Effective Medical Treatment Research Articles

Bioinformatics screening and verification of ischemic stroke-related key genes and drug prediction.

Stroke is one of the major causes of disability and death worldwide. The lack of effective medical treatment for stroke heightens the need for new therapeutic targets. In this study, we obtained two microarray data sets from the Gene Expression Omnibus (GEO) database and identified differential genes (DEGs) between MCAO and control groups. Then, enrichment analysis of the DEGs was performed using DAVID and Metascape. The results show 27 DEGs shared between the two datasets. The functional enrichment analysis showed that these genes are mainly enriched in immune response, complement and coagulation cascades, apoptotic processes. The four hub genes (C1qc, Fcgr2b, C1qb, and Cd14) were screened out using the Cytoscape. Next, real-time PCR and Western blot analysis showed that expression of C1q and CD14 increased at 14 days after tMCAO. Furthermore, we took eight small molecule compounds with the lowest score using Cmap and studied their background characteristics. These results are built on a meta-analysis of data, which are generally accessible from the online space. Finally, we evaluated the protective effect of the rolipram through behavior tests after tMCAO, and results showed that the rolipram significantly attenuated neurobehavioral dysfunction at 14 days after brain ischemia. The present results provide novel insights into the biological process and potential therapeutic drugs involved in stroke.

Differences in prescribing patterns of opioid dependence drugs among patients with primary alcohol use problems and opioid use disorders within New York State by social determinant factors, 2005-2018

BackgroundThe increase in alcohol use problems and opioid use disorder (OUD) highlights the need for research on effective medication treatments for patients with dual diagnoses. ObjectivesThis study analyzed trends and social disparities in prescribing OUD medications for patients who initially had alcohol use problems and later received their first OUD diagnosis. MethodsThis study used merged data from the New York State Office of Addiction Services and Supports and the Medicaid to analyze individuals aged 18 years and older who initially had primary alcohol use problems and later had OUD for the first time between 2005 and 2018. It examined the rates of new buprenorphine and naltrexone prescriptions across various demographic and socioeconomic groups. ResultsAmong 27,029 clients, the average rate of new buprenorphine was 64.23 per 1000 clients (95% CI 61.30–67.15), with upward trends. The 18-35 age group had the highest buprenorphine utilization (111.48 per 1000 clients) and highest increase rates compared with other age groups. The white non-Hispanic group had the highest rates of buprenorphine (119.23 per 1000 clients) and showed larger increase over time compared with other race/ethnicity groups. Disabled patients showed slower increasing rates of buprenorphine than other groups. Upward trends were observed in naltrexone. All observed differences were statistically significant (P < 0.05). ConclusionsTrends showed increased use of OUD medications, with varying rates of buprenorphine utilization across different ages, races, and employment statuses. Despite this, the rates of receiving new buprenorphine remained low, suggesting a need for innovative methods to expand access to treatments.

KHSRP ameliorates acute liver failure by regulating pre-mRNA splicing through its interaction with SF3B1

Acute liver failure (ALF) is characterized by the rapidly progressive deterioration of hepatic function, which, without effective medical intervention, results in high mortality and morbidity. Here, using proteomic and transcriptomic analyses in murine ALF models, we found that the expression of multiple splicing factors was downregulated in ALF. Notably, we found that KH-type splicing regulatory protein (KHSRP) has a protective effect in ALF. Knockdown of KHSRP resulted in dramatic splicing defects, such as intron retention, and led to the exacerbation of liver injury in ALF. Moreover, we demonstrated that KHSRP directly interacts with splicing factor 3b subunit 1 (SF3B1) and enhances the binding of SF3B1 to the intronic branch sites, thereby promoting pre-mRNA splicing. Using splicing inhibitors, we found that Khsrp protects against ALF by regulating pre-mRNA splicing in vivo. Overall, our findings demonstrate that KHSRP is an important splicing activator and promotes the expression of genes associated with ALF progression by interacting with SF3B1; thus, KHSRP could be a possible target for therapeutic intervention in ALF.

