International Journal of Endocrinology The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. BRAF Mutations in an Italian Regional Population: Implications for the Therapy of Thyroid Cancer Thu, 26 Nov 2015 13:29:28 +0000 Background. Molecular diagnostics has offered new techniques for searching for mutations in thyroid indeterminate lesions. The study’s aim was to evaluate the BRAF mutations’ incidence in an Italian regional population. Subjects and Methods. 70 Caucasian patients born in Liguria with indeterminate or suspicious cytological diagnoses. Results. A BRAF gene mutation was successfully analyzed in 56/70 patients. The mutation was BRAF V600E in 12/56 cases (21%) and BRAF K601E in 2/56 (4%). Of the BRAF mutated samples on cytological diagnosis (14/56 cases), 2/14 cases (14%) were benign on final histology and 12/14 (86%) were malignant. All BRAF-mutated cases on cytology that were found to be benign on histological examination carried the K601E mutation. Of the nonmutated BRAF cases (42/56, 75%) which were later found to be malignant on definitive histology, 5 cases were follicular carcinomas (36%), 3 cases were incidentally found to be papillary microcarcinomas (22%), 2 were cases papillary carcinomas (14%), 1 was case follicular variant of papillary carcinoma (7%), 1 was case medullary carcinoma (7%), 1 case was Hurtle cell tumor (7%), and 1 case was combined cell carcinoma and papillary oncocytic carcinoma (7%). Conclusions. The presence of the BRAF V600E mutation may suggest a more aggressive surgical approach. BRAF K601E mutation did not correlate with malignancy indexes. Eleonora Monti, Michela Bovero, Lorenzo Mortara, Giorgia Pera, Simonetta Zupo, Elena Gugiatti, Mariella Dono, Barbara Massa, Gian Luca Ansaldo, and Giusti Massimo Copyright © 2015 Eleonora Monti et al. All rights reserved. Sexual Dimorphisms of Adrenal Steroids, Sex Hormones, and Immunological Biomarkers and Possible Risk Factors for Developing Rheumatoid Arthritis Thu, 26 Nov 2015 13:18:59 +0000 Innate immunity and immunological biomarkers are believed to be interrelated with sex hormones and other neuroendocrine factors. Sexual dimorphism mechanisms may be operating in certain rheumatic and inflammatory diseases which occur more frequently in women than men, as rheumatoid arthritis (RA). Less data have been available on altered interrelations of the combined neuroendocrine and immune (NEI) systems as risk factors for development of certain diseases. In this study, serological interrelations of NEI biomarkers are analyzed before symptomatic onset of RA (pre-RA) versus control (CN) subjects, stratified by sex. Sexual dimorphism was found in serum levels of acute serum amyloid A (ASAA), soluble interleukin-2 receptor alpha (sIL-2Rα), and soluble tumor necrosis factor receptor 1 (sTNF-R1). Multiple steroidal and hormonal (neuroendocrine) factors also showed highly significant sexual dimorphism in their assayed values, but less for cortisol , and not for 17-hydroxyprogesterone . After stratification by sex and risk of developing RA, differential NEI correlational patterns were observed in the interplay of the NEI systems between the pre-RA and CN groups, which deserve further investigation. Alfonse T. Masi, Azeem A. Rehman, Laura C. Jorgenson, Jennifer M. Smith, and Jean C. Aldag Copyright © 2015 Alfonse T. Masi et al. All rights reserved. Eosinophils Reduce Chronic Inflammation in Adipose Tissue by Secreting Th2 Cytokines and Promoting M2 Macrophages Polarization Wed, 25 Nov 2015 08:52:48 +0000 Obesity is now recognized as a low-grade, chronic inflammatory disease that is linked to a myriad of disorders including cardiovascular diseases, type 2 diabetes, and liver diseases. Recently it is found that eosinophils accelerate alternative activation macrophage (AAM) polarization by secreting Th2 type cytokines such as interleukin-4 and interleukin-13, thereby reducing metainflammation in adipose tissue. In this review, we focused on the role of eosinophils in regulating metabolic homeostasis and obesity. Yi Zhang, Peng Yang, Ran Cui, Manna Zhang, Hong Li, Chunhua Qian, Chunjun Sheng, Shen Qu, and Le Bu Copyright © 2015 Yi Zhang et al. All rights reserved. Low Serum Vitamin D Is Associated with Anti-Thyroid-Globulin Antibody in Female Individuals Sun, 22 Nov 2015 14:34:11 +0000 Objectives. Some evidence has pointed out that vitamin D plays a significant role in reducing the incidence of autoimmune diseases, especially autoimmune thyroid diseases. The authors aimed to examine the relationship between circulating 25-hydroxyvitamin D and thyroid autoantibody in a population-based health survey of Xinjiang Chinese population. Subjects and Methods. A total of 1714 Chinese adults were analyzed. 25(OH)D, anti-thyroid antibodies, and thyroid function were measured. Results. The prevalence of vitamin D insufficiency was 28.3% in Hans and 9.3% in Uyghurs, and the prevalence of vitamin D deficiency was 61.6% in Hans and 87.6% in Uyghurs. Overall prevalence of TgAb positivity was 6.2% (0.9% males; 5.3% females). In female subjects, mean serum 25(OH)D levels were significantly lower in Hans and Uyghurs compared with males, and the difference was statistically significant. Importantly, after adjusting for age and ethnicity, a negative correlation (, ) was recognized between 25(OH)D and TgAb levels only in female subjects. Conclusion. Vitamin D insufficiency and deficiency are prevalent among Chinese adults. Low serum 25(OH)D is related to the presence of TgAb in females. The causal effect of low vitamin D level on thyroid autoimmunity should be studied further more. Xinling Wang, Jazyra Zynat, Yanying Guo, Reziwan Osiman, Aihemaitjan