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Pathological Functions of Prostaglandin E2-specific E-type Prostanoid Receptors within Hormone-sensitive along with Castration-resistant Cancer of the prostate.
Thyrotoxic periodic paralysis (TPP) is a muscular disorder characterized by sudden episodes of muscle weakness and hypokalemia in the setting of thyrotoxicosis. OBJECTIVE We aimed to report our experience with TPP in West Texas and compare its clinical presentation to that of patients admitted for complicated thyrotoxicosis. METHOD Retrospective review of records of adult patients with admission diagnosis of hyperthyroidism, thyrotoxicosis and/or discharge diagnosis of periodic paralysis seen at our institution in a six-year period. RESULTS Patients admitted for complicated thyrotoxicosis were more commonly females of a mean age of 44 years. Patients with TPP were more commonly Hispanic males of a mean age of 27 years. Despite no significantly different thyroid hormone levels, patients with TPP presented with less severe signs and symptoms of hyperthyroidism, as reflected by lower Burch Wartofsky score on admission (19 vs 35, p less then 0.001) and lower occurrence of atrial fibrillation in the TPP group (0% vs 36%, p less then 0.001). Finally 89% of TPP patients presented with QTc prolongation whereas only 19% of thyrotoxic patient presented with a prolonged QTc. CONCLUSION Hispanic patients with TTP seems to have relative resistance to the actions of thyroid hormones, and commonly present with QTc prolongation, a risk factor for cardiac arrhythmias.Objective. Diabetes mellitus (DM) is a risk factor for pancreatic cancer but its prognostic impact remains controversial. We aimed to investigate the association between long-standing DM and the risk of mortality. Methods. This population-based cohort study analyzed data from the national healthcare database in Taiwan. We identified all patients diagnosed with pancreatic cancer and excluded those who were diagnosed with DM within 2 years of the cancer diagnosis. Eligible patients were grouped into long-standing DM (>2 years) and non-diabetic controls, and were compared for overall survival using a Cox proportional hazard model. Sensitivity tests stratified by cancer stages (as indicated by specific treatment) were performed. Results. Patients with long-standing DM were significantly older (mean age, 71.38 vs. 66.0 years, P less then 0.0001) and had a higher Charlson comorbidity index (9.53 vs. 6.78, P less then 0.0001) and diabetes comorbidity severity index (2.38 vs. 0.82, P less then 0.0001) compared with the non-DM controls. Although the unadjusted analysis showed a higher risk of mortality in the patients with long-term DM (crude hazard ratio [HR], 1.26; 95% confidence interval [CI], 1.20-1.33, P less then 0.0001), the association became insignificant after adjustment for age, sex, and comorbidity index (adjusted HR, 1.01; 95% CI, 0.95-1.06, P = 0.84). Subgroup analyses also showed no association between long-term DM and mortality in various subgroups stratified by cancer treatment. Conclusion. After adjusting for associated comorbidities and complications, long-standing DM per se was not an independent prognostic factor for overall survival in this nationwide population-based cohort with pancreatic cancer.Objective Software updatable insulin pumps, such as the tslim X2 pump from Tandem Diabetes Care, enable access to new technology as soon as it is commercialized. The remote software update process allows for minimal interruption in therapy compared to purchasing a new pump, however little quantitative data exists on the software update process nor on pre/post therapeutic outcomes. We examined real-world usage and impact of a remote software updatable predictive low-glucose suspend (PLGS) technology designed to reduce hypoglycemic events in people with insulin-dependent diabetes. Methods Approximately 15,000 U.S. Tandem pump users remotely updated their tslim X2 software to Basal-IQ PLGS technology since its commercial release. We performed a retrospective analysis of users who uploaded at least 21 days of pre/post PLGS update usage data to the Tandem tconnect web application between August 28, 2018 and October 21, 2019 (n=6,170). Insulin delivery and sensor-glucose values were analyzed per recent international consensus and ADA guidelines. Selleck Wortmannin Software update performance was also assessed. Results Median software update time was 5.36 minutes. Overall glycemic outcomes for pre and post software update showed a decrease in sensor time less then 70 mg/dL from 2.14 to 1.18% (-1.01, 95% CI -0.97, -1.05, p less then 0.001), with overall sensor time 70-180 mg/dL increasing from 57.8 to 58.5% (0.64, 95% CI 0.04, 1.24, p less then 0.001). These improvements were sustained at 3, 6 and 9 months after the update. Conclusion Introduction of a software updatable PLGS algorithm for the Tandem tslim X2 insulin pump resulted in sustained reductions of hypoglycemia.Objective In a cohort of medullary thyroid cancer (MTC) patients with biochemical incomplete responses, 37-48% developed structural persistent disease; however, few indictors were available to distinguish those patients who were more likely to develop structural disease. We hypothesized that the relationship between preoperative calcitonin (Ctn) and postoperative Ctn (within 3 days after surgery) could be used to predict early prognosis of these patients. Methods A total of 92 sporadic MTC patients were enrolled in this study. Our team proposed a novel indicator of structural persistent MTC called the Calcitonin Ratio (CR, CR = postoperative Ctn / preoperative Ctn). Cox regression models and the Kaplan-Meier method were used to evaluate the prognostic capability of CR. The area under the time-dependent receiver-operating characteristic curves (AUC) and the Harrell concordance index (C-index) were used for analysis. Results The cutoff CR value used to determine MTC prognosis was 0.15. Multivariate Cox analysis revealed that CR (HR 22.974, 95% CI 3.259-161.959, P = 0.002), TNM (HR 3.968, 95% CI 1.360-21.857, P = 0.031) and multifocality (HR 8.466, 95% CI 1.286-55.716, P = 0.026) independently correlated with MTC prognosis. Kaplan-Meier survival curves demonstrated a lower proportion with structural persistent disease in patients with CR less then 0.15 (P less then 0.001). The 3, 5 and 10-year AUC values were 0.798, 0.752, and 0.743 respectively. The C-index of CR was 0.788 (95% CI 0.763-0.813). Conclusion In this study, CR was identified as a sensitive and specific risk stratification marker for patients with biochemical incomplete responses in sporadic MTC.
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