Neuro endocrinology letters最新文献

Cognitive-behavioural therapists and trainees are encouraged to undergo supervision when offering therapy to troubled clients and to process personal attitudes and events likely to affect their therapeutic work. We discuss common problems in cognitive behavioural therapy (CBT) supervision, which may arise at the client, supervisee, or supervisor level. These issues include difficulties with case formulation, therapeutic strategies, and the therapeutic relationship. A supervisor can help their supervisee deal with clients with multifaceted or particularly challenging problems, such as difficulties with compliance, complex psychosocial problems, or chronic mental disorders. We also discuss matters related to the supervision process, the supervisor's role, different supervisory styles, and issues affecting a supervisee's feelings of vulnerability and shame. Furthermore, we analyze distinct supervision styles and potential problems arising from the supervision of experienced CBT therapists.

Background: The aim of the work is to define the morphological peculiarities of the autonomic nervous system (ANS) in the thoracic region.

Material and methods: An anatomical study was performed on 20 cadavers, 17 men and 3 women. We studied cadavers within 24 h of death. We observed the vertebral and prevertebral section of the truncus sympathicus, their morphological peculiarities depending on the type of ANS. To show the intimate relationship of both systems, we also focused on the details of the structure related to the connections of the ANS with the spinal nervous system.

Results: In the thoracic region, the segmental arrangement of the truncus sympathicus ganglia prevailed in 16 (80%) cases. Rami communicantes gave anastomoses to spinal nerves. Small ganglia were observed on the rami communicantes to the spinal nerves. In the case of the concentrated type, in 4 cases (20%), we observed a reduction in the number of ganglia, as well as the absence of small ganglia on the connecting branches. Connections between n. vagus and sympathetic branches were poorly developed. We observed right-left asymmetry and differences in the formation of ganglia and anastomoses in the truncus sympathicus in the vertebral and prevertebral section. Variations of distance of n. splanchnicus major were observed in 16 cases (80%).

Conclusion: This study allowed us to identify and describe the morphological peculiarities of the thoracic ANS. The variations were numerous; their preoperative diagnosis is difficult to impossible. The knowledge gained can be helpful in clarifying clinical signs and symptoms.

Background: Borderline personality disorder (BPD) patients commonly suffer from nightmares. Still, the prevalence of this issue does not match the little clinical attention it usually receives. Nightmares impact sleep and daily functioning and may play a role in BPD symptomatology, including suicidality. Since BPD has been linked with high rates of suicide, the potential connection with suicidality is crucial to address.

Aims: To create an up-to-date review of current knowledge on nightmares in BPD and to explore the links between nightmares, insomnia, and suicidality or self-harm in BPD patients.

Method: This narrative review was conducted using the PubMed, Web of Science, and Google Scholar databases to search for articles published between January 1990 and October 2022, using the following key terms: 'borderline personality disorder' and 'nightmares' or 'insomnia' and 'suicidality' or 'self-harm' or 'self-injuring'. The final list consisted of 99 publications.

Results: Sleep disturbances often occur in BPD patients. The prevalence of nightmares in BPD is higher than in general or clinical populations. Nightmares influence borderline personality traits and vice versa through emotional dysregulation, poorer sleep quality, nightmare anxiety, higher arousal, and worsened self-control. A link between nightmares and suicidal behaviour was established in some psychiatric conditions (depression, insomnia); studies on BPD are lacking in this area. Studies comparing nightmares in BPD to other disorders are also missing. There are some suggestions for pharmaceuticals or psychotherapy in treating nightmares, but their application to BPD needs more research.

Conclusion: Sleep disturbance and nightmares are common among individuals with BPD yet underrepresented in research. Nightmares have been linked with suicidality in other conditions (depression, PTSD) but only indirectly in BPD. More clinical studies are needed to explore the phenomenon further.

Chronic pain and drug addiction seriously threaten human health and generate a large loss of labor. Most highly addictive drugs are derived from opioids, which have severe side effects and are difficult to quit completely. On the other hand, opioid analgesics are widely used in detoxification for opioid addiction. These opioids are effective for controlling acute withdrawal symptoms, but can be problematic under long-term usage as maintenance therapy. Both chronic pain and opioid abuse are related to neurotransmitters and central reward pathways in the brain. As to provide new weapons for defending human health, this article summarized the similarities and differences between chronic pain and opioid addiction, based on their common neurobiological basis, and discussed the breakthroughs in targeted therapeutic approaches. Furthermore, we have brought out an innovative and integrative therapeutic scheme by combining drugs, medical devices, and phycological / behavioral therapies, according to the patient's individual situation, aiming at achieving better effects against these two types of diseases.

