Tailoring the care in patients with chronic heart failure: a feasibility study on psychological support at distance

Continuity of care at home is essential for the management of patients with chronic heart failure (CHF) suffering also from anxiety/depressive symptoms. This study was aimed at evaluating the possibility of providing psychological support to CHF patients after hospital discharge. A psychodynamic model of counselling was approached by telephone by a psychotherapist and evaluated in terms of feasibility. 16 out 67 CHF patients who continue to suffer from mild to moderate anxiety/depressive disorders, which, because of location, transports or infirmity impediments, could not have access to any other care support, were enrolled in this feasibility study. At time of discharge, every 7–10 days for a pilot period of 6 months, patients were followed by a telephone call (lasting 45 min, as an in office visit) by the same psychotherapist who had previously performed in-hospital interview and tests. Evaluation of anxiety and depression and quality of life were performed by appropriate tests (Hospital Anxiety and Depression Scale and WHOQOL-Brief, respectively), questionnaires of satisfaction by patients and operator were also provided. There were 109 total contacts/6 months, with an average of 6.8 ± 3.6 calls per patient. 82 out of 109 calls (75%) were managed in the first 3-month period. Main areas of discussion were the insight and experience of disease and interaction with the health staff. At the end of the 6-month study, six patients needed further specific psychotherapist’s support and the programme was extended till 1 year (42 further calls). More than 90% patients were satisfied of the service. Operator encountered difficulties mainly due to schedule contacts during working time for worker patients. This preliminary study shows the assessment and feasibility of the psychodynamic counselling by telephone in CHF patients which needs further organizational improvement.     

An unusual localization of intraosseus schwannoma: mandibular localization and new pathogenetic prospectives

AIM: The aim of the study is to give an explanation on the Intra-osseous Schwanoma etio-pathogenesis, based on the isto-pathological findings presented by the Authors. MATERIAL OF STUDY: In a 40 years old patient with pain on the territory innervated by the third right trigeminal branch, OPT showed a like ground-glass area that involved the mandible with the mandibular canal disappearance and dental roots resorption. They removed the lesion with preservation of the vascular-neural beam on which the lesion were extremely attached; the histological examination confirmed the diagnosis of intra-osseous Schwannoma. Immunohistochemically the Schwannoma labelled with antibodies to S-100, Vimentin, Osteopontin and Osteonectin. RESULST: The clinical and radiological follow-up after one year since the surgery, using OPT showed an improvement of bone formation and the disappearance of the pain. DIscussioN: Schwannoma rarely presents as an intraosseous mass, comprising less than 1% of all bone tumors with a strong predilection for the mandible. Data like the expression of osteopontin are believed to be distinctive feature of other schwannian cell tumors such as the granular cell tumor. Such data might explain the prevalence of mandibular location among the rare intraosseous schwannomas and might point out that the calcified shwannoma of the skull is similar to an hamartomatous lesion.     

