Neuro endocrinology letters最新文献

An 80-year-old Japanese woman had shown no indication of diabetes but regularly saw a primary-care physician for health management. Six months before her referral to our hospital, her HbA1c was 6.0%. She was referred to us for diabetic ketosis because she was urine ketone body-positive with a blood glucose level of 397 mg/dL and HbA1c of 14.6%. She was diagnosed with type 1 diabetes mellitus (T1DM) with glutamic acid decarboxylase (GAD) antibodies >2,000 U/mL (by ELISA) and IA-2 antibodies >30 U/mL. Insulin injections were introduced, and she was discharged. Laboratory tests during her hospitalization were negative for thyroid antibodies (TgAb, TPOAb). Elderly individuals with first-onset T1DM who are positive for IA-2 antibody are rare, and multiple-positive cases of pancreatic islet-associated autoantibodies are particularly rare. IA-2 antibodies have an approx. 60% positive rate in acute-onset T1DM, but they are more likely to be positive in children and adolescents and are known to turn negative earlier than anti-GAD antibodies. Although a large amount of insulin is needed in general in such cases, our patient was successfully treated with a small amount of insulin. IA-2 antibody has been reported to be positive even in GAD antibody-negative individuals. In some cases, IA-2 antibody and other antibodies are positive even in elderly-onset diabetes, and this contributes to the diagnosis of T1DM.

Determining body contents such as body water volume and body cell mass have significant uses in health and disease. Accumulation of extracellular water is particularly difficult to monitor using classical methods. Bioelectrical impedance analysis (BIA) is a simple, rapid, and noninvasive method, based on the principle that the flow of altering electrical current through a particular tissue differs depending on the content of water and electrolytes. It is thus able to measure body composition, including total body and extracellular water. Although bioimpedance holds up quite well compared to the gold standard that is dual-energy X-ray, it has certain limitations in critically ill patients. Specifically, it cannot distinguish between intravascular and interstitial volume in the extracellular compartment, and as it employs equations based on population measurement, compositions can diverge significantly with severe overhydration or in the morbidly obese. Bioelectrical vector analysis (BIVA) does not use the calculations and is part of the measurements in newer multifrequency bioimpedance devices. There is growing evidence of the adverse effect of overhydration in critically ill patients and bioimpedance can be used to monitor hydration, but there is no information on how to use this method for bedside monitoring in practice. In this review we present a practical approach to Phase angle and BIA/BIVA interpretations for monitoring hydration status and rapid loss of skeletal muscle mass and their clinical use, on a cohort of critical COVID patients under artificial lung ventilation.

Excessive daytime sleepiness (EDS) is a common symptom of sleep disorders such as narcolepsy, obstructive sleep apnea, and hypersomnia. The most common tools for assessing EDS are various specialized questionnaires such as Epworth Sleepiness Scale (ESS) and Stanford Sleepiness Scale (SSS). However, the scores obtained from self-rating questionnaires do not seem to measure physiological sleepiness but rather a more complex phenomenon of subjective sleepiness modulated by other factors such as motivation, expectation, and capability of self-perception. The golden standard for measuring physiological sleepiness and assessing EDS is the Multiple Sleep Latency Test (MSLT). However, MSLT is very time consuming and requires trained personnel and expensive equipment. Different method modifications are employed in various medical and industrial fields for different purposes. The infrared pupillography in darkness has the potential to measure objective physiological sleepiness, especially the Pupillographic Sleepiness Test (PST), which is the method of choice for pupillographic measurement of daytime sleepiness. The method has also been employed in several specific sleep disorders, outlining possible future usage. This narrative review summarizes the current state of knowledge on the relevance and usefulness of pupillography in sleep medicine.

Objectives: Studies of schizophrenia endophenotypes may help clinicians better understand the etiopathogenesis and treatment of this mental disorder. The aim of the study was to determine if retinal arteriolar or venular abnormalities are an endophenotype of schizophrenia.

Design: We performed a one-time cross-sectional study.

Materials and methods: We enlisted schizophrenic patients (n = 53) hospitalized in the Department of Psychiatry, University Hospital Hradec Kralove; their mentally healthy first-degree relatives (n = 53); and unrelated, age- and sex-matched mentally healthy controls (n = 49). We recorded all participants´ sociodemographic and, if relevant, clinical variables. Retinal imaging was carried out using a digital fundus camera (FF450 + IR). Outcomes included retinal vessel calibers measured using the software application VAMPIRE.

