bluuebunny/crossref_metadata_2025 huggingface dataset:
Peripheral Blood Hematopoietic Stem-cell Mobilization for Autologous Transplantation
Authors: Copelan Edward A , Malik Shahbaz , Avalos Belinda R ,   Director, Acute Leukemia Program, Department of Hematologic Oncology and Blood Disorders, Taussig Cancer Institute, Cleveland Clinic,   Internal Medicine Resident, Department of Internal Medicine, Cleveland Clinic,   Professor of Medicine, Division of Hematology/Oncology, Ohio State University
Published: October 2015

Autologous hematopoietic stem-cell transplantation is important in the treatment of several lymphohematopoietic malignancies. Procurement of adequate stem cells, for which CD34 positivity serves as a useful surrogate, is necessary prior to the procedure. Several methods of mobilization are widely used, but methods for individual patients should depend on their specific clinical situation. More than 20% of patients do not achieve adequate mobilization and those who require numerous aphereses to accomplish adequate CD34+ cell yield may experience delayed hematopoietic recovery.
The Role of Positron-emission Tomography–Computed Tomography for Prediction of Treatment Response After Chemoradiation for Advanced-stage Head and Neck Cancer
Authors: Malone James P , Bekker Simon , Robbins K Thomas ,   Associate Professor and Residency Program Director,   Clinical Instructor,   Professor, Division of Otolaryngology – Head and Neck Surgery, and Director, Simmons Cancer Institute, Southern Illinois University School of Medicine
Published: October 2015

Concurrent chemoradiotherapy (CRT) is a common treatment modality for patients with advanced-stage head and neck cancer and results in high rates of locoregional disease control. Accurate assessment of disease response following completion of treatment is necessary to detect persistent disease and to direct surgical intervention if necessary.18F-fluorodeoxyglucose (FDG) positron-emission tomography (PET) or combined PET–computed tomography (CT) has become a valuable tool in the assessment of treatment response after chemoradiotherapy. While the precise timing of the scan remains controversial, the high negative predictive value of post-treatment PET-CT strongly suggests that a complete clinical response has been achieved. The functional imaging information provided by PET-CT can be combined with the structural imaging of contrastenhanced CT or magnetic resonance imaging (MRI) and physical examination to better predict those patients who would benefit from post-treatment surgical intervention.
Clinical Outcomes of Pediatric Soft-tissue Sarcoma in the Extremities
Authors: Anderson Megan E ,   Orthopaedic Surgeon, Beth Israel Deaconess Medical Center and Children’s Hospital Boston, and Instructur, Harvard Medicial School
Published: October 2015

Soft-tissue sarcomas are rare malignancies in children and adolescents, representing only 7.4 % of cancer cases in children <20 years of age. They are categorized into rhabdomyosarcomas (RMS) and non-rhabdomyosarcoma soft-tissue sarcomas (NRSTS). RMS of the extremities is associated with a poorer prognosis than RMS overall. Important negative prognostic factors are higher stage and clinical group, positive regional nodes, larger size, and greater tumor invasiveness. Overall survival for extremity RMS is around 70 % at five years, with significant variability based on clinical group. NRSTS is a heterogeneous group with frequent location in the extremities. Data are more limited in pediatric NRSTS, but general negative prognostic factors are extent of disease, tumor size, quality of resection, and grade. Survival ranges from 90 % for low-grade tumors to 15 % for patients presenting with metastatic disease. Further efforts to improve the outcome for extremity RMS and to research pediatric NRSTS in general are essential for future studies.
Positron Emission Tomography–Computed Tomography Evaluation of Maxillary Rhabdomyosarcoma in an Adult
Authors: Cube Regino , Kao Yang-En , Yoest Stephen ,   Resident, Department of Radiology,   Chief, Department of Nuclear Medicine,   Attending Neuroradiologist, Department of Radiology, Madigan Army Medical Center
Published: October 2015

Rhabdomyosarcoma is a rare primary head/neck tumor. This article illustrates the utility of multimodality imaging techniques in a 34-year-old male with metastatic alveolar rhabdomyosarcoma, including an apparently favorable metabolic response to chemotherapy between baseline and early post-treatment positron emission tomography–computed tomography. Clinical and histopathologic features of the disease are also presented.
Allogeneic Hematopoietic Stem Cell Donation—Current Status with Regard to Safety
Authors: Bosi Alberto , Bartolozzi Benedetta ,   Full Professor of Hematology,   Fellow, Department of Hematology, Bone Marrow Transplantation Unit, University of Florence
Published: October 2015

Allogeneic hematopoietic stem cell transplantation (HSCT) represents the first choice of treatment or an important therapeutic option for numerous diseases. Several stem cell sources, such as bone marrow, mobilized peripheral blood stem cells, and umbilical cord blood, are suitable for HSCT in clinical practice. However, this procedure is strongly related to availability of a histocompatible donor. In order to increase the probability of finding a histocompatible donor, national and international registries have been developed. Voluntary donation of bone marrow or peripheral blood stem cells for HSCT, both in the related or unrelated setting, is a well-established procedure with an invaluable ethical significance. Even if both procedures are safe, they are not risk free; therefore, the greatest attention has to be paid to the donor and to the donation process through a careful monitoring protocol for donor safety.
Treatment of Nausea and Vomiting During Chemotherapy
Authors: Mustian Karen M , Devine Katie , Ryan Julie L , Janelsins Michelle C , Sprod Lisa K , Peppone Luke J , Candelario Grace D , Mohile Supriya G , Morrow Gary R ,   James P Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry,   James P Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry,   James P Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry,   James P Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry,   James P Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry,   James P Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry,   James P Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry,   James P Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry,   James P Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry
Published: October 2015

