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Objective Mild autonomous cortisol secretion (MACS) has been associated with a higher prevalence of osteoporosis, although most data rely on single-center studies with limited sample size. We aimed to assess the prevalence of fragility fractures and contributing factors in a large cohort of patients with adrenal incidentalomas. Design and Methods Medical records of 1023 patients with adrenal incidentalomas from 1990 to 2019 were reviewed, and 735 patients were selected. Clinically obtained electronic radiological images closest to first endocrine evaluation, such as lateral views of spine X-rays or CT thoraco-abdominal scans, were reviewed to screen for asymptomatic morphometric vertebral fractures. Clinical fragility fractures, hormonal, and dual-energy x-ray absorptiometry (DXA) indices were also recorded. Results Four hundred seventy-four patients had nonfunctioning (NF) adrenal incidentalomas, 238 had MACS and 23 adrenal Cushing's syndrome (AC). Prevalence of fragility fractures was different (P = .018) between groups, respectively, 24.1% (NF), 34.0% (MACS), and 30.4% (AC), with significant difference between NF and MACS (P = .012). When analyzed separately by sex and menopausal status, this difference remained significant in postmenopausal women (P = .011), with a fracture prevalence of 22.2% (NF) and 34.6% (MACS). Fracture prevalence was similar in males. Women with MACS aged ≥65 years reported a 48.8% prevalence of fractures, as compared with 29.5% in NF (P < .01). In postmenopausal women, fragility fractures were associated with age (odds ratio [OR] 1.1, P < .001), smoking (OR 1.8, P = .048), and 1 mg-dexamethasone suppression test (DST) cortisol (OR 3.1, P = .029), while in men, only age was associated with fragility fractures. Conclusions A considerable fracture burden was shown in postmenopausal women with adrenal incidentalomas and MACS, with clinical implications for the evaluation and management of bone metabolism.

SommarioIl riscontro di lesioni surrenaliche è in crescente aumento nella pratica clinica. Le lesioni surrenaliche secernenti (aldosterone, cortisolo o catecolamine) si associano a un elevato rischio di comorbidità ed eventi cardiovascolari rispetto alle lesioni non secernenti e alla popolazione generale, con quadri clinici sostanzialmente diversi in accordo al tipo di secrezione ormonale. Questa rassegna riassume le principali problematiche cardiovascolari nelle lesioni surrenaliche benigne.

Background\ud \ud The association between cortisol secretion and mortality in patients with adrenal incidentalomas is controversial. We aimed to assess all-cause mortality, prevalence of comorbidities, and occurrence of cardiovascular events in uniformly stratified patients with adrenal incidentalomas and cortisol autonomy (defined as non-suppressible serum cortisol on dexamethasone suppression testing).\ud \ud \ud \ud Methods\ud \ud We conducted an international, retrospective, cohort study (NAPACA Outcome) at 30 centres in 16 countries. Eligible patients were aged 18 years or older with an adrenal incidentaloma (diameter ≥1 cm) detected between Jan 1, 1996, and Dec 31, 2015, and availability of a 1 mg dexamethasone suppression test result from the time of the initial diagnosis. Patients with clinically apparent hormone excess, active malignancy, or follow-up of less than 36 months were excluded. Patients were stratified according to the 0800–0900 h serum cortisol values after an overnight 1 mg dexamethasone suppression test; less than 50 nmol/L was classed as non-functioning adenoma, 50–138 nmol/L as possible autonomous cortisol secretion, and greater than 138 nmol/L as autonomous cortisol secretion. The primary endpoint was all-cause mortality. Secondary endpoints were the prevalence of cardiometabolic comorbidities, cardiovascular events, and cause-specific mortality. The primary and secondary endpoints were assessed in all study participants.\ud \ud \ud \ud Findings\ud \ud Of 4374 potentially eligible patients, 3656 (2089 [57·1%] with non-functioning adenoma, 1320 [36·1%] with possible autonomous cortisol secretion, and 247 [6·8%] with autonomous cortisol secretion) were included in the study cohort for mortality analysis (2350 [64·3%] women and 1306 [35·7%] men; median age 61 years [IQR 53–68]; median follow-up 7·0 years [IQR 4·7–10·2]). During follow-up, 352 (9·6%) patients died. All-cause mortality (adjusted for age, sex, comorbidities, and previous cardiovascular events) was significantly increased in patients with possible autonomous cortisol secretion (HR 1·52, 95% CI 1·19–1·94) and autonomous cortisol secretion (1·77, 1·20–2·62) compared with patients with non-functioning adenoma. In women younger than 65 years, autonomous cortisol secretion was associated with higher all-cause mortality than non-functioning adenoma (HR 4·39, 95% CI 1·93–9·96), although this was not observed in men. Cardiometabolic comorbidities were significantly less frequent with non-functioning adenoma than with possible autonomous cortisol secretion and autonomous cortisol secretion (hypertension occurred in 1186 [58·6%] of 2024 patients with non-functioning adenoma, 944 [74·0%] of 1275 with possible autonomous cortisol secretion, and 179 [75·2%] of 238 with autonomous cortisol secretion; dyslipidaemia occurred in 724 [36·2%] of 1999 patients, 547 [43·8%] of 1250, and 123 [51·9%] of 237; and any diabetes occurred in 365 [18·2%] of 2002, 288 [23·0%] of 1250, and 62 [26·7%] of 232; all p values

