and MetS resolution

Effect of Weight Loss after Bariatric Surgery on Thyroid-Stimulating Hormone Levels in Patients with Morbid Obesity and Normal Thyroid Function

Background: Several studies have reported that morbid obesity is associated with increased thyroid-stimulating hormone (TSH) levels. However, it is not clear what is the impact of bariatric surgery on postoperative thyroid function. The aim of this study was to evaluate the effect of weight loss after bariatric surgery on TSH levels in euthyroid patients with morbid obesity. Methods: We performed a retrospective observational study of 949 euthyroid patients (86.1% female; age 42.0 ± 10.3 years, BMI 44.3 ± 5.7 kg/m2) with morbid obesity submitted to bariatric surgery (laparoscopic adjustable gastric band, Roux-en-Y gastric bypass, or sleeve gastrectomy). Patients were subdivided in two groups: normal TSH group (TSH <2.5 mU/L) and high-normal TSH group (TSH ≥2.5 mU/L). The impact of anthropometric parameters, comorbidities, TSH, free thyroxine (FT4), free triiodothyronine (FT3), type of surgery, and excessive body weight loss (EBWL) on TSH variation 12 months after surgery was evaluated. Results: The high-normal TSH group (24.3% of patients) included more women, presented a higher BMI, higher systolic blood pressure, and higher FT3 levels. There was a significant decrease of TSH 12 months after surgery that was more marked in the high-normal TSH group (normal TSH group: 1.57 ± 0.49 to 1.53 ± 0.69 mIU/L, p = 0.063; high-normal TSH group: 3.23 ± 0.59 to 2.38 ± 0.86 mIU/L, p < 0.001). In a multivariate analysis, after adjusting for relevant covariates, EBWL, baseline BMI, and baseline FT3 were significantly associated with TSH decrease 12 months after bariatric surgery. Conclusion: Bariatric surgery promotes a decrease of TSH that is significantly greater in patients with high-normal TSH and is independently associated with EBWL after surgery

Assessing the Effects of the Transition from Multiple Daily Insulin Injections (MDI) to Continuous Subcutaneous Insulin Infusion in the Intensive Treatment of Type 1 Diabetes Mellitus

Introduction: Intensive insulin therapy is currently the main treatment in type I diabetes mellitus (DM) which includes multiple daily insulin injections (MDI) and continuous subcutaneous insulin infusion (CSII). The latter has become the preferred therapeutic mode, since it better mimics the physiological pancreatic action, althought there is limited evidence that supports its superiority to MDI. The aim of our study was to assess the effects of the transition from MDI to CSII in the intensive treatment of type 1 DM. Material and Methods: A retrospective longitudinal study was perfonned in MDI patients that transited to CSII between 2006 and 2014. Data were collected regarding to weight, HbA1c, plasma glucose, lipid profile, creatinine, weekly frequency of episodes of hypoglycemia and hyperglycemia and presence of microvascular complications. The effects of the transition to CSII were also compared according to the following subgroups: pre-CSII HbA1c (7.0%); age ( 35 years); gender (male versus female); BMI (25 kg/m2); duration of illness ( 15 years); total daily dose (TDD) of insulin ( 45 units of insulin); ISF ( 40) and microvascular complications (presence versus absence). Results: The sample included 85 patients, mean age 38 +/- 11 years, 50 (58.8%) female, with duration of the disease 21 +/- 9 years. There was a significant reduction in the frequency of hypo and hyperglycemia events after transition to CSII (3.0 +/- 5.0 vs 2 +/- 2.2 per week, p= 0.001 and 5.5 +/- 6.1 vs 2.5 +/- 2.6 per week, p = 0.05, respectively). We also observed a greater glycemic benefit in the subgroups of patients with poorer metabolic control (HbA1c > 7%) compared to those with HbA1c s <= 7% (Delta HbA1c =-0.55% vs 0.20%, respectively, p < 0.05), for the first 6 months after CSII, being additionally reported a significant increase in HDL-C levels (2.81 +/- 10.34 mg/dL, p = 0.039). Conclusion: In this study, CSII therapy was shown to be more effective compared to MDI in patients with poorer metabolic control, being also noted a significant reduction of weekly frequency of hypo and hyperglycemia events. Notwithstanding the encouraging results linked with CSII, in the future, longer longitudinal studies will be mandatory in order to assess the real relative effectiveness of CSII in the treatment of type 1 DM

Nanostructured 3D Constructs Based on Chitosan and Chondroitin Sulphate Multilayers for Cartilage Tissue Engineering

