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We here discuss a detailed investigation of the dense water formation, evolution and spreading in the Aegean Sea during the year 1987, immediately prior to the onset of the Eastern Mediterranean Transient (EMT). We use hydrologic data collected during the LIA cruise; satellite images for SST (Sea Surface Temperature), and PROTHEUS data (a coupled ocean–atmosphere numeric model) along with theoretical streamtube models. These hydrological analyses are related to late Quaternary sedimentary drifts in the Cyclades Plateau and in the Myrtoon Basin. Our analysis shows that streamtube dynamics provide a novel model of dense water evolution and spreading in the Aegean Basin. Applying this model to dense water masses observed in winter and spring 1987 near Samothrace and over the Limnos-Lesbos Plateau, results in a geostrophic flow of this dense, cold water towards the Limnos-Sporades Channel, in the North Aegean Sea. There it mixes with dense water from the Limnos-Lesbos Plateau and finally both move geostrophically towards the Cyclades Plateau. These results indicate that most of the dense water observed near the Cyclades, formed initially about 3 months earlier at Samothrace and Limnos shelves. During its long pathway it partially mixed with adjacent water masses. Although our analysis concerns only one year of dense water analyses, these results are thought to reflect a more general and recurrent phenomenon in the Aegean basin. Indeed, high-resolution (Airgun 10 in.) seismic-reflection data from the Cyclades Plateau reveal the presence of late Quaternary sediment drifts. These observations are concordant with results from our theoretical model. This suggests a direct link between such a dense-water cascading and contourite dynamics. The continuation of sediment drifts into the deep basin floor (≈ 900 m deep) of the Myrtoon Basin, moreover, indicates a cascading character of such bottom currents at the flanks of the basin, a feature that set further investigations.

Remotely sensed ocean chlorophyll concentration is related to the presence of phytoplankton in the upper ocean layers. Its spatial and temporal variability significantly differs from region to region, originating from both purely ecological factors and local environmental conditions (e.g. species involved, grazing, light and nutrient availability, temperature, etc.). As a result, various physical processes are known to significantly affect chlorophyll distribution especially in coastal areas. Among these, wind-driven upwelling, river discharge, cross-shelf exchanges related to local dynamics and horizontal advection due to larger scale dynamics are often invoked as dominant mechanisms. In this work, we investigate which physical process mostly contributes to the phytoplankton variability in the Channel of Sicily (Mediterranean Sea), based on satellite estimates of surface chlorophyll (CHL) concentration, kinetic energy (KE) and sea surface temperature (SST). An empirical orthogonal function (EOF) analysis is applied to the three time series, spanning the 1998-2006 period. The main patterns of variability of each parameter and the physical processes associated with KE and SST modes are identified. The successive cross-correlation analysis shows that most of the CHL variability (explained variance 78%) is induced by the seasonal advection of the Atlantic Waters (r=0.7), while wind-driven upwelling, generally considered the main process modulating phytoplankton growth in the area, only explains 1.4% of the total CHL variance. (C) 2014 Elsevier Ltd. All rights reserved.

BackgroundSubclinical Cushing's syndrome (SCS) is defined as alterations in hypothalamic–pituitary–adrenal axis without classic signs/symptoms of glucocorticoid excess. Whether SCS leads to metabolic and cardiovascular diseases is still controversial.AimTo evaluate the prevalence of hypertension, type 2 diabetes (T2D), coronary heart disease (CHD), ischemic stroke, osteoporosis, and fractures, and their relationship to increasing patterns of subclinical hypercortisolism, in patients with nonsecreting adrenal adenomas (NSA) and SCS.MethodsUsing the 1 mg dexamethasone suppression test (DST), 348 patients were classified as follows: 203 were defined as NSA and 19 SCS, using the most stringent cutoff values (138 nmol/l respectively). Patients with cortisol post-DST (50–138 nmol/l) were considered as intermediate phenotypes and classified as minor (n=71) and major (n=55) using plasma ACTH and/or urinary free cortisol as additional diagnostic tools.ResultsSCS patients showed higher prevalence of T2D, CHD, osteoporosis, and fractures with respect to NSA. Intermediate phenotypes also showed higher prevalence of CHD and T2D with respect to NSA. The prevalence of all clinical outcomes was not different between intermediate phenotype patients, which were therefore considered as a single group (IP) for multivariate logistic regression analysis: both IP and SCS-secreting patterns showed a significant association with CHD (odds ratio (OR), 4.09; 95% confidence interval (CI), 1.47–11.38 and OR, 6.10; 95% CI, 1.41–26.49 respectively), independently of other potential risk factors. SCS was also independently associated with osteoporosis (OR, 5.94; 95% CI, 1.79–19.68).ConclusionsPatterns of increasing subclinical hypercortisolism in adrenal adenomas are associated with increased prevalence of adverse metabolic and cardiovascular outcomes, independently of other potential risk factors.