Nausea and vomiting are two of the most troubling adverse effects patients experience during chemotherapy. While newly available treatments have improved our ability to manage nausea and vomiting, anticipatory and delayed nausea and vomiting are still a major problem for patients receiving chemotherapy. Many cancer patients will delay or refuse future chemotherapy treatments and contemplate stopping chemotherapy altogether because of their fear of experiencing further nausea and vomiting. The purpose of this article is to provide an overview of the patho-psychophysiology of chemotherapy-induced nausea and vomiting and the recommended guidelines for treatment.
Basal-like Breast Cancer—Characteristics, Risks, and Associations
Authors: Shuen Andrew Y , Foulkes William D ,   Medical Genetics Resident, Department of Medical Genetics, McGill University Health Centre,   James McGill Professor, Departments of Medicine, Human Genetics and Oncology, McGill University
Published: October 2015

Breast cancer is a heterogeneous disease. Gene expression profiling has demonstrated the existence of at least five ‘intrinsic’ subtypes: luminal A, luminal B, human epidermal growth factor-2 receptor (HER2), normal-like, and basal-like. While the estrogen receptor (ER), progesterone receptor (PR), and HER2 remain the most important prognostic markers and predictors of response to therapy, interrogating thousands of genetic transcripts more accurately captures the biological complexity and clinical heterogeneity of this disease. Target identification through massively parallel sequencing is likely to bear fruit in the coming years. Attention to basal-like breast cancers has grown substantially due to their generally poor prognosis, lack of targeted therapies, and connection withBRCA1-related cancers. In this article, we discuss the basal-like subgroup with respect to its cellular origins, relationship toBRCA1, and associated epidemiological risk factors.
Therapeutic Mechanisms of Treatment in Cervical and Vaginal Cancer
Authors: AKunos Charles ,   Director of Gynecologic Radiation Oncology, Department of Radiation Oncology, University Hospitals Cleveland
Published: October 2015

Cervical and vaginal cancers remain serious health problems. Worldwide, more than 530,000 women annually are diagnosed with these diseases, with most new incident cases occurring in nations with limited health resources and underdeveloped screening programs. For women whose disease is too bulky or widespread for surgery, radiochemotherapy should be looked upon as the standard of care. Randomized clinical trials have indicated that radiochemotherapy strategies that disrupt the repair of damaged DNA are key to the management of advanced stage cervical and vaginal cancers. Here, from a viewpoint of cancer cell molecular biology, treatments for advanced stage cervical and vaginal cancers are discussed.
Hodgkin’s Lymphoma in Adolescents and Young Adults
Authors: Rodriguez Laura , Punnett Angela ,   Research Fellow, Division of Haematology/Oncology, Department of Paediatrics, SickKids Hospital and University of Toronto,   Fellowship Program Training Director, Division of Haematology/Oncology, Department of Paediatrics, SickKids Hospital and University of Toronto, Toronto, Canada
Published: October 2015

Adolescents and young adults (AYAs) are defined as those individuals between the ages of 15 and 39 years. Hodgkin’s lymphoma (HL) is the most common cancer observed in AYAs. Over the last two decades, significant improvements in both survival from HL and the reduction of therapy-related late effects have resulted from the work of collaborative study groups in pediatric and adult domains. The adolescent and young adult (AYA) population falls between these domains. AYA patients are in a critical developmental transition, with significant psychosocial challenges that may impact on the outcome of the primary treatment as well as on the medical care and surveillance of long-term sequelae in survivors. This article will examine available literature regarding outcomes for HL in the AYA population, identifying issues unique to this group, therapeutic options, and specific concerns in follow-up.
Combined Chemoradiation Therapy in the Treatment of Squamous Cell Carcinoma of the Head and Neck—An Evolving Paradigm
Authors: Morris Zachary S , Mohindra Pranshu , Kruser Tim J ,   Department of Human Oncology, University of Wisconsin, Madison, Wisconsin, US,   Department of Human Oncology, University of Wisconsin, Madison, Wisconsin, US,   Radiation Oncology Consultants, Ltd, and Delnor Hospital, Geneva, Illinois, US
Published: October 2015