Nanostructured three-dimensional constructs combining layer-by-layer technology (LbL) and template leaching were processed and evaluated as possible support structures for cartilage tissue engineering. Multilayered constructs were formed by depositing the polyelectrolytes chitosan (CHT) and chondroitin sulphate (CS) on either bidimensional glass surfaces or 3D packet of paraffin spheres. 2D CHT/CS multi-layered constructs proved to support the attachment and proliferation of bovine chondrocytes (BCH). The technology was transposed to 3D level and CHT/CS multi-layered hierarchical scaffolds were retrieved after paraffin leaching. The obtained nanostructured 3D constructs had a high porosity and water uptake capacity of about 300%. Dynamical mechanical analysis (DMA) showed the viscoelastic nature of the scaffolds. Cellular tests were performed with the culture of BCH and multipotent bone marrow derived stromal cells (hMSCs) up to 21 days in chondrogenic differentiation media. Together with scanning electronic microscopy analysis, viability tests and DNA quantification, our results clearly showed that cells attached, proliferated and were metabolically active over the entire scaffold. Cartilaginous extracellular matrix (ECM) formation was further assessed and results showed that GAG secretion occurred indicating the maintenance of the chondrogenic phenotype and the chondrogenic differentiation of hMSCs

A New Heterobinuclear FeIIICuII Complex with a Single Terminal FeIII–O(phenolate) Bond. Relevance to Purple Acid Phosphatases and Nucleases

A novel heterobinuclear mixed valence complex [Fe^IIICu^II(BPBPMP)(OAc)_2]ClO_4, 1, with the unsymmetrical N_5O_2 donor ligand 2-bis[{(2-pyridylmethyl)aminomethyl}-6-{(2-hydroxybenzyl)(2-pyridylmethyl)} aminomethyl]-4-methylphenol (H_2BPBPMP) has been synthesized and characterized. A combination of data from mass spectrometry, potentiometric titrations, X-ray absorption and electron paramagnetic resonance spectroscopy, as well as kinetics measurements indicates that in ethanol/water solutions an [Fe^III-(nu)OH-Cu^IIOH_2]+ species is generated which is the likely catalyst for 2,4-bis(dinitrophenyl)phosphate and DNA hydrolysis. Insofar as the data are consistent with the presence of an Fe_III-bound hydroxide acting as a nucleophile during catalysis, 1 presents a suitable mimic for the hydrolytic enzyme purple acid phosphatase. Notably, 1 is significantly more reactive than its isostructural homologues with different metal composition (Fe^IIIM^II, where M^II is Zn^II, Mn^II, Ni^II,or Fe^II). Of particular interest is the observation that cleavage of double-stranded plasmid DNA occurs even at very low concentrations of 1 (2.5 nuM), under physiological conditions (optimum pH of 7.0), with a rate enhancement of 2.7 x 10^7 over the uncatalyzed reaction. Thus, 1 is one of the most effective model complexes to date, mimicking the function of nucleases

Inmobilization of Zn(II) in Portland cement pastes. Determination of microstructure and leaching performance

