المؤلفون: Dario Giugliano, Miriam Longo, Lorenzo Scappaticcio, Giuseppe Bellastella, Maria Ida Maiorino, Katherine Esposito

المصدر: Cardiovascular Diabetology, Vol 20, Iss 1, Pp 1-11 (2021)

مصطلحات موضوعية: Cardiovascular outcome trials, Type 2 diabetes, SGLT-2 inhibitors, Cardiorenal outcomes, Diseases of the circulatory (Cardiovascular) system, RC666-701

الوصف: Abstract Background It has been suggested that sodium–glucose cotransporter 2 (SGLT-2) inhibitors reduce the cardiorenal risk in patients with type 2 diabetes (T2D). The purpose of this study is to provide an update of all large cardiovascular outcome trials (CVOTs) with SGLT-2 inhibitors to assess their cardiorenal efficacy in patients with and without T2D. Methods An electronic search up to 30 September 2021 was conducted in PubMed, EMBASE, the Cochrane Database of Systematic Reviews, and ClinicalTrials.gov. to determine eligible trials. We included CVOTs comparing any SGLT-2 inhibitor with placebo, reporting desired cardiovascular or renal outcomes and with a follow-up duration of at least 6 months. Results Eleven CVOTs, with data from five SGLT-2 inhibitors (empagliflozin, canagliflozin, dapagliflozin, ertugliflozin and sotagliflozin) and 77,541 participants, were included. In the overall analysis, the risk of the composite CV mortality or hospitalization for heart failure (HF) was reduced by 23% (HR = 0.77, 95% CI 0.73–0.82, P 65 vs ≤ 65 years, P for interaction = 0.78). The risk of CV mortality, total mortality and hospitalization for HF was significantly reduced by 16%, 13%, and 32%, respectively; similarly, the risk of the composite renal outcome was reduced by 35% (HR = 0.65, 95% CI 0.56–0.75), with moderate heterogeneity (I2 = 32%). In the analysis of 6 CVOTs reporting the data, the risk of major cardiovascular events (MACE) was reduced by 12%, with low heterogeneity (I2 = 21.2%, P = 0.19) and irrespective of the presence of established CV disease at baseline (P for interaction = 0.46). Conclusions Therapy with SGLT-2 inhibitors in patients with cardiometabolic and renal diseases results in a sustained to moderate reduction of the composite CV death or hospitalization for HF, robust reduction of HF and renal outcomes, moderate reduction of CV mortality, total mortality and MACE.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1475-2840Test

الوصول الحر: https://doaj.org/article/3c366d570ad24c4d8a1bcf39be258452Test

المؤلفون: Giovanni Conzo, Renato Patrone, Luigi Flagiello, Antonio Catauro, Alessandra Conzo, Chiara Cacciatore, Federico Maria Mongardini, Giovanni Cozzolino, Rosetta Esposito, Daniela Pasquali, Giuseppe Bellastella, Katherine Esposito, Ludovico Docimo

المصدر: Journal of Clinical Medicine, Vol 12, Iss 13, p 4384 (2023)

مصطلحات موضوعية: laparoscopic adrenalectomy, pheochromocytoma, minimally invasive adrenalectomy, Cushing’s syndrome, incidentaloma, energy-based devices, Medicine

الوصف: Background: Laparoscopic adrenalectomy (LA), which avoids large abdomen incisions, is considered the gold standard technique for the treatment of benign small- and medium-size adrenal masses (

وصف الملف: electronic resource

العلاقة: https://www.mdpi.com/2077-0383/12/13/4384Test; https://doaj.org/toc/2077-0383Test

الوصول الحر: https://doaj.org/article/5197aa737fde4ae3936ceb5d8073277bTest

المؤلفون: Dario Giugliano, Lorenzo Scappaticcio, Miriam Longo, Giuseppe Bellastella, Katherine Esposito

المصدر: Cardiovascular Diabetology, Vol 20, Iss 1, Pp 1-5 (2021)

