Treatment of Obesity with Thyroid hormones in Europe. Data from the THESIS* Collaboration

We analyzed time trends in incidence of and mortality from malignant cutaneous melanoma in European populations since 1953. Data were extracted from the EUROCIM database of incidence data from 165 cancer registries. Mortality data were derived from the WHO database. During the 1990s, incidence rates were by far highest in northern and western Europe, whereas mortality was higher in males in eastern and southern Europe. Melanoma rates have been rising steadily, albeit with substantial geographic variation. In northern Europe, a deceleration in these trends occurred recently in persons aged under 70. Joinpoint analyses indicated that changes in these trends took place in the early 1980s. In western Europe, mortality rates have also recently leveled off [estimated annual percentage change (EAPC) from -13.6% (n.s.) to 3.3%], whereas in eastern and southern Europe both incidence and mortality rates are still increasing [incidence EAPCs 2.3-8.9%, mortality EAPCs -1.8% (n.s.) to 7.2%]. Models including the effects of age, period and birth cohort were required to adequately describe the rising incidence trends in most European populations, with a few exceptions. Time trends in mortality were adequately summarized on fitting either an age-cohort model (with the leveling off of rates starting in birth cohorts between 1930 and 1940) or an age-period-cohort model. The most plausible explanations for the deceleration or decline in the incidence and mortality trends in recent years in northern (and to a lesser extent western) Europe are earlier detection and more frequent excision of pigmented lesions and a growing public awareness of the dangers of excessive sunbathing.

The combined heatwave and drought in 2018 notably affected the state and functioning of European ecosystems. The severity and distribution of this extreme event across ecosystem types and its possible implication on ecosystem water fluxes are still poorly understood. This study estimates spatio-temporal changes in evapotranspiration (ET) during the 2018 drought and heatwave and assesses how these changes are distributed in European ecosystems along climatic gradients. We used the ET eight-day composite product from the MODerate Resolution Imaging Spectroradiometer (MODIS) together with meteorological data from the European Centre for Medium-Range Weather Forecasts (ECMWF ERA5). Our results indicate that ecosystem ET was strongly reduced (up to −50% compared to a 10-year reference period) in areas with extreme anomalies in surface air temperature (Tsa) and precipitation (P) in central, northern, eastern, and western Europe. Northern and Eastern Europe had prolonged anomalies of up to seven months with extreme intensities (relative and absolute) of Tsa, P, and ET. Particularly, agricultural areas, mixed natural vegetation, and non-irrigated agricultural areas were the most affected by the increased temperatures in northern Europe. Our results show contrasting drought impacts on ecosystem ET between the North and South of Europe as well as on ecosystem types.

Abstract. Dermacentor marginatus is a vector disease of both humans and animals and transmits the causative agents of Q fever (Coxiella burnetii) and the spotted fever group (Rickettsia raoultii and R. slovaca), as well as of Crimean–Congo hemorrhagic fever. Dermacentor reticulatus can transmit various pathogens such as Francisella tularensis, Babesia spp., tick encephalitis virus, Coxiella burnetii, Omsk hemorrhagic fever virus, and Rickettsia spp. and can cause serious skin lesions. Herein, ecological niche modeling (ENM) is used to characterize the niches of these two ticks and describe their potential distributional patterns under both current and future climate conditions, as a means of highlighting geographic distributional shifts that may be of public health importance. We assessed distributional implications of five general circulation models (GCMs), under two shared socio-economic pathways (SSP245 and SSP585) for the period 2041–2060. Predictions for D. marginatus showed broad suitable areas across western, central, and southern Europe, with potential for expansion in northern and eastern Europe. Dermacentor reticulatus has suitable areas across western, central, and northern Europe. Under future scenarios, new expansions were observed in parts of northern and eastern Europe and highland areas in central Europe. Despite broad overlap between the niches of the ticks, D. marginatus has a broader niche, which allows it to show greater stability in the face of the changing climate conditions. Areas of potential geographic distributional expansion for these species should be monitored for actual distributional shifts, which may have implications for public health in those regions.