Multiwell-based G0-PCC assay for radiation biodosimetry

In major radiological events, rapid assays to detect ionizing radiation exposure are crucial for effective medical interventions. The purpose of these assays is twofold: to categorize affected individuals into groups for initial treatments, and to provide definitive dose estimates for continued care and epidemiology. However, existing high-throughput cytogenetic biodosimetry assays take about 3 days to yield results, which delays critical interventions. We have developed a multiwell-based variant of the chemical-induced G0-phase Premature Chromosome Condensation Assay that delivers same-day results. Our findings revealed that using a concentration of phosphatase inhibitor lower than recommended significantly increases the yield of cells with highly condensed chromosomes. These chromosomes exhibited increased fragmentation in a dose-dependent manner, enabling to quantify radiation damage using a custom Deep Learning algorithm. This algorithm demonstrated reasonable performance in categorizing doses into distinct treatment groups (84% and 80% accuracy for three and four iso-treatment dose bins, respectively) and showed reliability in determining the actual doses received (correlation coefficient of 0.879). This method is amendable to full automation and has the potential to address the need for same-day, high-throughput cytogenetic test for both dose categorization and dose reconstruction in large-scale radiation emergencies.

Impact of moderate-to-high-suicide-intent in major depressive disorder: a retrospective cohort study on patient characteristics and healthcare resource utilisation in England

BackgroundMajor depressive disorder (MDD) is a disabling mental illness that can affect all aspects of daily life and is a leading cause of healthcare resource utilisation (HCRU).AimsWe aimed to characterise patients with MDD with moderate-to-high-suicide-intent, compare their HCRU to patients with MDD without moderate-to-high-suicide-intent, and better understand their patient pathways.MethodsThis retrospective cohort study used data collected from primary care electronic health records from Clinical Practice Research Datalink (CPRD), linked to Hospital Episode Statistics, Mental Health Services Data Set, and Office for National Statistics in England. Adults diagnosed with ≥ 1 MDD diagnosis between 04/2007 and 11/2015 were categorised by suicide intent.Results307,476 patients with MDD were included (294,259 patients without moderate-to-high-suicide-intent and 13,217 with moderate-to-high-suicide-intent). Patients with MDD with moderate-to-high-suicide-intent were younger on average (39.0 vs. 44.8 years) and included a lower percentage of females (58% vs. 65%) compared to patients without moderate-to-high-suicide-intent. HCRU was greater among patients with moderate-to-high-suicide-intent than patients without moderate-to-high-suicide-intent during the first follow-up year for general practitioner consultations (38.5 vs. 29.4), psychiatric outpatient visits (1.5 vs. 0.1), psychiatrist visits (3.6 vs. 0.3), emergency visits (1.5 vs. 0.3), and hospitalisations (86% vs. 26%). Overall, 56% of patients with moderate-to-high-suicide-intent had an antidepressant prescription within 30 days from the initial moderate-to-high-suicide-intent.ConclusionsPatients with MDD and moderate-to-high-suicide-intent were younger, included more males and incurred greater HCRU than those without moderate-to-high-suicide-intent. These results suggest a greater need for effective medical care and appropriate treatments for patients with moderate-to-high-suicide-intent, which could help reduce associated symptoms, mortality, and HCRU.

Investigation of the status of immune checkpoint molecules (PD-L1 and PD-1) in meningiomas by immunohistochemistry.

Meningiomas are the most common primary brain tumors of the central nervous system. Immunotherapy is a promising treatment method applied in many types of cancer. There is no standard and effective medical treatment to reduce recurrence and mortality in cases of incomplete resection of meningiomas and in high-grade cases. In order to investigate medical treatments in addition to surgery and radiotherapy, in this study, the status of immune checkpoint molecules (PD-L1/PD-1), which are the target of immunotherapy, in meningiomas was investigated. Four hundred two cases of meningioma diagnosed between 2007 and 2020 at our institution were used. New blocks were prepared from the appropriate blocks of the cases using the tissue microarray method. Sections obtained from these blocks were immunohistochemically stained with PD-1 and PD-L1 antibodies. Obtained data were interpreted with statistical analysis. Expression of PD-L1 was observed in 28.4% of meningiomas. Staining rates are higher in high-grade tumors. The staining rate of PD-L1 in the tumor increased significantly with pattern loss. PD-L1 expression in immune cells is 19.9%. Immune cell expression and the number of expressing immune cells correlate with spontaneous necrosis. Immune cell expression and the number of expressing immune cells are increased in high-grade meningiomas. PD-1 expression in immune cells is 9.0%, and this correlates with brain invasion. With these data, it was observed that the expression of immune checkpoint molecules PD-L1 and PD-1 increased especially in high-grade meningiomas. It may be the subject of research that these molecules may be targets of immunotherapy in the treatment of meningiomas.

