Neuro endocrinology letters最新文献

Background and objectives: To differentiate preoperatively between benign nodule and thyroid cancer (TC) is highly important. Therefore, we investigated the risk assessment indicators that correlate preoperative clinical, radiological, and pathological features with post-operative TC characteristics.

Methods: An observational retrospective study was performed in Bahrain Defense Force (BDF) hospital for all patients suspected of having thyroid cancer from January 2016 to October 2020. All the medical records, including clinical, laboratory, radiological, and pathological assessments of these patients, were retrieved and analyzed for association using binary and multivariate logistic regression analysis to estimate significance, odds ratio (OR), and 95% confidence interval.

Results: A total of 87 patients were included in the study with a mean age of 40 ± 12.5 years old. The histopathology revealed that 27 patients had TC with a mean age of 38.1±10.8 years (p>0.05 vs. benign conditions). Furthermore, the TC frequencies within gender were 29.9% and 36.4% for females and males, respectively. Besides, most patients (85.2%) had papillary TC cancer, whereas 7.4% had follicular cancer, and 3.7% had either medullary TC or minimally invasive follicular TC. The correlation results between demographic, clinical characteristic evaluations, laboratory findings of the study patients, and TC as reported by the histopathology were all not significant except for ultrasound features including solitary nodule (p<0.05), lymph node involvement, and consistency (p<0.01). The sensitivity and specificity values of FNAC for detection of TC were 77.8% and 86.3%, respectively. Multivariate analysis revealed that only solid consistency of the tumor (OR = 9.88) and lymph node involvement (OR = 14.78) were correlated with TC detection. On the other hand, gender, symptoms of hypothyroidism, hyperthyroidism, or compression, family history of TC, abnormal thyroid function tests, neck swelling, and ultrasounds imaging with regards to vascularization and microcalcification were not correlated with the detection of TC.

Conclusion: Preoperative nodule and FNAC assessments need further research and development to approach higher sensitivity in detecting TC.

Acyclovir is an antiviral drug frequently used in clinical practice. It is indicated for the treatment of infections caused by herpes simplex virus and varicella zoster virus. The drug has a good safety profile; however, severe side effects may rarely occur during therapy. These include renal failure as a major risk factor for neurotoxic side effects potentially developing within 24-48 hours of therapy initiation. The paper presents the cases of two patients developing neurotoxic side effects while treated for herpes zoster. The aim of the authors is to highlight the potential for developing neurotoxic side effects in high-risk groups such as the elderly, patients with impaired renal function or multiple comorbidities on polypharmacy, or those using nephrotoxic drugs. Acyclovir use could lead to renal impairment and an increase in its plasma and CNS concentrations with severe neuropsychiatric side effects. The neurotoxic side effects are reversible after therapy withdrawal. Thus, in patients developing mental impairment or showing other neurological symptoms during acyclovir therapy, the patient should be promptly assessed for potential drug neurotoxicity, their therapy should be discontinued and drug elimination with forced diuresis or hemodialysis considered. Early recognition of acyclovir neurotoxic side effects can significantly improve a patient's prognosis.

Objectives: X-linked adrenoleukodystrophy (X-ALD) causes cerebral adrenoleukodystrophy (cALD), myelopathy and/or adrenal insufficiency in males, and myelopathy/peripheral neuropathy in females. These distinct phenotypes are scarcely linked to a specific mutations. The objective herein was to find a link between the phenotype with the genotype mutation, serum very long-chain fatty acids (VLCFA), and the diet with Lorenzo´s and GTO oils in hemizygous males and heterozygous females.

Methods: A retrospective study design with follow-up of 45 hemizygous males and 50 heterozygous females carrying mutations in ABCD1 from 35 unrelated families with X-ALD. Mutation analysis was performed by Sanger sequencing of PCR and/or RT-PCR and the severity of missense mutations was evaluated using GERP++ score and CADD score.

Results: Twenty-five described and eight novel ABCD1 mutations were identified. Fifteen males and 23 females had severe mutations while 30 males and 27 females had less detrimental ones. cALD developed in 25 males (56%) including nine boys with severe mutations, 10 boys with less detrimental mutations and 6 adults with adrenomyelopathy. Myelopathy and/or adrenal insufficiency developed in 14 males (31%), six were asymptomatic. Adrenal insufficiency developed in two of five boys treated with hematopoietic stem cell transplantation (HSCT). Myelopathy/peripheral neuropathy developed in 26% of females. No correlation was found between the disease severity and the genotype, GERP++ and CADD scores, presence/absence of aberrant ALDP protein or X-inactivation. VLCFA were higher in males than heterozygous females and decreased during Lorenzo´s and GTO oils diet without a clear clinical impact on the disease.