Tuhuti, Hongli Zhao, Munira Abdunaimu, Huili Wang, Xiaoping Jin, and Shuqing Xing Copyright © 2015 Xinling Wang et al. All rights reserved. Safety Profile and Effects of Pulsed Methylprednisolone on Vital Signs in Thyroid Eye Disease Sun, 22 Nov 2015 12:26:54 +0000 Objective. To analyze changes in vital signs (heart rate (HR), systolic (SBP), and diastolic blood pressure (DBP)) during and after intravenous methylprednisolone (IVMP) and any other adverse effects. Methods. Retrospective review of charts of patients who received IVMP as treatment regime for thyroid eye disease. All subjects had vital signs charted during and after infusions. Results. This study included 38 subjects and a total of 242 infusions administered. IVMP resulted in a small but significant percentage drop in mean SBP at 30 min () and 60 min () but no difference at 90 min. There was also small but significant percentage drop in mean DBP and HR (DBP: for 30 min, for 60 min, and for 90 min and HR: for 30 min, 60 min, and 90 min). There were no cumulative effects on change of blood pressure or HR. There were 6 episodes of bradycardia (2.5%) and 12 episodes of moderate to severe hypertension (5%). No significant cardiovascular or hepatic toxicity was found. Conclusion. IVMP is relatively safe and efficacious. IVMP demonstrated mild and noncumulative effects on vital signs. Severe hypertension may occur in susceptible individuals such as those with underlying hypertension and uncontrolled thyroid dysfunction, whereas bradycardia may be more likely in those on beta-blockers. Kai-Ling Yong, Chiaw Ling Chng, Hla Myint Htoon, Lee Hooi Lim, and Lay Leng Seah Copyright © 2015 Kai-Ling Yong et al. All rights reserved. Glycolipid Metabolism Disorder in the Liver of Obese Mice Is Improved by TUDCA via the Restoration of Defective Hepatic Autophagy Thu, 19 Nov 2015 15:16:16 +0000 Objective. Tauroursodeoxycholic acid (TUDCA) has been considered an important regulator of energy metabolism in obesity. However, the mechanism underlying how TUDCA is involved in insulin resistance is not fully understood. We tested the effects of TUDCA on autophagic dysfunction in obese mice. Material and Methods. 500 mg/kg of TUDCA was injected into obese mice, and metabolic parameters, autophagy markers, and insulin signaling molecular were assessed by Western blotting and real-time PCR. Results. The TUDCA injections in the obese mice resulted in a reduced body weight gain, lower blood glucose, and improved insulin sensitivity compared with obese mice that were injected with vehicle. Meanwhile, TUDCA treatment not only reversed autophagic dysfunction and endoplasmic reticulum stress, but also improved the impaired insulin signaling in the liver of obese mice. Additionally, the same results obtained with TUDCA were evident in obese mice treated with the adenoviral Atg7. Conclusions. We found that TUDCA reversed abnormal autophagy, reduced ER stress, and restored insulin sensitivity in the liver of obese mice and that glycolipid metabolism disorder was also improved via the restoration of defective hepatic autophagy. Qinyue Guo, Qindong Shi, Huixia Li, Jiali Liu, Shufang Wu, Hongzhi Sun, and Bo Zhou Copyright © 2015 Qinyue Guo et al. All rights reserved. Association of Pre-miR-146a rs2910164 Polymorphism with Papillary Thyroid Cancer Wed, 18 Nov 2015 14:32:06 +0000 The incidence rate of papillary thyroid cancer (PTC) has increased over the past decades, but the pathogenesis remains unclear. rs2910164, located in pre-miR-146a, has been studied in PTCs with different ethnicity, but the results were inconsistent. Here we evaluate the association between rs2910164 polymorphism and PTC and investigate the effect of this polymorphism on patients’ clinicopathological characteristics. 1238 PTC patients and 1275 controls, all Han population, from Northern China, were included in our study. rs2910164 was genotyped using Matrix-Assisted Laser Desorption/Ionization Time of Flight Mass Spectrometry (MALDI-TOF-MS). Analysis of inheritance model was performed using the SNPStats program. Strength of association was assessed by odds ratio (OR) and 95% confidence interval (CI). Overall, no statistical difference in rs2910164 genotype distribution and allelic frequencies between cases and controls was found, and patients with different genotypes had similar clinicopathological characteristics in terms of stage, location, concurrent of benign thyroid tumor, and thyroiditis, while, as the number of G alleles increased, proportion of patients aged ≥45 years and those without metastasis increased ( and , resp.). However, no association remained significant after Bonferroni correction under any model of inheritance. Our results suggest no association between rs2910164 polymorphism with PTC and patients’ clinicopathological characteristics. Xin Zhang, Yulu Gu, Xiaoli Liu, Yaqin Yu, Jieping Shi, Qiong Yu, Hui Sun, Joseph Sam Kanu, Siyan Zhan, and Yawen Liu Copyright © 2015 Xin Zhang et al. All rights reserved. Association Analysis of MET Gene Polymorphism with Papillary Thyroid Carcinoma in a Chinese Population Sun, 15 Nov 2015 09:04:40 +0000 To investigate the association of MET SNPs with gender disparity in thyroid tumors, as well as the metastasis and prognosis of patients, 858 patients with papillary thyroid carcinoma (PTC), 556 patients with nodular goiter, and 896 population-based normal controls were recruited. The genotyping of MET SNPs was carried out using the Sequenom MassARRAY system. The distribution of MET SNPs (rs1621 and rs6566) was different among groups. Gender stratification analysis revealed a significant association between the rs1621 genotype and PTC in female patients (), but not in