Neuro endocrinology letters最新文献

Introduction: Panic disorder (PD), obsessive-compulsive disorder (OCD), and borderline personality disorder (BPD) are associated with various psychosocial factors that may influence their onset and psychopathology. Dissociation encompasses a wide range of manifestations, from benign experiences to severe mental health issues. Research comparing childhood trauma and dissociation, general psychopathology, and the onset of the disorder among patients with PD, OCD, and BPD has not yet been published.

Results: The severity of dissociative symptoms negatively correlated with the onset of the disorder, whereas it positively correlated with the disorder's overall severity and general symptomatology. Patients with more severe childhood trauma had an earlier onset of the disorder and more severe depressive and dissociative symptoms. They rated higher on the overall severity of the disorder. Physical abuse and neglect were associated with more severe PD, OCD, and BPD. Patients with BPD had higher levels of dissociation than those with PD or OCD. BPD was also connected with more severe childhood trauma than PD and OCD patients. Comorbidity exacerbated the severity of the psychiatric disorders.

Conclusions: Childhood trauma and dissociation play a significant role in anxiety and depressive symptoms in patients with PD, OCD, and BPD.

Objectives: Malignant tumors of the nasopharynx make up 3% of malignancies in the ENT area. The most common nasopharyngeal malignancy is nasopharyngeal carcinoma (NPC), followed by lymphomas. Other nasopharyngeal tumors are very rare. In this study, we aimed to assess the age distribution and behavior of the primary nasopharyngeal malignancies, NPC, and lymphoma over a ten-year period in a tertiary hospital patient group.

Design: Retrospective cohort study.

Material and methods: A total of 48 patients participated in this retrospective monocentric study. The group consisted of 13 females (27.1%) and 35 males (72.9%) diagnosed with nasopharyngeal malignancy and treated between 2012 and 2022. The patients' ages ranged from 14 to 83 years, with a mean age of 57.5 and a median of 55 years. The variables monitored in the study were histology, symptoms (such as nasal obstruction, Eustachian tube function, presence of glue ear, neck mass, weight loss), smoking status, TNM classification, and survival.

Results: In NPC grading and staging, two statistically significant variables were found to be associated with survival: distant metastases (p < 0.0001) and stage of the process (p = 0.0153). We did not find age and gender to be significant variables for lymphomas (p = 0.4066; p = 0.1797, respectively) or for NPC (p = 0.8630; p = 0.0573, respectively). Neither did we find any significant cut-off levels. In our analysis of therapy, we discovered that the use of chemoradiotherapy and palliative care in the NPC group is statistically significantly connected with disease-specific survival (p = 0.0094; p = 0.0004). This, however, was not the case in the lymphoma group. For the NPC group, we found statistically significant symptoms only in weight loss (p = 0.0081) and smoking (p = 0.0483).

Conclusion: Our research confirmed that nasopharyngeal tumors are rare, with the most common type being nasopharyngeal carcinoma. In our patient group, 76.9% of cases involved nasopharyngeal cancer, which was five times more common in men than in women, and typically occurred in individuals over the age of 50. Lymphomas and other tumors accounted for less than a quarter of the cases. The overall five-year survival rate for nasopharyngeal malignancies in our group was 42.3%. We also observed an interesting gender perspective: 75% of women (6 women) survived for five years, whereas 72.2% of men died within five years of diagnosis.

Introduction: PAdverse Childhood Experiences (ACEs) are associated with an increased risk of mental health issues in general, but their relationship with panic disorder (PD) and obsessive-compulsive disorder (OCD) has received less attention compared to borderline personality disorder (BPD). Dissociative experiences are significant predictors of increased symptoms, reduced treatment adherence, and poor prognosis in several psychiatric conditions, including PD, OCD, and BPD; still, their impact remains underexplored. This part of the study focuses on the overall efficiency of psychotherapeutic programs on treatment-resistant patients diagnosed with PD, OCD, and BPD (or combined), as well as the relationship between ACEs, dissociation rates, and treatment results.

Method: The study was conducted under standard conditions in an inpatient psychotherapy unit that specialized in anxiety, affective disorders, and personality disorders. Patients were hospitalized for 6 weeks and treated with a comprehensive CBT program and pharmacotherapy. The study included patients diagnosed with PD, OCD, or BPD (or combined). Two independent psychiatrists confirmed the inclusion and exclusion criteria. Patients were assessed using the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI-II), Clinical Global Impression Scale - Severity (CGI-S), Dissociative Experience Scale (DES), and Childhood Trauma Questionnaire (CTQ-SF).

Results: A total of 349 out of 357 patients completed the study. The average age of patients was 33.33 ± 11.59 years. After the 6 week treatment, there was a statistically significant decrease in mean scores across all assessed scales. Changes in any scale during treatment did not correlate with the total CTQ-SF score or sub-scores. The relative change in CGI-S showed a statistically significant negative correlation with the total dissociation score on the DES scale at the beginning of treatment but not with pathological dissociation assessed by the DES-T questionnaire. Statistically significant decreases in mean CGI-S scores were observed in patients with a single diagnosis of PD, OCD, and BPD. Among comorbid groups, significant changes were observed only in patients with comorbid OCD and BPD. No statistically significant change in mean BDI-II scores was observed in patients with comorbid PD and OCD or comorbid OCD and BPD.

