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Chronic stress leads to many psychiatric disorders, including social and anxiety disorders that are associated with over-activation of neurons in the basolateral amygdala (BLA). However, not all individuals develop psychiatric diseases, many showing considerable resilience against stress exposure. Whether BLA neuronal activity is involved in regulating an individual's vulnerability to stress remains elusive. In this study, using a mouse model of chronic social defeat stress (CSDS), we divided the mice into susceptible and resilient subgroups based on their social interaction behavior. Using in vivo fiber photometry and in vitro patch-clamp recording, we showed that CSDS persistently (after 20 days of recovery from stress) increased BLA neuronal activity in all the mice regardless of their susceptible or resilient nature, although impaired social interaction behavior was only observed in susceptible mice. Increased anxiety-like behavior, on the other hand, was evident in both groups. Notably, the CSDS-induced increase of BLA neuronal activity correlated well with the heightened anxiety-like but not the social avoidance behavior in mice. These findings provide new insight to our understanding of the role of neuronal activity in the amygdala in mediating stress-related psychiatric disorders.
Subject(s)
Animals , Mice , Amygdala , Anxiety/etiology , Anxiety Disorders , Avoidance Learning , Mice, Inbred C57BL , Social Behavior , Stress, Psychological/complicationsABSTRACT
This review describes the cognitive function impairment and recovery during the active and remission phases of Cushing’s syndrome (CS) , a glucocorticoid over-exposure disease. Memory, attention, executive ability, and intelligence disorders are included. A comprehensive view of the present studies on the CS-related cognitive functions provides new ideas for a simpler and full-scale psycho-cognitive assessment of neuroendocrine diseases.
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Gliomas are malignant tumors with strong invasiveness. The current treatment strategy is surgical treatment assisted by a variety of radiotherapies, chemotherapies and immunotherapies. However, the curative efficacy is limited. Adrenergic receptor (AR) is an important stress hormone receptor, which is highly involved in the regulation of the tumorigenesis and progression of various tumors by activating different downstream signal transduction pathways. Recent studies have shown that AR is dysregulated in glioma cells and tissues, and plays an important role in a series of biological behaviors such as tumorigenesis, invasion and metastasis of glioma. This article reviews the research progress of AR in the field of glioma in recent years, which provides a theoretical basis for the prevention and treatment of glioma targeting the AR.
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Humans , Brain Neoplasms , Pathology , Carcinogenesis , Cell Line, Tumor , Cell Proliferation , Gene Expression Regulation, Neoplastic , Glioma , Pathology , Neoplasm Invasiveness , Neoplasm Metastasis , Receptors, Adrenergic , Physiology , Signal TransductionABSTRACT
Objective:To investigate the clinical features and pathological classification of patients with nonfunctional pituitary adenomas(NFPAs)in single medical center according to 2017 World Health Organization.Methods:The clinical and pathological characteristics of 166 patients with NFPAs diagnosed by neurosurgery in Peking Union Medical College Hospital from April 2019 to January 2020 were analyzed retrospectively.Results:In 166 patients, the ratio of male to female was almost equal(1.05∶1). Their average operation age was(49.9±12.3) years, which was significantly higher than that of functional pituitary tumor patients in the same period. Headache, visual acuity decline, and visual field defect were the most common causes for the first visit. All the maximum diameter of tumors was more than 10 mm, and 15 cases(9.0%)were giant tumors. 18 patients(10.8%)were recurrent cases. According to the results of immunohistochemistry for anterior pituitary hormones and transcriptional factors, the most common pathological type was gonadotroph adenomas(50.6%), followed by corticotroph adenomas(24.7%), plurihormonal pituitary adenomas(11.4%), PIT-1-positive adenomas(6.6%), and null cell adenomas(6.6%). Gonadotroph adenomas were more common in men(male∶female ratio=4.1∶1), while corticotroph adenomas occurred mainly in women(male∶female ratio=1∶12.7). The average age of patients with gonadotroph adenomas was the highest, while those of patients with PIT1-positive adenomas and rare combining IHC plurihormonal pituitary adenoma were significantly lower than that of the former. There were no significant differences in the mean diameters of tumors, the proportion of giant adenomas, and recurrent cases among different pathological types of tumors. However, the mean Ki-67 index of PIT-1-positive adenomas was significantly higher than those of other groups( P=0.001). Conclusion:Although the clinical manifestations of NFPAs were similar, their pathological classifications were different. Gonadotroph adenomas occurs mainly in male patients while corticotroph adenomas is more common in women. The prognosis may be different among various pathological types of NFPAs.
