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Purpose In adults and children, transsphenoidal surgery (TSS) represents the cornerstone of management for most large or functioning sellar lesions with the exception of prolactinomas. Endocrine evaluation and management are an essential part of perioperative care. However, the details of endocrine assessment and care are not universally agreed upon. Methods To build consensus on the endocrine evaluation and management of adults undergoing TSS, a Delphi process was used. Thirty-five statements were developed by the Pituitary Society’s Education Committee. Fifty-five pituitary endocrinologists, all members of the Pituitary Society, were invited to participate in two Delphi rounds and rate their extent of agreement with statements pertaining to perioperative endocrine evaluation and management, using a Likert-type scale. Anonymized data on the proportion of panelists’ agreeing with each item were summarized. A list of items that achieved consensus, based on predefined criteria, was tabulated. Results Strong consensus (≥ 80% of panelists rating their agreement as 6–7 on a scale from 1 to 7) was achieved for 68.6% (24/35) items. If less strict agreement criteria were applied (ratings 5–7 on the Likert-type scale), consensus was achieved for 88% (31/35) items. Conclusions We achieved consensus on a large majority of items pertaining to perioperative endocrine evaluation and management using a Delphi process. This provides an international real-world clinical perspective from an expert group and facilitates a framework for future guideline development. Some of the items for which consensus was not reached, including the assessment of immediate postoperative remission in acromegaly or Cushing’s disease, represent areas where further research is needed.

To investigate mechanisms for regulation of intracellular cAMP involved in cancer cell invasion, phosphodiesterase (PDE) activity in a colon cancer cell line, DLD-1, was studied. Activities of PDE 2, 4, and 5 were detected in DLD-1 cells by pharmacological approach. Specific and cell permeable inhibitors for those PDEs were used to determine which PDE is responsible for cAMP turnover involved in cancer cell motility. Treatment of DLD-1 cells with rolipram and Ro-20-1724, inhibitors for PDE 4, elevated intracellular cAMP contents three to five times of control. EHNA, an inhibitor for PDE 2, and zaprinast, an inhibitor for PDE 5, did not affect cAMP levels. To assess cellular motility, we utilized chemotaxis assay. EHNA and zaprinast did not suppress serum-induced chemotaxis. In contrast, rolipram and Ro-20-1724, suppressed chemotaxis in a dose dependent fashion. These suggest that PDE 4 plays a critical role in regulating intracellular cAMP levels of colon cancer cells and is involved in cancer invasion. PDE 4 can be a novel target of anti-invasion drug.

The present controversy over the origin of glasslike thermal conductivity observed in certain crystalline materials is addressed by studies on single-crystal x-ray diffraction, thermal conductivity k(T) and specific heat Cp(T) of carrier-tuned Ba8Ga16X30 (X = Ge, Sn) clathrates. These crystals show radically different low-temperature k(T) behaviors depending on whether their charge carriers are electrons or holes, displaying the usual crystalline peak in the former case and an anomalous glasslike plateau in the latter. In contrast, Cp(T) above 4 K and the general structural properties are essentially insensitive to carrier tuning. We analyze these combined results within the framework of a Tunneling/Resonant/Rayleigh scatterings model, and conclude that the evolution from crystalline to glasslike k(T) is accompanied by an increase both in the effective density of tunnelling states and in the resonant scattering level, while neither one of these contributions can solely account for the observed changes in the full temperature range. This suggests that the most relevant factor which determines crystalline or glasslike behavior is the coupling strength between the guest vibrational modes and the frameworks with different charge carriers., Comment: 8 pages, 4 figures, 4 tables, submitted to Phys. Rev. B

We report the electrical resistivity, Hall coefficient, thermoelectric power, specific heat, and thermal conductivity on single crystals of the type-VIII clathrate Ba8Ga16Sn30 grown from Sn-flux. Negative S and R_H over a wide temperature range indicate that electrons dominate electrical transport properties. Both rho(T) and S(T) show typical behavior of a heavily doped semiconductor. The absolute value of S increases monotonically to 243 uV/K with increasing temperature up to 550 K. The large S may originate from the low carrier concentration n=3.7x10^19 cm^(-3). Hall mobility u_H shows a maximum of 62 cm^2/Vs around 70 K. The analysis of temperature dependence of u_H suggests a crossover of dominant scattering mechanism from ionized impurity to acoustic phonon scattering with increasing temperature. The existence of local vibration modes of Ba atoms in cages composed of Ga and Sn atoms is evidenced by analysis of experimental data of structural refinement and specific heat, which give an Einstein temperature of 50 K and a Debye temperature of 200 K. This local vibration of Ba atoms should be responsible for the low thermal conductivity (1.1 W/m K at 150 K). The potential of type-VIII clathrate compounds for thermoelectric application is discussed., Comment: 6 pages, 6 figures, submitted to Phys. Rev. B

Metallothionein (MT) is induced in the liver not only by heavy metals, but also by stress such as starvation. However, the meaning of the induced MT during starvation has never been clear. In this study, we investigated the relationship between changes in hepatic MT synthesis and the hepatic damage that occurs during starvation. MT synthesis was assessed by measuring MT contents and the expression of the MT gene in the liver. The hepatic damage was assessed by measuring glutamic pyruvic transaminase (GPT) and glutamic oxaloacetic transaminase (GOT) activities in the serum. MT synthesis in the liver increased over the normal level by starvation, but decreased under the normal level by refeeding after starvation. Both GPT and GOT activities of the refeeding group were higher than those of the control group. However, MT synthesis increased by a subcutaneous injection with CdCl(2) (1 mg Cd /kg) at the same time as refeeding after starvation. At this point, GOT activity decreased until it reached the normal level. MT synthesis decreased by refeeding after starvation, and from the results found in this study, we proposed the hypothesis that the liver damage caused by refeeding after starvation might be due to the decrease in the synthesis of a sufficient amount of MT induced by metals.