male patients (). For female patients, the rs1621 AG genotype was significantly higher in patients with PTC than in normal controls () and revealed an increasing risk of PTC (OR: 1.465, 95% CI: 1.118–1.92). However, association analysis of the rs1621 genotype with metastasis and prognosis revealed no significant correlation in both male and female patients. The findings of our study showed that polymorphism of SNP locus rs1621 in MET gene may be associated with gender disparity in PTC. Higher AG genotypes in rs1621 were correlated with PTC in female patients, but not in male patients. Lifeng Ning, Yaqin Yu, Xiaoli Liu, Lizhe Ai, Xin Zhang, Wenwang Rao, Jieping Shi, Hui Sun, and Qiong Yu Copyright © 2015 Lifeng Ning et al. All rights reserved. Influence of Acarbose on Plasma Glucose Fluctuations in Insulin-Treated Patients with Type 2 Diabetes: A Pilot Study Wed, 11 Nov 2015 09:15:42 +0000 Background and Aims. To evaluate the effect of adding acarbose on glycemic excursions measured by continuous glucose monitoring system (CGMS) in patients with type 2 diabetes mellitus (T2DM) already on insulin therapy. Materials and Methods. This was an opened and unblended study. 134 patients with T2DM were recruited. After initial rapidly corrected hyperglycaemia by continuous subcutaneous insulin infusion (CSII) for 7 d, a 4–6-day premixed insulin titration period subsequently followed. Patients were then randomized 1 : 1 to acarbose plus insulin group or insulin therapy group for 2 weeks. CGMS was used to measure glucose fluctuations for at least 3 days after therapy cessation. Results. Patients in acarbose plus insulin group achieved a significant improvement of MAGE compared to that of insulin therapy only group ( versus  mmol/L, ), accompanied by a significant decrease in the incremental AUC of plasma glucose concentration above 10.0 mmol/L (0.5 versus 0.85  mmol/L per day, ). Conclusions. Add-on acarbose to insulin therapy further improves glucose fluctuation in patients with T2DM. This study was registered with registration number ChiCTR-TRC-11001218. Feng-fei Li, Xiao-hua Xu, Li-yuan Fu, Xiao-fei Su, Jin-dan Wu, Chun-feng Lu, Lei Ye, and Jian-hua Ma Copyright © 2015 Feng-fei Li et al. All rights reserved. Association among Fibrinolytic Proteins, Metabolic Syndrome Components, Insulin Secretion, and Resistance in Schoolchildren Sun, 08 Nov 2015 07:53:34 +0000 We investigated the role of urokinase plasminogen activator (uPA) and its soluble receptors (suPAR) and plasminogen activator inhibitor-1 (PAI-1) in metabolic syndrome (MetS) components, insulin secretion, and resistance in schoolchildren. We enrolled 387 children, aged 10.3 ± 1.5 years, in Taipei. Anthropometry, fibrinolytic proteins, MetS components, insulin secretion, and resistance were measured. Subjects were divided into normal, overweight, and obese groups. Finally, the relationship between fibrinolytic proteins and metabolic syndrome in boys and girls was analyzed. In boys, PAI-1 was positively associated with body mass index (BMI) percentile, hypertriglyceride, insulin secretion, and resistance. In girls, PAI-1 was positively associated with obesity, hypertriglyceridemia, and insulin secretion. In girls, uPA was positively associated with insulin secretion. suPAR was positively associated with high-sensitivity C-reactive protein in both boys and girls, and with BMI percentile and body fat in girls. The obese boys had higher suPAR and PAI-1 levels than the normal group. The obese girls had higher uPA, suPAR, and PAI-1 than the normal group. Boys and girls with MetS had higher PAI-1. Fibrinolytic proteins, especially PAI-1, are associated with MetS components and insulin secretion in children. Fibrinolytic proteins changes were more likely to occur in girls than in boys. Jin-Shuen Chen, Chung-Ze Wu, Nain-Feng Chu, Li-Chien Chang, Dee Pei, and Yuh-Feng Lin Copyright © 2015 Jin-Shuen Chen et al. All rights reserved. Galectin-3 and Cyclin D3 Immunohistochemistry and Tumor Dimensions Are Useful in Distinguishing Follicular Oncocytic Carcinomas from Oncocytic Adenomas of the Thyroid Thu, 29 Oct 2015 08:10:40 +0000 Aims. Oncocytic (Hurthle) follicular cell tumors (OTs) of the thyroid are both adenomas (OAs) and follicular carcinomas (OCs). The routine diagnosis of these tumors can be problematic even after an accurate sampling and histological examination. Beside preoperative evaluation due to the tumor’s dimension several studies have been performed to find markers able to distinguish malignant from benign follicular tumors in the thyroid, with Galectin-3 being one of the most effective. Recently, some authors suggested cyclin D3 as adjunct to the diagnosis of the oncocytic lesions of the thyroid. Methods and Results. In this paper we assess the role of Galectin-3 and cyclin D3 in a well-selected group of follicular oncocytic tumors (14 OCs and 26 OAs). The diameter of each lesion was also evaluated. The combination of Galectin-3 and cyclin D3 has a good specificity (81%) and sensitivity (100%). Moreover, the maximum diameter (in cm) of OCs is greater than OAs (4.1 versus 2.3). Conclusions. We believe that the use of Galectin-3 and cyclin D3 in OTs of the thyroid can be a helpful panel in daily practice when histology is doubtful. C. Cacchi, H. M. Arnholdt, C. J. Haas, H. Kretsinger, L. Axt, and B. Märkl Copyright © 2015 C. Cacchi et al. All rights reserved. Association between Serum Soluble Klotho Levels and Mortality in Chronic Hemodialysis Patients Wed, 28 Oct 2015 13:09:55 +0000 Klotho is a single-pass transmembrane protein predominantly expressed in the kidney. The extracellular domain of Klotho is subject to ectodomain shedding and is released into