The aim of this paper is to study the solidification/ stabilization potential of cementitious matrices on the immobilization of Zn(II) before its disposal into the environment by determining the mechanisms of interaction between the Zn(II) ions and the binder. The results of structural and mineralogical characterization of cement pastes formed with different amounts of immobilized Zn(II) ions are presented and the study includes results from thermogravimetric analysis (TG), scanning electron microscopy, X-ray diffraction, and leaching performance. Zn(II) ions delay the hydration reaction of Portland cement due to the formation of mainly CaZn2(OH)6 2H2O , as well as Zn5(CO3)2(OH)6, Zn(OH)2, and ZnCO3 in minor proportion. Correlations between total mass loss in TG analysis and leached Zn(II) ions in long-term curing pastes have been obtained. This result is important because in a preliminary approach from a TG on an early-aged cement paste containing Zn(II), it could be possible to perform an estimation of the amount of Zn(II) ions that could be leached, thus avoiding costly and time-consuming tests.Mellado Romero, AM.; Borrachero Rosado, MV.; Soriano Martinez, L.; Paya Bernabeu, JJ.; Monzó Balbuena, JM. (2013). Inmobilization of Zn(II) in Portland cement pastes. Determination of microstructure and leaching performance. Journal of Thermal Analysis and Calorimetry. 112(3):1377-1389. doi:10.1007/s10973-012-2705-8S137713891123Mojumdar SC, Sain M, Prasad RC, Sun L, Venart JES. Selected thermoanalytical methods and their applications from medicine to construction, Part I. J Therm Anal Calorim. 2007;90:653–62.Perraki M, Perraki T, Kolovos K, Tsivilis S, Kakali G. Secondary raw materials in cement industry. Evaluation of their effect on the sintering and hydration processes by thermal analysis. J Therm Anal Calorim. 2002;70:143–50.Neves A, Dias Toledo R, de Moraes Rego E, Dweck J. Early stages hydration of high initial strength Portland cement. Part I. Thermogravimetric analysis on calcined mass basis. J Therm Anal Calorim. 2012;108:725–31. doi: 10.1007/s10973-012-2256-z .Balek V, Bydžovský J, Dufka A, Drochytka R, Beckman IN. Use of emanation thermal analysis to characterize microstructure development during Portland cement hydration. J Therm Anal Calorim. 2012. doi: 10.1007/s10973-012-2314-6 .Zhang Q, Ye G. Dehydration kinetics of Portland cement paste at high temperature. J Therm Anal Calorim. 2012. doi: 10.1007/s10973-012-2303-9 .Menéndez E, Vega L, Andrade C. Use of decomposition of portlandite in concrete fire as indicator of temperature progression into the material. Application to fire-affected builds. J Therm Anal Calorim. 2012. doi: 10.1007/s10973-011-2159-4 .Galan I, Andrade C, Castellote M. Thermogravimetrical analysis for monitoring carbonation of cementitious materials. Uptake of CO2 and deepening in C–S–H knowledge. J Therm Anal Calorim. 2012. doi: 10.1007/s10973-012-2466-4 .Batchelor B. Overview of waste stabilization with cement. Waste Manag (Oxford). 2006;26:689–98.Gineys N, Aouad G, Damidot D. Managing trace elements in Portland cement-Part I: interactions between cement paste and heavy metals added during mixing as soluble salts. Cem Concr Compos. 2010;32:563–70.Erdem M, Özverdi A. Environmental risk assessment and stabilization/solidification of zinc extraction residue: II. Stabilization/solidification. Hydrometallurgy. 2011;105:270–6.Nocuń-Wczelik W, Małolepszy J. Application of calorimetry in studies of the immobilization of heavy metals in cementitious materials. Thermochim Acta. 1995;269(270):613–9.Dweck J, Buchler PM, Cartledge FK. The effect of different bentonites on cement hydration during solidification/stabilization of tannery wastes. J Therm Anal Calorim. 2001;64:1011–6.Melchert MBM, Viana MM, Lemos MS, Dweck J, Buchler PM. Simultaneous solidification of two catalyst wastes and their effect on the early stages of cement hydration. J Therm Anal Calorim. 2011;105:625–33.Vessalas K, Thomas PS, Ray AS, Guerbois JP, Joyce P, Haggman J. Pozzolanic reactivity of the supplementary cementitious material pitchstone fines by thermogravimetric analysis. J Therm Anal Calorim. 2009;97:71–6.Tommaseo CE, Kersten M. Aqueous solubility diagrams for cementitious waste stabilization systems. 3. Mechanism of zinc immobilization by calcium silicate hydrate. Environ Sci Technol. 2002;36:2919–25.Peyronnard O, et al. Study of mineralogy and leaching behavior of stabilized/solidified sludge using differential acid neutralization analysis. Cem Conc Res. 2009. doi: 10.1016/j.cemconres.2009.03.016 .Moulin I, et al. Lead, zinc and chromium (III) and (VI) speciation in hydrated cement phases. International conference on the science and engineering of recycling for environmental protection, waste materials in construction (WASCON 2000), Harrogate, England, 2000, pp. 269–280.Ziegler F, Gieré R, Johnson CA. Sorption mechanisms of zinc to calcium silicate hydrate: sorption and microscopic investigations. Environ Sci Technol. 2001;35:4556–61.Qiao XC, Poon CS, Cheeseman CR. Investigation into the stabilization/solidification performance of Portland cement through cement clinker phases. J Hazard Mater. 2007;B139:238–43.Chen QY, et al. Immobilisation of heavy metal in cement-based solidification/stabilisation: a review. Waste Manag (Oxford). 2009;29:390–403.Chen QY, et al. Characterisation of products of tricalcium silicate hydration in the presence of heavy metals. J Hazard Mater. 2007;147:817–25.Fernandez-Olmo I, Chacon E, Irabien A. Influence of lead, zinc, iron (III) and chromium (III) oxides on the setting time and strength development of Portland cement. Cem Concr Res. 2001;31:1213–9.Fernandez-Olmo I, Chacon E, Irabien A. Leaching behavior of lead, chromium (III) and zinc in cement/metal oxides systems. ASCE J Environ Eng. 2003;129:532–8.Cappuyns V, Swennenb R. The application of pHstat leaching tests to assess the pH-dependent release of trace metals from soils, sediments and waste materials. J Hazard Mater. 2008;158:185–95.Payá J, Monzó J, Borrachero MV, Velázquez S. Evaluation of the pozzolanic activity of fluid catalytic cracking catalyst residue (FC3R): thermogravimetric analysis studies on FC3R-Portland cement pastes. Cem Concr Res. 2003;33:603–9.Wang S, Yang Z, Zeng L. Study of calcium zincate synthesized by solid-phase synthesis method without strong alkali. Mater Chem Phys. 2008;112:603–6.Stumm A, et al. Incorporation of zinc into calcium silicate hydrates, Part I: formation of C–S–H(I) with C/S = 2/3 and its isochemical counterpart gyrolite. Cem Concr Res. 2005;35:1665–75.Stephan D, Mallmann R, Knöfel D, Härdtl R. High intakes of Cr, Ni, and Zn in clinker, Part II. Influence on the hydration properties. Cem Concr Res. 1999;29:1959–67.Liu Y, et al. Thermal decomposition of basic zinc carbonate in nitrogen atmosphere. Thermochim Acta. 2004;414:121–3.Wahab R, et al. Synthesis and characterization of hydrozincite and its conversion into zinc oxide nanoparticles. J Alloy Compd. 2008;461:66–71.Hatakeyama T, Liu Z. Handbook of thermal analysis. New Yok: Wiley; 2000