Results: The study enrolled fifty-three schizophrenic patients (average age 32.1 years; males n = 38), an equal number of healthy relatives (average age 47.3 years; males n = 18), and forty-nine unrelated healthy controls (average age 32.2 years; males n = 35). Patients with schizophrenia had significantly increased retinal arteriolar diameters when compared to unrelated healthy controls (left eye p = 0.003; right eye p = 0.011) but not when compared to healthy relatives. The sizes of the retinal venules were not significantly different among the study groups.

Conclusions: Our cross-sectional findings do not support the notion that retinal microvascular anomalies are an endophenotype in schizophrenia. Longitudinal studies of this subject should be included in further research.

Objective: We report a case of small-cell neuroendocrine carcinoma (SNEC) of uterine cervix associated with adenocarcinoma in situ (AIS), and we discuss prognosis, treatment benefit and goals of care.

Case report: A 36-year-old pluriparous woman presented with vaginal bleeding. Bimanual pelvic examination revealed a exophytic mass arising from the posterior lip of the cervix. A transvaginal ultrasound revealed endometrium thickness of 7mm and exophytic 39x19mm mass arising from the posterior lip of the cervix. Histopathological analysis of the tumorous lesion revealed a small-cell neuroendocrine carcinoma admixed with adenocarcinoma in situ. Differential immunohistochemistry of the small-cell neuroendocrine carcinoma component was CKAE1/AE3, CD 56, TTF -1 positive with diffuse expression of chromogranin and synaptophysin. HPV type 18 has been detected through PCR sequencing analysis. The next generation sequencing based on a 324-gene panel showed that tumor was microsatellite stable (MSS) with low mutational burden (TMB). Only missense mutations of FGF10, HSD3B1, NBN, PBRM1, RICTOR, SDHA were detected. Radical surgery was performed and the patient received adjuvant chemotherapy consisting of cisplatin/etoposide for six cycles. During 12 months of follow up the patient is free of disease.

Conclusion: Neuroendocrine tumour of uterine cervix is an extremely rare and aggressive cancer. Because of its low incidence there is still no standardized treatment approach based on controlled trials. Radical surgery and adjuvant or neoadjuvant chemotherapy is the mainstay of treatment.

Background: As an "off-target" effect, cephalosporins can enhance glutamate transporter-1 expression in astrocytes to recycle glutamate from synaptic cleft, and exhibited analgesic properties in animals and humans with chronic pain.

Methods: In the present study, we focused on making a side-by-side comparison of the analgesic potentials of cefadroxil and ceftriaxone, using rodent models of peripheral neuropathic pain, inflammatory pain and incisional pain. Microdialysis technique was adopted to validate the in vivo glutamate regulatory properties of these two drugs in central nervous system.

Results: We have shown that cefadroxil and ceftriaxone are beneficial in a variety of pain scenarios, without inducing observable side effects. The two cephalosporins worked better on neuropathic pain, rather than inflammatory pain or incisional pain, suggesting nociceptive system was differentially affected. Further, microdialysis has confirmed that cephalosporins can effectively reverse the elevated levels of glutamate in brain of animals with neuropathic pain.

Conclusions: The outcome of this study may guide us to identify a molecular skeleton derived from cefadroxil, based on which we could possibly develop new non-antibiotic analgesic compounds with glutamate recycling properties.

Neuroendocrine tumors (NETs) of duodenal origin are an unusual subset among all NETs, comprising only about 3% of this neoplasm class. In general, NETs are characterized by overexpression of somatostatin receptors and carry an excellent prognosis with early diagnosis and intervention. Chromogranin A (CgA), a protein originating in secretory vesicles of neurons and endocrine cells, has gained wide usage in NET diagnosis and surveillance. Lanreotide is a synthetic octapeptide somatostatin analog with potent anti-proliferative action which has been approved by the FDA (U.S.) and EMA (E.U.) for NET treatment. It is known for its inhibitory effects on growth hormone, serotonin, CgA, and other markers. Here we describe a 56yr-old female with functional NET of duodenal origin, where serum CgA was successfully reduced from 3636 to <100 ng/mL after multidose lanreotide within five months. Of note, no metastatic spread was identified on positron emission tomography/computed tomography with 64Cu-labeled somatostatin analog tracer. Surgical resection of distal antrum, pylorus, and proximal duodenum was completed without complication. Histology revealed well-differentiated tumor cells with characteristic neuroendocrine features and clear surgical margins; low proliferation index (2%) was noted on Ki-67 staining. While select laboratory and imaging modalities are available for diagnosis and monitoring of duodenal NET, this is the first reported therapeutic use of lanreotide in this NET setting. The observed serum chromogranin A attenuation, even before surgery, supports its effectiveness in management of primary nonmetastatic duodenal NET after resection.