مصطلحات موضوعية: Type 2 diabetes, SGLT-2 inhibitors, GLP-1 receptor agonists, Cardiorenal benefits, Diseases of the circulatory (Cardiovascular) system, RC666-701

الوصف: Abstract Cardiovascular disease (CVD) remains the leading cause of death in patients with type 2 diabetes (T2D). Older age, prior heart failure (HF) and CV events, peripheral artery disease, and kidney complications can identify a subgroup of patients with T2D at high risk of mortality who are likely to achieve the greatest benefit from newer glucose-lowering agents. Both glucagon-like peptide-1 receptor agonists (GLP-1RA) and sodium-glucose cotransporter-2 (SGLT-2) inhibitors can reduce CV risk in patients with T2D, and both are recommended by the American Diabetes Association to reduce the risk of major cardiovascular events (MACE). The magnitude of the benefits of GLP-1RA and SGLT-2 inhibitors on MACE are similar, ranging from 12 to 14% reduction of risk, but only GLP-1RA may reduce the risk of stroke. The most striking difference between the two classes of drugs relates to the amelioration on hospitalization for HF, as the benefit of SGLT-2 inhibitors surpass by threefold that obtained with GLP-1RA. Despite this, GLP-1RA also exert a significant benefit on HF which suggest their use when SGLT-2 inhibitors are contraindicated or not tolerated. The difference between the two classes is less impressive for the kidney outcome. Overall, the results of CVOTs published so far seems to suggest that the gap between the cardiorenal benefits of SGLT-2 and GLP-1RA is narrowing.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1475-2840Test

الوصول الحر: https://doaj.org/article/a251e070cf0e4baf80ee66f12731b997Test

المؤلفون: Maria Ida Maiorino, Miriam Longo, Lorenzo Scappaticcio, Giuseppe Bellastella, Paolo Chiodini, Katherine Esposito, Dario Giugliano

المصدر: Cardiovascular Diabetology, Vol 20, Iss 1, Pp 1-10 (2021)

مصطلحات موضوعية: Cardiovascular outcome trials, Type 2 diabetes, DPP-4i, GLP-1RA, SGLT-2i, Cardiorenal outcomes, Diseases of the circulatory (Cardiovascular) system, RC666-701

الوصف: Abstract Background Besides providing reassurance about cardiovascular (CV) safety of newer diabetes drugs, cardiovascular outcome trials (CVOTs) have also shown encouraging benefits on some CV endpoints. The contribution of the better glycemic control in the reduction of major cardiovascular events (MACE) remains an open question. The aim of this study is to evaluate the associations between the reduction of HbA1c and risk of MACE, MACE components, hospitalization for heart failure (HF) and all-cause death in CVOTs. Methods An electronic search up to July 2021 was conducted to determine eligible trials. Systematic review identified eighteen CVOTs reporting prespecified CV outcomes. Pooled summary estimates and 95% confidence intervals (CI) were calculated according to the random effects model using the Paule-Mandel method; restricted maximum likelihood estimators were used to estimate model parameters in the metaregression. Results The eighteen CVOTs evaluated 161,156 patients and included four trials with dipeptidyl-peptidase-4 inhibitors (DPP-4i), eight trials with glucagon-like peptide-1 receptor agonists (GLP-1RA) and six trials with sodium-glucose cotransporter-2 inhibitors (SGLT-2i). Random-effects model meta-analysis showed an association between treatment and risk of MACE (hazard ratio [HR] 0.90; 95% CI 0.86, 0.94, P

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1475-2840Test

الوصول الحر: https://doaj.org/article/9aedeaf813a14594b1a2323b1bd72ef0Test

المؤلفون: Dario Giugliano, Lorenzo Scappaticcio, Miriam Longo, Paola Caruso, Maria Ida Maiorino, Giuseppe Bellastella, Antonio Ceriello, Paolo Chiodini, Katherine Esposito

المصدر: Cardiovascular Diabetology, Vol 20, Iss 1, Pp 1-11 (2021)

مصطلحات موضوعية: Cardiovascular outcome trials, Type 2 diabetes, GLP-1RA, Cardiorenal outcomes, Lixisenatide, Liraglutide, Diseases of the circulatory (Cardiovascular) system, RC666-701

