Pituitary deficiency after aneurysmal subarachnoid hemorrhage

OBJECTIVE:

Aneurysmal subarachnoid hemorrhage puts patients at high risk for the development of pituitary insufficiency. We evaluated the incidence of pituitary dysfunction in these patients and its correlation with clinical outcome.

METHODS:

Pituitary function was tested in 66 consecutive patients in the first 15 days after aneurysmal subarachnoid hemorrhage. The following were measured in all patients: thyroid-stimulating hormone, free thyroxine, triiodothyronine, luteinizing hormone, follicle-stimulating hormone, total testosterone (in males), estradiol (in females), prolactin, serum cortisol, plasma adrenocorticotropic hormone, growth hormone and insulin growth factor.

RESULTS:

The endocrine assessment was made at a mean of 7.4 days (standard deviation ±6.6) after subarachnoid hemorrhage. Forty-four (66.7%) female and 22 (33.3%) male patients were evaluated. Thirty-nine patients (59.1%) had some type of pituitary dysfunction. Follicle-stimulating hormone/luteinizing hormone deficiency was the most frequent disorder (34.8%), followed by growth hormone/insulin growth factor (28.7%), adrenocorticotropic hormone (18.1%) and thyroid-stimulating hormone (9%). Seventeen (25.7%) patients showed deficiencies in more than one axis. A greater incidence of hormone deficiency was observed in patients with a Glasgow Coma Scale score ≤13 (t test, p = 0.008), Hunt-Hess grade ≥4 (t test, p<0.001), or Fisher grade 4 (t test, p = 0.039). Hormone deficiency was not significantly associated (p>0.05) with increased hospitalization or clinical outcome.

CONCLUSION:

Pituitary dysfunction was identified in a substantial portion of patients with previous aneurysmal subarachnoid hemorrhage, but no association was found between this dysfunction and poor clinical outcome.     

Correlation between corpus callosum shape and cognitive performance in healthy young adults

Corpus callosum (CC) might be related to cognitive performance because of its role in interhemispheric communication. Previous research has focused mainly on volumetric analyses of the CC, yielding contradictory results to some extent. Shape is an approach that integrates and extends the data obtained with the volumetric methodology. Here, we analyze the relationships between midsagittal CC shape variation and several cognitive measures. 2D coordinates from 102 MRI-scanned young adult human CCs were superimposed through a Procrustes approach. The residual variation was regressed onto 21 cognitive measures completed by the participants. Most of these measures (including general intelligence, working memory, executive functioning, and mental speed) were unrelated to midsagittal CC morphology. However, attentional control did show consistent and significant correlations with CC shape variation. Slower responses in attentional control were systematically associated with more curved and thinner CC, with consequent rotation of the splenium and the genu. Although the magnitude of the correlations suggests a small relationship of midsagittal CC geometry and attention, the results provide interesting clues regarding the links between brain anatomical configuration and human cognitive function.     

Calorie restriction and rapamycin inhibit MMTV-Wnt-1 mammary tumor growth in a mouse model of postmenopausal obesity

Obesity is an established risk and progression factor for postmenopausal breast cancer. Interventions to decrease caloric intake and/or increase energy expenditure beneficially impact tumor progression in normoweight humans and animal models. However, despite the increasingly high global prevalence of obesity, the effects and underlying mechanisms of these energy balance modulating interventions are poorly characterized in obese individuals. The goal of this study was to better characterize the mechanism(s) responsible for the link between energy balance and breast cancer progression in the postmenopausal obesity context. We compared the effects of calorie restriction (CR), treadmill exercise (EX), and mammalian target of rapamycin (mTOR inhibitor) treatment on body composition, serum biomarkers, cellular signaling, and mammary tumor growth in obese mice. Ovariectomized C57BL/6 mice were administered a diet-induced obesity regimen for 8 weeks, then randomized into three treatment groups: control (semipurified diet fed ad libitum, maintained the obese state); 30% CR (isonutrient relative to control except 30% reduction in carbohydrate calories); and EX (control diet fed ad libitum plus treadmill exercise). Mice were implanted with syngeneic MMTV-Wnt-1 mammary tumor cells at week 12. Rapamycin treatment (5 mg/kg every 48 h) started at week 14. Tumors were excised at week 18. CR and rapamycin (but not EX) significantly reduced final tumor weight compared to control. In follow-up analysis, constitutive activation of mTOR ablated the inhibitory effects of CR on Wnt-1 mammary tumor growth. We conclude that mTOR inhibition may be a pharmacologic strategy to mimic the anticancer effects of CR and break the obesity-breast cancer progression link.     

