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The cortical bone is the most severely affected site in patients with primary hyperparathyroidism (PHPT) and thus, a low bone mineral density (BMD) is predominantly observed in distal forearm. Several studies have investigated potential associations between the weight of the gland and bone mineral loss. In this study, we wanted to investigate the relationship between parathyroid adenoma (PTA) volume and bone mineral loss.

Objectives. Pituicytomas are rare, solid, well-circumscribed, low grade (grade I), non-neuroendocrine, and noninfiltrative tumors of the neurohypophysis or infundibulum, which appear in the sellar/suprasellar regions. Herein, we present a case with Cushing’s disease (CD) caused by an ACTH-secreting pituitary adenoma in association with an infundibular pituicytoma.

This study was carried out to investigate the effect of Natural zeolite (clinoptilolite) (NZ) used in briquette production on physical and mechanical properties of briquettes. To do this, six briquette classes were formed by changing the volume of NZ and the coarse aggregate and porous briquettes were produced for each class according to Turkish Codex no. 406 (TS 406) and tested. Increasing ratio of NZ volume affected the compressive strength, water absorption and losses due to freezing-thawing of the briquettes negatively. As for the bulk densities and heat conductivity decreased and was affected positively. It was concluded that NZ might be used in briquette production replaced the coarse aggregate in certain ratio to make them profitable and lessen their adverse effects on the environment. [ABSTRACT FROM AUTHOR]

Particleboard panels were made from various wood particle/needle litter of Scotch pine (Pinus sylvestris L.) mixtures bonded with urea formaldehyde resin. Litter was characterized by having higher solubility’s in alcohol–benzene, with diluting alkali and hot water, and resulted in lower pH values than those of wood particles. The mechanical properties (modulus of rupture, modulus of elasticity, and internal bond strength) of boards containing up to 6.25% litter were lower than those of panels made from wood particles. However, needle litter usage improved the physical property (thickness swelling) and decay resistance of the panels, significantly. Panels consist of 6.25% and 12.50% needle litter met the minimum EN standard requirements of mechanical properties for general-purposes. Particleboards contain more than 50% needle litter had the required level of thickness swelling for 24h immersion. [Copyright &y& Elsevier]

Objective: Gestational diabetes mellitus (GDM) is a common condition that occurs during pregnancy and results in cesarean section, pre-eclampsia, and neonatal morbidity. Angiotensin II is a potent vasoconstrictor and an important determinant of uteroplacental perfusion. Toll-like receptor 4 (TLR4) was found to contribute to diabetes progression. This study aimed to determine how TLR4 activation affects the contraction mediated by angiotensin II type 1 receptor in the isolated umbilical arteries of normal and GDM women., Methods: Angiotensin II was applied with either a TLR4 agonist or TLR4 antagonists to isolated arteries from normal and GDM umbilical cords. The changes in the angiotensin II response were expressed as the maximal contraction percentage and pD2 values. The mRNA expression levels of TLR4 and angiotensin II type 1 receptor gene were measured via quantitative  real-time polymerase chain reaction analysis., Results: This study displayed an increased sensitivity to angiotensin II in the arteries of the GDM group compared with the normal group. The TLR4 agonist showed a synergistic effect with angiotensin II, while the TLR4 antagonists were not strongly determinant. In the GDM group, the TLR4 mRNA level is slightly higher than in the normal pregnancy group; however, no statistical difference was noted., Conclusion: Toll-like receptor 4 may determine the vasoconstrictive effect of angiotensin II in normal and GDM umbilical arteries. Some studies showed a similar interaction as supportive. However, comprehensive animal and/or human studies are promising.