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Objective To explore the influence of the iodine disinfection on nasal bacterial colonization through the transsphenoidal approach. Methods Totally 133 pituitary adenoma patients who underwent transsphenoidal surgery in our department from January to August 2017 were enrolled in this study. Before disinfection,pharyngeal swabs of inferior turbinate root secretions were taken for bacterial culture. After iodine disinfection,pharyngeal swabs were taken again at the same site. Changes in the nasal bacterial spectrum before and after disinfection were compared. Patients were followed up for three months after the surgery,during which any intracranial infection/bacteraemia was recorded,and its correlation with nasal bacteria colonization was analyzed. Results Nasal bacterial colonization was detected in 45 (33.8%) of 133 patients before iodine disinfection and in only 6 cases (4.5%) after iodine disinfection (χ=34.5,P=0.000). Thus,iodine disinfection eliminated 86.7%(39/45) of the colonized bacteria. The most common nasal bacterium was Staphylococcus aureus (24.4%,11/45),followed by Klebsiella pneumoniae (24.4%,11/45),and Staphylococcus epidermidis (13.3%,6/45). One patient had high fever and chills 2 days after surgery,but blood culture and cerebrospinal fluid culture showed negative Results . After the administration of third-generation cephalosporins,the symptoms disappeared after two days. Conclusion sThere are colonized bacteria in nasal cavity. Iodine disinfection of nasal cavity can effectively clear most of the nasal bacteria. The possibility of intracranial infection/bacteremia after transsphenoidal approach is low.
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Objective To evaluate the incidence and microbiology profile of infectious complications ( namely menin-gitis and/or bacteremia ) after trans-sphenoidal pituitary adenomectomies ( TSPA ) .Methods All hospitalized patients undergoing TSPA in Dept .Neurosurgery of Peking Union Medical College Hospital ( PUMC) between January 2012 and December 2016 were retrospective recorded .Results The incidence of postoperative meningitis and/or bacteremia was 1.2%( 59/5098) .27 cases of meningitis were documented for a total of 41 isolates, 26 cases of bacteremia for 34 isolates, and 6 cases of coinfection.Gram-positive organisms predominated (27 cases, 65.9%) in meningitis, among which Coagulase-negative staphylococci were the main isolates (14 cases).The most common organisms causing bacteremia were Gram-negative organisms (25 case,73.5%),including Klebsiella pneu-monia ( 9 cases ) , Enterobacter aerogenes ( 7 cases ) and Escherichia coli ( 5 cases ) , all of which were sensitive to amikacin, imipenem and meropenem .Fifty-two patients were cured after antibiotic treatment , whereas 7 died.The morality in patients with meningitis was relatively lower than those with bacteremia (21.2%vs 3.1%,P<0.001). Conclusions Postoperative meningitis and/or bacteremia can occur after TSPA .They differ in etiology profile and prognosis , and should be treated with proper antibiotics according to the drug resistance .
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Exosome is a kind of functional vesicles secreted to the extracellular matrix .The role of glioma exosomes in the development , diagnosis and treatment of glioma is increasingly recognized .This review aims to summarize the most common biomarkers of glioma exosomes and the applications of exosomes in treatments , which mainly includes mediating immune therapy , anti-tumor therapeutic vehicles , and intervention of intercellular communications in tumor cells.
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Neoplasms are well known to be a complication in cases of acromegaly,especially thyroid and colorectal neoplasia. The incidence and mortality of neoplastic complications in acromegaly patients are higher than that of the general population,the pathogenesis of which is correlated with elevated serum levels of insulin-like growth factor 1 (IGF-1) and activation of IGF-1 signaling pathway. Early screening and intervention of neoplastic complications play an important role in decreasing the mortality of acromegaly patients.
