Biochemical Control in Acromegaly With Multimodality Therapies: Outcomes From a Pituitary Center and Changes Over Time

Abstract Purpose To determine the prevalence of insulin-like growth factor-1 (IGF-1) normalization with long-term multimodality therapy in a pituitary center and to assess changes over time. Methods Patients with acromegaly (N = 409), with ≥1 year of data after surgery and at least 2 subsequent clinic visits were included in long-term analysis (N = 266). Biochemical data, clinical characteristics, and therapeutic interventions were reviewed retrospectively. Results At diagnosis, mean [standard deviation] age was 43.4 [14.3] years, body mass index was 28.5 (24.9–32.1) kg/m2 (median, interquartile range), serum IGF-1 index (IGF-1 level/upper limit of normal) was 2.3 [1.7–3.1], and 80.5% had macroadenomas. Patients with transsphenoidal surgery after 2006 were older [46.6 ± 14.3 vs 40.0 ± 13.4 years; P < 0.001]. Age and tumor size correlated inversely. Overall (N = 266), 93.2% achieved a normal IGF-1 level during 9.9 [5.0–15.0] years with multimodality therapy. The interval to first normal IGF-1 level following failed surgical remission was shorter after 2006: 14.0 (95% confidence interval, 10.0–20.0) versus 27.5 (22.0–36.0) months (P = 0.002). Radiation therapy and second surgery were rarer after 2006: 28 (22%) versus 62 (47.0%); P < 0.001 and 12 (9.4%) versus 28 (21.2%); P = 0.010, respectively. Age at diagnosis increased over time periods, possibly reflecting increased detection of acromegaly in older patients with milder disease. Male gender, older age, smaller tumor and lower IGF-1 index at diagnosis predicted long-term sustained IGF-1 control after surgery without adjuvant therapies. Conclusion The vast majority of patients with acromegaly can be biochemically controlled with multimodality therapy in the current era. Radiotherapy and repeat pituitary surgery became less frequently utilized over time. Long-term postoperative IGF-1 control without use of adjuvant therapies has improved.

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Long-Term Outcomes of Patients with Acromegaly - A Report from the Swedish Pituitary Register

Acta Endocrinologica ◽

10.1530/eje-21-0729 ◽

2022 ◽

Author(s):

Steinunn Arnardóttir ◽

Jacob Järås ◽

Pia Burman ◽

Katarina Berinder ◽

Per Dahlqvist ◽

...

Keyword(s):

High Rate ◽

Hormone Deficiency ◽

Visual Field Defects ◽

Mortality Data ◽

Pituitary Hormone ◽

Biochemical Control ◽

Long Term Outcomes ◽

Over Time

Objective: To describe treatment and long-term outcomes of patients with acromegaly from all health-care regions in Sweden. Design and Methods: Analysis of prospectively reported data from the Swedish Pituitary Register of 698 patients (51% females) with acromegaly diagnosed from 1991-2011. The latest clinical follow-up date was December, 2012, while mortality data were collected for 28.5 years until June, 2019. Results: The annual incidence was 3.7/million; 71% of patients had a macroadenoma, 18% had visual field defects, and 25% had at least one pituitary hormone deficiency. Eighty-two percent had pituitary surgery, 10% radiotherapy and 39% medical treatment. At the 5- and 10-year follow-ups, IGF-I levels were within the reference range in 69% and 78% of patients, respectively. In linear regression the proportion of patients with biochemical control including adjuvant therapy at 10 year follow-up increased over time with 1.23 % per year. The SMR (95% CI) for all patients was 1.29 (1.11-1.49). For patients with biochemical control at the latest follow-up, SMR was not increased, neither among patients diagnosed 1991-2000, SMR 1.06 (0.85-1.33) or 2001-2011, SMR 0.87 (0.61-1.24). In contrast, non- controlled patients at the latest follow up from both decades had elevated SMR, 1.90 (1.33-2.72) and 1.98 (1.24-3.14), respectively. Conclusions: The proportion of patients with biochemical control increased over time. Patients with biochemically controlled acromegaly have normal life expectancy while non-controlled patients still have increased mortality. The high rate of macroadenomas and unchanged age at diagnosis illustrates the need for improvements in the management of patients with acromegaly.