Purpose: Levothyroxine (LT4) is the first-line hormone replacement therapy for hypothyroidism. Several factors which have an influence on oral LT4 absorption have been previously described; however, the influence of exercise on oral LT4 absorption has not been reported, yet. It was aimed to investigate the possible effect of morning exercise, right after LT4 ingestion, on the absorption of LT4 tablets in this study., Patients and Methods: Patients with primary hypothyroidism who fulfilled the inclusion criteria were offered to participate in a 6-week morning exercise programme and those who agreed to participate were enrolled in our study. Patients were required to have a walk for 30 min with a regular speed right after taking their daily LT4 treatments and start having breakfast the first hour after LT4 intake. Pre- and post-exercise TSH levels were recorded and TSH percentage change was calculated., Results: All patients had decreased TSH levels after the exercise programme. There was a significant decrease in TSH levels (p < 0.001). A significant positive correlation between TSH percentage change and daily dose of LT4 per kg of body weight was also shown., Conclusions: This is the first study which demonstrates the significant positive effect of morning exercise on the absorption of LT4 tablets. In addition to that, it was also found that as the daily dose of LT4 increases, the percentage decrease of TSH level becomes greater., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: N-Nitrosomorpholine (NMO) is one of the most common N-nitroso compounds. An oncocytic transformation has been demonstrated in renal tubules of NMO-treated rats. In our study, we aimed to investigate the potential transformation of oncocytic cells in 6 endocrine organs, i.e., thyroid, adrenal and pituitary glands, pancreas, testis, and bone, of NMO-exposed rats., Methods: Thirty male rats were born and raised. Fifteen of them were given a single dose of 320 mg NMO per kg body weight, dissolved in drinking water, by a gavage tube. At the end of 52 weeks, the animals in both series were killed. Right after the killing, 6 different endocrine organs (hypophysis, thyroid, pancreas, adrenal gland, bone [femur], and testicles) of each animal were excised., Results: There was no evidence of oncocytic cell development in the control group. In contrast, oncocytes were observed in 8 out of 13 NMO-treated rats: 2 in the adrenal sections, 1 in the thyroid sections, 3 in the pituitary sections, and 2 in the pancreas sections. Thesticle and bone sections were completely normal., Conclusions: We showed that NMO induced an oncocytic change in pancreas, thyroid, pituitary, and adrenal glands. To date, no identified specific environmental risk factors that lead to an oncocytic transformation in endocrine glands have been reported previously. Given the increasing prevalence of endocrine-disrupting chemicals in the environment, personal care products, manufactured goods, and food sources, there is a need to advance our understanding of the pathological mechanisms underlying oncocytosis in endocrine organs., (© 2024. The Author(s).)