the circulation as a soluble form. Soluble Klotho is also generated from alternative splicing of the Klotho gene. In mice, defects in Klotho expression lead to complex phenotypes resembling those observed in dialysis patients. However, the relationship between the level of serum soluble Klotho and overall survival in hemodialysis patients, who exhibit a state of Klotho deficiency, remains to be delineated. Here we prospectively followed a cohort of 63 patients with a mean duration of chronic hemodialysis of years for a median of 65 months. Serum soluble Klotho was detectable in all patients (median 371 pg/mL, interquartile range 309–449). Patients with serum soluble Klotho levels below the lower quartile (<309 pg/mL) had significantly higher cardiovascular and all-cause mortality rates. Furthermore, the higher all-cause mortality persisted even after adjustment for confounders (hazard ratio 4.14, confidence interval 1.29–13.48). We conclude that there may be a threshold for the serum soluble Klotho level associated with a higher risk of mortality. Naoko Otani-Takei, Takahiro Masuda, Tetsu Akimoto, Sumiko Honma, Yuko Watanabe, Kazuhiro Shiizaki, Takuya Miki, Eiji Kusano, Yasushi Asano, Makoto Kuro-o, and Daisuke Nagata Copyright © 2015 Naoko Otani-Takei et al. All rights reserved. Cardiovascular System Changes and Related Risk Factors in Acromegaly Patients: A Case-Control Study Tue, 27 Oct 2015 14:02:04 +0000 Background. Cardiovascular complications are known to be the main determinants of reduced life expectancy and decreased quality of life in acromegaly patients. Our study aimed to provide insight into the cardiovascular changes that occur in acromegaly patients and to investigate the correlative risk factors. Methods. A total of 108 patients definitively diagnosed with acromegaly and 108 controls matched for age and gender were recruited into study and control groups, respectively. Standard echocardiography was performed on all of the participants, and data were collected and analyzed. Results. All acromegaly patients presented with structural cardiac changes, including a larger heart cavity, thicker myocardial walls, and increased great vessel diameters compared with the control group. Additionally, the acromegaly patients presented with reduced diastolic function. Aging and increased body mass index (BMI) were correlated with myocardial hypertrophy and diastolic dysfunction; a longer disease duration was correlated with larger great vessel diameters. Conclusions. Ageing and increased BMI are independent risk factors for acromegalic cardiomyopathy, and a long disease duration results in the expansion of great vessels. Increased efforts should be made to diagnose acromegaly at an early stage and to advise acromegaly patients to maintain a healthy weight. Xiaopeng Guo, Lu Gao, Shuo Zhang, Yilin Li, Yue Wu, Ligang Fang, Kan Deng, Yong Yao, Wei Lian, Renzhi Wang, and Bing Xing Copyright © 2015 Xiaopeng Guo et al. All rights reserved. Four-Point Preprandial Self-Monitoring of Blood Glucose for the Assessment of Glycemic Control and Variability in Patients with Type 2 Diabetes Treated with Insulin and Vildagliptin Mon, 26 Oct 2015 07:35:00 +0000 The study explored the utility of four-point preprandial glucose self-monitoring to calculate several indices of glycemic control and variability in a study adding the DPP-4 inhibitor vildagliptin to ongoing insulin therapy. This analysis utilized data from a double-blind, randomized, placebo-controlled crossover study in 29 patients with type 2 diabetes treated with vildagliptin or placebo on top of stable insulin dose. During two 4-week treatment periods, self-monitoring of plasma glucose was undertaken at 4 occasions every day. Glucose values were used to assess several indices of glycemic control quality, such as glucose mean, GRADE, M-VALUE, hypoglycemia and hyperglycemia index, and indices of glycemic variability, such as standard deviation, CONGA, J-INDEX, and MAGE. We found that vildagliptin improved the glycemic condition compared to placebo: mean glycemic levels, and both GRADE and M-VALUE, were reduced by vildagliptin . Indices also showed that vildagliptin reduced glycemia without increasing the risk for hypoglycemia. Almost all indices of glycemic variability showed an improvement of the glycemic condition with vildagliptin , though more marked differences were shown by the more complex indices. In conclusion, the study shows that four-sample preprandial glucose self-monitoring is sufficient to yield information on the vildagliptin effects on glycemic control and variability. Andrea Tura, Johan Farngren, Anja Schweizer, James E. Foley, Giovanni Pacini, and Bo Ahrén Copyright © 2015 Andrea Tura et al. All rights reserved. Long-Term Ultrasonography Follow-Up of Thyroid Colloid Cysts at the Health Center: A Single-Center Study Thu, 22 Oct 2015 14:01:32 +0000 Objective. No previous study has employed long-term follow-up ultrasonography (US) examinations for evaluating thyroid colloid cysts (TCCs) in the general population. This study aimed to assess the interval changes of TCCs at the health center by evaluating long-term US follow-up examinations. Methods. For evaluation of the thyroid gland at our health center from 2006 to 2010, 3692 individuals underwent 4 or more thyroid US examinations at an interval of 1 year or 2 years. We assessed the interval changes of TCCs ≥ 5 mm on US follow-up examinations. Results. Of the 3692 subjects, only 115 (3.1%) showed TCCs ≥ 5 mm on one or more thyroid US examinations. The interval changes in TCCs, as shown by the thyroid US examinations performed during the study period, were classified as follows: no interval change (), gradual increase (), gradual decrease (), positive fluctuation (), negative fluctuation (), and disappearance (). No subject reported any relevant symptom pertaining to TCCs. Conclusions. Overall, follow-up US examinations showed various interval changes in TCCs, but a majority of TCCs showed no interval change or a gradual increase in size. Myung Ho Rho and Dong Wook Kim Copyright © 2015 Myung Ho Rho and Dong Wook Kim. All rights reserved. Lithium Carbonate in the Treatment of Graves’ Disease with ATD-Induced Hepatic Injury or Leukopenia Tue, 20 Oct 2015 13:14:55 +0000 Objective. GD with ATD-induced hepatic injury or leukopenia occurs frequently in clinical practice. The purpose of the present study was to observe the clinical effect of lithium carbonate on hyperthyroidism in patients with GD with hepatic injury or leukopenia. Methods. Fifty-one patients with GD with hepatic injury or leukopenia participated in the study. All patients were treated with lithium carbonate, in addition to hepatoprotective drugs or drugs that increase white blood cell count. Thyroid function, liver function, and white blood cells were measured. Clinical outcomes were observed after a 1-year follow-up. Results. After treatment for 36 weeks, symptoms of hyperthyroidism and the level of thyroid hormones were improved and liver function, and white blood cells returned to a normal level. Twelve patients (23.5%) obtained clinical remission, 6 patients (11.8%) relapsed after withdrawal, 25 patients (49.0%) received radioiodine therapy, and 8 patients (15.7%) underwent surgical procedures after lithium carbonate treatment. Conclusion. Lithium carbonate has effects on the treatment of mild-to-moderate hyperthyroidism caused by GD, and it is particularly suitable for patients with ATD-induced hepatic injury or leukopenia. Rendong Zheng, Kemian Liu, Kun Chen, Wen Cao, Lin Cao, Huifeng Zhang, Hongping Sun, and Chao Liu Copyright © 2015 Rendong Zheng et al. All rights reserved. Challenges of Diabetes Self-Management in Adults Affected by Food Insecurity in a Large Urban Centre of Ontario, Canada Tue, 20 Oct 2015 11:07:50 +0000 Objective. To explore how food insecurity affects individuals’ ability to manage their diabetes, as narrated by participants living in a large, culturally diverse urban centre. Design. Qualitative study comprising of in-depth interviews, using a semistructured interview guide. Setting. Participants were recruited from the local community, three community health centres, and a community-based diabetes education centre servicing a low-income population in Toronto, Ontario, Canada. Participants. Twenty-one English-speaking adults with a diagnosis of diabetes and having experienced food insecurity in the past year (based on three screening questions). Method. Using six phases of analysis, we used qualitative, deductive thematic analysis to transcribe, code, and analyze participant interviews. Main Findings. Three themes emerged from our analysis of participants’ experiences of living with food insecurity and diabetes: (1) barriers to accessing and preparing food, (2) social isolation, and (3) enhancing agency and resilience. Conclusion. Food insecurity appears to negatively impact diabetes self-management. Healthcare professionals need to be cognizant of resources, skills, and supports appropriate for people with diabetes affected by food insecurity. Study findings suggest foci for enhancing diabetes self-management support. Justine Chan, Margaret DeMelo, Jacqui Gingras, and Enza Gucciardi Copyright © 2015 Justine Chan et al. All rights reserved. The Effects of Reduction Mammaplasty on Serum Leptin Levels and Insulin Resistance Tue, 13 Oct 2015 14:33:05 +0000 Background. The reduction mammaplasty has been a well-executed and known procedure in which considerable amount of fatty tissue is removed from the body. The authors aimed to show the effects of the reduction mammaplasty on serum leptin levels and insulin resistance. Methods. 42 obese female patients who had gigantomastia were operated on. We recorded patients’ demographic and preoperative data, including age, weight, height, and body mass index. Fasting serum leptin, glucose, and insulin levels were noted. Homeostasis model assessment scores were calculated. At the postoperative 8th week, patients were reevaluated in terms of above parameters assessing the presence of any difference. Results. Serum leptin levels were decreased postoperatively and the decrease was statistically significant. We were able to show a decrease in homeostasis model assessment score, which indicated an increase in insulin sensitivity, and this change was statistically significant. A significant correlation between body mass index and leptin change was found postoperatively. Conclusion. Reduction mammaplasty is not solely an aesthetic procedure but it decreases serum leptin levels and increases insulin sensitivity, which may help obese women to reduce their cardiovascular risk. Hakan Uzun, Ozan Bitik, Yahya Baltu, Çiğdem Sönmez, and Ayşegül Öztürk Kaymak Copyright © 2015 Hakan Uzun et al. All rights reserved. Evaluating the Efficacy of Treatment with a GnRH Analogue in Patients with Central Precocious Puberty Tue, 13 Oct 2015 11:52:21 +0000 Objective. GnRH analogues (GnRHa) are used in the treatment of central precocious puberty (CPP). The purpose of this study was to evaluate the efficacy of treatment with a GnRHa (leuprolide acetate) in patients with CPP. Subjects and Methods. A total of 62 female child patients who had been diagnosed with CPP, rapidly progressive precocious puberty (RP-PP), or advanced puberty (AP) and started on GnRHa treatment (leuprolide acetate, Lucrin depot, 3.75 