Cranial surgery in the North Pontic region during the 3rd millennium BC.

This study examines the development of cranial surgery in the North Pontic region during the Early and Middle Bronze Age (late 4th and 3rd millennium BC according to the Eastern European chronology). 389 skulls from burials of this period were examined for evidence of surgical intervention. Twenty five such cases were identified and analysed for sex, age, temporal and spatial distribution, size and number of lesions, signs of healing, technique, motivation and complications of the surgery. The study indicates that cranial surgery was a well-developed medical practice in the North Pontic region during the period under consideration. Most of the cases are concentrated in the Dnipro steppe area, suggesting the possibility of outlining another centre of cranial surgery on the map of Europe. The predominant trepanation technique used here was scraping, although alternative methods were also practised. Treatment of traumatic injuries is considered to be one of the main reasons for cranial surgery in our sample. The percentage of individuals who underwent cranial intrusions increased significantly from 1.2% in the first half to 10.4% in the second half of the 3rd millennium BC, indicating a chronological shift in the distribution of cranial surgery. This trend is believed to be related to changes in weaponry during the Middle Bronze Age. The introduction of stone battle axes and maces as common weapons led to a significant increase in the occurrence of blunt force injuries, both depressed and penetrating. Trepanation may have been employed as an effective medical treatment for such traumas.

From beaks to brains-Challenges in translating woodpecker biology into traumatic brain injury innovation.

The biomechanics of woodpeckers have captivated researchers for decades. These birds' unique ability to withstand repeated impacts, seemingly without apparent harm, has piqued the interests of scientists and clinicians across multiple disciplines. Historical and recent studies have dissected the anatomical and physiological underpinnings of woodpeckers' protective mechanisms and sparked interest in the development of woodpecker-inspired safety equipment. Despite the intuitive appeal of translating woodpecker adaptations into strategies for human traumatic brain injury (TBI) prevention, significant challenges hinder such innovation. Critical examinations reveal a lack of direct applicability of these findings to human TBI prevention, attributed to fundamental biological and mechanical dissimilarities between humans and woodpeckers. Additionally, some commercial endeavors attempting to capitalize on our fascination with woodpeckers are rooted in unsubstantiated claims about these birds. This paper explores the narrative surrounding woodpecker biomimicry, including its origins and history, and highlights the challenges of translating findings from unconventional animal models of TBI into effective human medical interventions.

Mental Health Evacuation Rate in USCENTCOM.

Mental health diagnosis requiring further treatment is one of the top reasons for medical evacuation in the U.S. Central Command (USCENTCOM) area of responsibility (AOR) as of 2022. This study establishes a baseline in which the effectiveness of medical interventions can be measured to determine if they have an impact on the rate of evacuation out of USCENTCOM. The study period was January 1, 2017 to December 31, 2021. Individual evacuation data including date of initial movement and necessary specialty care requirements originating from the USCENTCOM AOR were acquired via U.S. Transportation Command's Regulating and Command & Control Evacuation System. The base evacuation rate was calculated for each month, and evacuation rates were analyzed for variations. For the entire study period, the mean monthly evacuation rate was 0.44 evacuations per 1,000 people in the AOR (95% CI, 0.41-0.47). There was no statistically significant difference between any monthly evacuation rate (P = .505). There is a statistically significant difference in the mean evacuation rates for calendar years (P = .003). The highest evacuation rate occurred in 2021. The study establishes a benchmark mental health evacuation rate. This rate will be useful for assessing mental health evacuation reduction initiatives in the USCENTCOM AOR.

Single-Cell Transcriptomic Profiling of Cholangiocyte Organoids Derived from Bile Ducts of Primary Sclerosing Cholangitis Patients

Background and AimsPrimary sclerosing cholangitis (PSC) is a chronic inflammatory liver disorder without effective medical treatment which is characterized by inflammation and fibrotic structures around the bile ducts. Biliary epithelial cells (cholangiocytes) are the target and potential disease drivers in PSC, yet little is known if cholangiocytes from PSC patients differ from non-PSC controls. To characterize cholangiocytes at early rather than end-stage disease, cholangiocyte organoids (COs) were derived from diseased bile ducts of PSC patients and compared to organoids generated from disease controls.MethodsCholangiocytes were obtained during endoscopic retrograde cholangiopancreatography (ERCP) brushing of diseased bile duct areas and expanded as organoids using previously established culture methods. Stable CO lines were analyzed for cell type identity, basic cholangiocyte function, and transcriptomic signature.ResultsWe demonstrate that cholangiocytes, derived from the damaged area within the bile ducts of PSC patients, can be expanded in culture without displaying functional or genetic disease-related features. We further show that COs from patients who later were diagnosed with dysplasia exhibit higher expression of the cancer-associated genes PGC, FXYD2, MIR4435-2HG, and HES1.ConclusionsOur results demonstrate that PSC organoids are largely similar to control organoids after culture and highlight the significance of COs as a tool for regenerative medicine approaches as well as their potential for discovering new potential biomarkers for diagnosing cholangiocarcinoma.