Purpose: This study aims to analyze the clinicopathological features, diagnostic steps, and therapeutic results of TSHomas and to reveal the effective factors on remission., Methods: The clinical, radiological, and pathological features and surgical and endocrinological results of 41 TSHoma cases followed between 2005 and 2022 were retrospectively analyzed. The factors affecting the surgical cure were investigated by comparing the groups with and without remission., Results: A total of 41 patients (23 male,18 female) were included in the study and the mean age was 42 (31.5-49). Palpitation and headache were the most common complaints. The time from the onset of symptoms to diagnosis was 8 (3-20) months. There were 8 patients with a preoperative clinical and biochemical diagnosis of TSH + GH co-secretion. In the TRH stimulation test, a blunted TSH response was obtained in 18 patients (90.0%). Complete suppression could not be obtained in any of the patients who underwent the T3 suppression test. The median maximum tumor diameter was 19.0 mm (6.8-41). There was microadenoma in 4 (9.8%) patients and macroadenoma in 37 patients (92.8%). Remission was achieved in 31 (75.6%) of 40 patients who underwent endoscopic transsphenoidal surgery (eTSS). The Ki-67 labeling index was 2% (1.00-4.00) in the entire patient group. Preoperative use of antithyroid drugs appears to be significantly associated with surgical cure., Conclusion: Diagnosis of TSHoma is still full of challenges and dynamic tests remain important. Recognition and good management of inappropriate TSH secretion states affect subsequent surgical outcomes., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Insulinoma is a rare pancreatic neuroendocrine tumor with an incidence of 1-4 cases per million. Here we present our 10 years of experience in 13 cases of insulinoma. We retrospectively reviewed all insulinoma patients diagnosed and treated between 2012 and 2022. Clinical and pathological features, diagnostic methods, and follow-up results of insulinoma patients were discussed. A total of 13 patients were included in this study (7 men, and 6 women). The mean age at the time of diagnosis was 58 (36.5-70.5) years. There is only one patient diagnosed with MEN-1 syndrome. The mean time from the onset of symptoms to the diagnosis was 15 (7-27.5) months. In the prolonged fasting test, symptomatic hypoglycemia occurred in all patients within 48 h. The median size of lesions was 15 (12-24) mm, and 46.2% of these lesions were isolated in the pancreatic tail. Ga-68 DOTATATE PET/CT detected lesions with 100% accuracy. Three patients met the criteria for malignant insulinoma. Octreotide LAR was given to 1 patient with metastatic disease and 1 patient who did not accept surgery. The metastatic patient received 8 cycles of Lu treatment and died after 51 months of follow-up. The diagnosis of insulinoma can be challenging. The 48-h fasting test period provided sufficient information for the diagnosis of insulinoma. Ga-68 DOTATATE PET/CT may be an alternative in cases where cross-sectional imaging cannot localize the pancreatic lesion., Competing Interests: Competing InterestsAll co-authors declare no conflict of interest., (© The Author(s), under exclusive licence to Indian Association of Surgical Oncology 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Purpose: The patient-reported outcome becomes important to evaluate the situation perceived by the patients and to develop new strategies. This study aims to adapt the Acromegaly Treatment Satisfaction Questionnaire (Acro-TSQ), which was specially developed for patients with acromegaly, into Turkish by conducting a validity and reliability study., Methods: After the translation and back-translation process, Acro-TSQ was filled in by face-to-face interviews with 136 patients diagnosed with acromegaly and currently receiving somatostatin analogue injection therapy. Internal consistency, content validity, construct validity, and reliability of the scale were determined., Results: Acro-TSQ had a six-factor structure and explained 77.2% of the total variance in the variable. The Cronbach alpha value calculated for internal reliability showed high internal consistency (Cronbach's alpha = 0.870). Factor loads of all items were found to be between 0.567 and 0.958. As a result of EFA analysis, one item fell into a different factor in the Turkish version of the Acro-TSQ, different from its original form. CFA analysis shows that acceptable fit values are obtained for fit indices., Conclusion: The Acro-TSQ, a patient-reported outcome tool, shows good internal consistency, and good reliability, suggesting it is an appropriate assessment tool for patients with acromegaly in the Turkish population., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Cushing's disease (CD) is characterized by endogenous hypercortisolism that is associated with increased mortality and morbidity. Due to high recurrence rates in CD, the determination of high-risk patients is of paramount importance. In this study, we aimed to determine recurrence rates and clinical, laboratory, and histological predictors of recurrence in a high volume single-center. This retrospective study included 273 CD patients operated in a single pituitary center between 1997 and 2020. The patients with early postoperative remission were further grouped according to recurrence status (recurrent and sustained remission groups). Demographic, radiologic, laboratory, pathologic, and follow-up clinical data of the patients were analyzed and compared between groups. The recurrence rate was 9.6% in the first 5 years; however, the overall recurrence rate was 14.2% in this study. Higher preoperative basal ACTH levels were significantly correlated with CD recurrence even with ACTH levels adjusted for tumor size, Ki-67 levels, and tumoral invasion. Recurrence rates were significantly higher in patients with ACTH levels higher than 55 pg/ml, tumor diameter>9.5 mm, and if adrenal axis recovery was before 6 months. The severity of hypercortisolism, morbidities, and demographic factors except age were not predictive factors of recurrence. Based on our study data, younger age at diagnosis, a diagnosis of osteoporosis, higher preoperative ACTH levels, larger tumor size, invasive behavior, higher Ki 67 index, and early recovery of the adrenal axis during the postoperative period attracted attention as potential predictors of recurrent disease., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Background: Opening the neck through a submental incision allows accurate management of deep neck structures and results in exceptional neck contours., Objectives: The authors aimed to evaluate the distribution of deep neck structures and investigate the detailed vascular anatomy of the submandibular gland., Methods: A total of 26 fresh frozen cadaver heads (15 female, 11 male) were utilized. The authors evaluated the weights of the excised tissues simulating cosmetic resections, including subcutaneous fat, subplatysmal fat, the anterior belly of the digastric muscle, and submandibular glands. The vascular supply of the submandibular gland and intracapsular vessel diameters were also investigated., Results: Whereas female cadavers had greater mean tissue weight removed from the supraplatysmal plane (mean 20.9 g, 56.6%) than the subplatysmal plane (16 g, 43.4%), male cadavers had higher mean tissue weight removed from the subplatysmal plane (10.5 g, 60.7%) than the supraplatysmal plane (mean 6.8 g, 39.3%). The mean subcutaneous (6.8 g) and subplatysmal (6.4 g) fat weights were almost equal in male cadavers; mean subcutaneous fat weight (20.9 g) was 3 times higher than subplatysmal fat weight (6.8 g) in female cadavers. There was a statistically significant relationship between body mass index and fat removed. The intraglandular vessel diameters increased as resections approached the main feeding vessels located posterosuperior (facial artery) and anterosuperior (submental artery) to the submandibular gland., Conclusions: The results suggest that to achieve exceptional neck contour the structures deep to the platysma often need to be addressed. The submandibular gland reduction can be safely performed with comprehensive understanding of its vascular anatomy., (© The Author(s) 2023. Published by Oxford University Press on behalf of The Aesthetic Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: The pathological effects of acute pulmonary embolism (APE) on the right ventricle are one of the most important determinants of mortality in patients with APE. Frontal QRS-T angle (fQRSTa) predicts ventricular pathology and poor prognosis in many different cardiovascular diseases. In this study, we investigated whether there is a significant relationship between fQRSTa and APE severity., Material and Methods: A total of 309 patients were included in this retrospective study. The severity of APE was classified as massive (high risk), submassive (intermediate risk), or nonmassive (low risk). fQRSTa calculated from standard ECGs., Results: fQRSTa was significantly higher in massive APE patients (p < 0.001). fQRSTa was also found to be significantly higher in the in-hospital mortality group (p < 0.001). fQRSTa was an independent risk factor for the development of massive APE (odds ratio:1.033; 95% CI: 1.012-1.052; p < 0.001)., Conclusion: Our study showed that increased fQRSTa predicts high-risk APE patients and mortality in APE patients., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Although proteasome inhibitors have emerged as the therapeutic backbone of multiple myeloma treatment, patients often relapse and become drug refractory. The combination between proteasome and histone deacetylase inhibitors has shown to be more efficient compared to monotherapy by enhancing the anti-myeloma activity and improving the patient's lifetime expectancy. Hybrid molecules, combining two drugs/pharmacophores in a single molecular entity, offer improved effectiveness by modulating more than one target and circumventing differences in the pharmacokinetic and pharmacodynamic profiles, which are the main disadvantages of combination therapy. Therefore, eleven histone deacetylase-proteasome inhibitor hybrids were synthesized, combining pharmacophores of entinostat and bortezomib. Compound 3 displayed the strongest antiproliferative activity with an IC 50 value of 9.5 nM in the multiple myeloma cells RPMI 8226, 157.7 nM in the same cell line resistant to bortezomib, and 13.1 nM in a 3D spheroid model containing multiple myeloma and mesenchymal stem cells. Moreover, the compound inhibited 33% of histone deacetylase activity when RPMI 8226 cells were treated for 8 h at 10 µM. It also inhibited the proteasome activity with an IC 50 value of 23.6 nM.