Changes in dynamics of excess mortality rates and net survival after diagnosis of follicular lymphoma or diffuse large B-cell lymphoma: comparison between European population-based data (EUROCARE-5)

The HiLo Trial: a Multicentre Randomised Trial of High- versus Low-dose Radioiodine, with or without Recombinant Human Thyroid Stimulating Hormone, for Remnant Ablation after Surgery for Differentiated Thyroid Cancer

Background The growing amount of monkeypox cases in non-endemic regions raises concerns in societies as a potential pandemic. This study highlights the prevalence and epidemiological trends of a human monkeypox outbreak in various regions in Europe. Methods This cross-sectional study was conducted in the Department of Physiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia. The data about the monkeypox outbreak in European countries were recorded by the World Health Organization (WHO), and Centers for Disease Control and Prevention (CDC) reports. The period prevalence-based data were recorded from Jan 1, 2022, to July 7, 2022, and analyzed, and epidemiological trends were established in different European regions and countries. Results In Europe, the human monkeypox rapidly spread in all the four subregions and involved 30 European countries, infecting 6077 people. The rising number of monkeypox cases is identified in Western Europe, 2599 (42.76%); Southern Europe, 1932 (31.79%); Northern Europe, 1487 (24.46%); and Eastern Europe, 59 (0.97%). In Western Europe, significant cases are found in Germany (1304), France (604), the Netherlands (352), Belgium (168), and Switzerland (131). In Northern Europe, it is found in the United Kingdom (1351), Ireland (44), Sweden (28), and Denmark (26); in Southern Europe, it is found in Spain (1256), Portugal (415), and Italy (233). However, a smaller number of cases are found in Eastern European states, Hungary (22), Poland (13), and Romania (12). The results further revealed that the number of monkeypox cases per million people in Northern Europe was 14.40%; Southern Europe, 13.49%; Western Europe, 13.26%; and Eastern Europe, 0.70%. The highest monkeypox cases per million population are found in Portugal, 40.70; Gibraltar, 29.68; Spain, 26.86; the United Kingdom, 19.90; Malta, 18.12; the Netherlands, 20.54; Germany, 15.56; Switzerland, 15.14; Belgium, 14.50; France, 9.27; and Ireland, 8.90. Conclusions In a short period, the monkeypox cases swiftly spread in 30 non-endemic European countries and involved all four European regions. The healthcare authorities must take timely decisions to control the outbreak of human monkeypox disease, as the world cannot afford the global burden of human monkeypox outbreak as another potential pandemic.

Combined alcoholic and non-alcoholic steatohepatitis.

Background: Gestational Diabetes Mellitus (GDM) is defined as the type of hyperglycemia diagnosed for the first-time during pregnancy, presenting with intermediate glucose levels between normal levels for pregnancy and glucose levels diagnostic of diabetes in the non-pregnant state. We aimed to systematically review and meta-analyze studies of prevalence of GDM in European countries at regional and sub-regional levels, according to age, trimester, body weight, and GDM diagnostic criteria. Methods: Systematic search was conducted in five databases to retrieve studies from 2014 to 2019 reporting the prevalence of GDM in Europe. Two authors have independently screened titles and abstracts and full text according to eligibility using Covidence software. A random-effects model was used to quantify weighted GDM prevalence estimates. The National Heart, Lung, and Blood Institute criteria was used to assess the risk of bias. Results: From the searched databases, 133 research reports were deemed eligible and included in the meta-analysis. The research reports yielded 254 GDM-prevalence studies that tested 15,572,847 pregnant women between 2014 and 2019. The 133 research reports were from 24 countries in Northern Europe (44.4%), Southern Europe (27.1%), Western Europe (24.1%), and Eastern Europe (4.5%). The overall weighted GDM prevalence in the 24 European countries was estimated at 10.9% (95% CI: 10.0–11.8, I2: 100%). The weighted GDM prevalence was highest in the Eastern Europe (31.5%, 95% CI: 19.8–44.6, I2: 98.9%), followed by in Southern Europe (12.3%, 95% CI: 10.9–13.9, I2: 99.6%), Western Europe (10.7%, 95% CI: 9.5¬–12.0, I2: 99.9%), and Northern Europe (8.9%, 95% CI: 7.9–10.0, I2: 100). GDM prevalence was 2.14-fold increased in pregnant women with maternal age ≥30 years (versus 15-29 years old), 1.47-fold if the diagnosis was made in the third trimester (versus second trimester), and 6.79- fold in obese and 2.29-fold in overweight women (versus normal weight). Conclusions: In Europe, GDM is significant in pregnant women, around 11%, with the highest prevalence in pregnant women of Eastern European countries (31.5%). Findings have implications to guide vigilant public health awareness campaigns about the risk factors associated with developing GDM.