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Neoplasms are well known to be a complication in cases of acromegaly,especially thyroid and colorectal neoplasia. The incidence and mortality of neoplastic complications in acromegaly patients are higher than that of the general population,the pathogenesis of which is correlated with elevated serum levels of insulin-like growth factor 1 (IGF-1) and activation of IGF-1 signaling pathway. Early screening and intervention of neoplastic complications play an important role in decreasing the mortality of acromegaly patients.
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Objective To explore the application of video laryngoscope in patients with pituitary adenoma during endotracheal intubation.Methods Fifty-one patients (19 males, 32 females, aged 18-71 years, ASA physical status I or II) scheduled for resection of pituitary adenoma under general anesthesia were enrolled.These patients were randomly divided into two groups: Macintosh laryngoscope Group (group M, n=25) and Video laryngoscope Group (group VL, n=26).When performing endotracheal intubation, Macintosh laryngoscope was used to expose the glottis in group M, and video laryngoscope was used in group VL.Head tilted backward angle, mouth opening, thyromental distance, neck circumference, mandibular ramus length, modified Mallampati classification and the difficulty classification of mask ventilation of the patients in two groups were recorded during peri-operation period.The Cormark-Lehane grade, needed pressing of the cricoids cartilage, the ratio of a second attempt during intubation and the intubation time consumed were recorded.Results Less patients in group VL needed cricoids cartilage press (7.7% vs 48.0%) during the intubation than that in group M (P<0.01).Compared with group M, the Cormack-Lehane grade was significantly lower (P<0.01) and the intubation time consumed was significantly shorter in group VL [(32.4±11.7)s vs (45.8±12.6)s] (P<0.01).Conclusion In patients with pituitary adenoma,video laryngoscope may improve the glottis exposure and the success rate of intubation, as well as shorten the intubation time.
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Objective To investigate the correlation between different postoperative serum cortisol cut-off values measured in different periods and the long-term outcomes in patients with Cushing's disease (CD). Methods The clinical data of 102 CD patients undergoing transsphenoidal surgery (TSS) in Peking Union Medical College Hospital from May 1985 to July 2008 were analyzed retrospectively. The differences of long-term outcomes were compared between patients with cortisol levels below 2 μg/dl (2 μg/dl group) and levels between 2 and 5 μg/dl (5 μg/dl group) in the 1postoperative day and 3 and 6 months after surgery. Results The mean follow-up duration was (10.7±1.7) years (range:5-29.1 years). Among these 102 patients,the disease was cured in 74 patients (72.5%) and recurred in 28 patients (27.5%). On the 1postoperative day,there were 63 patients in the 2 μg/dl group,in which 48 patients (76.2%) achieved long-term cure;there were 39 patients in the 5 μg/dl group,in which 26 (66.7%) achieved long-term cure. The difference was not statistically significant (χ=1.097,P=0.295). Three months after TSS,the long-term cure rate was 84.2% (48/57) in the 2 μg/dl group,which was significantly higher than that (65.0%,26/40) in the 5 μg/dl group (χ=4.795,P=0.029). Six months after TSS,the long-term cure rate was 88.7% (47/53) in the 2 μg/dl group,which was significantly higher than that(69.2%,27/39) in the 5 μg/dl group(χ=5.400,P=0.020). Conclusion The serum cortisol level of below 2 μg/dl is more useful than 2-5 μg/dl 3 months and 6 months after surgery in predicting the prognosis of CD patients.