Aim: To investigate the association of bone mineral density (BMD) Z-scores with early-postoperative remission rate and clinical parameters in patients with Cushing's disease (CD)., Methods: We retrospectively evaluated the records of patients diagnosed with CD. After the exclusion of 230 patients, 87 CD patients were finally enrolled. BMD was determined by dual-energy x-ray absorptiometry (DXA) at the lumbar spine 1-4 (L1-4) and left femur. Early-postoperative remission was defined as a morning cortisol concentration on the first day after surgery of less than 5 μg/dL. The diagnosis of BMD "below the expected range for age" was defined as a Z-score≤-2.00 standard deviations., Results: DXA results were not significantly associated with early postoperative remission. They also did not significantly differ between eugonadal and menopausal groups. Preoperative morning cortisol significantly negatively but weakly correlated with Z-score of the total femur, while preoperative adrenocorticotropic hormone/cortisol ratio positively but weakly correlated with DXA results of L1-4., Conclusion: The severity of bone loss was not significantly related to the failure of transsphenoidal surgery for Cushing's disease.

The prevalence of polycystic ovary syndrome (PCOS) among trans men has been reported as higher than among the cisgender population, which varies between 14.4% and 58%. In this cross-sectional study, we aimed to evaluate the association of oligo-anovulation and/or features of hyperandrogenism with the scores on the Utrecht Gender Dysphoria Scale (UGDS), the Body Image Scale (BIS), and the Short Form-36 Health Survey (SF-36) in treatment-naive trans men with PCOS seeking help for gender transition. The study sample consisted of trans men who were diagnosed with gender dysphoria (GD) between December 2019 and November 2020. To assess body dissatisfaction and psychological functioning, the UGDS, BIS, and SF-36 were administered to all transgender individuals as part of the routine assessment procedure. A total of 49 treatment-naive trans men were included in our study; 38.8% ( n =19) of the participants were diagnosed with PCOS using the Rotterdam 2003 criteria. The scores of UGDS and BIS were significantly lower in the PCOS group compared with the non-PCOS group ( p <0.001 and p =0.003, respectively). Among the eight parameters within SF-36, general health, emotional role, and vitality scores were significantly higher in the PCOS group ( p =0.031, p =0.015, and p =0.006, respectively). Our study is the first study that demonstrates significantly lower GD, higher body image satisfaction and quality of life in trans men with PCOS compared with those without PCOS. Our findings are promising for larger prospective cohort studies to develop a consensus on the management of PCOS in trans men., Competing Interests: No competing financial interests exist., (Copyright 2022, Mary Ann Liebert, Inc., publishers.)

Background: The size of a thyroid nodule and certain sonographic features, such as marked hypoechogenicity, microcalcifications, taller-than-wide shape, microlobulated, or irregular margins, indicate the greater malignancy risk. The frequency of the atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) category among cytology reports from thyroid fine-needle aspirations ranges from 0.8% to 28%, whereas the risk of malignancy of these nodules varies from 6% to 97%. This retrospective analysis investigated whether the preoperative ultrasonographic location of Bethesda 3 thyroid nodules is a predictive risk factor for differentiated thyroid cancer (DTC)., Methods: A total of 387 patients who underwent total thyroidectomy for a nodule with AUS/FLUS cytology and diagnosed with a DTC at five tertiary referral centers between 2010 and 2020 were retrospectively analyzed. The location of the thyroid nodule with AUS/FLUS cytology was categorized into two groups: one group was composed of the isthmus, upper lobe, middle lobe, and lower lobe, whereas the latter consisted of right lobe, left lobe, and isthmus., Results: DTC was diagnosed in 40.6% (n = 157) of the operated nodules. Multiple logistic regression analysis has revealed that hypoechogenicity of the nodule (odds ratio [OR] = 2.929, p  < 0.001) was the only independent predictive factor for the malignancy of the nodules with AUS/FLUS, whereas the location of the nodule, age, and sex were not significantly independent risk factors. Multifocality and contralateral benign nodules were independent predictive factors for multicentricity (OR = 3.5, p  = 0.002; OR = 5.5, p  = 0.001, respectively)., Conclusion: As the first study investigating the association between a Bethesda 3 nodule location and the risk of malignancy by evaluating postoperative cytology reports, the results showed that nodule location with AUS/FLUS on fine-needle aspiration biopsy was not a predictive risk factor for the diagnosis of DTC., (© 2022 Gezer, Demirkan, Cantürk, Selek, Çetinarslan, Sözen, Çalis¸kan, Karci, Özcan, Topaloğlu, Bayrak, Demirkol, licensee HBKU Press.)

Background: The SAGIT® instrument has been developed for acromegaly to assist clinicians in staging the disease accurately, assessing the response to therapy, and adjusting the treatment. We aimed to evaluate the preoperative utility of the SAGIT® instrument and to discover a cut-off value for predicting the surgery outcome and long-term prognosis of patients with acromegaly., Methods: A total of 832 patients with acromegaly were identified from the medical record system. Acromegaly diagnosis was confirmed by elevated IGF-1 levels according to the age-adjusted upper limit of normal, lack of suppression of GH concentration to <0.4 μg/L following a 75 g oral glucose tolerance test, and the existence of a pituitary adenoma demonstrated by MRI. The SAGIT® instrument comprises five key components of acromegaly: signs and symptoms (S), associated comorbidities (A), GH levels (G), IGF-1 levels (I), and the features of the tumor (T). The initial postoperative remission was evaluated 3 months after surgery., Results: A final cohort of 132 patients has been included in our study. Median preoperative SAGIT scores were significantly different (10.00 [9.00 - 11.00] to 11.00 [10.00 - 13.00], [p = 0.002]) between patients who achieved initial remission at 3 months and those who were not in remission. The threshold SAGIT score distinguishing between initial remission and nonremission groups was 10 with an AUC of 0.660 (p < 0.001)., Conclusions: In our retrospective cohort study, the findings suggested that the SAGIT® instrument may be a beneficial preoperative tool to predict the initial remission postoperatively and long-term prognosis of the patients with acromegaly.