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The Long-Term Struggle for Violence against Women Legislation: The Guatemalan Women's Movement and the Politics of Patience

Politics & Gender ◽

10.1017/s1743923x21000349 ◽

2021 ◽

pp. 1-34

Author(s):

Erin Beck

Keyword(s):

Gender Equality ◽

Violence Against Women ◽

Women's Movement ◽

Political Reform ◽

Women's Movements ◽

Social Mobilization ◽

History Of ◽

Term Analysis ◽

Over Time

Abstract A scholarly consensus depicts strong, autonomous domestic women's movements as critical for the passage of gender equality reforms, alongside openings in domestic and international political contexts. What, then, is a nascent women's movement seeking gender equality reforms to do if it lacks strength or a history of autonomous organizing? A long-term analysis of the Guatemalan women's movement's push for reforms to address violence against women demonstrates that one potential road forward is through a “politics of patience,” rooted in the pursuit of cumulative, incremental victories. Adopting a politics of patience allows nascent domestic movements in developing and post-transition contexts to achieve incremental victories that create future political openings while simultaneously building movement strength and autonomy over time. This finding highlights the temporal and strategic power of women's movements, as well as the iterative and potentially reinforcing nature of social mobilization and political reform.

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Distinct Regional Changes Over Time In Lung Metabolic Activity In A Long-Term Model Of Endotoxin And Ventilator-Induced Lung Injury

10.1164/ajrccm-conference.2012.185.1_meetingabstracts.a3693 ◽

2012 ◽

Author(s):

Tyler J. Wellman ◽

Nicolas de Prost ◽

Tilo Winkler ◽

Guido Musch ◽

Mauro Tucci ◽

...

Keyword(s):

Lung Injury ◽

Metabolic Activity ◽

Ventilator Induced Lung Injury ◽

Term Model ◽

Changes Over Time ◽

Over Time

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Does vegetation change over 28 years affect habitat use and reproductive success?

The Auk ◽

10.1093/auk/ukz061 ◽

2019 ◽

Vol 137 (1) ◽

Author(s):

Karolina Fierro-Calderón ◽

Thomas E Martin

Keyword(s):

Reproductive Success ◽

Habitat Use ◽

Nest Survival ◽

Selection Function ◽

Patch Use ◽

Fitness Consequences ◽

Long Term Changes ◽

Changes Over Time ◽

Over Time

Abstract Individuals should prefer and use habitats that confer high fitness, but habitat use is not always adaptive. Vegetation in natural landscapes changes gradually and the ability of species to adaptively adjust their habitat use to long-term changes is largely unstudied. We studied nest patch and territory use over 28 yr in Orange-crowned Warblers (Oreothlypis celata) in a system that has undergone natural long-term changes in vegetation. Abundance of maple (Acer grandidentatum), its preferred nesting habitat, gradually declined from 1987 to 2015. We examined whether habitat use and its fitness consequences changed as the availability of preferred habitat decreased. We used resource selection function models to determine changes over time in the probability of using a nest patch given available patches, and the probability of using a territory given available territories. We estimated nest survival to evaluate changes over time in the fitness consequences of nest patch use. We also compared habitat use (nest patch and territory) and fitness (nest survival) between areas with naturally reduced abundance of maple and experimentally increased abundance of maple (fenced areas). Nest patch use depended on maple abundance and did not change drastically across 28 yr, even though the availability of preferred maple patches decreased over time. In contrast, nest survival tended to decrease over time. We did not see differences in nest patch use and nest survival between unfenced and fenced areas, unlike territory use, which increased with the abundance of maple in fenced areas and decreased in unfenced areas. Our study depicts one example of relatively unchanged habitat use in the face of decreased availability of preferred vegetation across years, with a resulting decrease in reproductive success. Investigating changes in habitat use and fitness consequences for animals exposed to long-term habitat change is necessary to understand adaptive behavioral responses.

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Monitoring of agrophysical properties of the active layer of drained long-frozen peat deposits in Western Siberia

E3S Web of Conferences ◽

10.1051/e3sconf/202016407016 ◽

2020 ◽

Vol 164 ◽

pp. 07016

Author(s):

Vasily Novokhatin ◽

Nadezhda Osipova

Keyword(s):

Western Siberia ◽

Soil Reclamation ◽

Hydromorphic Soils ◽

Investment Projects ◽

Long Term Study ◽

Peat Deposits ◽

Changes Over Time ◽

Reclaimed Soils ◽

Over Time

In this study, the authors considered the dynamics of the main agrophysical properties of hydromorphic geosystems in Western Siberia. In the process of evolution, as well as in the conditions of technogenic impact, the soils of natural-territorial complexes, their properties are subject to significant changes. New hydromorphic geosystems are formed, the soils of which are characterized by changed agrophysical properties. Modern technologies for developing investment projects for soil reclamation of hydromorphic geosystems should be based on agrophysical characteristics of reclaimed soils, on the basis of which it is possible to create the necessary parameters of drainage systems and, as a result, provide optimal soil regimes for agricultural crops for a long period. The difficulty is that these soil characteristics are variable over time. Until recently, agrophysical characteristics of soils obtained in other regions of the country were used in the development of reclamation projects for hydromorphic soils in Western Siberia. The attempt to borrow them has led to the fact that large areas of drained soil have become completely unsuitable and to restore their project productivity, a number of agro-reclamation activities and the attraction of large financial resources are currently required. In this regard, there is a need for a comprehensive, long-term study of the main properties of hydromorphic soils used for agricultural purposes, and especially their changes over time under the influence of anthropogenic load.

