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This study aimed to evaluate the effectiveness and safety of the MiniMed™ 780G advanced hybrid closed-loop (AHCL) system in people with type 1 diabetes (T1D) previously treated with continuous subcutaneous insulin infusion combined with flash glucose monitoring in a real-life setting. A total of 47 subjects (mean age 41 ± 13.6 years, 60% females, diabetes duration 28 ± 11 years) were included and switched to an AHCL system. Baseline and 6-month data were analyzed. Time in range 70-180 mg/dL increased from 65.3% at baseline to 73.8% at 6 months. Time in hyperglycemia180 mg/dL decreased from 26.6% to 19.3%. Time in hypoglycemia70 mg/dL decreased from 4.6% to 2.3%. The coefficient of variation also decreased from 36% to 31.6%. No episodes of severe hypoglycemia, diabetes ketoacidosis, or diabetes-related hospital admissions occurred. In conclusion, the MiniMed 780G AHCL system enables the safe achievement of recommended glycemic targets in people with T1D after 6 months of use.

[Background] Despite major medical advances, Type 1 Diabetes (T1D) patients still have greater morbimortality than the general population. Our aim was to describe our cohort of T1D patients and identify potential risk factors susceptible to prevention strategies., [Methods] Cross-sectional, observational study, including T1D patients treated at our center, from 1 March 2017 to 31 March 2020. Inclusion criteria: T1D, age > 14 years and signed informed consent. Exclusion criteria: diabetes other than T1D, age < 14 years and/or refusal to participate., [Results] Study population n = 2181 (49.8% females, median age at enrollment 41 years, median HbA1c 7.7%; 38.24% had at least one comorbidity). Roughly 7.45% had severe hypoglycemia (SH) within the prior year. Macro/microvascular complications were present in 42.09% (5.83% and 41.14%, respectively). The most frequent microvascular complication was diabetic retinopathy (38.02%), and coronary disease (3.21%) was the most frequent macrovascular complication. The risk of complications was higher in males than in females, mainly macrovascular. Patients with SH had a higher risk of complications (OR 1.42; 1.43 in males versus 1.42 in females)., [Conclusions] Our T1D population is similar to other T1D populations. We should minimize the risk of SH, and male patients should perhaps be treated more aggressively regarding cardiovascular risk factors.

The primary treatment for non-functioning pituitary tumors (NFPTs) is surgery, but it is often unsuccessful. Previous studies have reported that NFPTs express receptors for somatostatin (SST1-5) and dopamine (DRDs) providing a rationale for the use of dopamine agonists and somatostatin analogues. Here, we systematically assessed SST1-5 and DRDs expression by real-time quantitative PCR (RT-qPCR) in a large group of patients with NFPTs (n = 113) and analyzed their potential association with clinical and molecular aggressiveness features. SST1-5 expression was also evaluated by immunohistochemistry. SST3 was the predominant SST subtype detected, followed by SST2, SST5, and SST1. DRD2 was the dominant DRD subtype, followed by DRD4, DRD5, and DRD1. A substantial proportion of NFPTs displayed marked expression of SST2 and SST5. No major association between SSTs and DRDs expression and clinical and molecular aggressiveness features was observed in NFPTs ISCIII-Subdirección General de Evaluación y Fomento de la Investigación co-funded with Fondos FEDER PI16/00175 to A.S.-M. and D.A.C; PI16/00264 to R.M.L. Sistema Andaluz de Salud A-0006-2017 and A-0055-2018 to A.S.-M, C-0015-2014 and RC-0006-2018 to D.A.C. Ministerio de Ciencia, Innovación BFU2016-80360-R to J.P.C.; PID2019-105564RB-I00 to R.M.L. Junta de Andalucía BIO-0139 to J.P.C. and R.M.L. Instituto de Salud Carlos III, Ministerio de Sanidad, Servicios Sociales e Igualdad, Spain

Acromegaly is a hormonal disorder resulting from excessive growth hormone (GH) secretion frequently produced by pituitary adenomas and consequent increase in insulin‐like growth factor 1 (IGF‐I). Elevated GH and IGF‐I levels result in a wide range of somatic, cardiovascular, endocrine, metabolic and gastrointestinal morbidities. Somatostatin analogues (SSAs) form the basis of medical therapy for acromegaly and are currently used as first‐line treatment or as second‐line therapy in patients undergoing unsuccessful surgery. However, a considerable percentage of patients do not respond to SSAs treatment. Somatostatin receptors (SSTR1‐5) and dopamine receptors (DRD1‐5) subtypes play critical roles in the regulation of hormone secretion. These receptors are considered important pharmacological targets to inhibit hormone oversecretion. It has been proposed that decreased expression of SSTRs may be associated with poor response to SSAs. Here, we systematically examine SSTRs and DRDs expression in human somatotroph adenomas by quantitative PCR. We observed an association between the response to SSAs treatment and DRD4, DRD5, SSTR1 and SSTR2 expression. We also examined SSTR expression by immunohistochemistry and found that the immunohistochemical detection of SSTR2 in particular might be a good predictor of response to SSAs.

