Vascular endothelial growth factor:an essential neurotrophic factor for motoneurons?

正Vascular endothelial growth factor(VEGF),an angiogenic factor with neuroprotective effects:The VEGF was initially characterized by its vasculogenic and angiogenic activities and its capacity to promote vascular permeability(Yancopoulos et al.,2000).VEGF is also known as VEGF-A and is the prototype member of a related group of five trophic factors,VEGF-B,VEGF-C,VEGF-D and placental growth factor(Pl GF;Lange et al.,2016).Interestingly,VEGF-B shares a high degree of homology     

Is progestin an independent risk factor for incident venous thromboembolism? A population-based case-control study

Introduction

Because the risk of venous thromboembolism (VTE) associated with progestin is uncertain, we tested oral contraceptives, estrogen and progestin as independent VTE risk factors.

Materials and Methods

Using longitudinal, population-based Rochester Epidemiology Project resources, we identified all Olmsted County, MN women with objectively-diagnosed incident VTE over the 13-year period, 1988-2000 (n = 726) and one to two Olmsted County women per case matched on age, event year and duration of prior medical history (n = 830), and reviewed their complete medical history in the community for previously-identified VTE risk factors (i.e., hospitalization with or without surgery, nursing home confinement, trauma/fracture, leg paresis, active cancer, varicose veins and pregnancy/postpartum), and oral contraceptive, oral estrogen, and oral or injectable progestin exposure. Using conditional logistic regression we tested these hormone exposures as VTE risk factors, both unadjusted and after adjusting for previously-identified VTE risk factors.

Results

In unadjusted models, oral contraceptives, progestin alone, and estrogen plus progestin were significantly associated with VTE. Individually adjusting for body mass index (BMI) and previously-identified VTE risk factors, these effects remained essentially unchanged except that progestin alone was not associated with VTE after adjusting for active cancer. Considering only case-control pairs without active cancer, progestin alone was positively but non-significantly associated with VTE (OR = 2.49; p = 0.16). Adjusting for BMI and previously-identified VTE risk factors including active cancer, oral contraceptives, estrogen alone, and progestin with or without estrogen were significantly associated with VTE.

Conclusions

Oral contraceptives, estrogen alone, estrogen plus progestin, and progestin with or without estrogen are independent VTE risk factors.     

Constipation: an emerging risk factor for Parkinson's disease?

Constipation is the most prominent and disabling manifestation of lower gastrointestinal (GI) dysfunction in Parkinson's disease (PD). The prevalence of constipation in PD patients ranges from 24.6% to 63%; this variability is due to the different criteria used to define constipation and to the type of population enrolled in the studies. In addition, constipation may play an active role in the pathophysiological changes that underlie motor fluctuations in advanced PD through its negative effects on absorption of levodopa. Several clinical studies now consistently suggest that constipation may precede the first occurrence of classical motor features in PD. Studies in vivo, using biopsies of the GI tract and more recently functional imaging investigations, showed the presence of α‐synuclein (α‐SYN) aggregates and neurotransmitter alterations in enteric tissues. All these findings support the Braak proposed model for the pathophysiology of α‐SYN aggregates in PD, with early pathological involvement of the enteric nervous system and dorsal motor nucleus of the vagus. Therefore, constipation could have the potential sensitivity to be used as a clinical biomarker of the prodromal phase of the disease. The use of colonic biopsies to look at α‐SYN pathology, once confirmed by larger prospective studies, might eventually represent a feasible, albeit partially invasive, new diagnostic biomarker for PD.     

Steroid dementia: an overlooked diagnosis?

The authors studied a 72-year-old man with polymyalgia rheumatica who, after taking 100 mg of prednisone for 3 months, developed a psychosis followed by dementia. It was initially considered that the dementia was a separate neurodegenerative condition, probably of Alzheimer type, but when steroids were discontinued, he rapidly returned to his previous level of functioning. Reviewing the literature regarding the effects of steroids on cerebral function, the authors found that such cases of "reversible dementia" are not uncommon, although rarely given the emphasis they deserve. The authors believe, given the extensive use of steroids in medical practice, that physicians should be more aware of this important cause of reversible dementia.     