الوصف: Abstract Background A meta-analysis is presented of cardiovascular outcome trials (CVOTs) comparing glucagon-like peptide-1 receptor agonists (GLP-1RA) versus placebo on cardiorenal outcomes in patients with type 2 diabetes mellitus (T2DM). Methods We did an electronic search up to June 30, 2021, for eligible trials. We did a meta-analysis of available trial data using a random-effects model to calculate overall hazard ratios (HRs) and 95% CI (confidence intervals). We included data from 8 CVOTs and 60,080 patients (72.4% with established cardiovascular disease). Results GLP-1RA reduced major cardiovascular events (MACE) by 14% (HR = 0.86, 95% CI 0.79–0.94, P = 0.006) with a non-significant heterogeneity between subgroups of patients with and without cardiovascular disease (P = 0.127). GLP-1RA also reduced the risk of cardiovascular death by 13% (P = 0.016), nonfatal stroke by 16% (P = 0.007), hospitalization for heart failure by 10% (P = 0.023), all-cause mortality by 12% (P = 0.012), and the broad composite kidney outcome by 17% (P = 0.012), which was driven by a reduction in macroalbuminuria only (HR = 0.74, 0.67–0.82, P

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1475-2840Test

الوصول الحر: https://doaj.org/article/350ec22390e74c53b7c53d0cd7a32144Test

المؤلفون: Lorenzo Scappaticcio, Pierpaolo Trimboli, Sergio Iorio, Maria Ida Maiorino, Miriam Longo, Laura Croce, Marcello Filograna Pignatelli, Sonia Ferrandes, Immacolata Cozzolino, Marco Montella, Andrea Ronchi, Renato Franco, Mario Rotondi, Giovanni Docimo, Katherine Esposito, Giuseppe Bellastella

المصدر: Frontiers in Endocrinology, Vol 13 (2022)

مصطلحات موضوعية: thyroid FNAC, neck ultrasound, ICCRTC, EU-TIRADS, thyroid nodule, Diseases of the endocrine glands. Clinical endocrinology, RC648-665

الوصف: Our institution (University Hospital “L. Vanvitelli” - Naples, Italy) is a high-volume (HV) center in Naples metropolitan area and many patients are referred there to repeat thyroid fine-needle aspiration cytology (FNAC) after initial FNAC performed in low-volume institutions (LV). The aims of the study were to 1) examine the inter-observer agreement between HV and LV institutions according to the Italian thyroid cytology system, and 2) explore how the discordant FNAC reports were distributed in the European Thyroid Imaging and Reporting Data System (EU-TIRADS) categories. All consecutive cases of repeat FNAC performed at University Hospital “L. Vanvitelli” from January 2016 to December 2021 were retrospectively reviewed. Fleiss’ kappa (κ) was used to assess the inter-observer agreement, and categorical variables were compared by chi-square testing. P < 0.05 was considered statistically significant. A total of 124 nodules from 124 adults (mean age 49 years; mean maximum diameter 19 mm) were evaluated. Initial FNAC reports at LV were: 4 (3.2%) TIR1c, 64 (51.6%) TIR2, 48 (38.7%) TIR3A, 8 (6.5%) TIR3B, 0 TIR4, 0 TIR5. The overall FNAC reports were significantly different between the LV and HV institutions. At repeated FNAC, cytological diagnosis was unchanged in 64 (51.6%) cases including TIR2 and TIR3A results. A downgraded FNAC diagnosis (i.e., TIR2 vs TIR3A, TIR2 vs TIR3B) was observed in 36 (29%) nodules. An upgraded FNAC diagnosis (i.e., TIR3B vs TIR2, TIR3B vs TIR3A, TIR4 vs TIR3A, TIR5 vs TIR2, TIR5 vs TIR3B) was recorded in 24 (19.4%) nodules. The weighted inter-observer agreement between LV and HV institutions was poor (κ=0.133). Changed FNAC results were significantly (p=0.0023) more frequent in nodules at intermediate/high-risk (i.e., EU-TIRADS 4/5) than in those at no/low risk (EU-TIRADS 2/3) [i.e., 32/48 (66.7%) and 28/76 (36.8%), respectively]. Downgraded FNAC results were significantly more frequent in EU-TIRADS 2/3 (p=0.001) while upgraded FNAC were present only in EU-TIRADS 4/5 (24/24, 100.0%). The inter-observer agreement among LV and HV thyroid services was poor. The EU-TIRADS 4 and 5 categories included all the malignant nodules with FNAC results reclassified as higher risk (i.e., TIR3B-TIR4-TIR5) by the high-volume cytology service.