Crematogaster scutellaris is a common tree-nesting ant in Mediterranean olive groves, where it acts as both predator and soft scale insect tender. We aimed to quantify the predatory action of this species and assess whether it influences the distribution of soft scale insects. Predation was investigated through experiments using live prey. The mutualistic relationship between ants and soft scales was assessed by supplementing sugar, amino acids or water to ant colonies, then monitoring for changes in scale tending activity. The probability of soft scale infestation on trees hosting or not hosting ant nests was also estimated. Predation rates on trees hosting a C. scutellaris nest were significantly higher than on trees without nests. Tending activity was affected by carbohydrate and, surprisingly, water availability. While the presence of C. scutellaris was significantly correlated to soft scale infestation, it also favoured predation towards other insects, suggesting a potential role in influencing different insect pests.

Purpose: The effect of long-term glycemic variability upon corneal sub-basal nerve plexus (CSNP) morphology analyzed by in vivo confocal microscopy (IVCM) has been poorly investigated in the setting of type 1 diabetes mellitus (T1DM). Our purpose was to analyze the association between morphometric parameters of CSNP and new markers of glycemic variability in a population of patients with T1DM. Methods: Forty patients with T1DM underwent: assessment of diabetic neuropathy (DN); analysis of subcutaneous advanced glycated end-products; IVCM scans of CSNP. The fully automated software ACCMetrics was employed to analyze IVCM images and calculate seven corneal nerve parameters. Data of diabetes duration, mean and standard deviation (SD) of either last-year and all-time glycated hemoglobin (HbA1C) were retrieved. Results: Diabetes duration and all-time SD of HbA1C were independently associated with CNFD (R = –0.26, p = 0.01; R = –0.27, p = 0.047 respectively), CNFL (R = –0.12; p = 0.01; R = –0.17, p = 0.01 respectively) and CNFrD (R = –0.001, p = 0.009; R = –0.002, p = 0.007 respectively). The analysis of the association among IVCM parameters and specific subtypes of DN showed that altered cold sensitivity was independently associated with CNFD (B = –0.24, p = 0.01), CNFL (B = –0.46, p = 0.01) and CNFrD (B = –28.65, p = 0.03). Conclusions: All-time SD of HbA1C and disease duration were found to be independent predictors of damage to CSNP in patients with T1DM.