Purpose: To explore the effects of prepubertal obesity induced by high-fat diet during lactation and post-weaning on puberty onset and the neuroendocrine changes before puberty onset in a female mouse model, which may explain obesity in children starting early puberty.

Methods: A total of 72 female mice were assigned to the high fat diet group (HFD) and the control diet group (CONT) during lactation and post-weaning. The bodily indexes; pathological changes; and protein and gene expression levels in the hypothalamus were examined on postnatal days (P) 15, 28, and 45, respectively.

Results: The average vaginal opening time in HFD mice occurred significantly earlier than that in CONT mice (p < 0.05). On P15, no significant difference in the MKRN3, kisspeptin, GPR54 and GnRH level between HFD and CONT mice was noted (p > 0.05). Whereas on P28 and 45, compared to CONT mice, GnRH expression in HFD mice was significantly increased (p < 0.05); kisspeptin and GPR54 expression in HFD mice was also significantly increased (p < 0.05); but the MKRN3 level in HFD mice was significantly lower than that in CONT mice (p < 0.05). On P15, 28, and 45, compared with CONT mice, miR-30b expression in HFD mice increased (p < 0.05). Compared to P15, miR-30b, KiSS-1, GPR54 and GnRH mRNA level increased significantly, however MKRN3 decreased significantly in HFD mice on P28 and 45 (p < 0.01).

Conclusions: Prepubertal obesity induced by high-fat diet during lactation and post-weaning may advance the time of pubertal initiation in female mice. The increased expression of miR-30b, kisspeptin, GPR54 and GnRH, decreased the expression of MKRN3 may explain the early onset of puberty in obese female mice.

Objective: Light exposure at night is known to produce behavioral aberrations in both human and animal models. One way to mimic light-at-night is through constant light exposure (LL), wherein animals are placed in an environment where a dark phase never occurs. Additionally, the type of housing condition for the rodents in experiments - grouped-housed vs singly-housed - can produce different behavioral responses, even in female mice. This study investigated whether LL produces alterations to emotionality and sociability, and whether group housing can alleviate some of those negative behavioral outcomes in female mice.

Methods: Female Swiss Webster mice were placed into group or single housing conditions and either into a standard 12:12 light:dark cycle or LL. Novelty-induced (open-field, light-dark box) and circadian locomotor activity, sociability, and serum oxytocin were measured during the middle of the day.

Results: LL and group-housing produced alterations to circadian home-cage activity and increases novelty-induced locomotor activity in the open-field and light-dark box. LL led to increased aggression in both group-housed and single-housed mice, while single-housed/LL mice showed reduced encounters towards the social mouse. Group-housed/LL mice exhibited increased interactions with the empty enclosure. Additionally, both LL and group-housing increased oxytocin levels.

Conclusions: The increase in oxytocin may be a contributing factor to why female mice exhibit increased aggression and other impaired social behaviors in LL. Socialization via group housing was ineffective in reducing the negative sociability seen in mice under LL. These results indicate that aberrant light exposure and circadian misalignment are correlated with impaired social behaviors and emotionality.

Objectives: For patients with pituitary adenomas with an intact hypothalamus-pituitary-adrenal axis before surgery, whether routine steroid therapy is needed is still controversial. We conducted a meta-analysis to assess the safety of withholding hydrocortisone compared with hydrocortisone in pituitary adenoma patients during preoperative periods.

Material and methods: We searched PubMed, Embase, Web of Science, and Cochrane Library databases up to November 2022 using inclusion and exclusion criteria. We employed either a fixed-effect or random-effect model for the analysis and assessed heterogeneity using the I2 statistic.

Results: Three studies involving 512 patients out of 400 studies were conducted. The pooled data revealed a higher incidence of postoperative transient diabetes insipidus in the no-hydrocortisone group than in the hydrocortisone group (RR, 1.88; 95% CI, 1.13 to 3.12; p = 0.02). The cortisol level in the no-hydrocortisone group was lower than in the hydrocortisone group after tumor removal (mean difference, -36.82; 95% CI, -44.27 to -29.38; p < 0.00001) but higher on the second day after surgery (mean difference, 4.04; 95% CI, 2.38 to 5.71; p < 0.00001). No significant differences were observed in early adrenal insufficiency (RR, 1.04; 95% CI, 0.37 to 2.96; p = 0.93), adrenal insufficiency in the third month after surgery (RR, 1.56; 95% CI, 0.70 to 3.48; p = 0.28), cortisol level on the first day after surgery (mean difference, 0.24; 95% CI, -11.25 to 11.73; p = 0.97), postoperative permanent diabetes insipidus (RR, 1.61; 95% CI, 0.43 to 6.07; p = 0.48), postoperative delayed hyponatremia (RR, 1.06; 95% CI, 0.41 to 2.74; p = 0.91), or postoperative blood glucose level (mean difference, -0.41; 95% CI, -1.19 to 0.37; p = 0.31) between the no-hydrocortisone and hydrocortisone groups.

