Idiopathic intracranial hypertension: associations with coagulation disorders and polycystic-ovary syndrome

To better understand potentially reversible causes of idiopathic intracranial hypertension (IIH), also known as pseudotumor cerebri, and an apparent association of IIH with polycystic-ovary syndrome (PCOS), we assessed associations of IIH with coagulation disorders and with PCOS in 38 women with well-documented IIH. Fifteen women were found to have PCOS; 14 of them were obese, with a body-mass index (BMI) greater than 30 kg/m(2), and 10 were extremely obese (BMI > or = 40). Factor VIII concentration was high (>150%) in 9 of 38 (24%) IIH cases, compared with 0 of 40 healthy adults controls (P(f) =.0009). Familial aggregation of high concentrations of factor VIII, associated with thrombophilia, was documented in all 5 of the 9 high-level factor VIII probands' families who were sampled. Activated partial thromboplastin time (APTT) was prolonged (> or =31.5 seconds) in 10 of 38 (26%) IIH cases, compared with 1 of 32 (3%) controls (P(f) =.009) and, in 4 of these cases, was accompanied by the lupus anticoagulant. Plasminogen activator inhibitor activity (PAI-Fx) was high (>21.1 U/mL) in 9 of 38 cases (24%), compared with 1 of 40 controls (3%) (P(f) =.006). Lipoprotein A was high (> or =35 mg/dL) in 13 of 37 cases (35%), compared with 5 of 40 controls (13%) (P(f) =.03). IIH cases did not differ (P >.05) from controls for homocysteine, proteins C and S, free S, antithrombin III, ACLAs IgG and IgM, dilute Russell's viper venom time, Factor XI, factor V Leiden G1691A, G20210A prothrombin, C677T MTHFR, plasminogen activator inhibitor 4G/5G, or platelet glycoprotein PL A1A2 mutations. Exogenous estrogens (n = 23), clomiphene (n = 1), or pregnancy (n = 4) accompanied the first appearance of IIH in 28 women. PCOS and coagulation disorders, often augmented by exogenous estrogens or pregnancy, are associated with IIH.     

青少年的创伤后应激障碍对创伤后成长的影响:复原力的调节作用

目的:考察汶川地震后青少年的复原力在创伤后应激障碍(PTSD)与创伤后成长(PTG)之间的调节作用。方法:采用创伤后应激障碍量表、复原力量表和创伤后成长问卷,对汶川地震1年后的644名中学生进行追踪测量。结果:震后1年的PTSD和复原力分别对震后1.5年的PTG有显著的正向预测作用,震后1年的PTSD与复原力的交互项对震后1.5年的PTG有显著的正向预测作用。结论:震后1年的复原力在震后1年的PTSD预测震后1.5年的PTG过程中起着调节作用。在高复原力水平的条件下,震后1年的PTSD对震后1.5年的PTG没有显著的预测作用;在低复原力水平下,震后1年的PTSD对震后1.5年的PTG发挥着显著的正向预测作用。     

Idiopathic intracranial hypertension, polycystic-ovary syndrome, and thrombophilia

We studied thrombophilia, hypofibrinolysis, and polycystic-ovary syndrome (PCOS) in 65 women consecutively referred because of idiopathic intracranial hypertension (IIH) as a means of better understanding the origin of IIH, with the ultimate goal of developing novel medical therapies for IIH. Our hypothesis: IIH results in part from inadequate drainage of cerebrospinal fluid (CSF) resulting from thrombotic obstruction to CSF resorption-outflow, favored by thrombophilia-hypofibrinolysis. We conducted the polymerase chain reaction (PCR) and assessed serologic coagulation measures in 65 women (64 of them white) with IIH, PCR in 102 healthy white female controls (72 children, 30 age-matched adults), and serologic measures in the 30 adults. Of the 65 patients, 37 (57%) were found to have PCOS; 16 (43%) were obese (BMI > or = 30 to < 40), and 19 (51%) were extremely obese (BMI > or = 40). Of the 65 women with IIH, 25 (38%) were homozygous for the thrombophilic C677T MTHFR mutation, compared with 14% of controls (14/102) ( P = .0002). Thrombophilic high concentrations of factor VIII (>150%) were present in 9 of 65 (14%) IIH cases, compared with 0 of 30 controls (0%) (Fisher's p [p f ] = .053). An increased concentration of lipoprotein A (> or = 35 mg/dL), associated with hypofibrinolysis, was present in 19 of 65 IIH cases (29%), compared with 3 of 30 controls (10%) (p f = .039). IIH occurred in 18 of 65 IIH patients taking estrogen-progestin contraceptives (28%), in 6 patients taking hormone-replacement therapy (9%), and in 5 pregnant subjects (8%). We speculate that PCOS, associated with obesity and extreme obesity, is a treatable promoter of IIH. We also speculate that if thrombophilia-hypofibrinolysis and subsequent thrombosis are associated with reduced CSF resorption in the arachnoid villi of the brain, thrombophilia and hypofibrinolysis-often exacerbated by thrombophilic exogenous estrogens, pregnancy, or the paradoxical hyperestrogenemia of PCOS-are treatable promoters of IIH.     

