Purpose: Thyrotropin releasing hormone (TRH), a tripeptide hormone produced in the hypothalamus, controls thyroid stimulating hormone (TSH) production from the pituitary gland and hence the production of thyroid hormone. Extra-hypothalamic production and action of TRH has been detected, as has the presence of a C-terminal cyclised derivative, histidyl-proline diketopiperazine (His-Pro DKP). This study investigates the effects of these compounds on thyroglobulin release from thyroid follicular cells. Methods: DKPs were identified by chromatography and mass spectrometry. Expression of RNAs and proteins were identified in the FTRL-5 thyroid cell line and supernatant using RT-qPCR and immunoblotting. Results: We show that TRH is expressed by rat follicular thyroid cells, as is Pgpep1, the enzyme required for removal of the N-terminal amino acid of TRH. The rate of His-Pro DKP production from the C-terminal dipeptide of TRH is enhanced by thyroid extract in vitro. Both TRH and His-Pro DKP reduce thyroglobulin release from thyroid follicular cells with the magnitude of this effect attenuated in the presence of TSH, which also inhibits the expression of Pgpep1. Conclusion: Collectively, these data indicate that TRH and its cyclised dipeptide derivative directly regulate thyroid production within the thyroid gland, potentially in a manner dependent upon the activity of the hypothalamic-pituitary-thyroid (HPT) axis. These findings provide further evidence that C-terminal peptide derivatives of classical hormones possess intrinsic biological activities.
Bilaterally fixed and dilated pupils (BFDP) in traumatic acute subdural haematoma (ASDH) patients represent an ominous sign that portends irreversible brainstem injury and death. Whether patients with spontaneous ASDH and BFDP follow similar outcomes is unknown. We present a mid-60s man, found unconscious, with a Glasgow Coma Scale (GCS) of 4 following 8 days of headaches. Emergency CT imaging demonstrated a large right ASDH and the patient exhibited BFDP for >3 hours despite sedation and mannitol. Neurological improvement and spontaneously reduced SDH thickness were observed 10 hours postadmission, and he was later transferred for craniotomy and ASDH evacuation. His long-term outcomes were good: achieving independence in his activities of daily living and a GCS of 15. To the best of our knowledge, this is the first reported patient with a spontaneous, regressing ASDH and prolonged BFDP who clinically improved. This case raises important questions regarding factors used to determine prognosis and surgical viability for ASDH.
In-hospital length of stay (LOS) and discharge disposition following arthroplasty could act as surrogate measures for improvement in patient pathways, and have major cost saving implications for healthcare providers. With the ever-growing adoption of robotic technology in arthroplasty, we wished to evaluate its impact on LOS. The objectives of this study were to compare LOS and discharge disposition following robotic-arm assisted (RO THA) versus conventional technique Total Hip Arthroplasty (CO THA).This large-scale, single institution study included patients of any age undergoing primary THA (N = 1,732) for any cause between May 2019 and January 2023. Data extracted included patient demographics, LOS, need for Post Anaesthesia Care Unit (PACU) admission, anaesthesia type, readmission within 30 days and discharge dispositions. Univariate and multivariate logistic regression models were also employed to identify factors and patient characteristics related to delayed discharge.The median LOS in the RO THA group was 54 hours (34, 78) versus 60 (51, 100) in the CO THA group, p<0.001. Discharge disposition was comparable between the two groups. In the multivariate model, age, need for PACU admission, ASA score > 2, female gender, general anaesthesia and utilisation of the conventional technique were significantly associated with LOS > 2 days.Our study showed that robotic-arm assistance was associated with a shorter LOS in patients undergoing primary THA and no difference in discharge destination. Our results suggest that robotic-arm assistance could be advantageous in partly addressing the upsurge of hip arthroplasty procedures and the concomitant health care burden; however, this needs to be corroborated by long-term cost effectiveness analyses and data from randomised controlled studies.
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