Conclusion: Withholding preoperative steroid therapy is safe for pituitary adenomas patients with an intact hypothalamus-pituitary-adrenal axis.

Purpose: Self-awareness can be characterised as impartial, non-judgmental thoughtful attention towards the self. Self-reflection in therapy is when a therapist reviews their experiences, thoughts, and behaviours concerning therapy and changes them as needed to enhance the therapeutic process. Therapists with good quality self-reflection can make more effective and ethical decisions, differentiate their own needs from clients', understand transference and countertransference, and consider the optimal response during a session. Practising the CBT approach and reflecting on one's own experiences can be essential for successful therapeutic development. Furthermore, self-reflection forms the basis of a fruitful therapeutic relationship and the therapist's self-confidence and sense of competence.

Primary hyperparathyroidism (PHPT) in pregnancy is rare and may be associated with increased maternal and fetal morbidity and mortality. The ideal timing for parathyroidectomy is during the second trimester, and parathyroidectomy in the third trimester is extremely rare. We present a case of a 32-year-old woman who was admitted to our hospital with severe hypercalcemia in the 36th week of her first pregnancy. Conventional bilateral neck exploration was performed and parathyroid adenoma was removed. The surgical procedure was tolerated well by the mother, and she delivered a healthy girl 10 days after surgery. The newborn had mild hypocalcemia that required minimal substitution postnatally; however, no tetany occurred. This case demonstrates that parathyroidectomy in the third trimester followed by spontaneous delivery may be performed safely.

Introduction: Insulinomas are rare neuroendocrine tumors of pancreas. Clinical manifestations include various symptoms of hypoglycemia, which is the result of insulin overproduction. Symptoms of hypoglycemia are heterogenous what most probably contributes to diagnostic delay. In this study we retrospectively evaluated clinical features of hypoglycemia. We discovered that a substantial number of patients suffered from hypoglycemia unawareness.

Materials and methods: We performed retrospective analysis of prospectively collected patients with histologically confirmed insulinoma. We evaluated clinical features and signs of hypoglycemia and the duration of symptoms and performed thorough review of the patients' files in order to identify whether patients had been falsely diagnosed previously. Each patient underwent 72 hour fasting test during which levels of immunoreactive insulin (IRI), C-peptide and nadir blood glucose level were obtained. Based on the clinical findings and results of 72 hour fasting test we identified a subgroup of patients with hypoglycemia unawareness. These had an episode of clinically silent hypoglycemia. We compared IRI and C-peptide levels obtained at the time of the fasting test termination in the unawareness group and the group without hypoglycemia unawareness.

Results: Twenty two patients with insulinoma that had been hospitalized in our tertiary center were included in the analysis. Mean age was 51±16.7 years. The most common symptom reported by 63.6% of patients was fatigue, followed by increased appetite with consequent weight gain and the loss of consciousness, both reported by 40.9% of patients. Based on the review of clinical features and the results of the fasting test we identified a group of patients with hypoglycemia unawareness. We labeled the patient accordingly in case of the loss of consciousness in personal history as well as asymptomatic hypoglycemia or severe neuroglycopenic symptoms during the fasting test without any accompanying or preceding clinical signs. There were 7 patients with hypoglycemia unawareness in our cohort (31.8%). Patients with this phenomenon had significantly lower levels of both IRI (2.35±1.25 vs. 5.88±3.92ng/ml, p=0.01) and C-peptide (9.14±7.36 vs. 50±42.8 µU/ml, p=0.01) than the rest of the patients. Nadir blood glucose level during the fasting test showed no significant difference (9.4±8.2 vs. 12.2±8.2 months, p=0.28) in the unawareness group and the rest of the patients, respectively.

Conclusion: We described the phenomenon of unawareness to hypoglycemia in the patients with insulinoma. This has not been recognized in insulinoma patients yet since available evidence mostly relates to type I diabetic patients. It might lead to higher morbidity and diagnostic delay. Further studies with prospective evaluation should be performed to further confirm relatively high prevalence in patients with in