Subject(s)
Humans , Follow-Up Studies , Hydrocortisone , Blood , Pituitary ACTH Hypersecretion , Blood , General Surgery , Postoperative Period , Prognosis , Recurrence , Retrospective StudiesABSTRACT
<p><b>OBJECTIVE</b>To explore the effect of transsphenoidal adenectomy on glucose tolerance status in patients with growth hormone (GH)-secreting pituitary adenoma.</p><p><b>METHODS</b>The clinical data of 105 patients with GH-secreting pituitary adenoma who underwent transsphenoidal adenectomy in our department in 2013 were retrospectively analyzed. The glucose tolerance status, GH level, and insulin-like growth factor-1 (IGF-1) level before and after surgery were compared.</p><p><b>RESULTS</b>Among these 105 patients, the blood glucose tolerance status included normal glucose tolerance (NGT) in 47 cases (44.8%), early carbohydrate metabolism disorders (ECMDs) in 26 cases (24.8%), and diabetes mellitus (DM) in 32 cases (30.5%) before surgery. After the surgery, the fasting blood glucose (P=0.006, P=0.017) and postprandial blood glucose (P=0.000, P=0.000) in the ECMDs and DM groups were significantly improved. Also, the random GH (P=0.001, P=0.004, P=0.001), nadir GH (P=0.000, P=0.001, P=0.001), and IGF-1 (P=0.005, P=0.000, P=0.000) significantly decreased during the follow-up period in NGT, ECMDs and DM groups. Compared with ECMDs and DM groups, the decrease in fasting blood glucose (P=0.029, P=0.000), postprandial blood glucose (P=0.003, P=0.000), and serum IGF-1 (P=0.048, P=0.000) were more significant in DM group.</p><p><b>CONCLUSIONS</b>Transsphenoidal adenectomy can improve the blood glucose, GH, and IGF-1 levels in patients with growth hormone-secreting pituitary adenoma. Meanwhile,the surgery has a better effect in improving the glucose tolerance status and IGF-1 in patients with preoperatively confirmed DM.</p>
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Humans , Adenoma , Blood Glucose , Diabetes Mellitus , Glucose , Growth Hormone-Secreting Pituitary Adenoma , Human Growth Hormone , Insulin-Like Growth Factor I , Retrospective StudiesABSTRACT
Objective To analyze the predictive factor of surgical efficacy in male patients with prolactinoma. Method The clinical data of 184 male patients with prolactinoma who had undergone surgery were retrospectively analyzed.Results Before the surgery,the serum prolactin level from 150 to 204 952 ng/ml,the tumors sized 6 to 70 mm. Macroadenoma was seen in 152 cases (82.6%) and suprasellar adenoma with visual deficitsin 75 cases (40.7%). Complete resection was achieved in 149 patients. After surgical therapy,postoperative immediate prolactin level declined in 182 patients (98.4%);57 patients (31.0%)achieved initial remission,while the disease recurred in 26 patients (45.6%).Larger tumor had significantly lower rate of complete resection (P<0.05). The recurrence rate was significantly higher in the group with higher Ki-67 index (P<0.001). The recurrence rate was significantly lower in patients with intrasellar adenoma (P<0.001).No significant relationship was found between preoperative prolactin level and complete resection (P=0.306). Conclusions Tumor size can predictthe degree of surgical resection. The prognostic factors include tumor size,preoperative growth pattern of prolactinoma,and Ki-67 index.
Subject(s)
Humans , Male , Neoplasm Recurrence, Local , Pituitary Neoplasms , Pathology , General Surgery , Postoperative Period , Prolactin , Blood , Prolactinoma , Pathology , General Surgery , Retrospective StudiesABSTRACT
Few preoperative extrapontine myelinolysis (EPM) cases with pituitary adenoma have been reported. No such case had long follow-up to see the outcome of EPM. We reported a 38-year-old man complaining of nausea, malaise and transient loss of consciousness who was found to have severe hyponatremia. Neurologic deficits including altered mental status, behavioral disturbances, dysarthria and dysphagia developed despite slow correction of hyponatremia. Endocrine and imaging studies revealed hypopituitarism, nonfunctional pituitary macroadenoma and extrapontine myelinolysis. Transsphenoidal surgery was performed after three weeks of supportive therapy, when neurological symptoms improved significantly. The patient recovered function completely 3 months after surgery. Our case indicates that outcome of EPM can be good even with prolonged periods of severe neurologic impairment.
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Adult , Humans , Deglutition Disorders , Dysarthria , Follow-Up Studies , Hyponatremia , Hypopituitarism , Myelinolysis, Central Pontine , Nausea , Neurologic Manifestations , Pituitary Neoplasms , UnconsciousnessABSTRACT
Cushing's disease (CD) is a relatively rare disease,characterized by pathological hypercortisolism secondary to excessive adrenocorticotrophic hormone that is secreted by pituitary adrenocorticotrophic hormone adenoma or hyperplasia. In addition to the typical clinical symptoms such as moon face,buffalo hump,and central obesity,the CD patients may also experience mental disorders and cognitive dysfunction. This review mainly focuses on the cognitive state of CD patients,the mechanisms of cognitive impairment caused by high cortisol levels,and the imaging findings (especially magnetic resonance imaging) for the evaluation of cognitive functions.
