Divergences in insulin resistance between the different phenotypes of the polycystic ovary syndrome

Context/Objective: Current diagnostic criteria for polycystic ovary syndrome (PCOS) have generated distinct PCOS phenotypes, based on the different combinations of diagnostic features found in each patient. Our aim was to assess whether either each single diagnostic feature or their combinations into the PCOS phenotypes may predict insulin resistance in these women. Patients/Design: A total of 137 consecutive Caucasian women with PCOS, diagnosed by the Rotterdam criteria, underwent accurate assessment of diagnostic and metabolic features. Insulin sensitivity was measured by the glucose clamp technique. Results: Among women with PCOS, 84.7% had hyperandrogenism, 84.7% had chronic oligoanovulation, and 89% had polycystic ovaries. According to the individual combinations of these features, 69.4% of women had the classic phenotype, 15.3% had the ovulatory phenotype, and 15.3% had the normoandrogenic phenotype. Most subjects (71.4%) were insulin resistant. However, insulin resistance frequency differed among phenotypes, being 80.4%, 65.0%, and 38.1%, respectively, in the 3 subgroups (P < .001). Although none of the PCOS diagnostic features per se was associated with the impairment in insulin action, after adjustment for covariates, the classic phenotype and, to a lesser extent, the ovulatory phenotype were independently associated with insulin resistance, whereas the normoandrogenic phenotype was not. Metabolic syndrome frequency was also different among phenotypes (P = .030). Conclusions: There is a scale of metabolic risk among women with PCOS. Although no single diagnostic features of PCOS are independently associated with insulin resistance, their combinations, which define PCOS phenotypes, may allow physicians to establish which women should undergo metabolic screening. In metabolic terms, women belonging to the normoandrogenic phenotype behave as a separate group

Minimal Extrathyroidal Extension in Predicting 1-Year Outcomes: A Longitudinal Multicenter Study of Low-to-Intermediate-Risk Papillary Thyroid Carcinoma (ITCO#4)

Background: The role of minimal extrathyroidal extension (mETE) as a risk factor for persistent papillary thyroid carcinoma (PTC) is still debated. The aim of this study was to assess the clinical impact of mETE as a predictor of worse initial treatment response in PTC patients and to verify the impact of radioiodine therapy after surgery in patients with mETE. Methods: We reviewed all records in the Italian Thyroid Cancer Observatory (ITCO) database and selected 2237 consecutive patients with PTC who satisfied the inclusion criteria (PTC with no lymph node metastases and at least 1 year of follow-up). For each case, we considered initial surgery, histological variant of PTC, tumor diameter, recurrence risk class according to the American Thyroid Association (ATA) risk stratification system, use of radioiodine therapy, and initial therapy response, as suggested by ATA guidelines. Results: At 1-year follow-up, 1831 patients (81.8%) had an excellent response, 296 (13.2%) had an indeterminate response, 55 (2.5%) had a biochemical incomplete response, and 55 (2.5%) had a structural incomplete response. Statistical analysis suggested that mETE (odds ratio [OR] 1.16, p=0.65), tumor size &gt;2 cm (OR 1.45, p=0.34), aggressive PTC histology (OR 0.55, p=0.15), and age at diagnosis (OR 0.90, p=0.32) were not significant risk factors for a worse initial therapy response. When evaluating the combination of mETE, tumor size, and aggressive PTC histology, the presence of mETE with a &gt;2 cm tumor was significantly associated with a worse outcome (OR 5.27, 95% CI, p=0.014). The role of radioiodine ablation in patients with mETE was also evaluated. When considering radioiodine treatment, propensity score-based matching was performed, and no significant differences were found between treated and non-treated patients (p=0.24). Conclusions: This study failed to show the prognostic value of mETE in predicting initial therapy response in a large cohort of PTC patients without lymph node metastases. The study suggests that the combination of tumor diameter and mETE can be used as a reliable prognostic factor for persistence and could be easily applied in clinical practice to manage PTC patients with low-to-intermediate risk of recurrent/persistent disease