Enhancing Pulmonary Diagnosis in Chest X-rays through Generative AI Techniques

Chest X-ray imaging is an essential tool in the diagnostic procedure for pulmonary conditions, providing healthcare professionals with the capability to immediately and accurately determine lung anomalies. This imaging modality is fundamental in assessing and confirming the presence of various lung issues, allowing for timely and effective medical intervention. In response to the widespread prevalence of pulmonary infections globally, there is a growing imperative to adopt automated systems that leverage deep learning (DL) algorithms. These systems are particularly adept at handling large radiological datasets and providing high precision. This study introduces an advanced identification model that utilizes the VGG16 architecture, specifically adapted for identifying various lung anomalies such as opacity, COVID-19 pneumonia, normal appearance of the lungs, and viral pneumonia. Furthermore, we address the issue of model generalizability, which is of prime significance in our work. We employed the data augmentation technique through CycleGAN, which, through experimental outcomes, has proven effective in enhancing the robustness of our model. The combined performance of our advanced VGG model with the CycleGAN augmentation technique demonstrates remarkable outcomes in several evaluation metrics, including recall, F1-score, accuracy, precision, and area under the curve (AUC). The results of the advanced VGG16 model showcased remarkable accuracy, achieving 98.58%. This study contributes to advancing generative artificial intelligence (AI) in medical imaging analysis and establishes a solid foundation for ongoing developments in computer vision technologies within the healthcare sector.

The Impact of Stigma on Self-Management Behavior Among People with HIV in China: The Role of Social Support and Self-Esteem.

Understanding the psychosocial factors influencing self-management behaviors among people with HIV (PWH) is crucial for effective medical interventions and improving their quality of life. However, there has been limited research exploring the psychosocial mechanisms influencing self-management behaviors among PWH in China. Our study examined the relationship between stigma, social support, self-esteem, and self-management behaviors among PWH, as well as whether social support and self-esteem mediate these relationships. Cross-sectional data were collected from 282 PWH in Sichuan Province, China. Data were collected using four validated self-report measures (HIV Stigma Scale, HIV/AIDS Patient Self-Management Scale, Social Support Rating Scale, and Self-Esteem Scale). Structural equation modeling was used to examine the different pathways influencing self-management behaviors. All the impacts on self-management behavior outcomes were found to be significant. The final mediation model indicated that social support and self-esteem significantly mediated the relationship between stigma and self-management behaviors. These findings underscore the importance of addressing stigma and enhancing social support and self-esteem in interventions aimed at promoting self-management behaviors among PWH.

Window of opportunity for developing effective medical intervention for calcific aortic valve disease.

Window of opportunity for developing effective medical intervention for calcific aortic valve disease.

Comparison of Post-Vaccination Response (Humoral and Cellular) to BNT162b2 in Clinical Cases, Kidney and Pancreas Transplant Recipient with Immunocompetent Subjects over Almost Two Years of Parallel Monitoring.

Vaccination is one of the most effective medical interventions to prevent infectious diseases. The introduction of vaccines against coronavirus acute respiratory syndrome 2 (SARS-CoV-2) was aimed at preventing severe illness and death due to coronavirus disease 2019 (COVID-19). Solid organ transplant recipients (SOTRs) are at high risk of infection with SARS-CoV-2 and serious effects associated with COVID-19, mainly due to the use of immunosuppressive therapies, which further cause suboptimal response to COVID-19 vaccination. We aimed to compare post-vaccination response to BNT162b2 in kidney-pancreas transplant recipient, specifically in immunocompetent individuals, over two years of simultaneous monitoring. To determine the humoral response, the levels of the IgG and IgA anti-S1 antibodies were measured. To assess the cellular response to SARS-CoV-2, the released IFN-γ-S1 was determinate. After primary vaccination, compared to immunocompetent subjects, SOTR showed lower seroconversion for both antibody classes. Only the additional dose produced antibodies at the level reached by the control group after the baseline vaccination. During the monitored period, SOTR did not achieve a positive cellular response in contrast to immunocompetent individuals, so in order to obtain longer protection, including immune memory, the adoption of booster doses of the vaccine should be considered.