Objective: Thyroid function may be useful prognostic predictor of acute ischemic stroke. However, the relationship between thyroid function and stroke prognosis remains controversial. We aimed to explore the correlation between thyroid function at admission and 90-day functional outcome in patients with acute ischemic stroke.

Methods: Our data were collected from patients with AIS (acute ischemic stroke) registered in the Stroke Center of Jiangsu Provincial Hospital of Chinese Medicine from January 2021 to July 2021.The outcome was divided into good outcome as mRS (Modified Rankin Scale) score <3, poor outcome as mRS≥3 (including hemorrhage, recurrence, and death within 90 days after stroke).Univariate, multivariate logistic regression analysis, tertile analysis and subgroup analysis were used to evaluate the relationship between TSH (Thyroid-stimulating hormone), FT3 (Free Triiodothyronine), FT4 (Free thyroxine) and 90-day outcome.

Results: 699 patients with AIS were included in this study. In univariate analysis, FT3 was negatively correlated with poor outcome of AIS patients at 90-day, TSH was not statistically correlated with 90-day outcome. Multivariate analysis showed that FT3 was negatively correlated poor outcome of AIS patients at 90-day. After adjusting for potential confounders, TSH was negatively correlated with poor outcome. Participants were categorized based on the tertile cut-off points of FT3 and TSH. With the increase of TSH value, the incidence of poor outcomes in Q3 was 0.57 times higher than that of Q1. Similarly, with the increase of FT3 value, the incidence of poor outcomes in Q3 is 0.3 times than that of Q1.

Conclusions: FT3 and TSH were negatively correlated with poor 90-day outcome in patients with AIS. Measurement of thyroid function on admission may provide independent prognostic information for 90-day outcome of AIS.

Introduction: Borderline personality disorder (BPD) presents a highly stigmatised condition. Individuals with BPD may experience stigmatising attitudes and remarks from the general population and mental health professionals. Significant self-stigma also seems common. The paper reviews the current knowledge regarding the stigma connected to BPD.

Method: The Web of Science, Medline, and Scopus databases identified studies published from January 1990 to January 2023. Additional references were found using analyses of the primary articles. The search terms included "borderline", "stigma", and "self-stigma".

Results: Public knowledge of BPD is scarce. The general population may interpret the BPD symptoms as "purposeful misbehaviour" rather than signs of a mental disorder. Mental health professionals commonly distance themselves from patients with BPD and may prematurely give up their treatment efforts. This stance often comes from believing BPD is difficult or impossible to treat. Therefore, treating patients with a personality disorder should be consulted with a supervisor, especially when the psychotherapist shows a negative attitude towards the patient. Generally, few BPD-specific destigmatisation interventions have been verified by research. Limited evidence suggests that targeted training of the healthcare providers can reduce stigmatising attitudes and that interventions combining positive messages of the recovery potential with biological aetiology of the disorder are most impactful in reducing the stigma.

Conclusion: BPD is commonly stigmatised by the general population and mental health professionals. Destigmatising efforts need to tackle the stigma's primary sources, namely the general population's lack of understanding and the pessimistic beliefs in the healthcare providers. More BPD-specific research on stigma is needed.

Objective: Thyroid hormones play an essential role in metabolism regulation and circadian rhythm control. Recent studies approved their role in normal development and healthy function of central nervous system (CNS). The thyroid gland is a component of the hypothalamic-pituitary-thyroid axis disrupted during thyrotoxicosis and hypothyroidism, two main clinical conditions that induce more liability against dementia-related disease.

Method: In the first step, this study evaluated the circular level of neuropeptide Y (NPY), leptin, oxytocin, and vasopressin in hyperthyroidism and hypothyroidism patients. In the second step, we investigated neurological and cognitive abnormalities by assessment of the hallmark proteins and peptides such as amyloid β (Aβ) variants, glycogen synthase kinase 3β (GSK-3β), and tau protein in thyroid-deficient samples.

Results: The results show increased content of leptin hormone in patients with hypothyroidism who also manifested high levels of vasopressin. Underactivation and overactivation of the thyroid gland are accompanied by reduced circular oxytocin. We may conclude that thyroid deficiency is associated with neurohormone dysregulation. Interestingly, both patient groups exhibited significant increases in Aβ40 and Aβ42 levels relative to the control group, which was also accompanied by the rise in GSK-3β; this might be interpreted as cholinergic system dysfunction and cognitive impairment. The results revealed tau content increased considerably in thyrotoxicosis but did not change significantly in hypothyroidism compared to the control group.

Conclusion: Therefore, our results have shown that thyroid gland dysfunction is a risk factor for cognitive impairment, mainly through neuroendocrine dysregulation. This study provides a relationship between hyperthyroidism/hypothyroidism and biomarkers of neurological abnormalities in blood serum.