Combined modality chemoradiation therapy is a standard-of-care treatment for locally advanced squamous cell carcinoma of the head and neck (SCCHN) and is recommended as an adjuvant treatment for certain patients with high-risk features on surgical pathology. In this article, we review the data from clinical trials that have established this role for chemoradiation therapy in the treatment of head and neck cancer, and discuss prior and ongoing studies that have investigated concurrent versus induction chemotherapy in the definitive treatment setting. We briefly review historical and ongoing studies that have explored the impact of radiotherapy fractionation on clinical outcome in patients treated with chemoradiation. Finally, we explore the emerging role of molecular-targeted agents in multimodality treatment approaches for SCCHN. In appropriately selected patients the demonstrable survival benefit of chemoradiation outweighs the risks for additional toxicities. Simultaneous advances in surgical techniques and increasing understanding of the role of viral etiologies pose a number of important questions regarding appropriate combination of multimodality therapy.
Role of the Comprehensive Geriatric Assessment in an Elderly Consultation
Authors: Molina-Garrido MJ , Guillén-Ponce Carmen , Delgado Nieves Bravo , Mora-Rufete Antonia ,   Elderly Cancer Unit, Medical Oncology Section, Hospital General Virgen de la Luz, Cuenca, Spain,   Medical Oncology Department, Hospital General Universitario Ramón y Cajal, Madrid, Spain,   Cardiology Department, Hospital General Virgen de la Luz, Cuenca, Spain,   Internal Medicine Department, Hospital General Universitario de Elche, Alicante, Spain
Published: October 2015

The incidence of cancer increases dramatically with age and is reported to be 12 to 36 times higher in patients 65 years or older compared with those aged 25 to 44 years. The challenge for oncologists is to determine the optimum treatment for elderly patients. The Comprehensive Geriatric Assessment (CGA) is the main tool to take decisions in elderly patients diagnosed with cancer. And many screening tools have been tested to select which patients should be taken or not a complete CGA. Matters that influence geriatric assessment in the oncologic population will be highlighted in this article.
Colorectal Cancer—Management of Metastatic Disease
Authors: Sugarbaker Paul H ,   Medical Director, Center for Gastrointestinal Malignancies at MedStar Washington Hospital Center, Washington, DC and Chief, Program in Peritoneal Surface Oncology at MedStar Washington Cancer Institute, Washington, DC, US
Published: October 2015

Metastases from colon cancer occur to the regional lymph nodes, the liver, and the peritoneal surfaces. Rectal cancer may disseminate to these sites and also to the lungs. These metastases may occur synchronously with the detection of primary disease or metachronously in follow-up. The timing of the metastatic process is important in terms of treatment possibilities. Each anatomical site for metastatic disease has the potential for an individualized management strategy. Systemic chemotherapy as an adequate management plan for all sites of colorectal metastatic disease is not compatible with a high standard of care. Formulation of an optimal plan combining surgery with regional and systemic chemotherapy is a necessary function of the multidisciplinary team.
Future of Radiotherapy Delivery in Rectal Cancer—European and US Approaches
Authors: Torok Jordan A , Czito Brian G , Willett Christopher G , Palta Manisha ,   Resident,   Associate Professor,   Professor and Chair,   Assistant Professor, Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina, US
Published: October 2015

Neoadjuvant radiation therapy is integral in the management of patients with localized rectal cancer. In parts of Europe, patients with operable rectal cancer are treated with short-course radiation therapy delivered in five daily, 5 Gy fractions to a total dose of 25 Gy, followed by surgery within 1 week. In the US, the standard for locally advanced rectal cancer is neoadjuvant chemoradiotherapy. This approach is principally based on the results of the German Rectal Cancer Study Group trial evaluating preoperative compared with postoperative chemoradiation. Surgery is typically performed at 4–8 weeks following completion of long-course chemoradiotherapy, facilitating tumor downstaging, and potential sphincter sparing surgery. No significant difference in clinical outcomes has been observed between these two approaches in two randomized clinical trials; however, further follow-up of these studies and new results from ongoing trials are anticipated to further clarify the optimal neoadjuvant treatment strategy.
Breast Cancer Screening in Older Women—Current Evidence and Future Perspectives
Authors: Glas Nienke A de , Liefers Gerrit-Jan ,   PhD Candidate and Medical Doctor,   Surgical Oncologist and Head, Geriatric Oncology Research Group, Leiden University Medical Center, Department of Surgery, Leiden, The Netherlands
Published: October 2015

As populations of developed countries are aging, the number of older women with breast cancer will strongly increase. Randomized controlled trials in breast cancer screening rarely included patients over the age of 68. As a consequence, there is no solid evidence for beneficial effects of breast cancer screening in older women. In a recent observational study, we showed that the implementation of screening in women aged 7075 in the Netherlands resulted in a strong increase of the incidence of early-stage breast cancer, while the incidence of advanced stage breast cancer barely decreased. Hence, current data do not support population-based screening in women over the age of 70.
Importance of Self-care Behaviors in Diabetes Management
Authors: Austin Mary M
Published: October 2015

Diabetes educators are healthcare professionals such as nurses, dietitians, pharmacists, exercise specialists, physicians, and social workers, who specialize in diabetes education and who make a significant contribution to the care and management of persons with diabetes. The specialty of diabetes education has advanced to be based increasingly on evidence and focussed on achieving desired outcomes.The emphasis on outcomes-based interventions comes from both the National Standards for Diabetes Self-Management Education,1which emphasizes program outcomes, and the Standards for Outcomes Measurement of Diabetes Self-Management Education2of the American Association of Diabetes Educators, which focusses on individual patient outcomes as well as the reporting of aggregate patient data.
Cadiovascular Risk Factors in Metabolic Syndrome Impact of Insulin Resistance on Lipids, Hypertension, and the Development of Diabetes and Cardiac Events
Authors: Zarich Stuart W
Published: October 2015