Objective: Long-acting depot formulations of somatostatin analogs, i.e., octreotide and lanreotide, are the first-line medical therapies for patients with acromegaly to whom surgery/radiotherapy cannot be performed or who have inadequate response. In this study, we aimed to evaluate the short-term local and systemic adverse reactions developed after the somatostatin analogs injections in the patients with acromegaly, in order to compare the side effects of somatostatin analogs injections., Methods: Patients diagnosed with acromegaly who were referred to our endocrinology clinic for monthly somatostatin analogs injections were questionnaired. Wong-Baker Faces Pain Rating Scale was used to evaluate the injection-site pain at the time of injection. The existence of leg pain, nausea, diarrhea, and abdominal pain following the previous injection was also investigated during the next injection., Results: A total of 49 patients were included in the study. The statistical difference could not be shown between the injection-site pain, anorexia, and leg pain frequencies of the groups, while the frequency of gastrointestinal disturbances, i.e., diarrhea and abdominal pain, was significantly lower in the octreotide group (p<0.001 and p=0.015, respectively)., Conclusions: This is the first prospective study that compared the severity of the injection-site pain by using a scoring scale, following the long-acting somatostatin analogs injections. We have shown that there was no significant association of the injection-site pain severity with the somatostatin analogs regimen nor the dose differences within each somatostatin analogs treatment.

The aim of the study is to investigate the effects of intense anxiety and hopelessness experienced by healthcare workers during the pandemic on their quality of life. This cross-sectional, online questionnaire-based study was conducted between August 31, 2020 and October 31, 2020, with 729 healthcare workers in Turkey. The study showed that hopelessness, the weekly working time, fatigue, and the workload of healthcare workers negatively affected their quality of life, those who found the pandemic measures inadequate had a lower quality of life and higher hopelessness levels, and those who needed knowledge on various issues to improve their skills had lower quality of life and higher levels of anxiety and hopelessness. Increasing the measures to make healthcare workers feel competent and ready during the COVID-19 pandemic and meet their information needs to improve their skills will reduce their anxiety and hopelessness and improve their quality of life. Identifying the factors affecting anxiety, hopelessness, and quality of life will help achieve sustainable success in the delivery of health services and promote employee health and safety.

