Exploring the impact of bariatric surgery on high density lipoprotein.

Low HDL cholesterol is an independent cardiac risk factor. A general efficacy gradient exists for the resolution of cardiovascular risk factors after bariatric surgery (i.e.

Diabetes therapy and cancer risk: where do we stand when treating patients?

The pathophysiology of type 2 diabetes mellitus conveys increased cancer risk, and any antidiabetic drug may alter that risk in a favorable or unfavorable way. This article discusses the links between diabetes and cancer, the different agents available for treating diabetes, and the cancer risk associated with these therapies.

Determining pancreatic β-cell compensation for changing insulin sensitivity using an oral glucose tolerance test.

Plasma glucose, insulin, and C-peptide responses during an OGTT are informative for both research and clinical practice in type 2 diabetes. The aim of this study was to use such information to determine insulin sensitivity and insulin secretion so as to calculate an oral glucose disposition index (DI(OGTT)) that is a measure of pancreatic β-cell insulin secretory compensation for changing insulin sensitivity. We conducted an observational study of n = 187 subjects, representing the entire glucose tolerance continuum from normal glucose tolerance to type 2 diabetes.

Incidental papillary thyroid carcinoma: clinical characteristics and prognostic factors among patients with Graves' disease and euthyroid goiter, Cleveland Clinic experience.

Objective: The prevalence and clinical significance of incidental differentiated thyroid cancer (DTC) in patients with Graves' disease (GD) remain uncertain. Thyroid stimulating antibody (TSI Ab)-titers were thought to be responsible for the potentially increased incidence or aggressiveness of PTC in that setting. The aim of this study was to compare the prevalence of incidental DTC among patients with GD and euthyroid goiter (EG), to assess the ability of TSI to predict DTC in GD and to investigate the clinical features that may predict incidental DTC in GD and EG.

AACE/ACE Disease State Clinical Review: Medical Management of Cushing Disease.

Objective: To review available medical therapies for patients with Cushing disease and to provide a roadmap for their use in clinical practice.

Methods: PubMed searches were performed to identify all of the available published data on medical management of Cushing disease.

Results: Medical therapy is usually not the first-line treatment for patients with Cushing disease but may be used to improve clinical manifestations of Cushing disease in patients who are not suitable candidates for surgery, following unsuccessful surgery or recurrence, or as a "bridge therapy" in those who have undergone radiotherapy.

Adrenocortical cancer update.

Although preoperative clinical, biochemical, and radiologic features can aid in the diagnosis of adrenocortical cancer (ACC), uncertainty often remains. This diagnostic ambiguity and the subsequent potential for an inadequate surgical resection have likely contributed to the currently dismal disease-free survival, although unsettlingly high rates of locoregional recurrences still persist even in the setting of a supposedly R0 resection. Refinements in both diagnostic criteria and surgical techniques, as well as the increasing use and study of novel multimodality therapies for ACC, have provided advances in the treatment of these patients, and renewed hope for meaningful improvements in patient outcomes.

Risk prediction of complications of metabolic syndrome before and 6 years after gastric bypass.

Background: Roux-en-Y gastric bypass (RYGB) surgery has been shown to have favorable effects on components of metabolic syndrome. However, the long-term effect of RYGB on predicted risk of end-organ complications is less clear. The objective of this study was to examine long-term changes in predicted risk of metabolic syndrome-related complications after RYGB.

Predictors of hospital length of stay after implantation of a left ventricular assist device: an analysis of the INTERMACS registry.

Background: Few studies have reported on hospital length of stay (LOS) after left ventricular assist device (LVAD) implantation. The purpose of this study was to determine pre- and peri-operative predictors of hospital LOS after LVAD implantation.

Methods: We analyzed adult primary continuous-flow LVAD patients implanted between June 23, 2006 and December 31, 2010 at 105 institutions from the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS).

Bilateral posterior retroperitoneal robotic adrenalectomy for ACTH-independent Cushing syndrome.

Background: Laparoscopic posterior retroperitoneal (PR) adrenalectomy is preferable in patients with bilateral adrenal masses, as it obviates the need for repositioning. Robotic adrenalectomy has been reported to improve surgeon ergonomics and facilitate dissection. Although robotic bilateral transabdominal lateral adrenalectomy has been described in the literature, to our knowledge, the robotic bilateral PR approach has not been reported before.

Exercise-induced lowering of fetuin-A may increase hepatic insulin sensitivity.

Introduction: Fetuin-A is a novel hepatokine, and there is preliminary evidence that it may contribute to the pathogenesis of type 2 diabetes. Exercise reduces fetuin-A, but the specific metabolic effects particularly as they relate to the regulation of insulin resistance are unknown. This led us to examine the effect of exercise training on circulating fetuin-A in relation to skeletal muscle and/or hepatic insulin resistance in obese adults.