Influence of maternal obesity on insulin sensitivity and secretion in offspring

OBJECTIVE—The purpose of this study was to clarify the effects of maternal obesity on insulin sensitivity and secretion in offspring.RESEARCH DESIGN AND METHODS—Fifty-one offspring of both sexes of obese (Ob group) and 15 offspring of normal-weight (control group) mothers were studied. Plasma glucose, insulin, and C-peptide were measured during an oral glucose tolerance test (OGTT). Insulin sensitivity was calculated using the oral glucose insulin sensitivity index, and insulin secretion and β-cell glucose sensitivity were computed by a mathematical model. Fasting leptin and adiponectin were also measured. Body composition was assessed by dual-X-ray absorptiometry.RESULTS—No birth weight statistical difference was observed in the two groups. Of the Ob group, 69% were obese and 19% were overweight. The Ob group were more insulin resistant than the control group (398.58 ± 79.32 vs. 513.81 ± 70.70 ml⁻¹ · min⁻¹ · m⁻² in women, P < 0.0001; 416.42 ± 76.17 vs. 484.242 ± 45.76 ml⁻¹ · min⁻¹ · m⁻² in men, P < 0.05). Insulin secretion after OGTT was higher in Ob group than in control group men (63.94 ± 21.20 vs. 35.71 ± 10.02 nmol · m⁻², P < 0.01) but did not differ significantly in women. β-Cell glucose sensitivity was not statistically different between groups. A multivariate analysis of variance showed that maternal obesity and offspring sex concurred together with BMI and β-cell glucose sensitivity to determine the differences in insulin sensitivity and secretion observed in offspring.CONCLUSIONS—Obese mothers can give birth to normal birth weight babies who later develop obesity and insulin resistance. The maternal genetic/epigenetic transmission shows a clear sexual dimorphism, with male offspring having a higher value of insulin sensitivity (although not statistically significant) associated with significantly higher insulin secretion than female offspring.Type 2 diabetes is spreading out among young people as the incidence of obesity is increasing over time. This evidence has induced the American Diabetes Association (1) to include into the new classification recommendations of diabetes a form of type 2 diabetes with pubertal onset, variable insulin secretion, and decreased insulin sensitivity, strongly associated with obesity, which includes 10–20% of all diabetes in childhood and youth.Scientists have provided a pathophysiological explanation of this phenomenon by suggesting that the development of type 2 diabetes in youth reflects the combination of insulin resistance and relative insulin deficiency. However, the limited β-cell capacity is regarded as being of “little significance” (2) in the absence of obesity.Familial aggregation of BMI is well established in the medical literature. In a Swedish study on monozygotic twins reared in different familial contexts, within-pair correlations for BMI were 70% for men and 66% for women; these figures were quite similar for twins reared together, suggesting that familial environment did not play a relevant role in BMI in identical twins (3). Similar values for correlation coefficients (75%) were also found in a U.S. population of monozygotic twins (4).However, epigenetics also seems to contribute, together with genetic predisposition, to the development of obesity. Studies of inheritance unequivocally show that BMI of children correlates more closely with maternal than with paternal BMI, suggesting that in addition to the genetic influences, the in utero environment may contribute to the development of obesity in offspring. In fact, overweight/obese women are more likely to give birth to heavier babies (>90th centile) than normal-weight mothers (5). Studies of inheritance clearly demonstrated a stricter correlation between a child''s BMI and maternal rather than paternal BMI, suggesting that the in utero environment may contribute to the development of obesity in offspring (6,7). Gillman et al. (8) found that maternal BMI was an influencing variable in association with gestational diabetes and offspring obesity. Furthermore, Khan et al. (9–11) demonstrated that the consumption of a diet rich in saturated fat starting before conception and continuing through weaning led to increased hyperinsulinemia, adiposity, hypertension, and endothelial dysfunction in offspring at 6 months of age. Very recently, Shankar et al. (5) demonstrated that, at least in rats, maternal overweight at conception contributes to offspring obesity and insulin resistance and that programming of obesity occurs in the absence of changes in birth weights.However, at least to our best knowledge, there is only one study (12) in the literature that investigated insulin sensitivity but not insulin secretion in young lean offspring of obese parents compared with offspring of normal-weight parents. This study (12) failed to demonstrate any significant difference between groups.Our center follows obese subjects almost exclusively, and morbidly obese individuals represent >50% of the outpatient population. Recently, we have started to systematically study insulin sensitivity and insulin secretion in the offspring of obese and morbidly obese patients, after the observation that some of the young individuals with at least one parent, usually the mother, affected by obesity had impaired glucose tolerance (IGT) and/or hypertension independent of their body weight. In the present investigation insulin sensitivity, insulin secretion, and body composition were studied in offspring with a different maternal phenotype, namely normal weight or obesity.     

Valproic acid increases the in vitro effects of nitrosureas on human glioma cell lines

Valproic acid (VPA) has been recently investigated for its anticancer properties in different tumors, including malignant gliomas. The aim of the present work was to evaluate the effects of VPA, alone or in combination with other chemotherapeutic drugs, on in vitro growth of human glioma cell lines. A172, U373, U138, U87, and SW1783 were treated with VPA alone or in combination with mitoxantrone, etoposide, or 1,3-bis(2-chloroethyl)-l-nitrosourea (BCNU). The effects of treatments on cell growth were assessed with crystal violet staining and analyzed using the combination index (CI). The percentage of apoptotic cells and the DNA content for cell cycle phases detection were also investigated by flow cytometry. Despite a certain variability, glioma cell lines were rather resistant to the drugs tested. Addition of VPA decreased the IC50 of the chemotherapeutic agents in all cell lines tested. This effect was more evident with BCNU. The synergic effect of the association of VPA and BCNU was related to an increased block of cell cycle with accumulation in S-G2/M phases of cell cycle rather than an increased programmed cell death. In our experimental model, VPA showed anticancer properties per se on human glioma cell lines and our data support the hypothesis that, if used in association with conventional chemotherapy, it might improve the effects of single chemotherapeutic agents.     

Thyroid Function and Insulin Sensitivity Before and After Bilio-pancreatic Diversion

Background  

Bilio-pancreatic diversion (BPD) induces permanent weight loss in previously severe obese patients through a malabsorptive mechanism. The aim of the study was to evaluate the modifications of circulating thyroid hormones after BPD, a surgical procedure which interferes with the entero-hepatic circulation of biliary metabolites.