Acromegaly management in the Nordic countries: A Delphi consensus survey.

OBJECTIVE: Acromegaly is associated with increased morbidity and mortality if left untreated. The therapeutic options include surgery, medical treatment, and radiotherapy. Several guidelines and recommendations on treatment algorithms and follow-up exist. However, not all recommendations are strictly evidence-based. To evaluate consensus on the treatment and follow-up of patients with acromegaly in the Nordic countries. METHODS: A Delphi process was used to map the landscape of acromegaly management in Denmark, Sweden, Norway, Finland, and Iceland. An expert panel developed 37 statements on the treatment and follow-up of patients with acromegaly. Dedicated endocrinologists (n = 47) from the Nordic countries were invited to rate their extent of agreement with the statements, using a Likert-type scale (1-7). Consensus was defined as ≥80% of panelists rating their agreement as ≥5 or ≤3 on the Likert-type scale. RESULTS: Consensus was reached in 41% (15/37) of the statements. Panelists agreed that pituitary surgery remains first line treatment. There was general agreement to recommend first-generation somatostatin analog (SSA) treatment after failed surgery and to consider repeat surgery. In addition, there was agreement to recommend combination therapy with first-generation SSA and pegvisomant as second- or third-line treatment. In more than 50% of the statements, consensus was not achieved. Considerable disagreement existed regarding pegvisomant monotherapy, and treatment with pasireotide and dopamine agonists. CONCLUSION: This consensus exploration study on the management of patients with acromegaly in the Nordic countries revealed a relatively large degree of disagreement among experts, which mirrors the complexity of the disease and the shortage of evidence-based data.

Elevated One-Hour Post-Load Glucose Is Independently Associated with Albuminuria: A Cross-Sectional Population Study.

The purpose of this study was to examine and compare the associations between albuminuria and fasting (FPG), 1 h post-load (1 h PG) and 2 h post-load plasma glucose (2 h PG) in an oral glucose tolerance test (OGTT). A total of 496 people free of known diabetes (mean age 72 years) participated in the examinations including the OGTT with plasma glucose measurements at 0, 1, and 2 h and levels of HbA1c. Albuminuria was determined by the urinary albumin-to-creatinine ratio and was defined as ≥3.0 mg/mmol. Compared with those without albuminuria, participants with albuminuria had significantly higher 1 h PG and 2 h PG levels, but not FPG or HbA1c levels. An elevated 1 h PG increased the estimated odds ratio of albuminuria more than three times in people with prediabetic 1 h PG (8.6-11.5 mmol/L: OR 3.60; 95% CI 1.70-7.64) and diabetic 1 h PG (≥11.6 mmol/L: OR 3.05; 95% CI 1.29-7.23). After adjusting for blood pressure and age, the association of elevated 1 h PG with albuminuria remained significant. Prediabetic or diabetic FPG, 2 h PG, or HbA1c did not have a statistically significant association with albuminuria. These findings suggest that 1 h PG seems to be the best glycemic parameter and is useful in recognizing persons with an elevated risk of early kidney disease due to hyperglycemia.

Aging and non-native speech perception: A phonetic training study.

Cognitive decline is evident in the elderly and it affects speech perception and foreign language learning. A listen-and-repeat training with a challenging speech sound contrast was earlier found to be effective in young monolingual adults and even in advanced L2 university students at the attentive and pre-attentive levels. This study investigates foreign language speech perception in the elderly with the same protocol used with the young adults. Training effects were measured with attentive behavioural measures (N = 9) and with electroencephalography measuring the pre-attentive mismatch negativity (MMN) response (N = 10). Training was effective in identification, but not in discrimination and there were no changes in the MMN. The most attention demanding perceptual functions which benefit from experience-based linguistic knowledge were facilitated through training, whereas pre-attentive processing was unaffected. The elderly would probably benefit from different training types compared to younger adults.

Alcohol Consumption and Binge Drinking in Young Men as Predictors of Body Composition Changes During Military Service.

AIMS: To evaluate the influences of alcohol consumption frequency and binge drinking on changes in the body composition, lifestyle habits and physical fitness of healthy young men during military service. METHODS: A population-based study of men performing their military service in the Sodankylä Jaeger Brigade, Finland in 2005. Body composition, fitness and lifestyle habits were evaluated at baseline and 6-12 months follow-up. Alcohol consumption frequency and binge drinking were categorized as: 'not at all', 'at least once a month' and 'at least once a week'. RESULTS: Data were available for 983 participants. Mean (SD) age was 19.2 (1.0) years. At baseline, participants who reported binge drinking at least once a week (29.8%) had the most unfavourable body composition, lifestyle habits and physical fitness compared with the group with no binge drinking. Significant (P < 0.05) mean reductions in % body fat (-2.3%) and weight (-1.8 kg), as well as improvements in lifestyle habits and physical fitness were observed in the weekly binge drinking group during the military service. The reductions in relative weight (%) and % body fat were associated with binge drinking at least once a week (regression coefficient for relative weight -1.39, 95% CI [-2.32; -0.45], P = 0.004, and for % body fat -0.68, 95% CI [-1.35; -0.01], P = 0.049). CONCLUSION: Frequent binge drinking is associated with poorer body composition, lifestyle habits and fitness among young men. Frequent binge drinkers may obtain the greatest benefit of military-service-based exercise intervention, as reflected in the improvements in body composition, lifestyle habits and physical fitness. SHORT SUMMARY: Frequent binge drinking is associated with poorer body composition, lifestyle habits and fitness among young men. The greatest benefit of military service comprehending exercise intervention was observed among those with binge drinking once a week at the baseline, with favourable changes in lifestyle factors, body composition and fitness.