Conclusion: The prognosis was unfavourable in most males and significant part of females. Therapy with early HSCT is effective. Thus, the need for early diagnosis with the neonatal screening is crucial.

Objective: To explore the correlation between dose volume histogram (DVH) parameters and lung function changes before and after radiotherapy and the occurrence of radiation-induced lung injury (RILI), and to evaluate its value in predicting the risk of RILI.

Methods: 120 patients with advanced non-small cell lung cancer diagnosed in Jiaozhou Central Hospital of Qingdao City in the past three years and received chest conformal (intensity modulated) radiation therapy were selected. Before radiotherapy, irradiation of 45-50 Gy, and 1 month after radiotherapy, the patients were tested for lung function. The evaluation of radiation lung injury was based on the RTOG acute radiation lung injury classification standard, and the observation end point was ≥2 grade RILI.

Results: There are 34 patients with ≥2 grade RILI among all enrolled patients, including 23 cases of grade 2 and 11 cases of grade 3. The difference between FVC, FEV1, FEV1 / FVC, DLCO, V5, V10, V15 before radiotherapy, 45-50 Gy, and 1 month after radiotherapy were statistically significant (P <0.05). The lung function, V5, V10, and V15 before radiotherapy were related factors for RILI (P <0.05). And the risk of RILI was 1.855 times that of patients with higher FEV1 / FVC before radiation therapy (OR = 1.855 (1.199-1.946)), patients with V10 ≥50% were 3.673 times higher than patients with V10 <50% (OR = 3.673(1.548-7.582)).

Conclusions: V10≥50% and FEV1 / FVC are high-risk factors for RILI before radiotherapy, which has certain value in predicting the risk of RILI.

Objective: The purpose of the current study was to determine the predictive effect of physical growth and brain magnetic resonance imaging (MRI) on neurodevelopmental outcomes in very low birth weight infants (VLBW) infants.

Materials and methods: A total of 85 VLBW infants were included in the current study. They were cared according to the guideline of preterm management during hospitalization, and to planned follow-up rules after discharged strictly. All patients enrolled in the present study had undergone measurement of weight, length and head circumference and reported on the infants' weight-for-age z-score (WAZ), height-for-age Z-score (HAZ), head circumference-for-age Z-score (HCZ), and weight-for-height Z score (WHZ).

Results: At 29.38 ± 1.70 weeks old, the birth weight was 1240.06 ± 249.46g. MDI decreased gradually with the increase of corrective age (p<0.001), and MDI at 18 months of age decreased significantly compared to normal infants and young children of the same age (p<0.05), while at 24 months of age there was no significant difference between MDI and normal peers. Correcting PDI in 3, 6, 12, 18 and 24 months was significantly lower than that of normal infants and young children of the same age (p<0.05) and did not show a trend that changed with the correction of monthly age. WHZ gradually approaches normal as the age of the month increases (p<0.05), while HCZ decreases gradually with the correction of the age of the month (p<0.05).

Conclusion: VLBW has obvious motor development disorders, and there is no difference between intellectual development and healthy young children. MDI rises early and then gradually declines, eventually becoming 2 years old similar to that of healthy young children. PDI has consistently shown a significant decrease in infants and young children of the same age, and has not shown a trend that changes with the correction of monthly age. There is a great correlation between infancy physical development and long-term neurodevelopment, MRI at 12 months old is a valuable prediction method.

Background and aims: The effect in smokers of nicotine withdrawal following surgery may contribute to the development of postoperative delirium. Nicotine is known to increase myocardial oxygen demand, coronary vasoconstriction, and may cause platelet activation leading to thrombosis. All of this can negatively impact postoperative recovery. The aim of this study was to determine whether nicotine replacement therapy can overweigh its negative effects, reduce the incidence of delirium, reduce the need for sedatives/analgesics, and/or shorten the duration of artificial pulmonary ventilation.

Methods: This prospective randomized single-blind study was performed in a 21-bed ICU. Fifty-two patients (26 intervention/ 26 control) met the inclusion criteria. Patients in the intervention group received a 21mg nicotine patch daily until discharged from the ICU (up to 7 days), patients in the control group received a placebo patch. The incidence of delirium was monitored with the CAM-ICU test. Sedatives/analgesics used in the ICU, and the duration of both artificial ventilation as well as total ICU stay were recorded for both groups.

Results: Nicotine replacement in smokers did not reduce the incidence of delirium in patients who had undergone surgery. Neither did it statistically significantly affect the length of hospitalization, sedation, analgesia, or vasopressors.

Conclusion: This study did not confirm the effect of nicotine replacement therapy in reducing the incidence of delirium, it did not shorten the total duration of ICU stay or artificial ventilation and there was no reduced sedation requirement. We therefore saw no beneficial effect in patients receiving nicotine replacement therapy following elective surgery.