Context Chronic glucocorticoids excess leads to morphological and functional cardiac alterations, a substrate for arrhythmias. Autonomous cortisol secretion (ACS) in adrenal incidentalomas is a model of chronic endogenous hypercortisolism. Objective To investigate prevalence and incidence of atrial fibrillation (AF) in a large cohort of patients with ACS. Design Retrospective study. Setting University hospital. Patients Patients evaluated between 1990 and 2018 for adrenal incidentalomas (n = 632), without pheochromocytoma, primary aldosteronism, Cushing syndrome, congenital adrenal hyperplasia, and adrenal malignancy. Cortisol after 1-mg dexamethasone suppression test 50 nmol/L defined nonsecreting tumors (NST) (n = 420) and ACS (n = 212), respectively. Intervention Assessment of AF at baseline (n = 632) and during a median follow-up of 7.7 years retrospectively (NST, n = 249; ACS, n = 108). Comparison with general population. Main Outcome Measure Prevalence and incidence of AF. Results AF prevalence was higher in patients with ACS (8.5%) than NST (3.1%, P = 0.003) and the general population (1.7%; P Conclusions Patients with adrenal incidentalomas and ACS are at risk of AF. Electrocardiogram monitoring may be recommended during follow-up.

Background: Adrenal lipid-poor adenomas (LPA) are defined by high unenhanced density (≥ 10 HU), and absolute and relative contrast medium washout > 60% and > 40%, respectively, at computerized tomography (CT). To date, no thorough histopathological characterization has been performed in those frequent lesions (one-third of adrenal adenomas). Our aim was to analyze the histopathological characteristics of adrenal LPA. Methods: Patients with LPA (n = 57) were selected among consecutive subjects referred for an adrenal incidentaloma or ACTH-independent Cushing syndrome. FluoroDeoxyGlucose-Positron Emission Tomography (FDG-PET) was performed in 37 patients. In patients treated by adrenalectomy (n = 17), Weiss score and Lin–Weiss–Bisceglia score (in tumors composed entirely or predominantly of oncocytes) were calculated. Results: Radiological parameters did not differ among patients with ACTH-independent Cushing syndrome (n = 6) and those with adrenal incidentalomas associated with primary aldosteronism (n = 2), autonomous cortisol secretion (n = 14), or non-functioning (n = 35). Patients treated by adrenalectomy had larger tumors (28.9 ± 11.2 vs 17.3 ± 8.4mm, P < 0.001), higher CT unenhanced density (29.1 ± 11.0 vs 23.1 ± 9.0 HU, P = 0.043), and FDG-PET adrenal uptake (9.0 ± 6.4 vs 4.4 ± 2.3 SUV, P = 0.003) than non-operated ones. Oncocytic features > 75% of the tumor were detected in 12/17 cases (70.6%). Five of those showed borderline-malignant histopathological characteristics by Lin–Weiss–Bisceglia score. Among remaining non-oncocytic tumors, 1/5 had a Weiss score ≥ 3. Overall, 6/17 tumors (35.3%) had borderline-malignant potential. Radiological parameters were similar between patients with benign and borderline-malignant tumors. Conclusions: Adrenal LPA are a heterogeneous group of tumors, mostly composed of oncocytomas. Up to 1/3 of those tumors may have a borderline-malignant potential at histopathology.

IntroductionThe COVID-19 pandemic forced the Italian government to issue extremely restrictive measures on daily activities since 11 March 2020 (‘lockdown’), which may have influenced the metabolic control of type 1 diabetes mellitus (T1D). The aims of the study were to investigate continuous glucose monitoring (CGM) metrics in children and adults with T1D during lockdown and to identify their potentially related factors.Research design and methodsWe enrolled 130 consecutive patients with T1D (30 children (≤12 years), 24 teenagers (13–17 years), and 76 adults (≥18 years)) using either Dexcom or FreeStyle LibreCGM>70% during the study period, without hybrid closed-loop insulin pump. CGM metrics during the 20 days before and the 20 days after lockdown were calculated. By telephonic contact, we performed validated physical activity and perceived stress questionnaires.ResultsIn children, significantly lower glucose SD (SDglu) (p=0.029) and time below range (TBR)ConclusionIn patients with T1D during lockdown, CGM metrics mostly improved in children and adults, whereas it was unchanged in teenagers. In adults, age, physical activity, and perceived stress may be relevant contributing factors.