Application of Gaussian Process Regression (GPR) in estimating under-five mortality levels and trends in Iran 1990 - 2013, study protocol.

Background: Searching for the latest methods of estimating mortality rates is a major concern for researchers who are working in burden of diseases. Child mortality is an important indicator for assessing population health care services in a country. The National and Sub-national Burden of Diseases, Injuries, and Risk Factors (NASBOD) is conducted in Iran with comparative methods and definitions of Global Burden of Disease (GBD) 2010 to estimate major population health measures including child mortality rate.

Application of spatio-temporal model to estimate burden of diseases, injuries and risk factors in Iran 1990 - 2013.

Background: Identifying the burden of disease and its inequality between geographical regions is an important issue to study health priorities. Estimating burden of diseases using statistical models is inevitable especially in the context of rare data availability. To this purpose, the spatio-temporal model can provide a statistically sound approach for explaining the response variable observed over a region and various times.

Can diabetes be surgically cured? Long-term metabolic effects of bariatric surgery in obese patients with type 2 diabetes mellitus.

Objective: Evaluate the long-term effects of bariatric surgery on type 2 diabetes (T2DM) remission and metabolic risk factors.

Background: Although the impressive antidiabetic effects of bariatric surgery have been shown in short- and medium-term studies, the durability of these effects is uncertain. Specifically, long-term remission rates following bariatric surgery are largely unknown.

Mody-3: novel HNF1A mutation and the utility of glucagon-like peptide (GLP)-1 receptor agonist therapy.

Objective: An estimated 1 to 2% of cases of diabetes mellitus have a monogenic basis; however, delayed diagnosis and misdiagnosis as type 1 and 2 diabetes are common. Correctly identifying the molecular basis of an individual's diabetes may significantly alter the management approach to both the patient and his or her relatives. We describe a case of mature onset diabetes of the young (MODY) with sufficient evidence to support the classification of a novel HNF1A (hepatocyte nuclear factor-1-α) mutation as a cause of MODY-3.

Third-generation ELISA thyrotropin-receptor antibody levels as an adjuvant tool to guide management of patients with Graves orbitopathy.

Objective: When assessing patients with Graves orbitopathy (GO) in an endocrinology outpatient setting, it is desirable to have a diagnostic laboratory tool to complement the clinical activity score (CAS) in distinguishing patients with moderate-severe active GO requiring high-priority ophthalmological care from those with mild or inactive GO who can be electively scheduled and to asses response to treatment.

Methods: A retrospective study was conducted to evaluate the correlation between thyrotropin-receptor antibody (TRAb)-Fast-enzyme-linked immunosorbent assay (ELISA) results and CAS in patients with GO seen at a tertiary referral center between 2000 and 2009. TRAb levels were quantified using a commercial third-generation TRAb-specific ELISA.

Diagnosis of acromegaly: state of the art.

Introduction: Biochemical diagnosis of acromegaly relies on measurement of insulin-like growth factor-1 (IGF-1) and growth hormone (GH). An elevated IGF-1 level above the age- and gender-specific normal range and nonsuppression of GH to oral glucose load to a nadir < 0.4 ng/ml in sensitive assays are currently considered diagnostic of acromegaly.

Robotic endocrine surgery: state of the art.

Over the last decade, developments in technology have led a rapid progress in robotic endocrine surgery applications. Robotics is attractive to the surgeon because of the three-dimensional image quality, articulating instruments, and stable surgical platform. Safety and effectiveness of robotic adrenalectomy and thyroidectomy have been shown in many studies.

The endocrine surgery job market: a survey of fellows, department chairs, and surgery recruiters.

Introduction: Fifty endocrine surgery (ES) fellows have completed their training since the American Association of Endocrine Surgeons initiated a formal match process in 2007. This study was designed to better understand the job prospects of current and future endocrine surgeons and to evaluate the evolution of ES practices nationwide.

Methods: Three surveys were conducted of former fellows, surgery department chairs, and surgery recruiters.

Robotic adrenalectomy.

Over the last 2 decades, laparoscopic adrenalectomy has become the standard for removal of adrenal tumors. Although accepted as a safe and efficient procedure, laparoscopy has certain disadvantages, such as the 2-dimensional view, unstable camera platform, and rigid instrumentation. Robotic surgery offers a solution for these drawbacks and has opened a new era of telemedicine, providing the surgeons with a sophisticated stable 3-dimensional platform, 7 degrees of freedom, and enhanced vision.