The clustering of cardiovascular (CV) risk factors associated with insulin is known as ‘syndrome X’, the ‘deadly quartet’, and ‘dysmetabolic syndrome’ among others. In addition to the clustering of obesity, hypertension (HTN), glucose intolerance, high triglycerides, and low high-density lipoprotein (HDL), other metabolic abnormalities have been associated with this syndrome, including impaired fibrinolysis and a proinflammatory diathesis. This syndrome is most commonly recognized today as metabolic syndrome (MS) and affects approximately 24% of the US adult population.According to the Third National Health and Nutrition Examination Survey (NHANES III), MS affects nearly 50 million people, including 44% of subjects over the age of 50.
Cardiovascular Dysfunction in Chronic Diabetes
Authors: Dhalla Naranjan S
Published: October 2015

Diabetes is one of several risk factors for ischemic heart disease and is a major killer.1–3This complex disease affected around 171 million people all over the world in 2000 and is estimated to affect 366 million people by 2030. Of these, about 13 million cases have been diagnosed with diabetes in the US, and another 5.2 million people are unaware that they have the disease.
Pharmacologic Treatment of Diabetic Nephropathy
Authors: Young Bessie A
Published: October 2015

Diabetic nephropathy is the primary cause of renal failure in the US and most developed countries, accounting for over 40% of prevalent patients initiating dialysis in the US Endstage Renal Disease (ESRD) program. Pathologically, diabetic nephropathy is thought to have a similar histological presentation in both type 1 and type 2 diabetic patients, although less is known about the early presentation of type 2 diabetic nephropathy due to less precision regarding the date of onset of diabetes.
Electro-stimulation Parameter for Neuropathy
Authors: Young John D
Published: October 2015

As a result of conducting research and reviewing published studies from around the world, new models concerning the causes of neuropathy have been discovered. What is needed is a fuller understanding of the etiology of the condition so that new technology can be brought to bear with both ameliorative and therapeutic benefits. This article offers a description of an ideal type of electronic stimulator that would likely offer significant benefits to the treatment of neuropathy. Neuropathy results when nerve signal propagation is reduced between adjacent nerve cells due to insufficient oxygen being available to support nerve cell metabolism. This is responsible for 90% of all neuropathy cases.
The Potential of Phosphorus Metabolic Magnetic Resonance Imaging and Spectroscopy for Assessing the Risk of Developing Foot Ulceration in Diabetes
Authors: Greenman Robert L
Published: October 2015

The healthcare and social cost associated with diabetic peripheral neuropathy and the foot can be devastating. There are more than 300,000 hospitalizations in the US each year for diabetic foot complications and there were more than 92,000 lower extremity amputations of people with diabetes in 1999.1The problems of ulceration and amputation have a profound effect on the quality of life of those who are affected.
Dispelling the Myths about Rarely Diagnosed Pituitary Disorders
Authors: Knutzen Robert , Ezzat Shereen
Published: October 2015

Since events were first recorded in Judeo-Christian literature and depicted in drawings and hieroglyphics on Akhenaton’s tomb in Egypt, a fascination with pituitary disorders has developed both in the minds of story-tellers as well as in the studies and speculation among the healers’ or doctors’ communities of the time. In Norse and other mythologies, the rumors and myths, particularly about acromegalic patients, often overshadowed other pituitary disorders and diseases. Sadly, the ability to diagnose and receive efficacious treatment from experts often appears as difficult as it was 2,000 to over 5,000 years ago. Pituitary/hormonal issues are much older than SARS or HIV, yet are profoundly less appreciated and diagnosed than many other more or less significant medical issues. Across the industrialized world, research into and treatment for these often life-shortening and almost always life-altering diseases and disorders is accelerating, and refinements and nuances to treatment options are discovered and promoted regularly, while the ability to diagnose and refer patients for appropriate treatment is only moving at a ‘snail’s pace’. Far too many myths still surround the issues of pituitary tumors and hormonal disorders and patients, families, and society pay an extraordinarily high price for the failure to discern facts from fiction. Below are several examples of myths and explanations for their counterpart facts.
Hypogonadism and Testosterone Replacement Therapy
Authors: Dobs Adrian S
Published: October 2015

Male hypogonadism affects an estimated four to five million men in the US. It is defined as failure of the testes to produce an adequate amount of testosterone and/or conduct normal spermatogenesis. The production of adequate amounts of testosterone is necessary for development of external genitalia and development of secondary sexual characteristics in children and adolescents. In adults, androgen production is necessary for maintenance of lean body mass (LBM), bone mass, libido, sexual function, and spermatogenesis.
The Debate Over Testosterone Replacement in Aging Men
Authors: Shippen Eugene
Published: October 2015