1. The spatial arrangement of individuals and populations may have deep influences on all the biotic interactions within a community. 2. The spatial distribution of nests of the ant Crematogaster scutellaris Olivier was analysed in an olive orchard in central Italy. As this species nests inside tree trunks, the regular structure of this simplified ecosystem may help to reduce the confounding effect of habitat heterogeneity on the spatial distribution of nests. In total, 531 trees were mapped and their shape (size and structure of the trunk) recorded. The presence of C. scutellaris nests in each tree was assessed in spring–summer and autumn 2006 and 2007. 3. The number of occupied trees changed in time, from a maximum of 129 (summer 2006) to a minimum of 60 (autumn 2007). Occupancy of tree was related to its shape, with larger trees being more frequently and more steadily occupied than smaller ones. 4. Nests were spatially aggregated, forming well-defined clusters, but aggregation was not explained by a corresponding clumping of larger trees. Nests belonging to the same cluster were usually not aggressive to each other, whereas aggression was more common between nests belonging to different clusters. The dynamic nature of the system coupled with the clustered distribution of nests, is consistent with a hypothesis of seasonal polydomy, and suggest that whereas some trees are steadily occupied (core) others are opportunistically colonised when new resources are discovered (satellites). 5. Clusters size distribution was shown to follow a truncated power-law, a finding consistent with the idea that clusters are self-organised structures dependent on local interactions. These results suggest that spatial self-organisation in ant colonies may in principle be more common than previously thought, although the mechanisms generating these patterns still need to be clarified.

1 Stable isotopes signatures (δ13C and δ15N) of the most important tree-dwelling ants in an olive orchard were examined, together with the signatures of the most common herbivores, predators and sap-sucking insects. The olive orchard consists of separate subunits (trees) surrounded by a matrix of grasses or bare ground, and the role of ants in such a system is not fully understood. 2 None of the selected ant species was exclusive to the olive trees because they were also observed foraging on vegetation (mainly thistle) under the tree crowns. Hence, the relative contributions of these two sources of energy (olive trees versus herbs/grasses) were assessed by comparing the δ13C of ants with the signatures of plants and those of other arthropods collected on the trees and on nearby thistles. Next, the trophic level occupied by the ants and their ecological role within the olive food web were determined by examining the δ15N values and their relationship with indices of ecological performance measuring the potential pressure exerted by each species on the ecosystem. 3 The analysis of 13C signatures revealed a different contribution of the two energy sources, olive trees versus herbs and grasses, with the former being more important for ants. The analysis of 15N signatures suggested separate roles for different ant species: some (Crematogaster scutellaris, Lasius lasioides) occupied a higher trophic level, mostly involved in predation, whereas others (Camponotus piceus, Camponotus lateralis) occupied a lower level, probably involved more in homopteran tending. A fifth species (Camponotus aethiops) was in an intermediate position. Finally, the δ15N levels of the species were significantly correlated with indices of ecological performance.