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Intellectual Capital Change Management in the Construction Industry—The Case of an Inter-Organisational Collaboration

Journal of Open Innovation Technology Market and Complexity ◽

10.3390/joitmc7030199 ◽

2021 ◽

Vol 7 (3) ◽

pp. 199

Author(s):

José Vale ◽

Nádia Barbosa ◽

Rui Bertuzi ◽

Ana Maria Bandeira ◽

Vera Teixeira Vale

Keyword(s):

Construction Industry ◽

Intellectual Capital ◽

Competitive Advantages ◽

Traditional Media ◽

Intellectual Assets ◽

Changes Over Time ◽

The Impact ◽

Over Time

Nowadays, due to the complexity of the relationships with external entities, along with the importance that traditional media and the innovative social media have in creating competitive advantages, it is necessary for companies to collaborate in order to create Intellectual Capital (IC). Although collaboration is crucial to create IC, there is a paucity in literature regarding the effects that a specific type of collaboration may have on the IC of an organisation, specifically a franchising with a mediatic actor. Moreover, literature addressing IC creation and destruction over time is scarce, especially when applied to the construction industry. This paper’s goal is twofold: understanding the longitudinal changes of a construction SME’s Intellectual Capital, regarding its creation and destruction; analysing the impact that a specific inter-organisational collaboration franchising—with a mediatic actor may have on such IC. A single in-depth case study was conducted, allowing to conclude that the actions of an organisation can develop both Intellectual Assets and Intellectual Liabilities. It was also concluded that inter-organisational collaboration, through a franchise with an actor with experience in communication, can generate, in the long term, positive and innovative effects regarding the different IC components, namely the Relational one. More specifically, the paper allowed to ascertain that an organisation’s IC changes over time in a dynamic fashion, i.e., Intellectual Liabilities which emerged before an innovative collaboration can be transformed into Intellectual Assets and create competitive advantages. This paper contributes to stress the importance of managing IC, not only when it is created, but namely in when it can be destroyed, in a context of inter-organisational collaborations applied to a construction SME.

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What does Congress want from the National Science Foundation? A content analysis of remarks from 1995 to 2018

Science Advances ◽

10.1126/sciadv.aaz6300 ◽

2020 ◽

Vol 6 (33) ◽

pp. eaaz6300

Author(s):

A. Lupia ◽

S. Soroka ◽

A. Beatty

Keyword(s):

Text Analysis ◽

National Science Foundation ◽

Education Technology ◽

Congressional Record ◽

Scientific Organizations ◽

National Science ◽

Changes Over Time ◽

The U.S ◽

Over Time

The U.S. Congress writes the legislation that funds the National Science Foundation (NSF). Researchers who seek NSF support may benefit by understanding how Congress views the agency. To this end, we use text analysis to examine every statement in the Congressional Record made by any member of Congress about the NSF over a 22-year period. While we find broad bipartisan support for the NSF, there are notable changes over time. Republicans have become more likely to express concerns about accountability in how the NSF spends its funds. Democrats are more likely to focus on how NSF-funded activities affect education, technology, and students. We use these findings to articulate how researchers and scientific organizations can more effectively conduct transformative science that corresponds to long-term and broadly held Congressional priorities.

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OS09.4.A Health-related quality of life in low-grade glioma survivors 26 years after diagnosis

Neuro-Oncology ◽

10.1093/neuonc/noab180.038 ◽

2021 ◽

Vol 23 (Supplement_2) ◽

pp. ii12-ii12

Author(s):

F W Boele ◽

J C Reijneveld ◽

P C de Witt Hamer ◽

H F van Thuijl ◽

P Wesseling ◽

...