mg once every 28 days) were included in the study. The efficacy of treatment was evaluated with anthropometric data obtained, progression of pubertal symptoms observed, as well as GnRHa tests, and, when necessary, intravenous GnRH tests carried out in physical examinations that were performed once every 3 months. Results. In the current study, treatment of early/advanced puberty at a dose of 3.75 mg once every 28 days resulted in the suppression of the HHG axis in 85.5% of the patients. Conclusion. The findings of this study revealed that a high starting dose of leuprolide acetate may not be necessary in every patient for the treatment of CPP. Starting at a dose of 3.75 mg once every 28 days and increasing it with regard to findings in follow-ups would be a better approach. H. Nur Peltek Kendirci, Sebahat Yılmaz Ağladıoğlu, Veysel N. Baş, Aşan Önder, Semra Çetinkaya, and Zehra Aycan Copyright © 2015 H. Nur Peltek Kendirci et al. All rights reserved. Glycemic Control in Kenyan Children and Adolescents with Type 1 Diabetes Mellitus Thu, 01 Oct 2015 11:44:28 +0000 Background. Type 1 diabetes mellitus (T1DM) is the most common endocrine disorder in children and adolescents worldwide. While data about prevalence, treatment, and complications are recorded in many countries, few data exist for Sub-Saharan Africa. The aim of this study was to determine the degree of control in patients with T1DM aged 1–19 years over a 6-month period in 3 outpatient Kenyan clinics. It also sought to determine how control was influenced by parameters of patient and treatment. Methods. Eighty-two children and adolescents with T1DM were included in the study. Clinical history regarding duration of illness, type and dose of insulin, and recent symptoms of hypoglycemia/hyperglycemia were recorded. Glycaemia, HbA1c, and ketonuria were tested. HbA1c of 8.0% and below was defined as the cut-off for acceptable control. Results. The median HbA1c for the study population was 11.1% (range: 6.3–18.8). Overall, only 28% of patients had reasonable glycemic control as defined in this study. 72% therefore had poor control. It was also found that age above 12 years was significantly associated with poor control. Conclusions. African children and with T1DM are poorly controlled particularly in adolescents. Our data strongly support the necessity of Kenya children to receive more aggressive management and follow-up. Thomas Ngwiri, Fred Were, Barbara Predieri, Paul Ngugi, and Lorenzo Iughetti Copyright © 2015 Thomas Ngwiri et al. All rights reserved. Reported Diabetes Mellitus Prevalence Rates in the Colombia Healthcare System from 2009 to 2012: Analysis by Regions Using Data of the Official Information Sources Thu, 01 Oct 2015 06:52:22 +0000 The objective of this study was to describe the reported diabetes mellitus (DM) prevalence rates of the 20–79-year-old population in Colombia from 2009 to 2012 reported by the healthcare system. Information on number of patients treated for DM was obtained by the Integral Information System of Social Protection (SISPRO), the registry of the Ministry of Health and Social Protection, and the High Cost Account (CAC), an organization to trace high expenditure diseases. From both sources age-standardized reported DM prevalence rates per 100.000 inhabitants from 2009 to 2012 were calculated. Whereas the reported DM prevalence rates of SISPRO revealed an increase from 964/100.000 inhabitants (2009) to 1398/100.000 inhabitants in 2012 (mean annual increase 141/100.000; p value: 0.001), the respective rates in the CAC register were 1082/100.000 (2009) and 1593/100.000 in 2012 (mean annual increase 165/100.000; p value: 0.026). The number of provinces reporting not less than 19% of the highest national reported DM prevalence rates (1593/100.000) increased from two in 2009 to ten in 2012. Apparently, the registries and the information retrieving system have been improved during 2009 and 2012, resulting in a greater capacity to identify and report DM cases by the healthcare system. Noël C. Barengo and Diana Carolina Tamayo Copyright © 2015 Noël C. Barengo and Diana Carolina Tamayo. All rights reserved. A Retrospective Analysis of the Relationship between Ethnicity, Body Mass Index, and the Diagnosis of Gestational Diabetes in Women Attending an Australian Antenatal Clinic Thu, 01 Oct 2015 06:46:00 +0000 Purpose. To estimate the prevalence of gestational diabetes mellitus (GDM) in a multiethnic population, assess the association between country of birth (COB) and GDM, and assess whether the association varies by body mass index (BMI). Methods. A retrospective study of 5260 pregnant women attending Sunshine Hospital, Australia, between 1st July 2012 and 30th June 2013. We fitted logistic regression models to assess the association between COB and GDM. An interaction between BMI and COB was assessed by likelihood ratio test. Results. In the 4610 included in our analysis, most common were women born in Australia or New Zealand (ANZ, 1932, 41.9%) and in Southeast Asia (922, 20%). GDM was diagnosed in 606 (13.2%) women. After adjusting for confounders, women from East Asia were most likely to develop GDM (37, 24.0%) and 5-fold more likely than women from ANZ (OR = 4.77, 95% CI: 3.12, 7.31, ). Women from other Asian countries had a 3-fold increased risk of GDM compared to women from ANZ. There was no evidence of an interaction by BMI .  