ABSTRACTObjectiveThe practice of treating hypothyroid and euthyroid patients with thyroid hormones varies between countries, as observed in the recent surveys of European thyroid experts, THESIS. As part of the THESIS initiative, we investigated Canadian endocrinologists′ perspectives on this topic, focusing on combination therapy with either liothyronine (LT3) plus levothyroxine (LT4) or desiccated thyroid extract (DTE).DesignMembers of the Canadian Society of Endocrinology and Metabolism (CSEM) were invited to participate in an anonymous online survey.ResultsOut of 348 eligible CSEM members, 68 (19.5%) respondents were included in the analysis. All respondents used LT4 as the first‐line treatment for hypothyroid patients. Many respondents (64.7%) would consider LT4 + LT3 for patients on LT4 with persistent symptoms, whereas fewer would consider DTE (16.2%). Most respondents attributed persistent symptoms in LT4‐treated patients to psychosocial factors, comorbidities, or unrealistic expectations. Approximately half of the respondents stated that thyroid hormone therapy is never indicated for euthyroid patients. The remaining respondents considered thyroid hormones for euthyroid women with infertility and high thyroid antibody levels (36.8%), depression (13.2%), and growing goiter (7.4%).ConclusionsFollowing current guidelines, LT4 tablet is the preferred treatment for hypothyroidism. Most respondents would consider triiodothyronine‐containing therapy for patients with persistent symptoms, preferring LT4 + LT3 over DTE. The number of endocrinologists considering combination therapy for hypothyroid patients in Canada was higher than in Europe. Finally, at variance with current guidelines, a fraction of the respondents would consider thyroid hormones in patients with non‐thyroidal conditions.

Hepatitis C virus (HCV) infection is a major public health burden in Europe, causing an increasing level of liver-related morbidity and mortality, characterized by several regional variations in the genotypes distribution.A comprehensive review of the literature from 2000 to 2015 was used to gather country-specific data on prevalence and genotype distribution of HCV infection in 33 European countries (about 80 % of the European population), grouped in three geographical areas (Western, Eastern and Central Europe), as defined by the Global Burden of Diseases project (GBD).The estimated prevalence of HCV in Europe is 1.7 % showing a decrease than previously reported (− 0.6 %) and accounting over 13 million of estimated cases. The lowest prevalence (0.9 %) is reported from Western Europe (except for some rural areas of Southern Italy and Greece) and the highest (3.1 %) from Central Europe, especially Romania and Russia. The average HCV viraemic rate is 72.4 %, with a population of almost 10 million of HCV RNA positive patients.Genotype distribution does not show high variability among the three macro-areas studied, ranging between 70.0 % (Central Europe), 68.1 % (Eastern Europe) and 55.1 % (Western Europe) for genotype 1, 29.0 % (Western Europe), 26.6 % (Eastern Europe) and 21.0 % (Central Europe) for genotype 3. Genotype 2 seems, instead, to have a major prevalence in the Western Europe (8.9 %), if compared to Eastern (4.3 %) or Central (3.2 %), whereas genotype 4 is present especially in Central and Western area (4.9 % and 5.8 %, respectively).Despite the eradication of transmission by blood products, HCV infection continues to be one of the leading blood-borne infections in Europe. The aim of this review is, therefore, to provide an update on the epidemiology of HCV infection across Europe, and to foster the discussion about eventual potential strategies to eradicate it.