Andrea Brustolon 1662-1732 \u201cIl Michelangelo del legno\u201d

Il volume, catalogo della mostra allestita a Belluno nella Primavera-estate del 2009, rappresenta di fatto la prima monografia 'moderna' di Andrea Brustolon, il pi\uf9 importante interprete della scultura lignea tra Sei e Settecento nell'area veneto-lombarda. I vari contributi, dopo avere contestualizzato la sua figura nel quadro della cultura figurativa barocca (Colle, Pedrocco) ne prendono in esame la figura sotto vari punti di vista: ora dal punto di vista della produzione sacra (Spiazzi), ora inquadrando i debiti culturali della sua formazione (De Grassi), ora analizzandone l'opera grafica (Galasso) e quella preparatoria in terracotta, destinata poi alla traduzione lignea (De Grassi). Sono state poi prese in esame le fonti documentarie (Ceiner) e la fortuna critica goduta dall'autore nell'Ottocento (De Grassi). Completano il volume le schede scientifiche delle opere esposte, molte delle quali completamente inedite

Low body weight and menstrual dysfunction are common findings in both elite and amateur ballet dancers

Background. Several studies have reported that low body weight and menstrual alterations are very frequent findings in elite dancers, suggesting they could be at risk for associated medical problems. However, it is still largely unknown whether these alterations are also common in the very large number of young amateur dancers.Aim. The aim of this study was to assess whether there is an increased prevalence of menstrual dysfunction also in amateur dancers.Material/Subjects and Methods. 92 professional ballet dancers, 93 non-professional ballet dancers, and 293 (160 sedentary, 133 physically active) control women, ranging in age 14-23 yr were included in the study. In these subjects a detailed questionnaire that included questions on weight, height, age at menarche, training profile and menstrual alterations was administered.Results. BMI was lower in both professional and non-professional dancers than in controls. Frequency of menstrual dysfunction was 51%, 34% and 21% in professional dancers, non-professional dancers and controls, respectively (p<0.0001). Amenorrhea was reported by 23% of professional dancers, vs 1-7% in the other groups (p<0.0001). Age at menarche occurred later in professional dancers than in the other groups. Logistic regression analyses showed that menstrual dysfunction was associated with the training profile in professional dancers, and with BMI in non-professional dancers. Age at menarche was associated with menstrual dysfunction in both groups.Conclusions. This study shows that low body weight and menstrual dysfunction are frequent findings also in amateur ballet dancers

Onset of Addison Disease appeared during the first trimester of a twin pregnancy: A case report

Key Clinical MessageAddison Disease is an uncommon, life-threatening condition affecting people at any age, including women during pregnancy. If left untreated, the disease can be rapidly fatal, but the prognosis is good if promptly recognized and hormones are replaced

Thermal stability analysis of High Brightness LED during high temperature and electrical aging

In this paper we report the analysis of thermal stability of High Brightness Light Emitting Diode subjected to thermal and bias ageing. The degradation mechanisms of several families of commercial available devices were investigated. In the first part of the work we estimated thermal resistance and thermal behaviour under dc bias condition. After this thermal characterisation two different ageing tests were carried out on devices: thermal aging at high temperature levels without biasing the devices and accelerated dc stress at nominal current value (400mA). At each step a complete electrical and optical characterisation of aged devices was performed, in order to find a correlation between different aging and a better understanding of degradation mechanism. This characterisation included I-V measurements, optical power vs current characteristics and spectral analysis. During thermal stress we observed the increase of forward voltage at nominal current and the degradation of optical power with nearly exponential kinetics. We found that lifetimes were well correlated with stress temperature: therefore it was possible to find an activation energy of degradation mechanism of about 1.5eV. Moreover, modifications of spectral properties during electrical and thermal stress were found. Thus, a package level analysis was carried out in order to clarify the role of modification in optical properties of reflector cup and the efficiency of phosphors. Finally, evaluation of differential structure functions indicated that stress induces also the worsening of the properties of the chip-to-package thermal path: this phenomenon has been attributed to the partial detachment and degradation of the ohmic contacts