Coronary CT and the Coronary Calcium Score,the Future of ED Risk Stratification?

Accurate and efficient evaluation of acute chest pain remains clinically challenging because traditional diagnostic modalities have many limitations. Recent improvement in non-invasive imaging technologies could potentially improve both diagnostic efficiency and clinical outcomes of patients with acute chest pain while reducing unnecessary hospitalizations. However, there is still controversy regarding much of the evidence for these technologies. This article reviews the role of coronary artery calcium score and the coronary computed tomography in the assessment of individual coronary risk and their usefulness in the emergency department in facilitating appropriate disposition decisions. The evidence base and clinical applications for both techniques are also described, together with cost- effectiveness and radiation exposure considerations.     

中夜班护士巡视流程的改进及效果

目的 探讨改进中夜班护士巡视流程对病房护理质量的影响.方法 采用自制中夜班护士巡视病房流程表,引导护士完成中夜班工作,并对护士进行相关培训,监督巡视流程落实.比较实施前后护士夜间准确预测患者病情变化次数、夜间观察内容的遗漏或缺陷情况及统计护士中夜班工作量.结果 实施后,护士夜间巡视观察内容遗漏或缺陷较实施前明显减少,准确预测病变次数增多.结论 中夜班护士巡视病房流程的改进使巡视目标明确,提高巡视质量,保证夜间护理工作安全.     

Acute renal failure potentiates brain energy dysfunction elicited by methylmalonic acid

The influence of acute renal failure induced by gentamicin administration on the effects of MMA on mitochondrial respiratory chain complexes, citrate synthase, succinate dehydrogenase and creatine kinase activities in cerebral cortex and kidney of young rats were investigated. Animals received one intraperitoneal injection of saline or gentamicin (70 mg/kg). One hour after, the animals received three consecutive subcutaneous injections of MMA (1.67 μmol/g) or saline (11 h interval between injections) and 60 min after the last injection the animals were killed. Acute MMA administration decreased creatine kinase activity in both tissues and increased complexes I–III activity in cerebral cortex. Creatine kinase activity was also inhibited by gentamicin administration. Simultaneous administration of MMA and gentamicin increased the activities of citrate synthase in cerebral cortex and kidney and complexes II–III in cerebral cortex. The other enzyme activities in cerebral cortex and kidney of animals receiving MMA plus gentamicin did not significantly differ from those observed in animals receiving only MMA. Our present data is line with the hypothesis that MMA acts as a toxin in brain and kidney of rats and suggest that renal injury potentiates the toxicity of MMA on the Krebs cycle and respiratory chain in brain and peripheral tissues.     

Agreement Between Chart Diagnoses and Standardized Instrument Ratings of Youth Psychopathology

Rating scales are useful for evidence-based assessment of youth psychopathology. However, it is not known whether these scales contribute information beyond that which clinicians gather without them. This study examined agreement between chart diagnoses and the Child Behavior Checklist (CBCL) for 82 community mental health clinic clients. Agreement was low, suggesting that the CBCL was not redundant with clinicians’ clinical impressions. These findings suggest that use of an instrument like the CBCL could potentially improve clinician diagnostic accuracy; future research should examine how best to utilize these scales in the diagnostic process and how to train clinicians in their use.