What causes pregnancy loss? Preexisting mental illness as an independent risk factor

OBJECTIVE: Maternal mental health disorders in pregnancy are common and are associated with prematurity, low birth weight and delivery complications. We explored whether existing mental illness was associated not just with fetal complications but also with fetal death. METHOD: We conducted a retrospective cohort analysis using data from the National Comorbidity Survey (NCS). The NCS is a nationally representative multistage probability study of the prevalence of psychiatric disorders in the United States. We analyzed the association between a prepregnancy mental health diagnosis and subsequent miscarriage or stillbirth, using multivariable logistic regression to control for maternal age, race, health risks and other independent risk factors for fetal death. RESULTS: Patients with any mental health disorder prior to pregnancy [odds ratio (OR)=1.8], specifically those with affective disorders (OR=1.6) or substance use disorders (OR=1.4), were at significantly higher risk for fetal mortality in pregnancy. This risk remained significant even when controlling for health and behavioral risk factors that cause fetal loss. CONCLUSION: These results are consistent with studies showing mental health to be independently associated with morbidity and mortality in heart disease, stroke and cancer. The etiology remains poorly understood, but may include neuroendocrine, behavioral and genetic mediators.     

Hypertonic saline: first-line therapy for cerebral edema?

This article highlights the experimental and clinical data, controversies and postulated mechanisms surrounding osmotherapy with hypertonic saline (HS) solutions in the neurocritical care arena and builds on previous reviews on the subject. Special attention is focused on HS therapy on commonly encountered clinical paradigms of acute brain injury including traumatic brain injury (TBI), post-operative "retraction edema", intracranial hemorrhage (ICH), tumor-associated cerebral edema, and ischemia associated with ischemic stroke.     

Comorbid anxiety in bipolar disorder: does it have an independent effect on suicidality?

Objective:  Comorbid anxiety disorder is reported to increase suicidality in bipolar disorder. However, studies of the impact of anxiety disorders on suicidal behavior in mood disorders have shown mixed results. The presence of personality disorders, often comorbid with anxiety and bipolar disorders, may explain these inconsistencies. This study examined the impact of comorbid Cluster B personality disorder and anxiety disorder on suicidality in bipolar disorder.
Methods:  A total of 116 depressed bipolar patients with and without lifetime anxiety disorder were compared. Multiple regression analysis tested the association of comorbid anxiety disorder with past suicide attempts and severity of suicidal ideation, adjusting for the effect of Cluster B personality disorder. The specific effect of panic disorder was also explored.
Results:  Bipolar patients with and without anxiety disorders did not differ in the rate of past suicide attempt. Suicidal ideation was less severe in those with anxiety disorders. In multiple regression analysis, anxiety disorder was not associated with past suicide attempts or with the severity of suicidal ideation, whereas Cluster B personality disorder was associated with both. The results were comparable when comorbid panic disorder was examined.
Conclusions:  Comorbid Cluster B personality disorder appears to exert a stronger influence on suicidality than comorbid anxiety disorder in persons with bipolar disorder. Assessment of suicide risk in patients with bipolar disorder should include evaluation and treatment of Cluster B psychopathology.     

Does high field MRI allow an earlier diagnosis of multiple sclerosis?

Background

High field magnetic resonance imaging (MRI) provides higher lesion load measurements in patients presenting with clinically isolated syndromes (CIS) suggestive of demyelination and has impact upon the classification of these syndromes and potentially, the diagnosis of multiple sclerosis (MS).

Purpose

To investigate whether high field MRI can provide an earlier diagnosis of definite MS within the International Panel (IP) and Swanton criteria.

Methods

Forty patients presenting with CIS suggestive of MS were included. All patients received multi-sequence MRI at 1.5 Tesla (T) and 3T as well as a neurological assessment at baseline. Follow-up visits including MRI at both field strengths and neurological examinations were scheduled 3–4 and 6–7 months after the first clinical event. Based on MRI and clinical findings, fulfilled IP criteria as well as Swanton criteria were analysed.

Results

At baseline, the higher detection rate of inflammatory lesions using high field MRI leads to higher classifications according to the Swanton criteria in 15 % of the patients. One additional patient was diagnosed with dissemination in space according to Swanton and IP criteria. During follow-up, an earlier diagnosis of definite MS could not be accomplished, neither according to the IP nor to the Swanton criteria.

Conclusion

Although high field MRI shows a higher detection rate of inflammatory brain lesion in CIS and MS patients with an influence according to MRI criteria, this influence does not lead to an earlier diagnosis of lesion dissemination in time and therefore definite MS.     

Pineal cysts: an incidental MRI finding?

The incidence of pineal cysts (PC) in "standard" MRI was reviewed. Seven cases of PC were found from 400 consecutive MRI examinations. PC did not produce clinically relevant symptoms in any of the patients. Our data, as well as those emerging from a critical review of the literature, suggest that PC are often asymptomatic and represent an incidental MRI finding.     

Is sleep-disordered breathing an independent risk factor for hypertension in the general population (13,057 subjects)?