A 70-year-old woman was referred to the authors’ unit following hospitalization for cardiac failure, high urinary free cortisol concentrations and severe hypokaliemia. A computed tomography scan of the abdomen showed an adrenal adenoma. The 24-hour urinary free cortisol values were high and plasma cortisol levels failed to suppress following 1 mg dexamethasone test. Aldosterone to plasma renin activity ratio was also pathologic, confirmed by saline load. She showed no symptoms of glucocorticoid excess. She was diagnosed with combined primary hyperaldosteronism and Cushing’s syndrome. Cases of adrenal incidentalomas co-secreting cortisol and aldosterone are rare; they should be addressed in patients undergoing adrenal surgery for Conn’s syndrome to avoid adrenal insufficiency after removal of the tumor.

Primary hyperaldosteronism (PA) has recently been demonstrated to be strictly associated to metabolic syndrome as compared with essential hypertension (EH). Besides, the characteristics of metabolic syndrome are different in PA compared to EH, as high fasting glucose is more frequent in the former condition. The adverse effect of excess aldosterone on insulin metabolic signaling has generated increasing interest in the role of hyperaldosteronism in the pathogenesis of insulin resistance and resistant hypertension. Moreover, aldosterone receptor antagonist therapy in diabetic and cardiopathic patients improved coronary flow. The aim of this review is to present recent knowledge about the relationship between aldosterone, insulin resistance and diabetes.

Poster: "ECR 2016 / B-1242 / Radiological formula for differentiating between secreting and non secreting adrenal adenomas " by: "C. Mosconi, V. Vicennati, D. Papadopoulos , R. Pasquali, R. Golfieri; Bologna/IT"

A 73-year-old male with a known diagnosis of neurofibromatosis type 1 (or Von Recklinghausen’s disease) was referred to the authors’ unit because of suspected pheochromocytoma. He had poorly controlled hypertension with elevated metanephrine levels and incomplete cortisol suppression at 1 mg overnight dexamethasone test. Adrenal CT showed bilateral adrenal hyperplasia and a nodule suspected of being a pheochromocytoma, while 123I-MIBG SPECTCT showed intense hyperfixation in the left adrenal gland. Left transperitoneal Laparoscopic adrenalectomy was performed and the histologic diagnosis was diffuse and nodular adrenal medullary hyperplasia. We believe that medullary adrenal Hyperplasia is, among the causes of secondary hypertension, a separate entity and should be considered as a possible diagnosis in all patients with poorly controlled hypertension and radiological findings not typical of adenoma.

CONTEXT: Long-term follow-up studies revealed that patients with subclinical hypercortisolism (SH) due to adrenocortical adenomas have an increased incidence of cardiovascular diseases and mortality. No studies have yet investigated the steroid profile and its implications in patients with SH. OBJECTIVE: The objective of the study was to analyze the steroid profile by liquid chromatography-tandem mass spectrometry in sera from patients with unilateral adrenocortical adenomas. DESIGN: This was a cross-sectional study. SETTING: The study was conducted at an outpatient clinic. PARTICIPANTS: Patients with adrenocortical adenomas (nonsecreting, n = 66; SH, n = 28) and 188 age- and sex-matched controls drawn from the general population participated in the study. MAIN OUTCOME MEASURES: Cortisol, 21-deoxycortisol, 11-deoxycortisol, 17-hydroxyprogesterone, androstenedione, dehydroepiandrosterone, T, progesterone, 11-deoxycorticosterone, and corticosterone in the basal condition and after a 1-24 ACTH test, and clinical data were measured. RESULTS: Patients with SH showed lower basal and 1-24 ACTH-stimulated levels of dehydroepiandrosterone and androstenedione than those with nonsecreting adenomas and controls. T was also lower in SH females. Receiver-operating characteristic curves showed that androgens had good accuracy in predicting SH (sensitivity and specificity were 71% and 76% for dehydroepiandrosterone and 69% and 61% for androstenedione, respectively). Increased cortisol and reduced dehydroepiandrosterone levels were independently associated with increased waist circumference. Cortisol was also independently associated with increased number of cardiovascular risk factors in SH patients. After 1-24 ACTH stimulation, the SH patients also showed increased production of 21-deoxycortisol and 11-deoxycorticosterone. CONCLUSIONS: Liquid chromatography-tandem mass spectrometry steroid profile performed for the first time in sera from patients with adrenocortical adenomas showed impaired secretion of several steroids in SH patients. This fingerprint can help in better characterizing the functional status of these tumors.