Conclusions. Women born in Asia have higher risk of GDM compared to women born in ANZ. These data provide support for including COB in GDM management policies. Rebecca McDonald, Amalia Karahalios, Thao Le, and Joanne Said Copyright © 2015 Rebecca McDonald et al. All rights reserved. Diabetes Burden in Urban and Rural Senegalese Populations: A Cross-Sectional Study in 2012 Wed, 30 Sep 2015 17:35:44 +0000 Diabetes represents a challenging global health issue in the 21st century. Data from sub-Saharan African populations are scarce and are usually restricted to urban settings. The objective of this study was to compare prevalence and risk factors of diabetes in rural and urban areas in Senegal. Methods. In a community-based survey between January and May 2012, we included 1027 adults aged 18 years living in northern Senegal. Sociodemographic, clinical, and biological data were collected during household visits. Multivariate logistic regression was performed to identify factors associated with diabetes. Results. Mean age of participants was years and 65.7% were female. Participants from urban area represented 55.7%. The age-standardized prevalence of diabetes was 7.6% (6.0% in men versus 9.0% in women). Prevalence of diabetes was higher in urban areas (8.1%) compared to rural areas (4.6%). Disease awareness rate was 43%. After multivariate analysis, age (OR = 1.63, ), familial history of diabetes (OR = 1.42, ), and abdominal obesity (OR = 1.17, ) were associated with diabetes. Conclusion. Diabetes is frequent in urban and rural areas in Senegal. Awareness rate is very low among populations. Age, family history of diabetes, and abdominal obesity are the main risk factors identified. S. M. Seck, D. G. Dia, D. Doupa, A. Diop-Dia, I. Thiam, M. Ndong, and L. Gueye Copyright © 2015 S. M. Seck et al. All rights reserved. Serum Bisphenol A Level in Boys with Cryptorchidism: A Step to Male Infertility? Mon, 28 Sep 2015 13:04:12 +0000 Cryptorchidism is the most common congenital birth defect in boys and affects about 2–4% full-term male neonates. Its etiology is multifactorial. Purpose. To evaluate the serum bisphenol A (BPA) levels in boys with cryptorchidism and healthy boys and to assess the risk of environmental exposure to BPA using the authors’ questionnaire. The data were acquired from a study on boys with cryptorchidism () and a control group (). Prior to surgery, all patients had BPA serum levels evaluated. The size, position, rigidity of the testis, and abnormality of the epididymis of the undescended testis were assessed. Parents also completed a questionnaire on the risks of exposure to BPA in everyday life. Results. The testes in both groups were similar in size. The turgor of the undescended testis in the group of boys with cryptorchidism was decreased. Free serum BPA level in cryptorchid boys and in the control group was not statistically significant (). The conjugated serum BPA level in cryptorchid boys and in the control group was statistically significant (). Total serum BPA level in cryptorchid boys and in the control group was statistically significant (). Serum total BPA level was related with a positive answer about problems with conception (). Conclusion. Our study indicated that high serum BPA was associated with cryptorchidism. Marta Diana Komarowska, Adam Hermanowicz, Urszula Czyzewska, Robert Milewski, Ewa Matuszczak, Wojciech Miltyk, and Wojciech Debek Copyright © 2015 Marta Diana Komarowska et al. All rights reserved. Sex/Gender Differences in Metabolism and Behavior: Influence of Sex Chromosomes and Hormones Mon, 28 Sep 2015 12:11:05 +0000 Haifei Shi, Lynda M. Brown, and Roshanak Rahimian Copyright © 2015 Haifei Shi et al. All rights reserved. Regulation of Estrogen Receptor α Expression in the Hypothalamus by Sex Steroids: Implication in the Regulation of Energy Homeostasis Sun, 27 Sep 2015 13:26:18 +0000 Sex differences exist in the complex regulation of energy homeostasis that utilizes central and peripheral systems. It is widely accepted that sex steroids, especially estrogens, are important physiological and pathological components in this sex-specific regulation. Estrogens exert their biological functions via estrogen receptors (ERs). ERα, a classic nuclear receptor, contributes to metabolic regulation and sexual behavior more than other ER subtypes. Physiological and molecular studies have identified multiple ERα-rich nuclei in the hypothalamus of the central nervous system (CNS) as sites of actions that mediate effects of estrogens. Much of our understanding of ERα regulation has been obtained using transgenic models such as ERα global or nuclei-specific knockout mice. A fundamental question concerning how ERα is regulated in wild-type animals, including humans, in response to alterations in steroid hormone levels, due to experimental manipulation (i.e., castration and hormone replacement) or physiological stages (i.e., puberty, pregnancy, and menopause), lacks consistent answers. This review discusses how different sex hormones affect ERα expression in the hypothalamus. This information will contribute to the knowledge of estrogen action in the CNS, further our understanding of discrepancies in correlation of altered sex hormone levels with metabolic disturbances when comparing both sexes, and improve health issues in postmenopausal women. Xian Liu and Haifei Shi Copyright © 2015 Xian Liu and Haifei Shi. All rights reserved. Sex Hormones and Their Receptors Regulate Liver Energy Homeostasis Sun, 27 Sep 2015 13:05:37 +0000 The liver is one of the most essential organs involved in the regulation of energy homeostasis. Hepatic steatosis, a major manifestation of metabolic syndrome, is associated with imbalance between lipid formation and breakdown, glucose production and catabolism, and cholesterol synthesis and secretion. Epidemiological studies show sex difference in the prevalence in fatty liver disease and suggest that sex hormones may play vital roles in regulating hepatic