Objective: Sleep-disordered breathing has been hypothesized to have a close relationship with hypertension but previous studies have reported mixed results. This is an important health issue that requires further clarification because of the potential impact on the prevention and control of hypertension.Methods: The relationship between hypertension and three forms of sleep-disordered breathing (chronic snoring, breathing pauses and obstructive sleep apnea syndrome (OSAS)) was assessed using representative samples of the non-institutionalized population of the UK, Germany and Italy (159 million inhabitants). The samples were comprised of 13,057 individuals aged 15–100 years who were interviewed about their sleeping habits and their sleep symptoms over the telephone using the Sleep-EVAL system.Results: OSAS was found in 1.9% (95% CI: 1.2% to 2.3%) of the UK sample, 1.8% (95% CI: 1.4% to 2.2%) of the German sample and 1.1% (95% CI: 0.8% to 1.4%) of the Italian sample. OSAS was an independent risk factor (odds ratio (OR): 9.7) for hypertension after controlling for possible confounding effects of age, gender, obesity, smoking, alcohol consumption, life stress, and, heart and renal disease.Conclusions: Results from three of the most populated countries in Western Europe indicate that OSAS is an independent risk factor for hypertension. Snoring and breathing pauses during sleep appeared to be non-significant predictive factors.     

Psychiatric diagnosis by telephone: is it an opportunity?

Background

For reasons of feasibility, diagnostic telephone interviews are frequently used in research of psychiatric morbidity. However, it is unknown whether diagnostic telephone interviews are as valid as diagnostic face-to-face interviews.

Research question

Are diagnostic telephone interviews for psychiatric disorders as valid as diagnostic face-to-face interviews?

Method

A systematic review of original studies in PubMed, PsychINFO and Embase was carried out. We included studies considering (1) the sensitivity and specificity of diagnostic telephone interviews using face-to-face interviews as a golden standard and (2) the agreement between diagnostic telephone and diagnostic face-to-face interviews. Eligible were studies in the general population, in patients at risk for psychiatric disorders and in psychiatric outpatients. We assessed risk of bias with the quality assessment of diagnostic accuracy studies (QUADAS) instrument.

Results

We included sixteen studies. The included studies were generally small with thirteen studies reporting about <100 participants. Specificity was generally high in populations with low or intermediate prevalence of psychiatric morbidity. Sensitivity was low in these populations, but slightly higher in samples with more psychiatric disorders. Studies with a higher risk of psychiatric disorders generally reported higher percentages of agreement and higher kappa values. Considering the QUADAS-2 criteria, most studies had a medium or high risk of bias, especially concerning patient selection and unbiased judgement of the test. Of the six studies with a medium or low risk of bias, the three studies assessing current anxiety and depressive disorders yielded kappa values between 0.69 and 0.84, indicating good agreement.

Discussion

There is insufficient evidence that diagnostic telephone interviews for the diagnosis of psychiatric disorders are valid, although results for depression and anxiety disorders seem promising.     

Anticardiolipin antibodies are not an independent risk factor for stroke: an incident case-referent study nested within the MONICA and Västerbotten cohort project

BACKGROUND AND PURPOSE: Anticardiolipin antibodies (aCL) have been proposed to be an independent risk factor for stroke. To test this hypothesis, a nested case-control study was performed to compare aCL with the other known risk factors for stroke. METHODS: Within the framework of the World Health Organization Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) project and the V?sterbotten Intervention Program (VIP) health survey, 44 725 men and women were enrolled and followed up from January 1, 1985, through August 31, 1996. Individuals free from cardiovascular events were followed up, and 123 developed stroke (on average, 34.1 months after blood sampling; 21 cerebral hemorrhage and 102 cerebral infarction); they were compared with 241 age- and sex-matched control subjects from the same population. ELISA was used for the analysis of IgG, IgM, and IgA aCL. RESULTS: IgM-aCL were present in 11.4% of patients (14/123) who developed stroke and in 4. 1% of individuals (10/241) who remained healthy (P=0.013, OR 2.97, 95% CI 1.28 to 6.89). The OR for the levels of IgM-aCL was 1.34 (P=0. 01, 95% CI 1.07 to 1.68) without adjustment for other risk factors and 1.24 when adjusted for hypertension, diabetes mellitus, cigarette smoking, and use of smokeless tobacco (P=0.077, 95% CI 0. 98 to 1.56). There was no difference between patients and controls for the prevalence or level of IgG-aCL and IgA-aCL and also no difference between patients with cerebral hemorrhage and cerebral infarction for the prevalence of all 3 isotypes of aCL. CONCLUSIONS: We conclude that aCL are associated with future stroke but do not constitute an independent risk factor.