Testosterone replacement is at the center of intense debate for its proper uses, its benefits, and its potential long-term side effects.With the growing number of US Food and Drug Administration (FDA)-approved methods for testosterone replacement in deficient men, particularly the aging male population, the subject has taken on growing importance that impacts every specialty. Lacking in the debate are the scientific answers derived from long-term, randomized, controlled studies. The media blitz regarding health issues for both men and women, particularly regarding hormone replacement therapy and new questions of safety for different hormonal treatments spurred by the Women’s Health Initiative, leaves clinicians and patients struggling with the decision of whether to use these methods of replacement to relieve the many troubling symptoms of deficiency that significantly impair quality of life during the aging years. The key question of any treatment regards the risk/benefit ratio for a given patient and whether the treatment provides reasonable expectation of improvement in symptoms or disease state with reasonable risks of adverse events.
Intensive Treatment of Type-1 Diabetes The Balance of Benefits and Risks in the DCCT/EDIC Study
Authors: Genuth Saul
Published: October 2015

With the discovery of insulin in 1921 and its rapid introduction into therapy in 1922, the complexion of type-1 diabetes changed completely. From a disease that inevitably led to death in diabetic coma within a few short years, type-1 diabetes morphed into a chronic disease as, in the 1930s, diabetic retinopathy, nephropathy, and neuropathy emerged as major complications. These complications afflicted sufferers with loss of vision, renal failure, pain, amputations, and death from cardiovascular disease (CVD) after 30–40 years. There ensued a long-standing debate as to whether these complications were caused by hyperglycemia and other consequences of insufficiently normalized metabolism or were simply an intrinsic parallel manifestation of diabetes that could not be prevented by insulin therapy. This question of whether normalization of blood glucose with intensive treatment would reduce the risk of diabetic complications compared with then-conventional insulin treatment, which only minimized or eliminated symptoms resulting from glycosuria, prevented spontaneous diabetic ketoacidosis and avoided hypoglycemia, could only be definitively answered by a long-term, randomized clinical trial testing the glucose hypothesis. Thus, the Diabetes Control and Complications Trial (DCCT) emerged, followed by the Epidemiology of Diabetes Interventions and Complications (EDIC) observational follow-up study of the same cohort of research volunteer patients.
Diabetes and the Alpha Cell
Authors: Gerich John E
Published: October 2015

Despite wide variations throughout the course of a day in both the body’s glucose demand (e.g. during exercise) and the glucose supply (e.g. following meal ingestion), plasma glucose concentrations rarely exceed 160mg/dL or fall below 60mg/dL.1This exquisite regulation is dependent on the body’s ability to balance the movement of glucose into and out of the plasma. Although numerous factors contribute to this process (e.g. the release of hormones and the body’s sensitivity to them, neurohumoral mechanisms, and the supply of substrates), the major regulators on a moment-to-moment basis are insulin, glucagon, and catecholamines.2
Vildagliptin An Oral Dipeptidyl Peptidase-4 Inhibitor for Type 2 Diabetes
Authors: Standl Eberhard , Fuchtenbusch Martin , Hummel Michael
Published: October 2015

Vildagliptin is a member of a new class of oral antidiabetogenic agents known as dipeptidyl peptidase-4 (DDP-4) inhibitors.These drugs enhance islet function by improving α- and β-cell responsiveness to glucose. Mechanism of action studies in patients with type 2 diabetes show that vildagliptin increases plasma levels of active glucagon-like peptide-1, improves glucosedependent insulin secretion and β-cell function, improves insulin sensitivity, reduces inappropriate glucagon secretion, reduces fasting and postprandial glucose, and decreases HbA1c. Large-scale treatment trials with vildagliptin 50mg or 100mg per day as monotherapy or in combination in drug-naïve patients or as add-on therapy to on-going anti-diabetic treatment show that it is effective in reducing HbA1c (with greater decreases occurring in patients with higher initial HbA1c levels), maintains efficacy in glycemic control as monotherapy for at least 1 year, is associated with infrequent hypoglycemia, and does not cause weight gain.
Management of Cardiovascular Risk Factors in Racial and Ethnic Minorities with Type-2 Diabetes
Authors: Armani Annemarie , Ferdinand Keith C
Published: October 2015

Type-2 diabetes, which involves a perilous clustering of cardiovascular risk factors, primarily elevated blood pressure, atherogenic dyslipidemia and increased vascular thrombosis, affects 18 million Americans and is expected to reach almost epidemic proportions in the next decade.1Persons with type-2 diabetes are at a dramatically increased risk for the development of cardiovascular events, specifically acute myocardial infarction (MI) and stroke. A diagnosis of diabetes presents the same cardiovascular risk as those who have already had MI, deeming it a ‘coronary risk equivalent’.2More than 65% of deaths in diabetes patients are attributed to heart and vascular disease.1Although mortality from coronary heart disease (CHD) has been decreasing overall in the US in the last several decades, the increasing prevalence of type-2 diabetes may ultimately slow or reverse this trend.
The Problem of the Aggressive Pituitary Tumor
Authors: McCutcheon Ian E
Published: October 2015