To clarify the action of estrogenic endocrine disruptors on cadmium (Cd)-induced metallothionein (MT) synthesis in the liver, we investigated the effects of bisphenol A (BPA) on hepatic MT-I mRNA expression and MT contents after Cd injection. Liver damage after Cd injection was assessed by measuring glutamic-pyruvic transaminase (GPT) and glutamic-oxaloacetic transaminase (GOT) activities in the serum. It was found that BPA reduced the Cd-induced expression of MT-I mRNA and MT protein in the liver. The administration of tamoxifen, an estrogen receptor antagonist, prevented the reduction of hepatic MT content by PA. Moreover both the GPT and GOT activities of the BPA-treated groups were higher than those of the control groups. These findings suggest that BPA reduced hepatic MT synthesis after Cd injection via the estrogen receptor which resulted in increased damage to the liver.

Introduction With the goal of generate uniform criteria among centers dealing with pituitary tumors and to enhance patient care, the Pituitary Society decided to generate criteria for developing Pituitary Tumors Centers of Excellence (PTCOE). Methods To develop that task, a group of ten experts served as a Task Force and through two years of iterative work an initial draft was elaborated. This draft was discussed, modified and finally approved by the Board of Directors of the Pituitary Society. Such document was presented and debated at a specific session of the Congress of the Pituitary Society, Orlando 2017, and suggestions were incorporated. Finally the document was distributed to a large group of global experts that introduced further modifications with final endorsement. Results After five years of iterative work a document with the ideal criteria for a PTCOE is presented. Conclusions Acknowledging that very few centers in the world, if any, likely fulfill the requirements here presented, the document may be a tool to guide improvements of care delivery to patients with pituitary disorders. All these criteria must be accommodated to the regulations and organization of Health of a given country.

Background/Aims: We preliminarily examined the characteristics of patients who underwent laparoscopic assisted hepatic resection (LAPH) to clarify its advantages and limitations of this procedure. Methodology: We examined the demographics, surgical records and outcome in 9 patients undergoing LAPH between 2001 and 2007 by comparing results in 15 patients (control group) who did not undergo laparoscopy before 2000. Results: By comparing the control group, patient demographics were not different. Four patients underwent left lateral sectionectomy and others underwent partial hepatectomy. One patient needed combined resection of abdominal wall and left lateral sector because of direct invasion from a liver tumor. There was no remarkable morbidity or mortality in all patients. Mean operation time in the LAPH group was significantly longer than that in the control group (356+/-68 vs. 276+A59 minutes) (p=O.015), particularly in patients undergoing partial resection. Blood loss was not different between groups. Days of use of pain reliever and hospital stay in the LAPH group was significantly shorter than that in the control group (pO.OOl). These tendencies were similar in each operative procedure. Conclusions: LAPH can be safely performed even in patients with chronic liver injury and recovery of patients from operation was faster than that by conventional hepatectomy., Hepato-Gastroenterology, 56(90), pp.447-451; 2009

In a standard setting of Bayesian optimization (BO), the objective function evaluation is assumed to be highly expensive. Multi-fidelity Bayesian optimization (MFBO) accelerates BO by incorporating lower fidelity observations available with a lower sampling cost. In this paper, we focus on the information-based approach, which is a popular and empirically successful approach in BO. For MFBO, however, existing information-based methods are plagued by difficulty in estimating the information gain. We propose an approach based on max-value entropy search (MES), which greatly facilitates computations by considering the entropy of the optimal function value instead of the optimal input point. We show that, in our multi-fidelity MES (MF-MES), most of additional computations, compared with usual MES, is reduced to analytical computations. Although an additional numerical integration is necessary for the information across different fidelities, this is only in one dimensional space, which can be performed efficiently and accurately. Further, we also propose parallelization of MF-MES. Since there exist a variety of different sampling costs, queries typically occur asynchronously in MFBO. We show that similar simple computations can be derived for asynchronous parallel MFBO. We demonstrate effectiveness of our approach by using benchmark datasets and a real-world application to materials science data., Comment: 31 pages, 5 figures

BACKGROUND/AIMS: A new prognostic staging system, the SLiDe (S, stage; Li, liver damage; De, des-gamma-carboxy prothrombin) score was recently proposed. We examined 207 HCC patients following hepatic resection to determine the usefulness of this staging system for HCC patients after surgery. METHODOLOGY: Disease-free and overall survival rates were calculated according to the Kaplan-Meier method, and differences between groups were tested for significance using the log-rank test. RESULTS: Regarding disease-free survival, there were no significant differences in survival between SLiDe score 0 vs 1, between score 2 vs 3, and between score 4 vs 5. There were significant differences between 0-1 vs 2-3 (p < 0.01) and between 2-3 vs 4-5 (p < 0.01). Regarding overall survival, there were no significant differences in survival between score 0 vs 1, between score 2 vs 3, and between score 4 vs 5. There were significant differences between 0-1 vs 2-3 (p < 0.05) and between 2-3 vs 4-5 (p < 0.01). CONCLUSIONS: The SLiDe score, a staging system that combines tumor factors, a tumor marker and hepatic function, might be a better predictor of prognosis in HCC patients who have undergone hepatic resection., Hepato-gastroenterology, 56(93), pp.1137-1140; 2009