Ameliorative effect of nodakenin in combating TNBS-induced ulcerative colitis by suppressing NFƙB-mediated NLRP3 inflammasome pathway.

Ulcerative colitis (UC) is an enduring and complex inflammatory bowel disease that is clinically prevalent, progressive, and debilitating. As of now, the few effective medical treatments for UC have unacceptably high side effects. It is crucial to find safer and more effective UC treatments. Nodakenin possesses anti-inflammatory and antioxidant activity by suppressing several pro-inflammatory mediators. In the present study, we aimed to evaluate the colonoprotective effect of nodakenin in combating colitis through the NFƙB-mediated NLRP3 inflammasome pathway. In mice, UC was induced by 2,4,6-trinitrobenzene sulfonic acid (TNBS). Nodakenin (10, 20, and 40mg/kg) was introduced intragastrically, and disease activity index (DAI) score was calculated. Malondialdehyde (MDA), myeloperoxidase (MPO), superoxide dismutase (SOD), nitric oxide (NO) levels, tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) concentration were evaluated in colon homogenate. Colon samples were used for histopathological investigation and mRNA expression studies involving nuclear factor kappa B (NFƙB), cyclooxygenase-2 (COX-2), inducible nitric oxide (iNOS), nucleotide-binding receptor domain 3 (NLRP3), interleukin-1β (IL-1β), and interleukin-18 (IL-18). Nodakenin treatment was found effective in lowering the DAI score, histological score, MPO, MDA, and NO levels while elevating SOD levels as compared to the model control group, showcasing its anti-inflammatory and antioxidant properties. Nodakenin (40mg/kg) significantly downregulated the expression of TNF-α, IL-6, NFƙB (1.24-fold), iNOS (1.2-fold), COX-2 (1.98-fold), NLRP3 (1.78-fold), IL-1β (1.29-fold), and IL-18 (1.17-fold) conferring its great anti-inflammatory potential in combating colitis. Taking together, nodakenin presumably alleviated TNBS-induced colitis by NFƙB-mediated NLRP3 inflammasome pathway and reduced colon damage by downregulating various transcriptional genes and pro-inflammatory mediators.

Translating “AI for omics” into precision therapy

Precision medicine aims to empower clinicians to predict the most appropriate course of action for patients with complex diseases like cancer and others.1 With an efficient interrogation of the omics, molecular, and clinical data at play in diseases, effective, personalized, and precise medical treatment strategies are expected for many disorders. In addition, the treatment modality of precision medicine is increasingly diversified, spanning from mainstream drug and antibody treatment to newly developed gene and cell therapy, etc. In various treatment modalities including the treatment by Chinese medicine, precision is the highest demand, and the underlying patterns and rationales across various factors to uncover the biological mechanism and actionable information that support early detection, prevention and therapy of complex disorders can be identified by the omics data.1,2 Therefore, the omics sequencing technology and accumulated omics data serve as the core technology and resources that can have huge impact on such a course of action. Accordingly, the integrative analysis of such omics data provides a great opportunity to support precision medicine studies. However, facing the unique features of the omics data, like the dominant characteristics of “high dimension and small sample”, traditional data analysis strategies are likely unsuitable, and data-driven artificial intelligence (AI) technology is emerging as an effective paradigm for precision medicine study. To this end, this study aims to present a concise and overview perspective of the characteristics and the emerging directions of omics sequencing data, as well as the related AI analysis schema in handling such data, together with the summarized precision therapy cases based on the integration of AI and omics.

Surgical outcomes and complications associated with ovariectomy in the southern stingray Hypanus americanus.