Phonetic training and non-native speech perception--New memory traces evolve in just three days as indexed by the mismatch negativity (MMN) and behavioural measures.

Language-specific, automatically responding memory traces form the basis for speech sound perception and new neural representations can also evolve for non-native speech categories. The aim of this study was to find out how a three-day phonetic listen-and-repeat training affects speech perception, and whether it generates new memory traces. We used behavioural identification, goodness rating, discrimination, and reaction time tasks together with mismatch negativity (MMN) brain response registrations to determine the training effects on native Finnish speakers. We trained the subjects the voicing contrast in fricative sounds. Fricatives are not differentiated by voicing in Finnish, i.e., voiced fricatives do not belong to the Finnish phonological system. Therefore, they are extremely hard for Finns to learn. However, only after three days of training, the native Finnish subjects had learned to perceive the distinction. The results show striking changes in the MMN response; it was significantly larger on the second day after two training sessions. Also, the majority of the behavioural indicators showed improvement during training. Identification altered after four sessions of training and discrimination and reaction times improved throughout training. These results suggest remarkable language-learning effects both at the perceptual and pre-attentive neural level as a result of brief listen-and-repeat training in adult participants.

Phonological processing differences in bilinguals and monolinguals.

The present study examined whether monolinguals and balanced bilinguals perceive speech sounds similarly or whether the two phonological systems in bilinguals interact so that one language is affected by the other. Two groups, monolingual native speakers of Finnish and balanced Finnish-Swedish bilinguals, were tested. We measured mismatch negativity (MMN) responses and used individually selected, native language, stimuli. The results revealed that balanced bilinguals had a significantly longer MMN latency than the monolinguals which suggests slower and weaker preattentive processing in the bilinguals. This implies that the two phonological systems are intertwined which decreases the access of exemplars.

Different kinds of bilinguals: different kinds of brains: the neural organisation of two languages in one brain.

The aim of this study was to determine whether the type of bilingualism affects neural organisation. We performed identification experiments and mismatch negativity (MMN) registrations in Finnish and Swedish language settings to see, whether behavioural identification and neurophysiological discrimination of vowels depend on the linguistic context, and whether there is a difference between two kinds of bilinguals. The stimuli were two vowels, which differentiate meaning in Finnish, but not in Swedish. The results indicate that Balanced Bilinguals are inconsistent in identification performance, and they have a longer MMN latency. Moreover, their MMN amplitude is context-independent, while Dominant Bilinguals show a larger MMN in the Finnish context. These results indicate that Dominant Bilinguals inhibit the preattentive discrimination of native contrast in a context where the distinction is non-phonemic, but this is not possible for Balanced Bilinguals. This implies that Dominant Bilinguals have separate systems, while Balanced Bilinguals have one inseparable system.

Brain responses reveal hardwired detection of native-language rule violations.

Mismatch negativity (MMN) is a neural correlate of the preattentive detection of any change in the acoustic characteristics of sounds. Here we provide evidence that violations of a purely phonological constraint in a listener's native language can also elicit the brain's automatic change-detection response. The MMN differed between Finnish and Estonian listeners, conditions being equal except for the native language of the listeners. We used two experimental conditions: synthetic vowels in isolation and the same vowels embedded in a pseudo-word context. MMN responses to isolated vowels were similar for Finns and Estonians, while the same vowels in a pseudoword context elicited different MMN patterns depending on the listener's mother tongue.

Early exposure to non-native language alters pre-attentive vowel discrimination.

The present study examined whether early exposure in language immersion would result in better pre-attentive discrimination of non-native speech sound contrasts. Mismatch negativity (MMN) responses were measured from two groups of Finnish children. The Monolingual group had no prior exposure to other languages than the native one, while the Immersion group consisted of children attending a French immersion program. The subjects were presented with two vowel contrasts in the oddball paradigm: the first pair was phonemic in the native language and the second was a within category pair in Finnish, but phonological in French. The results revealed that the Monolingual group showed a larger response to the native contrast in comparison with the non-native one, whereas both contrasts elicited a similar response in the Immersion group. These results suggest that early exposure to a new language enhances the pre-attentive discrimination ability reflected in increased MMN amplitude.

Effects of genioglossal muscle advancement on speech: an acoustic study of vowel sounds.

OBJECTIVE: The effects of the genioglossal muscle advancement on phonetic quality of speech were studied analyzing the acoustic features of vowel sounds. STUDY DESIGN AND SETTING: The study group consisted of 5 men suffering from partial upper airway obstruction during sleep. To prevent tongue base collapse, genioglossal muscle advancement was made with chin osteotomy without hyoid myotomy and suspension. The speech material consisted of 8 vowels produced in sentence context repeated 10 times before the operation, and 10 days and 6 weeks after the operation. The acoustic features of vowels were analyzed. RESULTS: The operation had no significant effects on vowel quality. Only for 2 of the subjects the pitches changed systematically due to the operation. CONCLUSION: According to the acoustic analysis, genioglossal muscle advancement with chin osteotomy has no effects on vowel production. Some short-term changes were observed, but these changes were highly individual. SIGNIFICANCE: The operation seems to have no potential to change vowel production.