INTRODUCTION Non-functioning pituitary adenomas (NFPAs) are usually benign. However, a substantial proportion of pituitary adenomas show an aggressive behavior with local invasion and increased risk of regrowth or recurrence after surgery. The treatment of choice for these adenomas is transsphenoidal resection but it is not always successful. NFPAs express somastostatin receptors (SSTRs) thus providing a theoretical rationale for the pharmacological treatment with somatostatin analogues. However, a consistent method for evaluating SSTR expression needs to be implemented. AIM The aim of the study was to systematically evaluate the expression of SSTRs in NFPAs by quantitative PCR and by immunohistochemistry with reliable commercial antibodies and analyze their potential association with aggressive features. METHODS. In this retrospective descriptive study, 114 patients that underwent transsphenoidal surgery were evaluated. Clinical variables, histological subtype (including classification of agressive histological subtypes) and need for radiotherapy were collected to analyze potential associations between these variables and SSTR expression. Tumor size and cavernous sinus invasion data were obtained from magnetic resonance images. Cavernous sinus invasion was evaluated using the Knosp classification. Knosp grade 3 and 4 were defined as invasive. The expression of SSTRs (SSTR2. SSTR3 and SSTR5) was evaluated using a score system previously described [Venegas-Moreno et al. J Cell Mol Med. 2018;22(3):1640-1649]. RESULTS Quantitative PCR analysis revealed that SSTR3 was the predominant SSTR subtype detected, followed by SSTR2, SSTR5, and SSTR1. Immunohistochemistry data showed a similar expression pattern. However, The expression of the different SSTRs displayed a notable variability among NFPAs. Thus, 28,9% of NFPAs showed substantial SSTR2 expression, as indicated by high immunohistochemistry scores. Also, 12,3% of NFPAs displayed high SSTR5 expression while 86,8% of NFPAs displayed high SSTR3 levels. No significant associations between SSTR expression and sex, tumor size, invasion and surgical cure. Patients with elevated SSTR2 expression were younger but this association was not observed with SSTR3 and SSTR5. CONCLUSIONS No major association between SSTR expression and aggressive features was observed in NFPAs. A proportion of NFPAs displayed marked expression of SSTR2 and SSTR5 and thus, they might be considered potential candidates for therapy with somatostatin analogues. Sources of Research Support: Spanish Ministry of Health, ISCIII co-funded with Fondos FEDER (PI16/00175) and Novartis Oncology Spain.

Summary Introduction Gastrostomy feeding tube insertion has become a common procedure as it enables patients who require long term enteral feeding. Conventional surgical gastrostomies were the only way of gaining enteral access in patients in which it is not possible to pass an endoscope or a nasogastric tube required for endoscopic or radiological gastrostomies, and in patients in which certain anatomical abnormalities contraindicate performing these techniques. As conventional surgical gastrostomies are associated with high morbidity, especially gastric leakage around the tube, percutaneous laparoscopic assisted gastrostomy (PLAG) may be a better way to gain enteral access. Material and methods Observational study of a prospective cohort of 224 patients on whom a gastrostomy was performed for nutritional support between January 2009 and October 2015 at Virgen del Rocio University Hospital in Seville. The types of gastrostomies carried out were: percutaneous endoscopic gastrostomy (PEG, n = 106), percutaneous radiological gastrostomy (PRG, n = 89), conventional surgical gastrostomy, Open Stamn or Laparoscopic Janeway (SG, n = 9) and percutaneous laparoscopic assisted gastrostomy (PLAG, n = 20), technique that we describe in detail. Short and long term complications are described. Results Many more complications were seen in the conventional gastrostomy group than in the other three groups, especially leakage of gastric content around the tube, with burning and irritation of the skin (66% compared with 2.83% in PEG and 0% in PLAG and PRG). The group with the highest proportion of patients completely free of complications was PLAG (75%), whilst in the conventional surgical gastrostomy group, no patient was completely free of complications. Conclusions We found lower complication rate in PLAG than any other technique. We believe that PLAG could be preferred technique for patients on whom it is not possible to perform PEG or PRG, as it is safe and easy.