Southern stingrays (Hypanus americanus) are relatively large rays that are common and popular in public aquariums because of their size and gentle nature. In aquariums, as well as in the wild, female southern stingrays are fecund. They have a short gestation cycle and can sustain multiple pregnancies each year, each culminating with 2-10 young. This reproductive rate could quickly outpace capacity in managed care and result in a ray surplus. To prevent overpopulation, many aquaria have resorted to single sex groups with a preference for female-only populations. This is an effective way to control population growth, but forces the maintenance of two separated populations of rays; for females this interrupts normal reproductive cycling and replaces it with a protracted non-pregnant condition. An additional consideration is development of reproductive disease in females which is recognized by an enlarged, misshapen, and congested ovary with an abundance of cystic structures and an enlarged uterus with a thickened wall that is often filled with histotroph despite a non-pregnant status. There are no effective long-lasting medical treatments for this type of reproductive disease and mortality is often the result. This report describes a surgical technique for ovariectomy in southern stingrays including outcomes and complications. Ovariectomy as a surgical method prevents unwanted reproduction and has the benefit of reducing reproductive pathologies commonly observed in southern stingrays as they age. Seven stingrays 1-5.2 years old and 42-83.5 cm disc width underwent ovariectomy. After anesthesia, the ovary and a small amount of epigonal was excised via a left para-lumbar incision. Four of the seven rays survived five or more years post-procedure. Two rays died acutely of coelomitis and one ray died of complications unrelated to the procedure. This report details a surgical procedure for ovariectomy in southern stingrays including outcomes, complications, and recommendations.

A Random Forest-based Prediction for Liver Cirrhosis

Prediction of cirrhosis through timely screening and diagnosis with effective medical and lifestyle interventions can be taken to delay the disease progression and improve treatment effectiveness. Therefore, early cirrhosis prediction helps reduce associated complications and improve quality of life. This study established a random forest-based algorithm and compared its performance with other machine learning models based on an Indian Liver Patient Records. The dataset was divided 30% of the test set and 70% of the training set. The results showed that the Accuracy, Area under the curve (AUC) and Recall values of Random Forest (RF) model were 0.73, 0.76 and 0.88, respectively, which demonstrated the proposed model can predict the results better than other models. The proposed model for predicting liver cirrhosis in the future will continue to be improved and perfected to improve the accuracy of liver cirrhosis prediction and treatment effect, thereby reducing the health risks and burdens brought by the disease.

A Random Forest-based Prediction for Liver Cirrhosis

Prediction of cirrhosis through timely screening and diagnosis with effective medical and lifestyle interventions can be taken to delay the disease progression and improve treatment effectiveness. Therefore, early cirrhosis prediction helps reduce associated complications and improve quality of life. This study established a random forest-based algorithm and compared its performance with other machine learning models based on an Indian Liver Patient Records. The dataset was divided 30% of the test set and 70% of the training set. The results showed that the Accuracy, Area under the curve (AUC) and Recall values of Random Forest (RF) model were 0.73, 0.76 and 0.88, respectively, which demonstrated the proposed model can predict the results better than other models. The proposed model for predicting liver cirrhosis in the future will continue to be improved and perfected to improve the accuracy of liver cirrhosis prediction and treatment effect, thereby reducing the health risks and burdens brought by the disease.

Impact of medical therapy for hormone-secreting Pituitary tumors on bone.

Bone health is often impaired in patients with hormone-secreting pituitary tumors. Since medical therapy is central to their care, understanding how its use impacts on this is highly important. This review summarizes a systemmatic review of the literature on the effects of medical therapies for hormone-secreting pituitary tumors on bone. In acromegaly, medical therapy lowers bone turnover marker (BTM) levels, consistent with correction of the high bone turnover of active disease, and overall, areal bone mineral density (aBMD) does not change or increases. Somatostatin-receptor ligand (SRL) and pegvisomant-treated acromegaly patients have persistently reduced volumetric BMD and microarchitectural abnormalities of the peripheral skeleton, deficits that are similar to those in surgically-treated patients. Fracture risk remains elevated in medically-treated acromegaly patients but in conjunction with biochemical control the risk is lessened. Treatment of prolactin-secreting tumors with dopamine agonists is associated with improvements in aBMD, but this does not always fully normalize despite effective medical treatment of the prolactinoma. In one cross-sectional study, prolactinoma patients had lower total volumetric BMD and impaired microarchitecture suggesting that bone microstructure does not fully normalize despite dopamine agonist therapy. Cross-sectional studies show a high rate of VF in patients with prolactin-secreting tumors that is lowered on cabergoline therapy, but still the fracture rate of men and postmenopausal women is higher than that of controls in some studies. Studies on the effects of modern-day medical therapy for Cushing's disease on bone are lacking. More research is needed on the effectsof medical therapies for hormone secreting pituitary tumors on bone health.