steatosis. In this review, we summarize current literature and discuss the role of estrogens and androgens and the mechanisms through which estrogen receptors and androgen receptors regulate lipid and glucose metabolism in the liver. In females, estradiol regulates liver metabolism via estrogen receptors by decreasing lipogenesis, gluconeogenesis, and fatty acid uptake, while enhancing lipolysis, cholesterol secretion, and glucose catabolism. In males, testosterone works via androgen receptors to increase insulin receptor expression and glycogen synthesis, decrease glucose uptake and lipogenesis, and promote cholesterol storage in the liver. These recent integrated concepts suggest that sex hormone receptors could be potential promising targets for the prevention of hepatic steatosis. Minqian Shen and Haifei Shi Copyright © 2015 Minqian Shen and Haifei Shi. All rights reserved. Sodium Valproate Enhances the Urethane-Induced Lung Adenomas and Suppresses Malignization of Adenomas in Ovariectomized Female Mice Sun, 27 Sep 2015 12:59:22 +0000 In the present study, the possible effect of sodium valproate (NaVP) on urethane-induced lung tumors in female mice has been evaluated. BALB/c mice (; 4–6 weeks old, females) were used in the following groups: (1) urethane-treated; (2) urethane-NaVP-treated; (3) only NaVP-treated; (4) control. In the same groups, ovariectomized female mice () were investigated. Urethane was given intraperitoneally, with a total dose of 50 mg/mouse. In NaVP-treated mice groups, 0.4% aqueous solution of NaVP was offered to mice ad libitum. The duration of the experiment was 6 months. The number of tumors per mouse in ovariectomized mice and in those treated with urethane and NaVP was significantly higher than in mice treated with urethane only ( versus , ). No significant difference in the number of tumors per mouse was revealed while comparing the nonovariectomized urethane- and urethane-NaVP-treated groups (). A significant decrease of adenocarcinoma number in ovariectomized mice treated with a urethane-NaVP as compared with ovariectomized mice treated with urethane only was found (). NaVP together with low estrogen may have a protective effect on the malignization of adenomas in ovariectomized mice. Donatas Stakisaitis, Raminta Mozuraite, Nomeda Juodziukyniene, Janina Didziapetriene, Saule Uleckiene, Paulius Matusevicius, and Angelija Valanciute Copyright © 2015 Donatas Stakisaitis et al. All rights reserved. A Role for Estrogen in Schizophrenia: Clinical and Preclinical Findings Sun, 27 Sep 2015 12:52:48 +0000 Gender differences in schizophrenia have been extensively researched and it is being increasingly accepted that gonadal steroids are strongly attributed to this phenomenon. Of the various hormones implicated, the estrogen hypothesis has been the most widely researched one and it postulates that estrogen exerts a protective effect by buffering females against the development and severity of the illness. In this review, we comprehensively analyse studies that have investigated the effects of estrogen, in particular 17β-estradiol, in clinical, animal, and molecular research with relevance to schizophrenia. Specifically, we discuss the current evidence on estrogen dysfunction in schizophrenia patients and review the clinical findings on the use of estradiol as an adjunctive treatment in schizophrenia patients. Preclinical research that has used animal models and molecular probes to investigate estradiol’s underlying protective mechanisms is also substantially discussed, with particular focus on estradiol’s impact on the major neurotransmitter systems implicated in schizophrenia, namely, the dopamine, serotonin, and glutamate systems. Andrea Gogos, Alyssa M. Sbisa, Jeehae Sun, Andrew Gibbons, Madhara Udawela, and Brian Dean Copyright © 2015 Andrea Gogos et al. All rights reserved. 17β Estradiol Modulates Perfusion Pressure and Expression of 5-LOX and CYP450 4A in the Isolated Kidney of Metabolic Syndrome Female Rats Sun, 27 Sep 2015 12:49:15 +0000 Prevalence of metabolic syndrome and progression of nephropathy depend on sex. We examined a protective effect of estradiol against nephropathy in metabolic syndrome through the modulation of the arachidonic acid metabolism by activating the 5-lipoxygenase and cytochrome p450 4A pathways. 28 female Wistar rats were divided into four groups of seven animals each: control, intact metabolic syndrome, ovariectomized metabolic syndrome, and metabolic syndrome ovariectomized plus estradiol. Blood pressure, body weight, body fat, triglycerides, insulin, HOMA-index, albuminuria, and TNF- were increased in ovariectomized metabolic syndrome rats (). The perfusion pressure in isolated kidneys of ovariectomized metabolic syndrome rats in presence of 4 g of arachidonic acid was increased. The inhibitors of the arachidonic acid metabolism Baicalein, Miconazole, and Indomethacin in these rats decreased the perfusion pressure by 57.62%, 99.83%, and 108.5%, respectively and they decreased creatinine clearance and the arachidonic acid percentage. Phospholipase A2 expression in the kidney of ovariectomized metabolic syndrome rats was not modified. 5-lipoxygenase was increased in metabolic syndrome ovariectomized rats while cytochrome p450 4A was decreased. In conclusion, the loss of estradiol increases renal damage while the treatment with estradiol benefits renal function by modulating arachidonic acid metabolism through the 5-lipoxygenase and cytochrome p450 4A pathways. A. M. Zúñiga-Muñoz, V. Guarner Lans, E. Soria-Castro, E. Diaz-Diaz, R. Torrico-Lavayen, E. Tena-Betancourt, and I. Pérez-Torres Copyright © 2015 A. M. Zúñiga-Muñoz et al. All rights reserved.