Keyword(s):

Quality Of Life ◽

Low Grade ◽

Group Level ◽

Related Quality ◽

Health Related ◽

Changes Over Time ◽

Over Time

Abstract BACKGROUND Many patients with low-grade gliomas (LGGs) continue to survive for many years, yet little is known about patients’ health-related quality of life (HRQOL) in long-term survivorship. We previously investigated HRQOL in LGG patients diagnosed on average 6 years prior to assessment (T1, N=195) with a follow-up in stable patients on average 12 years after diagnosis (T2, N=65). We present a final follow-up of LGG survivors (T3), now decades after diagnosis. MATERIAL AND METHODS We invited patients who participated in our previous assessment (N=65), regardless of disease status. Patients completed questionnaires to assess HRQOL, fatigue, and depressive symptoms: Short Form-36 Health Survey (SF-36), European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Brain Tumour Module (EORTC BN20), Checklist Individual Strength (CIS), and the Center for Epidemiological Studies Depression Scale (CES-D). Changes over time (T1-T2-T3) on group level and participant level were assessed. RESULTS Of the 65 patients, 18 (27.7%) were deceased, 3 (4.6%) experienced tumour progression to WHO III, 7 (10.8%) declined, and 3 (4.6%) could not be contacted. Thirty-four patients (52.3%) participated. Of these, 2 had missing HRQOL data, with 32 patients included in analysis. Survivors were M=52.0 (sd=11.3) years old and diagnosed M=26.2 (sd=3.7, range 19–35) years prior. On group level, a statistically significant (but not clinically relevant) improvement in mental health (p=0.049), and a clinically relevant (but not statistically significant) decline in emotional role functioning was found. No other group-level changes over time in HRQOL were found. Minimal detectable change in HRQOL scale scores over time was observed in individual participants (28.1% only improvement; 25.0% only decline; 21.9% both improvement and decline) with 25.0% remaining completely stable. At T3, 25.0% of survivors scored above the cut-off for high risk of clinical depression (≥16 CES-D), and 53.1% of survivors classed as severely fatigued (≥35 CIS). CONCLUSION In this cohort of LGG survivors, assessed decades after diagnosis and treatment, HRQOL does not appear to be greatly impacted during survivorship. However, depressive symptoms and fatigue remain relatively common. Findings can help inform patients, their families, and clinicians and can serve as a benchmark for treatment trials evaluating interventions that can have very long-term effects.

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Significant GH deficiency after long-term cure by surgery in adult patients with Cushing’s disease

Acta Endocrinologica ◽

10.1530/eje.1.02329 ◽

2007 ◽

Vol 156 (2) ◽

pp. 233-239 ◽

Cited By ~ 21

Author(s):

Francesca Pecori Giraldi ◽

Massimiliano Andrioli ◽

Laura De Marinis ◽

Antonio Bianchi ◽

Antonella Giampietro ◽

...

Keyword(s):

Replacement Therapy ◽

Cushing’S Disease ◽

Gh Deficiency ◽

Pituitary Surgery ◽

Male Gender ◽

Cushing's Disease ◽

Gh Secretion ◽

Wide Variability ◽

Acth Secreting

Objective: Impaired GH secretion usually accompanies Cushing’s syndrome and a variable proportion of patients reportedly fail to recover normal GH secretion after successful treatment. This wide variability is most probably due to differences in the treatment (i.e. surgery and/or radiotherapy), timing of patient re-evaluation after surgery and dynamic tests employed to challenge GH secretion, and hinders a precise assessment of risk of GH deficiency after cure. The aim of the present study is to evaluate GH secretory status after long-term cure of Cushing’s disease achieved by surgery alone. Design and methods: We studied 34 patients (27 females and 7 males, age range 21–68 years) formerly affected by Cushing’s disease. Patients were studied 2–20 years (median 3.3 years) following remission of hypercortisolism; all patients underwent transsphenoidal surgery with the removal of an ACTH-secreting adenoma; repeat pituitary surgery for relapse was performed in two patients while bilateral adrenalectomy was necessary in two patients. In all subjects, the GH response to GHRH+arginine stimulation was evaluated. At the time of testing, 13 patients were still on steroid replacement therapy. Results: In long-term surgical remission, 22 patients (65.0%) presented subnormal GH secretion; partial GH deficiency (GH peak <16.5 μg/l) was found in 11 patients and severe GH deficiency (GH peak <9 μg/l) in another 11. Male gender and length of hypercortisolism were risk factors for postsurgical GH deficiency. Conclusions: This study demonstrates the presence of GH deficiency in a high percentage of patients with Cushing’s disease after long-term remission of hypercortisolism obtained by surgery alone. Male gender and length of hypercortisolism are the most significant predictors of postsurgical GH deficiency. This finding is significant as it highlights that even the most favourable therapeutical course, i.e. remission achieved by surgery alone, is accompanied by impaired GH secretion. Assessment of GH secretion is therefore recommended for all patients cured from Cushing’s disease, even if not submitted to radiotherapy. Studies on the clinical impact of GH deficiency and the use of GH replacement therapy seem warranted in patients cured from Cushing’s disease.

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