Reduced Foxo3a, FoxL2, and p27 mRNA expression in human ovarian tissue in premature ovarian insufficiency Abstract Purpose Previous studies have suggested that deletion of Foxo3a, FoxL2, PTEN, p27, and AMH leads to early exhaustion of the primordial follicle pool and premature ovarian insufficiency (POI) in transgenic mice. Our aim was to assess for the first time, to our knowledge, messenger RNA (mRNA) expression of these genes and AMHR2 in human ovarian tissue from women with POI. We hypothesized that these genes would be underexpressed in POI women compared with healthy controls. Methods mRNA levels were evaluated by quantitative reverse transcription-polymerase chain reaction and real-time polymerase chain reaction in cortical ovarian tissue obtained by laparoscopy from Caucasian Greek women with POI (n = 5) and healthy women with normal menstruation (n = 6). Morphological analysis of the ovarian biopsies was also performed to assess the presence of primordial or other types of growing follicles. Results Ovarian tissue from POI patients showed lower Foxo3a, FoxL2, and p27 mRNA expression compared with controls (p = 0.017, p = 0.017, and p = 0.030, respectively). mRNA expression of AMH, PTEN, and AMHR2 was reduced in ovarian biopsies from POI patients as well. However, these differences were not statistically significant (p = 0.143, p = 0.247, and p = 0.662, respectively). Morphological analysis showed complete lack of follicular structures in all POI biopsies. Conclusions Our findings suggest a possible role of Foxo3a, FoxL2, and p27 in the pathogenesis of human POI, which may prove to be of great diagnostic-therapeutic value. Further larger studies are needed to identify a similar pattern for AMH, PTEN, and AMHR2 and to investigate gene expression at a protein level.

Portrait of the Countess Anastasia Spini (1842): acromegaly in art

A year in type 2 diabetes mellitus: 2018 review based on the Endorama lecture Abstract The aim of this article is to review and present the most important studies published in the field of type 2 diabetes mellitus (T2DM) during 2018. These studies were presented in a lecture given on this topic at the Endorama Meeting in Patras, Greece, in January 2019. In order to identify the most important and relevant articles, a search in the English language was conducted in PubMed for publications up to the end of December 2018, with special attention paid to publications in high impact factor journals. The highlights of the main Diabetes Meetings [ADA (American Diabetes Association) and EASD (European Association of Diabetes)], as well as Medscape, were also reviewed. Last but not least, press releases regarding advances in the diagnosis and treatment of T2DM were considered. We finally selected and discussed important studies concerning diagnosis, pathophysiology, and management of this very common clinical entity (19 studies). The majority of studies were clinical trials dealing with new therapeutic tools for treatment of the disease, with the greatest focus being on GLP-1RA. We also presented in brief the main points of new guidelines published for T2DM by various scientific societies (3 sets of guidelines). During 2018, not only leading diabetes associations published guidelines on the disease, but also societies belonging to other primary scientific fields. This is indicative of the awareness of physicians and scientists that T2DM constitutes today a major health problem and of the need for public health strategies for its treatment and prevention.

Asporin levels are low in patients with nonalcoholic fatty liver disease and increase after vitamin E treatment

The relationship between estimated glomerular filtration rate and urine m/creatinine ratio and parathyroid hormone in elderly Koreans Abstract This study aimed to assess the relationship between estimated glomerular filtration rate (eGFR), urine microalbumin/creatinine ratio (uACR), and parathyroid hormone (PTH) levels in elderly Korean men and women. Data were analyzed from 2880 adults (1262 men and 1618 women) aged ≥ 50 years from the Fifth Korean National Health and Nutrition Examination Survey V-2 (KNHANES V-2). In men, after adjusting for related variables, the odds ratios (ORs) of the high PTH levels (PTH > 78.0 ng/L) were significantly higher in the decreased eGFR group [eGFR < 60 ml/min/1.73 m2; 1.353 (95% confidence interval [CI], 0.989–1.851)], elevated uACR group [uACR ≥ 30 mg/g; 1.804 (95% CI, 1.004–3.239)], and decreased eGFR plus elevated uACR group [eGFR < 60 ml/min/1.73 m2 and uACR ≥ 30 mg/g; 2.158 (95% CI, 1.208–3.858)] relative to the normal group (eGFR ≥ 60 ml/min/1.73 m2 and uACR < 30 mg/g). In women, after adjusting for related variables, the ORs of the high PTH levels were significantly higher in the decreased eGFR group [1.585 (95% CI, 0.911–2.760)], elevated uACR group [1.645 (95% CI, 1.127–2.400)], and decreased eGFR plus elevated uACR group [2.934 (95% CI, 1.267–6.795)] relative to the normal group. In conclusion, PTH was positively associated with an increase in uACR in elderly Korean men and women but was not associated with a decrease in eGFR. In addition, PTH increased greatly when both a decrease in eGFR and increase in uACR appeared simultaneously.