Truly aggressive pituitary tumors are uncommon, representing no more than 2% of the lesions encountered in any large pituitary clinic. Such tumors prove their atypical behavior by invading adjacent tissues, by proliferating rapidly (compared with the slow or absent growth seen in standard benign adenomas), and/or by showing metastasis to distant sites. Difficulty achieving complete removal at surgery, leading to a strong tendency to recur, is the expected result. Such tumors thus pose a challenge to surgeon and endocrinologist alike, and control rather than cure may be the more realistic therapeutic goal.
Salmon Calcitonin in the Treatment of Osteoporosis
Authors: Silverman Stuart L
Published: October 2015

Calcitonin is an important treatment option for postmenopausal women with vertebral compression fractures due to osteoporosis. It provides known efficacy in reducing further vertebral fracture and a possible analgesic effect, and is known to be safe and well tolerated in older individuals. As a significant number of women are intolerant of oral bisphonates, calcitonin is an important alternative in the arsenal against osteoporotic fracture.
Treatment of Osteoporosis in Postmenopausal Women Who Are At Risk of Fracture
Authors: Ioachimescu Adriana , Licata Angelo
Published: October 2015

Osteoporosis consists of decreased bone strength and increased risk of fractures due to decreased mass and abnormal bone microarchitecure. Almost 20% of postmenopausal women have osteoporosis as defined by World Health Organization (WHO) criteria (T-score <- 2.5). Besides the bone mineral density (BMD) expressed by T-score, advancing age, premature menopause, low body weight (≤120lbs), maternal history of hip fracture, previous fracture, loss of height (≥3 inches) and the use of glucocorticosteroids are risk factors for bone fractures. Identifying the postmenopausal women at risk include both an evaluation for risk factors (including secondary causes of osteoporosis) and measurement of bone mass density (BMD) by dual X-ray absorbtiometry (DXA).
Precocious Puberty
Authors: Kaplowitz Paul B
Published: October 2015

Precocious puberty refers to the appearance of physical and hormonal signs of pubertal development at an earlier age than is considered normal.Although traditionally, any signs of puberty in girls prior to age eight years have been considered abnormal, recent studies indicate that signs of early puberty (breasts and pubic hair) are often present in girls (particularly black girls) between ages 6–8 years.The early growth spurt initially can cause tall stature, but rapid bone maturation can cause linear growth to cease too early and result in short adult stature.The early appearance of breasts or menses in girls and increased libido in boys can cause emotional distress for some children.
Dilemmas Associated with Hormone Therapy for Post-menopausal Women
Authors: John Collins
Published: October 2015

More than 50% of women going through the menopause experience hot flashes, which may cause sleep disturbances and lethargy. The symptoms are due to estrogen deficiency, which may also cause urogenital atrophy and vaginal dryness. In 25% of women, symptoms of the menopause are severe enough to seek relief. In women who do not undergo treatment, the proportion with hot flashes decreases to about 30% within three years.1
Beyond the Diabetes Control and Complications Trial—Addressing Weight Gain in Type 1 Diabetes
Authors: Purnell Jonathan
Published: October 2015

The Diabetes Control and Complications Trial (DCCT) was a prospective, randomised, controlled clinical trial that began in the 1980s and was carried out over a decade to determine whether intensive treatment aimed at maintaining blood glucose concentrations close to the normal range could decrease the frequency and severity of microvascular complications in patients with type 1 diabetes. The results showed that intensive therapy effectively delays the onset and progression of diabetic retinopathy, nephropathy, and neuropathy in patients with type 1 diabetes.1The side effects associated with intensive therapy were a nearly three-fold increased frequency of severe hypoglycaemia and greater weight gain. For the majority of patients with type 1 diabetes, the benefits of intensive therapy were considered to vastly outweigh these risks. However, the potential detrimental effects of weight gain, especially on macrovascular risks, are being revisited.
Advances in Our Understanding of Pituitary Adenoma
Authors: Pekic Sandra , Popovic-Brkic Vera
Published: October 2015

Pituitary adenomas are common benign monoclonal neoplasms— accounting for 15% of intracranial neoplasms—that may be clinically silent or secrete anterior pituitary hormones such as prolactin, growth hormone (GH), adrenocorticotrophic hormone (ACTH), or, rarely, thyroid-stimulating hormone (TSH) or gonadotrophins. Radiological studies for other reasons using high-resolution computed tomography (CT) or magnetic resonance imaging (MRI) detect incidental pituitary adenomas in approximately 20% of asymptomatic patients.1The incidence of the various types of adenoma varies;2prolactinomas are the most common pituitary adenomas. Clinically non-functioning pituitary adenomas (NFPAs), which do not secrete hormones, often cause local mass symptoms and represent one-third of pituitary adenomas. GH- and ACTH-producing adenomas each account for 10–15% of pituitary adenomas, while TSH-producing adenomas are rare. Pituitary adenomas are infrequent in childhood: fewer than 10% of pituitary adenomas are diagnosed before 20 years of age.3These adenomas can be either microor macroadenomas. The natural course of microadenomas is that a few tumors enlarge over a period of more than eight years.

