Alterations in Serum Leptin in Chronic Liver Disease

The role of leptin in anorexia associated with liver cirrhosis remains controversial. The aim of this study was to quantify the serum leptin level in patients with hepatocellular or cholestatic liver disease and to assess its relationship with serum insulin, body mass index, and serum lipoproteins. The study population included 30 women, 15 with chronic hepatocellular liver disease and 15 with primary biliary cirrhosis; severity of disease was determined by Child-Pugh and histological criteria, respectively. Ten healthy, age-matched women served as controls. Levels of serum leptin and insulin were determined by radioimmunoassay. Mean serum leptin level was significantly lower in the primary biliary cirrhosis group compared to both the control (P 0.05) and the hepatocellular groups (P 0.05). Serum leptin level strongly correlated with body mass index in the hepatocellular group (P < 0.0001) and the controls (P < 0.001), but not in the primary biliary cirrhosis group; it showed no correlation with severity of liver disease. A positive correlation was found between serum leptin and serum cholesterol (P = 0.02), low density lipoprotein (P = 0.01), and triglycerides (P = 0.04) in the hepatocellular group and in the controls between serum leptin and serum high density lipoproteins (P = 0.01). Serum leptin is low in patients with primary biliary cirrhosis. The combined findings of normal insulin response less insulin resistance, and lower serum leptin level in primary biliary cirrhosis compared to hepatocellular liver disease may indicate that serum leptin is merely a passive marker and not a cause of anorexia in liver disease.     

Visual deterioration during pregnancy due to skull base tumors compressing the optic apparatus

Intracranial tumors may rapidly enlarge during pregnancy. When the tumor abuts the optic apparatus, tumor growth may cause visual deterioration. The decisions regarding the management of these tumors should take into consideration visual function, fetal and maternal safety, and the ability for total resection of the tumor. The objective of the study was to describe our experience and to establish principles for management of intracranial tumors compressing the optic apparatus that present during pregnancy or in the early post partum period. A retrospective case-series review was conducted. Women who presented with visual deterioration either during pregnancy or in the early post partum period due to an intracranial tumor were included. Neurosurgical and obstetrical data were collected from the patients’ hospital files and outpatient clinic records. Between 2005 and 2011, nine pregnant women with visual deterioration were diagnosed and treated. Of them, four underwent a neurosurgical procedure during pregnancy. Of the five patients who underwent surgery for tumor resection after delivery, three required urgent cesarean section either due to acute visual deterioration or obstetrical reasons. There was no maternal or fetal mortality and a good overall neonatal outcome was achieved. Improvement in visual acuity and visual fields was achieved in all patients. Postoperative complications included two cases of CSF leak, which resolved after treatment. Visual deterioration during pregnancy due to tumors that compress the optic apparatus requires treatment by a multi-disciplinary team. Surgery is well tolerated by mother and fetus during early and midpregnancy; thus, in cases where visual deterioration is detected, delay of surgery is not justified.     

Let's ask them: a national survey of definitions of quality of life and its enhancement among people aged 65 and over

This study aimed to explore older peoples' definitions of, and priorities for, a good quality of life for themselves and their peers. Nine hundred and ninety-nine people aged 65 and over, living at home in Britain, were interviewed for the study. Good social relationships were the most commonly mentioned constituent that gave respondents' lives quality (mentioned by 81 percent). Other important factors were social roles and activities, health, psychological outlook and well-being, home and neighborhood, finances, and independence. Poor health was most often mentioned as taking quality away from life (by 50 percent). Social relationships and health were judged to be the most important areas. Having health and enough money were the two most frequently mentioned things that would improve the quality of their own lives and those of their peers (though in different order of magnitude). The need for dynamic, multidimensional, and integrated models of quality of life in older age is suggested by these results.     

Understanding the health impact of caregiving: a qualitative study of immigrant parents and single parents of children with cancer

Purpose

Research looking at the health of parents of children with cancer typically uses outcome measures focused on symptoms of anxiety, depression, or post-traumatic stress. Our team builds on this literature to provide a more comprehensive understanding of the health impact of caregiving.

Methods

Interviews were conducted with 79 Canadian parents of children with cancer at least 6?months post-diagnosis. Line-by-line coding was used to establish categories and themes. Constant comparison was used to examine relationships within and across codes and categories. Interviewing continued until no new themes emerged.

Results

Parents described health concerns as including sleep disturbance, daytime fatigue, anxiety, depression, social isolation, and changes in social roles. Parents described the positive impacts of caregiving as including gaining a greater appreciation for child and family and developing compassion, empathy, patience, inner strength, and new perspectives on life.

Conclusion

Parents of children with cancer can experience a range of health problems due to the emotional impact of a cancer diagnosis and the intensive and often prolonged nature of treatment and aftercare. Given the central role parents play as caregivers, it is crucial to understand the health impact of caregiving so that supportive interventions can be implemented as necessary.     

Overexpression of semaphorin 3A in patients with urothelial cancer

Objective

A highly sensitive and specific urine marker for the detection of recurrent urothelial cancer and for screening healthy population or people at risk for urothelial cancer has not been found yet. As urine cytology is not sensitive enough, patients with non–muscle-invasive bladder cancer need lifelong follow-up involving multiple invasive cystoscopies. Our aims of study were to examine the expression of semaphorin 3A in urothelial cancer patients and to evaluate semaphorin 3A as a potential marker for urothelial cancer.

Dysfunctional Pain Modulation in Torture Survivors: The Mediating Effect of PTSD

Trauma survivors, and particularly torture survivors, suffer from high rates of chronic pain and posttraumatic stress disorder (PTSD) for years afterward, along with alterations in the function of the pain system. On the basis of longitudinal data on PTSD symptomatology, we tested whether exposure to torture, PTSD or PTSD trajectories accounted for chronic pain and altered pain perception. Participants were 59 torture survivors and 44 age-matched healthy control subjects. Chronic pain was characterized. Pain threshold, pain tolerance, conditioned pain modulation (CPM), and temporal summation of pain were measured. Three PTSD trajectories were identified among torture survivors; chronic, delayed, and resilient. Lack of CPM and more intense chronic pain was found among the chronic and delayed groups compared with the resilient and healthy control groups. Temporal summation of pain was strongest among the chronic group. PTSD trajectories mediated the relationship between torture and CPM. It appears that the duration and severity of posttraumatic distress, rather than the exposure to trauma, are crucial factors that mediate the association between trauma and chronic pain. Because PTSD and its resultant distress are measurable, their evaluation seems particularly important in the management of pain among trauma survivors. The results may be generalized to other instances in which chronic pain persists after traumatic events.

Suicide Ideation and Deliberate Self-Harm among Ex-Prisoners of War

The current study aims to assess the relations among war captivity, PTSD, suicidal ideation (SI), and deliberate self-harm (DSH) among former prisoners of war (ex-POWs). Israeli ex-POWs (N = 176) and a matched control group of combat veterans (controls; N = 118) were assessed using self-report measures. Ex-POWs with PTSD reported higher levels of both SI and DSH compared to ex-POWs and comparable veterans without PTSD. Furthermore, captivity-related variables as well as PTSD symptom clusters were positively related to both SI and DSH. However, only loss of emotional control in captivity and posttraumatic intrusion and emotional numbing symptoms, predicted SI. Ex-POWs with PTSD endorse high levels of SI and DSH. Among ex-POWs, both SI and DSH share similar captivity-related and posttraumatic symptoms correlates but only posttraumatic intrusion and emotional numbing symptoms predict SI.