Previous studies have revealed that thyroid hormone (TH) levels are associated with the risk of diabetic peripheral neuropathy (DPN) in euthyroid patients with type 2 diabetes mellitus (T2DM). However, the relationship between TH sensitivity, a complementary method for assessing thyroid function, and DPN remains unclear. This study aimed to investigate the correlation between DPN and TH sensitivity in euthyroid patients with T2DM. Exactly 708 euthyroid adults with T2DM were retrospectively enrolled. The FT3/FT4 ratio was used to estimate peripheral TH sensitivity. Central TH sensitivity was assessed using the Thyrotroph T4 Resistance Index (TT4RI), Thyroid-Stimulating Hormone Index (TSHI), Thyroid Feedback Quantile-based Index (TFQI), and Parametric TFQI (PTFQI). DPN was assessed using neurologic symptoms, signs, and nerve conduction velocity tests. The relationship between DPN and TH sensitivity was examined using logistic regression analysis. We observed that an elevated FT3/FT4 ratio was associated with DPN (OR = 1.36, 95%CI: 1.13–1.63, p = 0.0012). For each standard deviation (SD) increase in the TT4RI, TSHI, TFQI, and PTFQI, the OR of DPN was 0.80 (95%CI: 0.68–0.94, p = 0.0078), 0.72 (95%CI: 0.60–0.86, p = 0.0002), 0.69 (95%CI: 0.58–0.83, p < 0.0001), and 0.69 (95%CI: 0.58–0.82, p < 0.0001), respectively. These results suggested that reduced central and peripheral TH sensitivity is associated with a decreased risk of developing DPN.

The aim of the present study was to investigate the effects of increased haemoglobin (Hb) levels on the thyroid function in patients with beta-thalassaemia major. Basal levels of thyroid hormones (T4, T3) and free thyroid hormones (fT4, fT3), basal TSH concentrations and the TSH responses to a TRH bolus (0.2 mg iv) were studied in ten euthyroid thalassaemic patients, aged 8 to 19 years, and in one 12 years-old thalassaemic girl with primary hypothyroidism. Five euthyroid thalassaemic patients (aged 8 to 12 years), as well as the hypothyroid thalassaemic girl, were prepubertal, whereas five euthyroid thalassaemic patients (aged 15 to 19 years) had delayed puberty. In each patient, the endocrine evaluation was carried out under conditions of low Hb levels (31 days after the last blood transfusion, mean Hb = 9.8 +/- 1.5 g/dl), and 11 days after the transfusion of 2 units packed red blood cells (PRBC). The latter increased significantly Hb concentrations in all the thalassaemic patients (mean Hb = 12.8 +/- 2.5 g/dl, P less than 0.001). Twelve normal prepubertal subjects, aged 6 to 11 years, served as the control group. Before the PRBC transfusion, basal T4, T3, fT4, fT3 and TSH concentrations were similar in euthyroid prepubertal thalassaemic patients (EPT) and in euthyroid patients with delayed puberty (EDPT), and were comparable to those in control subjects. The TSH responses to TRH (TSH peak, area and delta area) observed in EPT patients were similar to those in the EDPT group, but significantly higher in comparison with the normal children.(ABSTRACT TRUNCATED AT 250 WORDS)