Epidemiological studies have shown that overweight and cancer are closely related, even though obesity alone does not apparently heighten cancer risk by the same amount. Given the low overall risk of all cancers with obesity, it is unlikely that obesity alone causes cancer, but should instead be considered as a tumor promoter. There are three main hypotheses that could explain how obesity might contribute to cancer development and growth: the inflammatory cytokines from adipose tissue hypothesis, the insulin resistance and hyperinsulinemia hypothesis, and the unopposed estrogen cancer hypothesis. The link between obesity and cancer is that adipocytes constitute a major component of the tumor microenvironment for breast and abdominally metastasizing cancers, promoting tumor growth. This review will mainly focus attention on the relationship between adipose tissue, estrogens, and cancer risk.

Summary Background Incidental discovery of adrenal masses has increased over the past few years. Mild alterations in cortisol secretion without clinical signs of overt hypercortisolism (subclinical Cushing's syndrome) are a common finding in patients with these tumours. Although metabolic alterations and increased cardiovascular risk have been noted in patients with subclinical Cushing's syndrome, incidence of cardiovascular events and mortality in the long term have not been assessed. We aimed to ascertain the frequency of new cardiovascular events and mortality in patients with non-secreting adrenal incidentalomas, tumours of intermediate phenotype, or those causing subclinical Cushing's syndrome. Methods From January, 1995, to September, 2010, consecutive outpatients with adrenal incidentalomas who were referred to the endocrinology unit of S Orsola-Malpighi Hospital, Bologna, Italy, were enrolled into our study. Individuals were assessed every 18–30 months for the first 5 years (mean follow-up 7·5 [SD 3·2] years, range 26 months to 15 years). Cortisol concentrations after the 1 mg dexamethasone suppression test (DST) were used to define non-secreting (+50 nmol/L) and intermediate phenotype (50–138 nmol/L) adrenal incidentalomas and subclinical Cushing's syndrome (+138 nmol/L). At the end of follow-up, patients were reclassified as having either unchanged or worsened secreting patterns from baseline. Findings 198 outpatients were assessed; at the end of follow-up, 114 patients had stable non-secreting adrenal incidentalomas, 61 had either a stable intermediate phenotype or subclinical Cushing's syndrome, and 23 had a pattern of secretion that had worsened. By comparison with patients with stable non-secreting adrenal incidentalomas, the incidence of cardiovascular events was higher in individuals with a stable intermediate phenotype or subclinical Cushing's syndrome (6·7% vs 16·7%; p=0·04) and in those with worsened secreting patterns (6·7% vs 28·4%; p=0·02). Cardiovascular events were associated independently with a change (from baseline to the end of follow-up) in cortisol concentrations post DST (hazard ratio 1·13, 95% CI 1·05–1·21; p=0·001). Survival rates for all-cause mortality were lower in patients with either stable intermediate phenotype adrenal incidentalomas or subclinical Cushing's syndrome compared with those with stable non-secreting masses (57·0% vs 91·2%; p=0·005). Factors associated with mortality were age (hazard ratio 1·06, 95% CI 1·01–1·12; p=0·03) and mean concentrations of cortisol post DST (1·10, 1·01–1·19; p=0·04). Compared with patients with stable non-secreting adrenal incidentalomas, unadjusted survival for cardiovascular-specific mortality was lower in patients with either a stable intermediate phenotype or subclinical Cushing's syndrome (97·5% vs 78·4%; p=0·02) and in those with worsened secreting patterns (97·5% vs 60·0%; p=0·01). Cancer mortality did not differ between groups. Interpretation Even when clinical signs of overt hypercortisolism are not present, patients with adrenal incidentalomas and mild hypercortisolism have an increased risk of cardiovascular events and mortality. Funding None.