Objectives: Evidence has accumulated that an autoimmune-mediated process in the central nervous system may underlie the development of schizophrenia. Various antibodies have also previously been detected in serum of patients with schizophrenia. Therefore, the aim of this study was to analyze antibody reactivity against proteins, selected based on potential schizophrenia disease relevance, in both cerebrospinal fluid and serum of patients with schizophrenia.

Material and methods: Cerebrospinal fluid and serum from 17 patients with schizophrenia or related psychosis and 12 controls were analyzed regarding antibody reactivity, using bead-based antigen arrays of protein fragments or peptides of 21 selected proteins. Additionally, the patients were accessed for clinical symptoms with the Positive and Negative Syndrome Scale (PANSS) for schizophrenia.

Results: Increased antibody reactivity was found in patients compared to controls against the insulin receptor (INSR), PAGE2B;2;5 and heat shock proteins (HSPs) in both cerebrospinal fluid and serum, and against the insulin like growth factor 1 receptor (IGF1R), insulin (INS), insulin like growth factor 1 (IGF1), cadherin 5 (CDH5), nerve growth factor (NGF) and vascular endothelial growth factor A (VEGFA) in serum alone. Moreover, patients' antibody reactivity in serum against PAGE2B;2;5, IGF1R or NGF correlated positively to their PANSS scores.

Conclusions: Taken together, these results point to that an autoimmune-mediated process underlies the development of a core group of schizophrenia cases and that the INSR and IGF1R, their ligands (INS and IGF1) and related inter- and intracellular proteins (CDH5, PAGE2B;2;5, HSPs, NGF and VEGFA) may constitute antigen targets.

Objective: POEMS syndrome is a rare multisystemic disease, with a wide spectrum of clinical endocrinopathies. Patients with POEMS syndrome may present with one or more hormone disorders during the disease course, but such phenomenon has usually been underestimated. In this report, we analyzed the prevalence and clinical characteristics of endocrine abnormalities in a large Chinese cohort with POEMS syndrome.

Methods: This retrospective review was performed in patients with a definite diagnosis of POEMS syndrome who were hospitalized in our hospital between January 2000 and January 2020. The clinical data about endocrine abnormalities were extracted from their medical records and analyzed.

Results: This study comprised 136 patients (95 male, 41 female) with a median age of 48(40-56) years old. Endocrine abnormalities were frequent (127 cases, 93.38%) in patients with POEMS syndrome. The prevalence of single endocrinopathy and multiple endocrinopathies were 12.60% (16/127 cases) and 87.40% (111/127), respectively. The most frequent endocrinopathy was hypogonadism (98/136, 72.06%), followed by hypothyroidism (83/136, 61.03%), hypocalcemia (50/136, 36.76%), hyperprolactinemia (47/136, 34.56%), abnormal glucose metabolism (41/136, 30.15%) and adrenal insufficiency (41/136, 30.15%). In patients with multiple endocrinopathies, the prevalence of 2, 3, 4, 5, and 6 kinds of endocrine axes involved were 29.92% (38/127), 30.71% (39/127), 17.32% (22/127), 7.09% (9/127) and 2.36% (3/127), respectively. Such hormone disorders cause complex clinical presentations, including overt or subclinical situations.

Conclusion: Endocrinopathy manifestations in POEMS syndrome are more frequent, and its clinical complicacy should be emphasized in differential diagnosis. For patients with a definite diagnosis of POEMS syndrome, an early and thorough endocrine evaluation should be performed.

Introduction: This review aims to present the current state of knowledge about attachment and obsessive-compulsive disorder (OCD), the connection to the disorder's course, and the treatment effectiveness.

Method: A literature search was performed using PubMed, Google Scholar, Web of Science, and ScienceDirect databases using the following search terms: obsessive compulsive disorder, attachment, therapy, treatment, and long-term outcome. The period of extraction was between January 1990 and October 2020.

Results: Insecure attachment leads to the formation of dysfunctional beliefs about the world and self, which influences the dynamics of OCD. It is associated with maladaptive cognitive processes such as an inflated sense of responsibility, perfectionism, and mind control. With worse emotional regulation and reduced self-esteem (which can also result from insecure attachment), it can lead to maladaptive behaviour such as perfectionistic and compulsive behaviour to secure and stabilize self-worth and safety. Of the two dimensions that define insecure adulthood attachment (anxiety and avoidance), attachment anxiety is more closely related to OCD. While anxious attachment can lead to a worse response in acute treatment, secure attachment is a protective factor that can improve remission.

Conclusions: Anxious attachment is common in patients with OCD and interconnects with primary OCD symptomatology. From this perspective, strategies that promote feelings of safety, acceptance, and appreciation within a therapeutic relationship may be essential in treating OCD.