Differentiated thyroid carcinoma is one of the most frequently diagnosed cancers during pregnancy, second only to breast cancer. Therefore, it would be of value to determine if there are pregnancy-related physiological effects that impact long-term prognosis for patients with this disease. Hormone effects attributable to β-human chorionic gonadotropin and estrogens seem particularly likely. We present a case of a 40-year-old woman with thyroid follicular carcinoma with accompanying bone metastases. The cancer was discovered immediately after childbirth and the woman became pregnant again when the disease was in an advanced stage. We describe the cancer evolution and present the maternal and fetal results. Pregnancy in women with advanced thyroid carcinoma could affect long-term prognosis. However, more studies are needed to evaluate this hypothesis. In this unique case, there were two pregnancies and the second occurred in an advanced state of the disease. We evaluated how these pregnancies could affect short-term prognosis of the disease.

The loss of mobility due to spinal cord injury is a risk factor for weight gain. Despite the well-documented outcomes of bariatric surgery in outpatients, little information is available about the surgery in paraplegic patients. We present two cases of patients with morbid obesity and spinal cord injury. After several attempts to lose weight conservatively, were assessed by the multidisciplinary team of our hospital and finally intervened by laparoscopic gastric bypass. After surgery have been no post-surgical complications. The patient in case 1, after two years of follow-up, a weight of 84 kg (BMI 25.08 kg/m2). Case 2, after a month of surgery has reduced weight and stopped taking antihypertensive therapy. It 's available to bariatric surgery as an important option to consider if all non-surgical interventions fail is highlighted.La pérdida de la movilidad, como consecuencia de una lesión medular, es un factor de riesgo para el aumento de peso. A pesar de los resultados bien documentados de la cirugía bariátrica en pacientes ambulatorios, hay poca información disponible acerca de la cirugía en pacientes parapléjicos. Presentamos dos casos clínicos de pacientes con obesidad mórbida y lesión medular. Tras varios intentos para perder peso de forma conservadora, fueron valorados por el equipo multidisciplinar de nuestro hospital y finalmente se intervinieron mediante bypass gástrico por vía laparoscópica. El caso 1, tras dos años de seguimiento, presenta un peso de 84 kg (IMC 25,08 kg/m2). El caso 2, tras un mes de la cirugía ha reducido de peso y ha dejado de tomar tratamiento hipotensor. En ellos, destaca la disposición de la cirugía bariátrica como una opción a tener en cuenta si todas las intervenciones no quirúrgicas fracasan.

Percutaneous gastrostomy, is the procedure of choice to provide enteral access in patients requiring nutritional support in this way in the long run, relegating the surgical gastrostomy.We present three patients requiring percutaneous gastrostomy for nutritional support. In two cases was performed endoscopic gastrostomy and another one using interventional radiology.While performing percutaneous gastrostomy clinical incidents were not detected, but when trying the replacement of gastrostomy tubes, showed the presence of gastrocolic fistula that caused failure or turnover in one case, or abdominal pain and diarrhea in the two other cases.Despite being a safe technique, should be done a proper patient selection in order to minimize the potential complications that may occur, as gastrocolic fistula, recommending in doubtful cases test of image such CT (computerized Tomography).Introducción: La gastrostomía percutánea es el procedimiento de elección para proporcionar acceso enteral en pacientes que requieren soporte nutricional por esta vía a largo plazo, relegando a la gastrostomía quirúrgica. Material y métodos: Presentamos tres pacientes con indicación de gastrostomía percutánea para soporte nutricional. En dos casos se realizó la gastrostomía mediante endoscopia y en otro mediante radiología intervencionista. Resultados: Durante la realización de las gastrostomías no se detectaron incidencias clínicas, pero al intentar recambio de las sondas de gastrostomía, se evidenció la presencia de fístula gastrocólica que, ocasionaba imposibilidad del recambio en un caso, o cuadro de dolor abdominal y diarrea en los otros dos casos. Discusión: Pese a ser una técnica segura, la gastrostomía percutánea debe realizarse con una correcta selección de los pacientes para minimizar posibles complicaciones que puedan acontecer, como fístula gastrocólica, recomendando en casos dudosos la realización de prueba de imagen tipo TC (tomografía computerizada).

Struma ovarii is a rare variant of teratoma characterized by the presence of thyroid tissue in more than 50%. Malignant transformation is rare (less than 5%) and the criteria to classify this condition have changed over time. Nowadays it must fulfill the histological categories of differentiated thyroid carcinoma. Its treatment is controversial and there is no unanimous management. We present three cases of women with malignant struma ovarii, diagnosed by the surgical specimen.