Although several genes and signaling pathways have been identified as important factors in the development of pituitary tumors, our understanding of pituitary tumorigenesis remains incomplete and is the focus of current research. The reason for this is that current treatment modalities fail to completely control this disorder and prevent the associated morbidity and mortality. This article reviews the advances in our understanding of pituitary adenoma, especially in the field of pathogenesis of pituitary tumors, and the possibility of new therapeutic approaches.
Diabetes and Tuberculosis – Old Associates Posing a Renewed Public Health Challenge
Authors: Kapur Anil , Harries Anthony D , Lönnroth Knut , Bygbjerg Ib C , Lefèbvre Pierre ,   Managing Director, World Diabetes Foundation,   Senior Advisor, International Union Against Tuberculosis and Lung Diseases,   Medical Officer, Stop TB Department, World Health Organization,   Professor, Department of International Health, Medical Microbiology and Immunology, University of Copenhagen,   Emeritus Professor of Medicine, University of Liège
Published: October 2015

Diabetes and tuberculosis (TB) have existed for thousands of years. Today, the global burden of disease from diabetes and TB is huge and, in the case of diabetes, rapidly increasing. Recent systematic reviews show that diabetes is associated with an increased risk of TB, yet the potential public health and clinical importance of the association seems to be largely ignored. Irrespective of whether the association is causal or a result of co-morbid factors, in low-resource societies with a dual disease burden, can a common health system approach for diabetes and TB be adapted to address prevention and care? How and to what extent can this be done? Good-quality implementation research is urgently needed to create robust action plans to address this double burden.
The Importance of Testing for Pre-diabetes—Using the Right Tool
Authors: Chajewski Olga S , Nichols James H ,   Pathology Resident, Baystate Medical Center,   Professor of Pathology, Tufts University School of Medicine, and Medical Director, Clinical Chemistry, Department of Pathology, Baystate Health System
Published: October 2015

Diabetes is one of the most prevalent chronic diseases affecting the US healthcare system today, and increasing emphasis is being placed on disease prevention and screening. Early detection of pre-diabetes can be of great benefit to patients as studies have shown that signs of early diabetic complications often exist at the time of diagnosis. Early intervention has been shown to delay, and in some cases prevent, the progression from pre-diabetes to diabetes. Venous blood sampling and core laboratory analysis remain the gold standard for diagnosis. While point-of-care testing (POCT) devices are convenient and readily available, many variables affect the technical performance of POCT devices to allow their use as a reliable diagnostic method. Future diagnostic techniques may include glycated hemoglobin (HbA1c) testing or genotyping and antibody screening. Currently, the HbA1c assay is used in the monitoring of diabetes, but its potential for diagnosis of diabetes is currently being examined. Genotyping and antibody screening for type 1 diabetes are showing promise as they add to the understanding of type 2 diabetes. However, this research is still in the early stages and is not yet available for clinical use.
Glucose Control in the Critically Ill Patient Utilizing Computerized Intravenous Insulin Dosing
Authors: Crockett Samuel E ,   Associate Professor of Medicine, Department of Medical Education, University of Central Florida College of Medicine
Published: October 2015

Hyperglycemia and hypoglycemia in the critically ill patient are associated with increased morbidity and mortality. Numerous studies have investigated the benefits of glucose control in the critically ill patient receiving intravenous insulin. Tight glucose control (blood glucose 80–110mg/dl) in this patient population has been difficult to achieve. When accomplished, it has been accompanied by an increased risk of hypoglycemia and in some studies increased mortality. Computer-guided glucose management systems (CGGMS) offer an alternative to paper protocols for the attainment of improved glucose control in critically ill patients requiring intravenous insulin. CGGMS provide a way to achieve improved glucose control with reduced hypoglycemia while reducing insulin infusion calculation errors and standardizing insulin therapy, thus improving patient safety.
Guideline-orientated Diagnosis of Thyroid Nodules
Authors: Paschke Ralf , Papini Enrico , Gharib Hossein ,   Professor of Internal Medicine and Endocrinology, III Medical Department, University of Leipzig,   Professor of Endocrinology, University of Rome ‘La Sapienza’ Medical School,   Professor of Medicine, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic College of Medicine
Published: October 2015

Thyroid nodules are very common. Their aetiology is due to the interaction between genetic and environmental factors. In 2006, two major society-sponsored guidelines and one major consensus statement for thyroid diagnosis and management were published by the American Association of Clinical Endocrinologists/Associazione Medici Endocrinologi (AACE/AME), the American Thyroid Association (ATA) and the European Thyroid Association (ETA). A careful review of these guidelines reveals that despite many similarities, significant differences are also present, likely reflecting differences in practice patterns, interpretation of existing data and availability of resources in different regions. The methodology of the guidelines is similar, but a few differences in the rating scales make a rapid comparison of the strength of both evidence and recommendations difficult for use in current clinical practice. Some recommendations are based mostly on expert opinion. The same recommendation may be based on different evidence; on the other hand, sometimes the same evidence may induce a different recommendation. A survey performed during an interactive symposium at the 32nd annual meeting of the ETA in Leipzig, Germany, was carried out to investigate whether these guidelines were able to affect the divergent management strategies for thyroid nodules that have previously been documented. The thyroid nodule guidelines obviously provide useful information and recommendations for practice and have a positive impact on patient care; however, guidelines should be considered as suggestions rather than a rigid formula for practice. With further accumulating evidence, these guidelines will need revision and updating.
Drug Profile—Saxagliptin, a Novel Dipeptidyl Peptidase-4 Inhibitor for the Treatment of Type 2 Diabetes
Authors: Gallwitz Baptist ,   Professor of Medicine, Department of Medicine IV, Eberhard Karls University of Tübingen
Published: October 2015