Neurocognitive impairment in type 2 diabetes mellitus Abstract There is emerging evidence that cognitive impairment could be a diabetes mellitus-related complication. It has been suggested that diabetic people are at increased risk of cognitive decline, since the metabolic and vascular disturbances of the disease affect brain function. Additionally, prolonged exposure to olther potential detrimental factors leads to irreversible cognitive decrements over time due to the aging process. Neurocognitive impairment signifies decreased performance in cognitive domains such as verbal and nonverbal memory, both immediate and delayed memory, executive function, attention, visuospatial and psychomotor performance, information processing speed, semantic knowledge, and language abilities. The aim of the present article is to review the existing literature on the issue of the neurocognitive decline in type 2 diabetes. A literature search of databases was performed, using as keywords “diabetes” and “cognitive impairment,” and the reference list of papers so identified were examined, with only English language papers being used. Understanding and preventing diabetes-associated cognitive deficits remains a key priority for future research. It is important to ascertain whether interventions to delay diabetes onset or better control of established disease could prevent some of its adverse effects on cognitive skills.

Swimming modifies the effect of noise stress on the HPG axis of male rats Abstract Background Few studies have examined the effect of noise pollution on the hypothalamic-pituitary-gonadal (HPG) axis. In this study, the effects of noise pollution and swimming on the HPG hormone axis of male rats were investigated. Methods Forty male Sprague Dawley rats were assigned to four groups of equal size, including control (C), swimming (S), noise (N), and noise with swimming (NS). Serum levels of GnRH, LH, FSH, and testosterone were measured through blood samples taken 48 h following the last session of treatment. The main treatment programs of voluntary swimming and noise stress were performed 5 days per week over 7 weeks. Results Serum levels of GnRH, LH, FSH, and testosterone decreased after exposure to the noise compared with the S and C groups, while in the S group, all hormone levels were higher than those in the C and N groups. Hormone levels of the SN group were higher than those in the N group but lower than those in the C group. Conclusions Long-term exposure to noise is known to have a negative impact on male sex hormones, while submaximal swimming exercise is likely to reduce these effects and improve HPG axis hormones.

Selenium and selenoprotein P in nonalcoholic fatty liver disease Abstract Conflicting data link nonalcoholic fatty liver disease (NAFLD), a disease with no currently approved treatment, with selenium (Se) and selenoprotein P (SELENOP), a glycoprotein synthesized and primarily secreted by the hepatocytes, functioning as a Se transporter from the liver to other tissues. This review aims to summarize the evidence between Se, SELENOP, and NAFLD, which may hopefully clarify whether current data on Se and SELENOP in NAFLD warrant further investigation for their diagnostic and therapeutic potential. Most, albeit not all, experimental data show a favorable effect of Se on hepatic steatosis, inflammation, and fibrosis. It seems that Se may exert an antioxidant effect on the liver, at least partly via increasing the activity of glutathione peroxidase, whose depletion contributes to the pathogenesis of hepatic inflammation and fibrosis. Se may also affect metalloproteinases, cytokines, and growth factors participating in the pathogenesis of NAFLD and, most importantly, may induce the apoptosis of hepatic stellate cells, the key players in hepatic fibrosis. However, the association between Se or SELENOP and insulin resistance, which is a principal pathogenetic factor of NAFLD, remains inconclusive. Clinical studies on Se or SELENOP in NAFLD are conflicting, apart from those in advanced liver disease (cirrhosis or hepatocellular carcinoma), in which lower circulating Se and SELENOP are constant findings. Existing data warrant further mechanistic studies in valid animal models of human NAFLD. Prospective cohort studies and possibly randomized controlled trials are also needed to elucidate the diagnostic and therapeutic potential of Se supplementation in selected NAFLD individuals with Se deficiency.

Mona Lisa is euthyroid: a modern-day diagnosis Abstract Making any medical diagnosis of an individual appearing in an old painting is risky. Throughout history, the famous painting of the Mona Lisa by Leonardo da Vinci has challenged many scientists and physicians to scrutinize this striking and enigmatic female image for the purpose of potentially explaining the woman “behind the smile” and offering a medical diagnosis of her state of health. A recent proposal was that she suffered from severe hypothyroidism and that her asymmetric smile was due to psychomotor retardation. Today, in the twenty-first century, can Mona Lisa get “a second opinion?”

An unsuspicious thyroid nodule with fatal outcome Abstract Introduction Over the last few years, several scientific societies have introduced specific evaluation systems to stratify the risk of malignancy of thyroid nodules. Most of these classifications have been created on the basis of ultrasonographic features of the commonest thyroid carcinoma histotype. Herein, we report a case of anaplastic thyroid carcinoma presenting at ultrasound (US) examination as an unsuspicious thyroid nodule associated with distant metastases, which was followed by the patient’s death a short time later. Case report A 77-year-old woman, because of worsening weight loss and vague abdominal pain, underwent a whole-body computed tomography scan, which revealed a large mass adherent to the large bowel, multiple pulmonary nodules, and a solitary thyroid nodule of the left lobe. On US, a round, well-defined, mixed solid-cystic, isoechoic lesion with a maximum diameter of 45 mm and peripheral vascularity was confirmed. No microcalcifications, extrathyroidal extension, cervical lateral lymphadenopathy, tracheal deviation, or compression were found. The nodule was classified as low or very low risk according to six US malignancy risk classification systems. Although only two of these recommended fine-needle aspiration cytology, on the basis of a dimensional criterion, the procedure was performed, the cytology report suggesting anaplastic cancer. Following total thyroidectomy, the histological examination revealed the presence of a follicular thyroid carcinoma with diffuse areas of anaplastic dedifferentiation. Conclusion This case highlights the importance of defining the US characteristics of rare variants of thyroid neoplasms, since an early diagnosis is decisive in defining the patient’s prognosis.