Polyether ionophores represent a large group of naturally occurring compounds mainly produced by Streptomyces species. With previously proven varieties of bioactivity including antibacterial, antifungal, antiparasitic, antiviral and anti-tumor effects, the discovery of undescribed polyethers leading to development of efficient therapeutics has become important. As part of our research on polyether-rich Streptomyces cacaoi, we previously performed modification studies on fermentation conditions to induce synthesis of specialized metabolites. Here, we report four undescribed and nine known polyether compounds from S. cacaoi grown in optimized conditions. Antimicrobial activity assays revealed that four compounds, including the undescribed (6), showed strong inhibitory effects over both Bacillus subtilis and methicillin-resistant Staphylococcus aureus (MRSA) growth. Additionally, K41-A and its C15-demethoxy derivative exhibited significant cytotoxicity. These results signified that selectivity of C15-demethoxy K41-A towards cancer cells was higher than K41-A, which prompted us to conduct mechanistic experiments. These studies showed that this uninvestigated compound acts as a multitarget compound by inhibiting autophagic flux, inducing reactive oxygen species formation, abolishing proteasome activity, and stimulating ER stress. Consequently, the optimized fermentation conditions of S. cacaoi led to the isolation of undescribed and known polyethers displaying promising activities., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Introduction: The aim of our study is to investigate the etiological distribution of ILD in Turkey by stratifying the epidemiological characteristics of ILD cases, and the direct cost of initial diagnosis of the diagnosed patients., Material-Method: The study was conducted as a multicenter, prospective, cross-sectional, clinical observation study. Patients over the age of 18 and who accepted to participate to the study were included and evaluated as considered to be ILD. The findings of diagnosis, examination and treatment carried out by the centers in accordance with routine diagnostic procedures were recorded observationally., Results: In total,1070 patients were included in this study. 567 (53%) of the patients were male and 503 (47%) were female. The most frequently diagnosed disease was IPF (30.5%). Dyspnea (75.9%) was the highest incidence among the presenting symptoms. Physical examination found bibasilar inspiratory crackles in 56.2 % and radiological findings included reticular opacities and interlobular septal thickenings in 55.9 % of the cases. It was observed that clinical and radiological findings were used most frequently (74.9%) as a diagnostic tool. While the most common treatment approaches were the use of systemic steroids and antifibrotic drugs with a rate of 30.7% and 85.6%, respectively. The total median cost from the patient's admission to diagnosis was 540 Turkish Lira., Conclusion: We believe that our findings compared with data from other countries will be useful in showing the current situation of ILD in our country to discuss this problem and making plans for a solution., Competing Interests: Each author declares that he or she has no commercial associations (e.g. consultancies, stock ownership, equity interest, patent/licensing arrangement etc.) that might pose a conflict of interest in connection with the submitted article., (Copyright: © 2021 SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES.)

Subacute thyroiditis is the most common cause of painful thyroiditis, which usually occurs after an acute viral upper respiratory tract infection. Rare cases of subacute thyroiditis have been reported after administration of viral vaccines. Here, we report four cases of subacute thyroiditis after administration of the COVID-19 mRNA vaccine (Pfizer/BioNTech®). We describe the clinical, laboratory and imaging features of five cases of subacute thyroiditis after COVID-19 mRNA vaccine (Pfizer/BioNTech®). COVID-19 mRNA vaccine (Pfizer/BioNTech®)-associated subacute thyroiditis may present with clinical findings typical of classic subacute thyroiditis such as fever, neck pain, weakness, and tremor within a few days following vaccination. Subacute thyroiditis may be focal or may progress with diffuse bilateral involvement. Depending on the extent of subacute thyroiditis involvement, significant increases in acute-phase reactants can be observed. COVID-19 mRNA vaccine (Pfizer/BioNTech®) associated subacute thyroiditis responds quite well to non-steroidal anti-inflammatory therapy. Clinicians should be aware of the risk of developing subacute thyroiditis after vaccination.

The levothyroxine absorption test for the assessment of pseudo-malabsorption in patients with refractory hypothyroidism has not been standardised. The aim of this observational study was to describe a protocol for levothyroxine (LT-4) absorption test in patients with refractory hypothyroidism, to report possible side effects and to emphasise the importance of pseudo-malabsorption in the differential diagnosis. The results of 10 patients, who underwent LT-4 absorption tests because thyroid stimulating hormone suppression could not be achieved despite the need for LT-4 >3 mcg/kg/day, were retrospectively analysed. When compared with basal free T4 (fT4), a statistically significant increase in fT4 was observed after the first hour (p=0.012). fT4 reached its peak level and plateau at the 4th hour. The fT4 peak level increased 3.25 times compared to baseline. The shorter LT-4 absorption test with low doses may provide an alternative method to the commonly used longer protocols with higher doses to rule out malabsorption. Key Words: Levothyroxine absorption test, Pseudo-malabsorption, Resistant hypothyroidism.