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Humans , Adenoma , Cognition , Cognitive Dysfunction , Diagnosis , Cushing Syndrome , Hyperplasia , Magnetic Resonance Imaging , Pituitary ACTH Hypersecretion , Pituitary NeoplasmsABSTRACT
<p><b>OBJECTIVE</b>To investigate the risk factors contributing to the development of obstructive sleep apnea hypopnea syndrome (OSAHS) and sleep hypopnea (SH) in patients with growth hormone-secreting pituitary adenoma (GHPA).</p><p><b>METHODS</b>A total of 85 patients with GHPA recruited strictly according to the inclusion and exclusion criteria underwent sleep monitoring overnight. Clinical manifestations, laboratory data and magnet resonance images were collected for analysis of the risk factors of GHPA and SH using binary logistic regression analysis.</p><p><b>RESULTS</b>The prevalence rate of OSAHS was 62.4% (53/85), and that of SH was 75.3% (64/85) in the recruited patients with GHPA. Regression analysis showed that age (OR=1.107) and BMI (OR=1.166) were the risk factors for OSAHS, and BMI (OR=1.334) was the risk factor of SH.</p><p><b>CONCLUSION</b>Ageing and an increased BMI are independent risk factors for OSAHS and SH in patients with GHPA. Preoperative sleep monitoring should be routinely conducted to ensure early diagnosis of OSAHS and SH, and patients with GHPA should be advised to control their body weight to lower the mortality associated with the respiratory system.</p>
Subject(s)
Humans , Age Factors , Body Mass Index , Growth Hormone-Secreting Pituitary Adenoma , Polysomnography , Prevalence , Risk Factors , Sleep , Sleep Apnea Syndromes , Sleep Apnea, ObstructiveABSTRACT
Objective To investigate the correlation between the uptake of 68Ga-DOTATATE in pituitary adenoma and clinical parameters such as hormonal hypersecretion,and to evaluate the curative effect with 68Ga-DOTATATE imaging after octreotide therapy in patients with growth hormone-secreting adenoma (GH adenoma).Methods A total of 34 patients (15 males,19 females) with pituitary adenoma were recruited,including 5 adrenocorticotropic hormone-secreting adenoma (ACTH adenoma),17 GH adenoma,and 12 non-functioning adenoma (NF adenoma).In the 17 patients with GH adenoma,there were 13 patients treated by octreotide intramuscular injection 3 times with a total dose of 60 mg for 3 months.The finial diagnosis was based on histology.68Ga-DOTATATE imaging was performed,and SUV tumor volume and density index (DI) were recorded in all patients.The DI was the ratio of tumor SUVmean to tumor volume.The effective therapy was defined as more than 50％ of hormonal suppression or more than 20％ of tumor shrinkage.Non-parametric Mann-Whitney u test was used.Results NF adenoma showed greater tumor volume than secretory adenoma,((9.10±7.00) cm3 vs (2.92±1.60) cm3,u=43.0,P＜0.05),whereas DI of secretory adenoma was higher than that of NF adenoma (7.16±4.52 vs 1.08±1.40,u=48.5,P＜0.05).Additionally,DI was significantly higher(3.55±0.91 vs 1.38±0.69,u =2.0,P＜0.05) in patients (n =8) with effective treatment than that in patients without effective treatment (n =5).Conclusion 68 Ga-DOTATATE may be a useful probe for PET imaging in patients with pituitary adenoma,and may be valuable for predicting the therapeutic effect of somatostatin analog treatment.