Growth-reductive therapy in children with marfan syndrome

OBJECTIVES: To determine the accuracy and precision of 2 height-prediction methods in Marfan syndrome and to assess the growth-reductive effect and side effects of sex hormone treatment. STUDY DESIGN: In a retrospective study in 31 untreated (17 boys) and 43 treated patients (21 boys) with Marfan syndrome, we assessed bone age and predicted adult height by 2 methods. The accuracy of the methods was assessed in the untreated group. The effect of therapy was corrected for outcome in the untreated group and other confounding variables with multivariate analysis. RESULTS: Accuracy strongly varied with sex, chronological age, and prediction method. Overall precision was low. Treatment was started at a mean age of 12.8 +/- 1.4 years (boys) and 11.4 +/- 1.2 years (girls). With multiple regression analysis, a statistically significant effect was observed only in boys using a pharmacologic dosage (5.5 cm, 95% CI 0.96-10.1 cm; P = .02). Side effects were worsening of acne and weight and muscle gain. CONCLUSIONS: In adolescents with Marfan syndrome, the accuracy and precision of 2 height-prediction methods were limited. The apparent growth-reductive effect of sex hormone treatment appears similar to earlier reports on adolescents with constitutional tall stature. There were no clinically important short-term side effects.     

PTSD and PTG among Israeli mothers: Opposite facets of exposure to terrorism

The aim of the this study was to test the association between posttraumatic stress disorder (PTSD), posttraumatic growth (PTG), and coping strategies among Israeli mothers with prolonged exposure to rocket missiles. One hundred fifty‐two mothers, from the Western Negev region of Israel, took part in the study. Respondents were affected by prolonged exposure to missile attacks even when they themselves had not been hit or injured. A positive correlation was found between PTSD and PTG. Problem‐focused coping was found to mediate the relationship between PTSD and PTG; the higher the PTSD, the greater the use of problem‐focused coping and the greater the posttraumatic growth. The results help understand the association between PTSD and PTG. The finding whereby problem‐focused coping mediates the PTSD–PTG relationship is important for comprehending the association between the variables and the significance of growth in human life and for constructing intervention programs that promote growth following trauma. In addition, the study contributes to raising awareness both of how mothers cope and that they are a separate risk group with distinct growth possibilities.     

Comparison of antibody measurements against Aspergillus fumigatus by means of double-diffusion and enzyme-linked immunosorbent assay (ELISA)

IgG antibody titers against Aspergillus fumigatus from different sera were measured by means of a standardized ELISA and compared with precipitates measured by double diffusion (D.D.). There was a significant correlation between the number of precipitates and the ELISA IgG titers in the 758 sera examined. However, in several individual sera within this group, large deviations between these two immunologic parameters were found. Further analysis indicated that ELISA detects antibodies against nonprecipitating antigenic components in addition to the antibodies detected by D.D. Furthermore, not all precipitating antigenic components appear to play a role in the detection of antibodies against A. fumigatus by ELISA. Patients with aspergillosis largely show increased titers of IgG antibody by ELISA even when the results of D.D. are negative, except those of patients with Aspergillus-provoked asthma which fall within a normal range.     