وصف الملف: electronic resource

العلاقة: https://www.frontiersin.org/articles/10.3389/fendo.2022.1001728/fullTest; https://doaj.org/toc/1664-2392Test

الوصول الحر: https://doaj.org/article/05a7dab3cf00487b9dbfd254d403174fTest

المؤلفون: Katherine Esposito, Maria Ida Maiorino, Giuseppe Bellastella, Dario Giugliano, Francesco Saverio Mennini, Marco Trabucco Aurilio, Lorenzo Scappaticcio, Miriam Longo, Claudia Nardone, Luca Coppeta, Simone Gazzillo, Raffaele Migliorini

المصدر: BMJ Open, Vol 12, Iss 5 (2022)

مصطلحات موضوعية: Medicine

وصف الملف: electronic resource

العلاقة: https://bmjopen.bmj.com/content/12/5/e057825.fullTest; https://doaj.org/toc/2044-6055Test

الوصول الحر: https://doaj.org/article/b5cc7e065a8a44f98bb9a1c63895e413Test

المؤلفون: Dario Giugliano, Maria Ida Maiorino, Giuseppe Bellastella, Katherine Esposito

المصدر: Cardiovascular Diabetology, Vol 20, Iss 1, Pp 1-4 (2021)

مصطلحات موضوعية: Diseases of the circulatory (Cardiovascular) system, RC666-701

الوصف: Abstract In this commentary, we introduce the concepts of removed and residual risks in conditioning thecardiorenal outlook of patients with type 2 diabetes (T2D). The removed cardiorenal risk represents the risk of progression of CV events (major adverse cardiovascular events, MACE; heart failure, HF) and diabetes kidney disease (DKD) taken away by optimal glycemic control or the use of newer antihyperglycemic drugs (glucagon-like peptide-1 receptor agonists, GLP-1RA, andsodium-glucose transporter-2 inhibitors, SGLT-2i) in patients with T2D, as demonstrated by the results of intensive glucose lowering trials (IGT) and cardiovascular outcome trials (CVOT). IGT have shown that successful glycemic control has modest benefits, as the removed cardiorenal risk ranges from 9% for MACE, to 20% for progression of DKD and to 0% for HF. The removed risk of MACE is 13% for GLP-1RA and 12% for SGLT-2i. However, SGLT-2i, as compared with GLP-1RA, removed twofold more risk (39% vs 17%) for kidney outcomes and fourfold more risk (33% vs 9%) for HF. Dipeptidyl peptidase-4 inhibitors have no clinically important cardiorenal benefits, as residual risk is 99% for MACE, 100% for kidney outcomes (excluding new albuminuria), and 100% for HF. Although the results of some real world, population-based cohort studies suggest the possibility that the cardiorenal protection afforded by newer antihyperglycemic drugs is additive to that of optimal glycemic control, only specific randomized controlled trials could answer this question.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1475-2840Test

الوصول الحر: https://doaj.org/article/f6c5bd9f4d4b477bba573c0b6b0cb286Test

المؤلفون: Giuseppe Bellastella, Raffaela Carotenuto, Francesco Caiazzo, Miriam Longo, Paolo Cirillo, Lorenzo Scappaticcio, Carla Carbone, Davide Arcaniolo, Maria Ida Maiorino, Katherine Esposito

المصدر: Frontiers in Reproductive Health, Vol 4 (2022)