Saxagliptin is a dipeptidyl peptidase-4 (DPP-4) inhibitor for the treatment of type 2 diabetes. It is a novel DPP-4 inhibitor with a high selectivity for DPP-4 compared with other dipeptidyl peptidases and a duration profile designed for once-daily application. DPP-4 inhibitors enhance endogenous concentrations of the incretin hormones glucagon-like peptide-1 (GLP-1) and gastric inhibitory polypeptide. This action leads to a glucose-dependent stimulation of insulin and inhibition of glucagon secretion post-prandially. DPP-4 inhibitors have no intrinsic risk of hypoglycemia and are weightneutral. Saxagliptin has been approved in the US and other countries. Phase I clinical trials demonstrated a dose-dependent inhibition of DPP-4 by saxagliptin in a dose range from 2.5 to 100mg daily without serious side effects. Patients with type 2 diabetes receiving 10mg saxagliptin once-daily in phase II trials showed a lowering of HbA1cand glucose together with good tolerability and safety. Phase III clinical studies demonstrated a good efficacy regarding glycemic parameters in different patient populations, either in monotherapy or in combination with metformin, as well as a favorable cardiovascular profile.
Type 1 Diabetes—Pathogenesis, Prediction, and Prevention
Authors: Baker II Peter R , Eisenbarth George S ,   Fellow, Clinical Genetics and Metabolism, University of Colorado Denver,   Executive Director, Barbara Davis Center for Childhood Diabetes, University of Colorado Denver
Published: October 2015

Type 1 diabetes affects over 1.4 million people in the US, with a rising incidence in many western nations. It is clear that there is a strong hereditary component and that autoimmunity plays a large role in disease pathogenesis. In the last two decades novel technologies have been developed to study the genetics, biochemistry, and molecular pathology of type 1 diabetes. These, in turn, have allowed for early recognition of disease as well as the potential for prevention trials and early insulin treatment. This article highlights the prediction of type 1 diabetes risk and developing immunotherapeutic concepts.
International Diabetes Federation—Putting Women and Diabetes on the Global Agenda
Authors: Keeling Ann , Dain Katie ,   Chief Executive Officer,   Advocacy and Programme Development Co-ordinator, International Diabetes Federation
Published: October 2015

Eighty percent of the 300 million people with diabetes live in low- and middle-income countries and women represent half of this worldwide diabetes community. Gender roles and power dynamics shape vulnerability to diabetes, affect women’s health-seeking behavior and access to health services, and influence the impact of diabetes on women’s health. This creates a set of concerns that are specific to women. In addition, as the prevalence of type 2 diabetes in women of reproductive age has increased, so has the prevalence of gestational diabetes mellitus (GDM), a form of diabetes with onset or that is first recognised during pregnancy. GDM is a major cause of maternal and infant morbidity and mortality and a major factor in the intergenerational transmission of diabetes. The International Diabetes Federation (IDF) is responding to this aspect of the global diabetes epidemic by launching a new program on women and diabetes. This programme will build the evidence base, promote awareness and political commitment, support gender-responsive health systems and empower women to take a leading role in diabetes prevention.
Can Blood Glucose Monitoring be Simplified/Modified in Order to Achieve Better Diabetes Management—Perspectives for the Future
Authors: Cuddihy Robert M ,   Medical Director, International Diabetes Center, Park Nicollet Health Services, and Adjunct Associate Professor, Department of Medicine, University of Minnesota Medical School
Published: October 2015

Self-monitoring of blood glucose (SMBG) with reflectance meters was heralded as a major advance in the management of diabetes and has been available to individuals with diabetes for home use since the late 1970s. This tool was put to use in the landmark Diabetes Control and Complications Trial (DCCT), which revolutionized care for individuals with type 1 diabetes, enabling these individuals to intensify their glucose control. SMBG has similar benefit in individuals with type 2 diabetes requiring insulin therapy. Its use in other individuals with type 2 diabetes treated with oral agents or non-insulin therapies is less clear. While SMBG is a potentially powerful tool to aid in the daily management of diabetes, to be used effectively, SMBG must be optimized to ensure the information derived from it can be acted on to modify physical activity, dietary intake, or medications to improve glycemic control. Recently, studies looking at this population have called into question the utility of SMBG in the management of individuals with type 2 diabetes treated with non-insulin therapies. However, these studies are lacking in the specifics of how such information was used to modify therapies. In addition to this, the lack of a universally accepted output for SMBG data significantly impedes its uptake and appropriate use by healthcare providers and patients. To maximize the effectiveness of SMBG, both patients and providers need to have a clear understanding of when and how to use SMBG data and, most importantly, act upon the data to effect a change in their diabetes management.