Objective Cushing’s disease (CD) may recur despite corticotropic insufficiency (COI) following pituitary surgery. The predictive value of the desmopressin test (DT) for recurrence in this setting remains controversial. We have evaluated whether the disappearance of the response to DT predicts a low probability recurrence in a large cohort of patients with post-operative COI. Design Multicentre retrospective study. Methods Ninety-five patients with CD (women 82%, age 41 ± 14 years), responding preoperatively to DT and with early post-operative COI (08 00 am cortisol: <138 nmol/L), underwent a DT within 3 months post-surgery. Association between DT findings and the prediction of recurrence was tested using regression and ROC analyses. Results Recurrence occurred in 17/95 patients within 29 to 91 months. The cortisol peak (327, 95% CI (237–417) vs 121 (79–164) nmol/L, P = 0.0001) and absolute increment during DT (208 (136–280) vs 56 (22–90) nmol/L, P = 0.005) were greater in the recurrence vs remission group. Cortisol peak (AUC: 0.786 (0.670–0.902)) and increment (0.793 (0.672–0.914)) yielded a higher prognostic performance for recurrence than did the early post-operative 08 00 am cortisol (0.655 (0.505–0.804)). In the context of COI, cortisol peak >100 nmol/L and increment >30 nmol/L had a high negative predictive value (94, 95% CI (88–100) and 94, (88–100), respectively). Patients with a cortisol peak ≤100 nmol/L (vs >100) or an increment ≤30 nmol/L (vs >30) were less likely to have CD recurrence (odds ratios: 0.12, 95% CI (0.03–0.41) and 0.11 (0.02–0.36), respectively). Conclusion The disappearance of the response to the post-operative DT was independently associated with a lower odds of CD recurrence and offers an incremental prognostic value, which may help to stratify patients with COI and refine their follow-up according to the risk of recurrence.
-Practical examples showcase the key role of plant-based lipids in the design of innovative sustainable specialty ingredients. Great diversity in plant origins and chemical transformations leads to great molecular diversity and explains why bio-based lipids are involved in broad ingredient categories such as biodegradable emollients, environmentally friendly surfactants, rheology modifiers and active ingredients. Choosing lipid structure, with varying fatty chain length, saturation level and branching, determines ingredient functionality and usage, as these vary, for instance in the case of surfactants, solubilizing, wetting, foaming and emulsifying properties (oil-in-water or water-in-oil). The lipid structure also impacts the ingredients' final solid or liquid appearance. Now ready-to-use ingredients can be created and we can innovate with cold processable new cosmetic formulation concepts. Perhaps most importantly, optimal selection of lipid structure and composition can also drive consumer benefits in cosmetic ingredients, especially, the final sensory experience (for excipients) and biological efficacy (for active ingredients). Biobased lipids lead to new ingredients with augmented performance and sensoriality.Keywords: ingredient / emollient / surfactant / efficacy / sensoriality Résumé -Des lipides biosourcés à forte valeur ajoutée pour la cosmétique. Cet article vise à illustrer à travers des exemples concrets le rôle clé des lipides biosourcés dans la création d'ingrédients de spécialités innovants et durables. La grande variété des plantes d'origine et la diversité des procédés de transformation chimiques expliquent la large implication des lipides biosourcés dans de nombreuses catégories d'ingrédients : les émollients et tensio-actifs respectueux de l'environnement, les modificateurs de rhéologie, ainsi que les ingrédients actifs. Le choix de la structure lipidique tel que la longueur de la chaîne grasse, son taux de saturation ou son caractère branché joue un rôle décisif dans la fonctionnalité de l'ingrédient et son usage comme, par exemple, en tant que solubilisant, mouillant, moussant ou émulsionnant (huile-dans-eau ou eau-dans-huile) pour les tensioactifs. La structure lipidique influence aussi l'aspect liquide à solide de l'ingrédient et permet ainsi de créer des ingrédients prêts à l'emploi et d'innover avec des concepts de formulation cosmétique à froid. Enfin, et cela est probablement le plus important, une choix judicieux de la structure et de la composition lipidique peut aussi orienter les bénéfices de l'ingrédient pour le consommateur final, en particulier l'expérience sensorielle pour les excipients et l'efficacité biologique pour les ingrédients actifs. Les lipides biosourcés sont à l'origine de nouveaux ingrédients avec toujours plus de performance et de sensorialité.
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