مصطلحات موضوعية: varicocele, hormones, androgen, testosterone, gonadotropins, Reproduction, QH471-489, Medicine (General), R5-920

الوصف: Varicocele affects 15% of male population but it is more frequently identified in patients searching medical care for infertility. The impact of varicocele on semen production and fertility is known, but the relationship between clinical varicocele and impaired hormonal production is not clear. In published literature there are some studies regarding hormonal alterations in patients with varicocele but no review in which all the hormonal findings are explained. The aim of this review is to evaluate, by most common search engine, what is known about hormonal alterations in varicocele-bearing patients, to verify if a cause-effect relationship is documented and to give a useful contribution to in clinical management of this kind of patients. We found contradictory results about hormonal status from literature. Some studies confirmed a decrease of testosterone levels and higher FSH and LH levels that normalize after varicocelectomy, others found lower than normal levels of dihydrotestosterone due to decreased activity of epididymal 5-α-reductase. Lower circulating Anti-Müllerian Hormone levels, accompanied by a decreased Inhibin-B level, were reported as indicators of the decreased Sertoli cells function in varicocele-bearing adult patients. The finding of higher basal 17-OH-progesterone concentrations in patients with varicocele was explained by some authors with a testicular C-17,20-lyase deficiency. There is no doubt that varicocele could led to hormonal alterations. This review proposes that the impaired free sexual steroid levels are the result of a slight, deep-rooted defect in the testes of a certain amount of men with varicocele but further multicentre, randomized controlled studies remain mandatory to better clarify the hormonal features of patients with varicocele and to assess the utility of hormonal evaluation for establishing the duration of varicocele and for better identifying patients who need surgical correction.

وصف الملف: electronic resource

العلاقة: https://www.frontiersin.org/articles/10.3389/frph.2022.863695/fullTest; https://doaj.org/toc/2673-3153Test

الوصول الحر: https://doaj.org/article/3513ab733a474e33a3bf018d55f59640Test

المؤلفون: Giuseppe Bellastella, Paolo Cirillo, Carla Carbone, Lorenzo Scappaticcio, Antonietta Maio, Graziella Botta, Maria Tomasuolo, Miriam Longo, Alessandro Pontillo, Antonio Bellastella, Katherine Esposito, Annamaria De Bellis

المصدر: Biomedicines, Vol 10, Iss 11, p 2855 (2022)

مصطلحات موضوعية: COVID-19, hypothalamus, pituitary gland, ACTH, cortisol, pituitary autoimmunity, Biology (General), QH301-705.5

الوصف: This review is aimed at illustrating and discussing the neuroimmune endocrinological aspects of the SARS-CoV-2 infection in light of the studies on this topic that have so far appeared in the literature. The most characteristic findings and pending controversies were derived by PubMed and Scopus databases. We included original and observational studies, reviews, meta-analysis, and case reports. The entry of the coronavirus into susceptible cells is allowed by the interaction with an ecto-enzyme located on human cells, the angiotensin-converting enzyme 2 (ACE2). SARS-CoV-2 also targets the central nervous system (CNS), including hypothalamic-pituitary structures, as their tissues express ACE2, and ACE2 mRNA expression in hypothalamus and pituitary gland cells has been confirmed in an autoptic study on patients who died of COVID 19. SARS-CoV-2 infection may cause central endocrine disorders in acute phase and in post-COVID period, particularly due to the effects of this virus at CNS level involving the hypothalamic-pituitary axis. The aggression to the hypothalamus-pituitary region may also elicit an autoimmune process involving this axis, responsible consequently for functional disorders of the satellite glands. Adrenal, thyroid and gonadal dysfunctions, as well as pituitary alterations involving GH and prolactin secretions, have so far been reported. However, the extent to which COVID-19 contributes to short- and long-term effects of infection to the endocrine system is currently being discussed and deserves further detailed research.

وصف الملف: electronic resource

العلاقة: https://www.mdpi.com/2227-9059/10/11/2855Test; https://doaj.org/toc/2227-9059Test

الوصول الحر: https://doaj.org/article/9c89116d16de4b49a23f39ac2eded0ccTest