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Acute spinal cord injury(ASCI),mainly caused by traffic accidents and fall injuries,is a catastrophic event that can profoundly affect the trajectory of a patient's life. Debate continues over the medical management of ASCI,in particular the usefulness,dosage,and potential risks of methylprednisolone(MP). Although the results of American National Acute Spinal Cord Injury Study 2 and 3 trials led to the wide adoption of a high-dose MP regimen for ASCI patients,the reliabilities of their study methods and data were still questionable. Based on the currently available literature,we conclude that high-dose MP is no longer a recommended therapy for ASCI;however,due to the lack of effective treatment,it remains a useful option for this condition.
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Humans , Clinical Trials as Topic , Methylprednisolone , Therapeutic Uses , Neuroprotective Agents , Therapeutic Uses , Spinal Cord Injuries , Drug Therapy , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To compare clinical outcomes of endoscopic thyroidectomy via mammary areola approach and conventional via chest wall and breasts approach.</p><p><b>METHODS</b>A total of 480 cases undergoing endoscopic thyroidectomy for thyroid nodules between September 2002 and September 2012 were reviewed, including 280 cases via the chest wall and breasts approach between September 2002 and August 2009 and 190 cases via mammary areola approach between September 2002 and September 2012. The mean operation time, the location and diameter of the puncture pore, intraoperative bleeding volume, the mean hospital stay after surgery, postoperative pain score scaled by visual analog scores (VAS) were compared between groups. After 3-month follow-up, long term post-surgical complications, the recurrence rates of nodules and scar cosmetic satisfaction evaluation were also compared. Statistical methods including χ(2) test, Students' test and ANOVA analysis were applied.</p><p><b>RESULTS</b>Two groups were followed for 12 months. The differences between groups were statistically obvious in variables of diameters of the puncture pore (15.5 mm ± 4.9 mm vs. 20.6 mm ± 7.6 mm, t = 2.42, P = 0.046) , intraoperative bleeding volume (16.2 ml ± 4.5 ml vs. 30.5 ml ± 11.4 ml, t = 2.53, P = 0.032) , pain score on the first day after operation (1.5 ± 0.4) and (1.0 ± 0.2), (t = 4.68, P = 0.020) , scar cosmetic satisfaction evaluation 3 months after operation (χ(2) = 6.20, P < 0.05) , chest wall numbness (0 vs. 72.4%,χ(2) = 380, P = 0.000) . But there were no significant differences in the mean operation time, the mean hospital stay after surgery, and the recurrence rates of nodules between two groups.</p><p><b>CONCLUSION</b>Minimally invasive endoscopic thyroidectomy via mammary areola approach is a safe and effective method for the surgery of thyroid nodules with good aesthetic outcome.</p>
Subject(s)
Adolescent , Adult , Female , Humans , Male , Middle Aged , Young Adult , Endoscopy , Thyroid Neoplasms , General Surgery , Thyroidectomy , Methods , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To evaluate the factors of CXCR4, CXCL12, CD44, and CD147 as early potential diagnostic biomarkers by determining their expression levels in invasive and non-invasive pituitary adenomas.</p><p><b>METHODS</b>Fresh pituitary adenoma specimens were collected from 35 pituitary adenoma (21 invasive and 14 non-invasive) patients who underwent surgical treatment in our Neurosurgery Department between January and April of 2009. The expression levels of CXCR4, CXCL12, CD44, and CD147 were evaluated firstly by flow cytometry, fluorescence microscopy in single cell suspensions, and then by immunohistochemical staining of paraffin tissue sections.</p><p><b>RESULTS</b>Flow cytometric analyses showed that the percentage of CXCR4- and CXCL12-positive cells from invasive pituitary adenomas (IPA) was significantly higher in the single cell suspensions than that from non-invasive pituitary adenomas (nIPA) (P<0.05). Immunohistochemical staining revealed that CXCR4 and CXCL12 staining index scores of the invasive pituitary adenomas were significantly higher than those of the non-invasive pituitary adenomas (P<0.05). In contrast, neither flow cytometry nor immunohistochemical staining demonstrated significant difference between CD44 and CD147 expression levels, respectively.</p><p><b>CONCLUSION</b>Expression levels of CXCR4 and CXCL12 are correlated with the invasiveness of pituitary adenomas. Therefore, rather than CD44 and CD147, CXCR4 and CXCL12 may potentially serve as biomarkers for early detection of pituitary adenomas.</p>