The energy hypothesis of sleep revisited

One of the proposed functions of sleep is to replenish energy stores in the brain that have been depleted during wakefulness. Benington and Heller formulated a version of the energy hypothesis of sleep in terms of the metabolites adenosine and glycogen. They postulated that during wakefulness, adenosine increases and astrocytic glycogen decreases reflecting the increased energetic demand of wakefulness. We review recent studies on adenosine and glycogen stimulated by this hypothesis. We also discuss other evidence that wakefulness is an energetic challenge to the brain including the unfolded protein response, the electron transport chain, NPAS2, AMP-activated protein kinase, the astrocyte-neuron lactate shuttle, production of reactive oxygen species and uncoupling proteins. We believe the available evidence supports the notion that wakefulness is an energetic challenge to the brain, and that sleep restores energy balance in the brain, although the mechanisms by which this is accomplished are considerably more complex than envisaged by Benington and Heller.     

Family history is a poor screen for prothrombotic genes in children with stroke

OBJECTIVE: To evaluate family history of early pathological thrombosis as a screen for genetic prothrombotic risk factors in children with stroke. STUDY DESIGN: A 5-year retrospective review of standardized pediatric stroke clinic evaluations of children with arterial ischemic stroke (AIS) or sinovenous thrombosis (SVT). A family history of early pathological thrombosis was defined as stroke, heart attack, or deep venous thrombosis before 50 years of age or multiple miscarriages in the parents or grandparents of the patient. We evaluated the association between family history and the presence of the Factor V Leiden mutation (FVL) and/or Prothrombin G20210A mutation (PTG) in these children. RESULTS: The study included 68 children. Thirteen (19.1%) had a positive family history of early pathological thrombosis, nine (13.2%) were heterozygous for FVL, and one (1.5%) was heterozygous for PTG. Family history was not associated with the presence of FVL (p = .36) or FVL combined with PTG (p = .40). For FVL, family history had a positive predictive value of 23.1% and a negative predictive value of 89.1%. CONCLUSION: A family history of early thrombosis is not associated with the presence of FVL or PTG in children with stroke. We recommend that all children with stroke receive a prothrombotic workup regardless of family history.     

救援官兵创伤后成长现况及韧性、 社会支持对其的影响研究

摘要:目的　探讨救援官兵创伤后成长（PTG）的现况及韧性、社会支持对其的影响。方法　采用创伤后成长问卷（PTGI）、韧性量表（CD-RISC）、领悟社会支持量表（PSSS）对执行鲁甸地震救援的404名官兵进行问卷调查。结果　（1）所有被试创伤后成长量表总分为（70.87±17.59）分,韧性量表总分为（70.29±13.00）分,社会支持量表总分为（34.68±6.90）分。（2）高韧性组PTGI总分及各维度得分显著高于低韧性组;高社会支持组PTGI总分及各维度得分显著高于低社会支持组（P＜0.01）。（3）韧性总分、社会支持总分与创伤后成长总分两两均呈显著正相关（P＜0.01）。（4）路径分析显示,韧性对创伤后成长有直接影响,同时也可通过社会支持间接影响创伤后成长;社会支持对创伤后成长有直接影响。结论　韧性和社会支持对官兵的创伤后成长具有显著的影响作用,社会支持在韧性和创伤后成长之间具有部分中介作用。     

PTTG和b-FGF在肾癌中的表达

目的探讨垂体肿瘤转化基因(PTTG)和碱性成纤维细胞生长因子(b-FGF)在肾癌中的表达及其与临床病理学参数之间的关系.方法采用免疫组织化学链霉菌抗生物素蛋白过氧化酶(SP)法检测40例肾细胞癌中PTTG和b-FGF的表达情况.结果PTFG、b-FGF在肾癌和正常肾组织中的阳性表达率分别为:52.5%和8.33%(P＜0.05),62.5%和16%(P＜0.05).PTTG表达程度与肾癌的临床分期和转移有关(P＜0.05),而与其细胞学类型和分级无关(P＞0.05).b-FGF表达程度与肾癌的分级、临床分期和转移有关(P＜0.05),而与其细胞学类型无关(P＞0.05).结论PTTG蛋白、b-FGP的高表达参与了肾细胞癌的发展,在肾癌的侵袭和转移中发挥重要作用.