Aim Illuminating the evolutionary history of Austropotamobius crayfish by uncovering patterns of biodiversity and biogeographical processes, thereby providing a foundation for accurate taxonomy and targeted conservation strategies. Location Europe. Time Period Miocene to present. Major Taxa Studied The crayfish genus Austropotamobius . Methods We synthesised existing knowledge and conducted additional analyses to resolve uncertainties in lineage divergence and distribution. Genetic variation across geographical regions was assessed using mitochondrial COI haplotypes, paired with accurate geolocation data from literature. Divergence times were estimated using a genus‐specific molecular clock calibrated to the tectonic‐driven separation of Austropotamobius bihariensis from its Dinaric relatives, based on 936 base pairs of concatenated COI and 16S mitochondrial sequences. To reconstruct historical connectivity and gene flow direction among regional populations, we applied coalescent‐based models comparing alternative scenarios. Results Our analysis suggests the common ancestor of Austropotamobius diverged ~30 Ma, coinciding with the temporary fragmentation of Balkanatolia from Western Europe, forming two major evolutionary lineages. In the west, between the Alps and Pyrenees, A. pallipes showed low genetic diversity and broad distribution. From this lineage, A. fulcisianus emerged around 14 Ma during an Alpine embayment, colonising the forming Italian Peninsula and later expanding into the southern Dinarides during the Messinian Salinity Crisis. Human‐mediated translocations further extended its range into Western and Northern Europe. The second major lineage, A. torrentium , spans Central and Eastern Europe and includes eight ancient, monophyletic and endemic lineages concentrated in the north‐central Dinarides (NCD), except for the most basal branch, A. bihariensis , located in the Apuseni Mountains. Two younger lineages expanded across the Balkans and Central Europe, likely beginning around 6.8 Ma with the formation of the Palaeo‐Danube system. Main Conclusions This study refines the evolutionary trajectory of Austropotamobius , highlights taxonomic clarification and underscores the need to reassess several lineages to support genuine, evolutionarily informed conservation strategies.

All of the available data describing the Earth’s magnetic field in Northern, Western, and Eastern Europe (c. 3 × 106 data points) are compiled and presented at a scale of 1:20 400 000. The compilation meets two requirements (i) that the total field intensity anomalies reflect a survey acquired at an altitude of 3000 m above m.s.l. and during the same epoch, 1980.0; and (ii) that the anomalies are residuals after subtracting the common reference field DGRF1980. As the data span many epochs, geomagnetic data recorded at observatories and repeat stations were used to determine the best model for estimating the secular variation in all data up to 1980. This yielded magnetic anomalies with wavelengths up to the order of 2000 km. The precision of the resultant anomalies (amplitudes about – 1700 nT to 8000 nT) differ between ± 10 nT in Central Europe and ± 20 nT in the outer parts of the compilation.The resultant anomaly map contains a wealth of information to geoscientists studying global tectonic processes and the deep crustal composition of major continental crusts. It clearly shows the different anomaly patterns between the Palaeozoic and Precambrian crusts of Central and Eastern Europe. These anomalies are interpreted as lateral changes of magnetization in a horizontal plate. A comparison between the low‐level compilation and maps derived from the MAGSAT satellite at about 360 km altitude allows the description of the two different crust types in Europe.

Results from investigations in one area of the world may not translate to another if patient characteristics and practices differ. We examine differences in the presentation and management of emergency department (ED) patients with dyspnoea from acute heart failure syndromes (AHFS) between the USA, Western Europe, and Eastern Europe. The URGENT Dyspnoea study was a multinational prospective observational study of dyspnoeic ED patients with AHFS from 18 countries. Acute heart failure syndrome patients from the USA and Western and Eastern Europe underwent dyspnoea assessments within 1 h of the first physician evaluation. Patient characteristics, evaluation, and treatments were compared between geographical regions using analysis of variance and χ(2) tests. Four hundred and ninety-three patients with AHFS met the inclusion criteria. Participants in the USA were more frequently non-white, younger, on chronic beta-blocker therapy, and with an ejection fraction ≤40% when compared with Eastern and Western Europe. Patients from Eastern Europe were more likely to present with de novo heart failure and have ischaemic electrocardiogram changes. Pulmonary oedema was more common on chest radiograph in Western Europe, but natriuretic peptide levels were elevated in all three regions. Diuretic use was similar across all the regions. Intravenous nitroglycerin was used more frequently in Eastern (32.8%) and Western Europe (24.4%) compared with the USA (2.5%). International differences in AHFS presentations and management between regions suggest results from clinical trials in one region may not translate directly to another. These differences should be considered when designing trials and interpreting the results from clinical investigations.