Conclusions: Our analysis showed that treatment led to a significant decrease in the severity of depressive symptoms assessed by BDI-II and anxiety symptoms assessed by BAI in patients with PD, OCD, and BPD. This decrease was not statistically significant in patients with comorbid disorders, suggesting that the presence of multiple diagnoses may affect treatment efficacy. ACEs did not correlate to treatment results, but dissociation rates were linked with poorer treatment outcomes.

A 33-year-old Japanese man with a history of atopic dermatitis and asthma had never been diagnosed with any apparent glucose intolerance but had been aware of palpitations for >10 years. A 75g oral glucose tolerance test (OGTT) at his physical examination in March 2021 revealed fasting hyperglycemia and post-load hypoglycemia. An OGTT recheck was performed in May 2021 and was normal. We hypothesized that gluconeogenesis from the liver had caused his fasting hyperglycemia and performed abdominal echocardiography, which revealed a right adrenal tumor with abnormal catecholamine production. We diagnosed pheochromocytoma and performed a right adrenalectomy in September 2021. Postoperatively, the patient's palpitations disappeared and his laboratory findings normalized. Glucose intolerance is well known to occur before surgery in patients with pheochromocytoma, but it is extremely rare that hypoglycemia is indicated by a presurgery OGTT, as in our patient's case. Only three similar cases are reported to date, and in all three, hypoglycemia occurred ≥2 hr after loading, accompanied by excessive insulin secretion compared to the plasma glucose level. Our patient's case is the only one in which preload hyperglycemia was observed. Before his OGTT, he had run from the train station to the hospital, which was likely to be the cause of the preload hyperglycemia. We speculate that the stimulation of adrenergic β2 receptors may be involved in the enhancement of insulin secretion in patients with pheochromocytoma, but the mechanism is unknown. Further reports may clarify the mechanism of hypoglycemia induced by pheochromocytoma.

Objectives: To determine whether selected single nucleotide polymorphisms (SNPs) of genes encoding proteins responsible for the activation, transport, or metabolism of dabigatran and apixaban might be associated with a risk of gastrointestinal bleeding in a cohort of adult patients treated with these drugs. No previous study has focused specifically on the association with gastrointestinal bleeding.

Materials and methods: Ninety-one patients treated with dabigatran or apixaban were genotyped for selected polymorphisms. The following polymorphisms were studied: ABCB1 gene rs1045642, rs4148738, rs1128503 and rs2032582; CES1 gene rs2244613, rs8192935 and rs2244614; and SULT1A1 gene rs9282861 and SULT1A2 gene rs1136703. Two groups divided by particular drugs and genotypes were compared in terms of the presence (bleeding group) or absence (nonbleeding group) of gastrointestinal bleeding. The genotype distribution was expressed via dominant and recessive models.

Results: In patients treated either with dabigatran or with apixaban, no evidence was found to support the association of gastrointestinal bleeding with any genotype for any of the studied SNPs.

Conclusion: In both dabigatran- and apixaban-treated patients, no associations between the selected polymorphisms and gastrointestinal bleeding risk were found, however the results should be interpreted with caution because of the small cohort size.

Drift is a phenomenon that can occur in cognitive-behavioral supervision, where core components of supervision are omitted, avoided, or deprioritized. This narrative review explores the signs, reasons, and impact of supervisory drift at the experiential, cognitive, and emotional levels for both the supervisor and the supervisee. Additionally, the article presents potential solutions for preventing and addressing supervisory drift, such as staying on track, anticipating problems before they arise, adapting supervision to the supervisee's needs, using active supervision methods to understand drift better, engaging in Supervision of Supervision (SoS), and using alliance measures. Through the use of case vignettes, we illustrate the potential solutions. We aim to provide a comprehensive understanding of supervisory drift and offer practical strategies for its prevention and management.

Objective: To test the hypothesis that patients with poorly controlled type 2 diabetes mellitus are more likely to develop sensorineural hearing loss (SNHL) than non-diabetic patients.

Study design: Retrospective cohort study.

Setting: TriNetX US Collaborative Network (2003-2022).

Methods: Electronic medical record data from the TriNetX US Collaborative Network was queried for subjects without prior hearing loss, defined using medical billing codes (ICD-10, CPT, etc.), who were diagnosed with type 2 diabetes mellitus after January 2003. Patients were stratified by most recent HbA1c (8.0-13.9% or ≥14.0%) and by age at diagnosis (21-30, 31-40, 41-50, 51-60, 61-70, ≥71 years). Primary outcome was development of SNHL ≤20 years after diabetes diagnosis. Cohorts were propensity-score matched for age, gender, race, and hearing loss-related conditions, including vascular disease and tobacco/nicotine use. Hearing loss risk in each cohort were compared against age-matched non-diabetic subjects.