In addition to its roles in providing insulation and mechanical support, adipose tissue (AT) has been recognised as the major site for storage of surplus fuel. Since leptin was discovered, white AT (WAT) has been recognised as an endocrine organ and an important source of biologically active substances with local and/or systemic action called adipokines. The metabolic and endocrine activities of AT are under the control of several hormones: a particular role has been played by glucocorticoids (GC), which able to participate, along with other hormones, both in recruitment of progenitor cells and in differentiation and secretive activities. AT is also able to generate cortisol from cortisone through 11β-hydroxysteroid-dehydrogenase (11β-HSD). There are controversial reports in the literature, showing a hyperactivity of 11β-HSD in obesity. It has been postulated that obesity, particularly the visceral body fat distribution (V-BFD), may be considered a maladaptation to stress exposure, thus leading to hyperactivation of the hypothalamic-pituitary-adrenal (HPA) axis, and higher-than-normal cortisol levels. In this review, we will examine the cross-talk between the HPA axis and AT, their relationship under stressful events, depending on steroid hormones and different adipokine secretions.

We present a study on the use of the Microsoft Kinect (Kinect) to implement interactive urban environments that integrate smart tourism and smart learning. The tests were carried out on a prototype containing a set of apps whose navigation was inspired by smart phones and tablets navigation. The results show that the quality of the interaction and of the overall user experience is already mature to allow for implementations in real-world settings.

In order to investigate wind-driven upwelling along the Italian coasts, preliminary wind data provided by the ISPRA Italian Tide Gauge Measurement Network (RMN) have been analyzed. In a further step, MyOcean Sea Surface Temperature (SST) data have been analyzed in order to define an SST index for wind-driven coastal upwelling assessment. At first, hourly wind data for the period 2009 - 2011 have been used in order to provide the statistical distribution and the wind rose plots at each RMN station. In particular, wind direction and speed have been selected in order to find upwelling-favorable areas and periods of time. E.g. wind directions in the sector between North and West in the Tyrrhenian Sea and between South and East in the Adriatic Sea have been defined as upwelling favorable, the wind sector being defined as the 30 arc around the direction parallel to the coast. Moreover only wind speeds greater than 3.0 m/s have been considered as significant for upwelling. For each location, the number of selected data has been divided by the total number of recorded wind data, thus obtaining a sort of upwelling frequency, which allows to define areas mostly exposed to upwelling. Once these areas were defined, satellite SST data have been used as a proxy to study the changes in upwelling intensity, since upwelling waters are colder than surrounding waters. So, in a given satellite SST image the upwelling event is identifiable through SST minima along the coasts. Finally, the SST upwelling index has been defined; also, this index has been "weighted" with wind intensity and direction indicating upwelling conditions obtained from the RMN wind dataset, to better distinguish between upwelling-favorable and downwelling-favorable conditions at each RMN site.

[1] This paper focuses on the study of the Tyrrhenian Sea, a subbasin of the western Mediterranean whose surface and near-surface dynamics are still relatively poorly known, in particular, its southern region. Its circulation is described first by a set of 53 surface drifters deployed in the area between December 2001 and February 2004. In order to supplement the drifter data with continuously and uniformly sampled observations and to characterize the seasonal, as well as higher-frequency variability of the surface circulation, the Lagrangian analysis was associated to simultaneous satellite remotely sensed altimeter, covering the period 2001–2004. The investigation was based on trajectory analysis and on the computation of the pseudo-Eulerian statistics using the same binning and space-time averaging for drifter and altimeter data. The data reveal a complex pattern of the circulation, especially in the southern region of the Tyrrhenian, dominated by semipermanent recirculations and transient features, which sometimes makes it difficult to identify a consistent mean flow, while the northern subbasin is characterized by a pair composed of cyclonic and anticyclonic circulations known in the literature as the North Tyrrhenian Cyclone and North Tyrrhenian Anticyclone. The pseudo-Eulerian statistics computed with the two data sets evidenced the representativeness of a joint analysis of altimeter and drifter data and yielded useful indications about proper preliminary preprocessing and resampling procedures, so as to make the comparison statistically sound.