1. The organisation of an ant assemblage inhabiting an olive orchard in central Italy was analysed and patterns of dominance among ant species were described in order to assess (i) the relationship between thermal dependency and degree of behavioural dominance, and (ii) the relationship between dominance and discovery ability. 2. Activity patterns of the most abundant species on trees were examined in a sample of 120 trees during spring and summer. The degree of behavioural dominance and the ability of different species to discover new food sources were assessed using tuna baiting on a subset of 80 trees. 3. Different ant species showed contrasting patterns of activity. Some species (such as Lasius lasioides, Camponotus lateralis, and Camponotus piceus) were most active during the warmer part of the day, while others restricted their activity to the cooler hours (Camponotus aethiops and Plagiolepis pygmaea). Some species (such as Crematogaster scutellaris) were active irrespective of the time of day. 4. No clear relationship was observed between temperature of maximal activity and degree of behavioural dominance. There was, however, a positive relationship between behavioural dominance and thermal range of activity. A positive relationship between dominance and ability to find resources, with the most behaviourally dominant and aggressive species being most efficient in finding food items, was also observed. 5. The results support the idea that the temperature–dominance relationship is much more complex in Mediterranean-type habitats than in other ecosystems. Of particular interest is the positive dominance–discovery relationship. This finding contrasts with previous investigations, which reported a negative relationship between dominance and discovery ability and suggested that this pattern plays a role in promoting the coexistence of species in ant communities.

Ant (Hymenoptera: Formicidae) assemblages were sampled with pitfall traps in three different habitats associated with a rehabilitated mine district and in undisturbed forests in Tuscany, Italy. The four habitats were (1) open fields (3-4 years old); (2) a middle-age mixed plantation (10 years); (3) an old-age mixed plantation (20 years); and (4) an oak woodland (40 years) not directly affected by mining activities. The aim of the study was to analyze ant recolonization patterns in order to provide insights on the use of Mediterranean ant fauna as indicators of restoration processes. Species richness and diversity were not significantly different among the four habitats. However, multivariate analyses showed that the assemblages in the different habitats were clearly differentiated, with similarity relationships reflecting a successional gradient among rehabilitated sites. The observed patterns of functional group changes along the gradient broadly accord with those of previous studies in other biogeographic regions. These were (1) a decrease of dominant Dolichoderinae and opportunists; (2) an increase in the proportion of cold-climate specialists; and (3) the appearance of the Cryptic species in the oldest plantations, with a maximum of abundance in the woodland. In conclusion, the results of our study supported the use of Mediterranean antsmore » as a suitable tool for biomonitoring of restoration processes, and in particular, the functional group approach proved a valuable framework to better interpret local trends in terms of global ecological patterns. Further research is, however, needed in order to obtain a reliable classification of Mediterranean ant functional groups.« less

Changes in ground-foraging ant assemblages occurring along an agricultural intensification gradient were analysed in Nicaragua (Central America). Five habitat types were compared: secondary forest fragments, organic shade coffee and cocoa plantations, corn fields and active pastures. Ants were captured by tuna baiting following standardised protocols. Species richness and diversity decreased along the gradient from forest to the pasture, and each of the agricultural systems (cocoa, coffee and corn plantations) significantly differed in diversity. Species composition also differed along the disturbance gradient, as shown by multivariate analysis. Forest and pasture were at the extremes of the gradient and shared no common species. The ant assemblages associated with coffee plots, although poorer in species, were more similar to those of the forest than to those of the cocoa plantations. The observed trends confirm that shaded agro-forestry plantations can help to maintain high biodiversity levels in tropic...

Lo scopo di questo studio e stato quello di analizzare la struttura e composizione delle comunita ornitiche di un ecosistema agricolo. L’indagine e stata realizzata utilizzando congiuntamente dati remoti (foto aeree) e rilievi sul campo. I dati cosi ottenuti sono stati analizzati sia a livello di comunita che di singole specie. Nel primo caso sono state utilizzate tecniche standard di analisi multivariata (nMDS, analisi cluster, test ANOSIM), al fine di stabilire correlazioni tra particolari caratteristiche ambientali e gruppi di specie di uccelli. Nel secondo caso sono stati implementati e validati modelli di tipo GLM e GAM, al fine di evidenziare le variabili ambientali capaci di spiegare la presenza o l’assenza delle specie studiate. Entrambi gli approcci hanno prodotto risultati utilizzabili per la produzione di mappe di idoneita delle diverse specie e per la messa a punto di modelli di previsione dell’effetto di cambiamenti ambientali sulle comunita ornitiche.