Results: All diabetic patients had greater risk of SNHL compared to age-matched controls; having a higher HbA1c (≥14.0%) additionally associated with greater risk than a lower HbA1c (8.0-13.9%) for all age groups except 21-30 and 31-40 years. Furthermore, risk was higher for older patients of both HbA1c ranges, with patients ≥71 years at diagnosis having greatest risk. Patients ≥71 with HbA1c ≥14.0% (n = 3,870) had a 0.51% (95% confidence interval: 0.28-0.74, p < 0.0001) greater hearing loss risk, and patients with HbA1c 8.0-13.9% (n = 155,066) had 0.24% (0.22-0.27, p < 0.0001) greater risk.

Conclusion: Type 2 diabetes diagnosis appears to strongly associate with greater risk of developing SNHL, especially in older patients. Audiometric screening may be warranted.

Objectives: The anti-infective, predominantly antibacterial protection of the periodontium has been well-mapped in its various inflammatory diseases, especially in different clinical forms of gingivitis and periodontitis. In various inflammatory periodontal diseases, many immunocompetent cells and substances have been identified in periodontal structures, including the gingiva, which implement and ensure this anti-inflammatory response. There is ample evidence that in many clinical forms of gingivitis and periodontitis, these immunological-defensive reactions occur in the gingival tissue. Our small review study aims to demonstrate that gingival tissue acts as a small immunological-defensive organ localized in the tissue of healthy gingiva at the necks of the teeth throughout the lifetime of our patients. Furthermore, through a literature search, we investigated whether the anti-inflammatory and defensive equipment and responses are identical in differently inflamed and clinically healthy gingiva.

Material and methods: We compiled a small review study that illuminates the knowledge on the gingiva as an immunocompetent organ through a focused search and retrieval of currently available literature sources. Our small review study aims to demonstrate that gingival tissue acts as a small defensive-immunological organ localized in the healthy gingival tissue at the dental necks throughout the lifetime of our patients. Furthermore, through a literature search, we investigated whether the anti-inflammatory and defensive equipment and responses are identical in differently inflamed and clinically healthy gingiva.

Conclusion: Our findings confirm ongoing anti-inflammatory, immunological, and regenerative responses and processes in healthy gingival tissue that prevent bacterial and viral microorganisms from crossing into deeper periodontal tissues. From these results, we can further conclude that the healthy human gingiva performs an essential function as a relatively independent and small anti-inflammatory and lymphatic organ.

Adipose dystrophy, also known as lipodystrophy, is a heterogeneous disease characterized by the complete or partial loss of adipose tissue. In some cases, patients with lipodystrophy may exhibit fat accumulation in other areas of the body, as well as metabolic abnormalities such as insulin resistance, hyperlipidemia, liver disease, and increased metabolic rate. The condition may also be associated with gene mutations, including those in acylglycerol-3-phosphate O-acyltransferase 2 (AGPAT2), Berardinelli-Seip Congenital Lipodystrophy 2 (BSCL2), caveolin-1 (CAV1), polymerase I and transcript release factor (PTRF), lamins A (LMNA), zinc metalloproteinase (ZMPSTE24), peroxisome proliferator-activated receptor gamma (PPARG), v-AKT murine thymoma oncogene homolog 2 (AKT2), perilipin 1 (PLIN1), and proteasome subunit, β-type, 8 (PSMB8). Lipodystrophy can be either congenital or acquired, and it may present as a systemic or localized condition. In this report, we describe a rare case of localized lipodystrophy characterized normal development and partial multifocal fat atrophy. This case aims to enhance clinicians' understanding of the clinical manifestation of this uncommon disease.

Background: An in-depth study of neurological symptoms and complications of influenza in elderly patients. This population group is more susceptible to complications of the disease and these complications are more likely to end in death.

Methods: A retrospective analysis of patient data was performed. All patients aged 65 years and older were included in the study. The study period was from the 1st of January , 2018 to 31st of December, 2021. All symptoms and complications of influenza were analyzed. Especially neurological and general symptoms were analyzed. Data were extracted from the complete medical records of the patients.

Results: The most common symptoms of influenza in the elderly were fever in 218 cases (83.52%), cough in 189 patients (72.41%), general weakness in 182 (69.73%) and fatigue in 166 patients (63.6%). Myalgias were experienced by 106 patients (40.61%) and arthralgias by 101 patients (38.7%). Headache occurred in only 21 patients (8.06%). Encephalopathy was observed in 7 elderly patients (2.68%) during hospitalization. Influenza encephalitis was noted in 2 cases.

Conclusion: The most common neurological symptoms of influenza in more than half of the elderly are general weakness and increased fatigue. Myalgias are common, headache less often. Nausea is not uncommon. Of the complications, encephalopathy is the most common. Cases of influenza encephalitis have also been reported. We have not encountered a stroke. Concerning other complications, bacterial pneumonia was the most common.