Aims: The aim of this study is to determine the impact of the COVID-19 pandemic on the management and disease control of the patients with diabetes mellitus in Kocaeli., Methods: This study was carried out in six leading central hospitals in five major districts of Kocaeli. The study was conducted between June 2020 and November 2020. The patients who had previous admissions to these clinics within 6 months prior to the pandemic were enrolled in the study., Results: A total of 283 patients were enrolled in the study, among them 151 (53%) patients were female, 268 (95%) had type 2 DM and remaining 5% had type 1 DM. The median weight of the patients was similar between the previous and last visits (84 kg vs 83 kg, p = 0,88). Laboratory parameters of previous and current visits revealed that mean fasting plasma glucose (FPG) and HbA1c levels were not significantly changed. The number of the patients who had controlled blood pressure was significantly decreased. The number of those who had neuropathic complains and the severity of dyslipidemia significantly increased during pandemic period., Conclusion: Our study demonstrated that despite decreased compliance with diet and exercise, and difficulty in accessing medication, there was no significant change in weight, FPG and HbA1c levels in diabetic patients. Since cultural differences, education level and socioeconomic opportunities differ between societies, national and international studies will be more accurate to evaluate the effects of epidemics on the course of chronic diseases., Competing Interests: Conflicts of interest/Competing interests The authors declare that they have no conflict of interest., (© Springer Nature Switzerland AG 2021.)

Introduction: The relationship between growth hormone (GH)/insulin-like growth factor 1 (IGF-1) and glucocorticoids (GC) was examined in various studies. Long-term GC treatment was shown to decrease GH concentration and, interestingly, to increase IGF-1 concentration. We performed a retrospective study in order to examine how preoperative IGF-1 concentrations vary within the reference range and if tertiles of age- and sex-adjusted normal IGF-1 are predictive for early postoperative remission in the patients with Cushing's Disease (CD)., Patients and Methods: Patients diagnosed with CD were retrospectively evaluated. After the exclusion of 67 patients, a final cohort of 250 CD patients were included. Age- and sex-adjusted normal IGF-1 levels were divided into tertiles (T1, T2 and T3). Early postoperative remission was defined as a nadir morning cortisol concentration measured within the first 3 consecutive days following surgery of less than 5 µg/dL (138 nmol/L)., Results: Early postoperative remission rate was the lowest in T1 and highest in T3; 49.1% (n = 28) versus 77.3% (n = 75), p = .001, respectively. Binary logistic regression analysis showed the remission rate in T3 was three times higher than that in T1 ( p = .003). Cortisol and ACTH concentration were significantly higher and GH concentrations were significantly lower in T1 compared to those in the other two tertiles., Conclusions: As the first study evaluating the correlation between early postoperative remission rate in patients with CD and the tertiles of normal age- and sex-adjusted IGF-1 levels, we have shown that higher IGF-1 levels could predict better outcome in CD.

Background: Extramedullary leukemia, also known as myeloid sarcoma, is a rare form of acute myeloid leukemia and often accompanies bone marrow involvement. Myeloid infiltration of the thyroid gland is extremely rare. Here, a unique case in which thyroid cancer tissue was infiltrated with myeloid cells is presented., Case Presentation: We present a case of thyroid papillary cancer infiltrated by blastic cells and bilateral breast and axillary myeloid sarcoma in a 30-year-old Caucasian female patient with a history of osteosarcoma and MDS-RAEB2. The patient firstly received 6 cycles of chemotherapy for osteosarcoma, and allogeneic hematopoietic stem cell transplantation was performed after anthracycline-based chemotherapy due to MDS-RAEB2. The patient remained in remission on follow-up in terms of both osteosarcoma and MDS-RAEB2. Malignant features (Bethesda VI) were observed in the fine needle aspiration biopsy performed from a newly developed firm, fixed thyroid nodule approximately 4-5 cm in length in the left thyroid lobe. Because of the Bethesda VI thyroid nodule, the patient underwent total thyroidectomy. In the pathological evaluation, CD34-, CD117-, MPO-, and HLA-DR-positive blastic cells which infiltrated into follicular variant papillary thyroid carcinoma were detected. In the evaluation performed due to blastic cell infiltration, multiple lesions showing increased 18-fluorodeoxyglucose activity in bilateral breast and axillae were detected. Myeloid sarcoma was found as a result of tru-cut biopsy from these lesions. A fungal cystic lesion was detected in the frontal region of the patient who developed altered consciousness after the second cycle of treatment of myeloid sarcoma. During her follow-up in the intensive care unit, she died of cranial septic embolism and acute infarction., Conclusions: Here, we present a very interesting case that is the first. A staged approach to diagnosis with methods including immunohistochemical staining, radiological imaging methods, and cytogenetic and molecular analyses can help make the definitive diagnosis., (© 2021. The Author(s).)