Social functioning in community residents with depression and other psychiatric disorders: results of the New Haven Epidemiologic Catchment Area Study

Social functioning was compared among 4913 community participants with current depression, past depression, other psychiatric disorders and no psychiatric history, from the New Haven Epidemiologic Catchment Area Wave I survey. Respondents with current major depressive disorder (1.5%) (based on the Diagnostic Interview Schedule) reported significantly poorer intimate relationships and less satisfying social interactions than respondents with past depression or other current disorders. Respondents with no psychiatric history (77%) reported significantly more active and satisfying social interactions than persons with any psychiatric disorder. These social functioning and depression associations were similar among males and females, and corroborated results from patient samples.     

经纵裂-透明隔间腔入路胼胝体切开术前对透明隔腔的MRI评估

目的 探讨采用透明隔腔(CSP)的术前MRI分型评估经纵裂-透明隔间腔(CSPV)入路行胼胝体切开术的可行性。方法 回顾性描述性研究。纳入上海仁济医院功能神经外科2014年1月—2020年12月耐药性癫痫患者31例,其中男21例、女10例,年龄2~31(15.3±7.3)岁,病程0.5~29(10.0±6.5)年。患者术前均行颅脑常规和/或薄层MR扫描,观察CSP形态并进行影像学分型。均采用经纵裂-CSPV入路行胼胝体切开术,术中对比观察术前MRI不同CSP分型患者手术操作特点及完成情况。结果 (1)31例中,术前MRI观察到CSP者29例,其中间隙型(Ⅱ型)28例、透明隔囊肿(Ⅳ型)1例;另外2例MRI未观察到CSP,为闭合型(Ⅰ型)。(2)29例术前MRI观察到CSP者,术中均探查到达CSP,并顺利分离两侧透明隔小叶:1例Ⅳ型CSP患者切开胼胝体即可到达CSPV,操作最为容易;28例Ⅱ型CSP患者,因CSP体积较小,定位有一定难度,但经仔细辨认均能到达,再向后分离两侧透明隔小叶没有困难。而2例Ⅰ型CSP患者术中未能分离出CSPV,改行经侧脑室入路完成手术。结论 通过对CSP的术前MRI观察及影像学分型,可预估术中CSPV的分离难度,进而判断经纵裂-CSPV入路胼胝体切开术的可操作性。术前MRI观察到CSP存在,可以作为选择经纵裂-CSPV入路行胼胝体切开术的一个影像学指标,而Ⅰ型CSP患者不宜采用该入路。     

透明隔间腔的MR影像解剖学研究

目的 探讨透明隔间腔的透明隔腔(CSP)和韦尔加腔(CV)的MRI特点并对其进行影像学分型,以便在选择手术入路时作为辅助参考。方法 纳入2019年1-4月上海交大医学院附属仁济医院行常规5.0 mm层厚头颅MR扫描的患者200例,观察透明隔间腔的出现概率和形态学特点,进行影像学分型。针对临床最为常见的CSP类型,纳入2018年3月-2019年3月难治性癫痫患者75例,行1.0~2.0 mm薄层MR扫描,经图像融合和三维重建,分别在横断面、冠状面图像中测量CSP长、宽、高的最大径,计算平均值。结果 200例头颅常规MR扫描,可以观察到CSP者189例(94.5%),提示存在显性CSP者占大多数。CSP通常显示在经室间孔层面及其上方1个层面,位于胼胝体膝部的后方和穹窿柱的前上方。将CSP进行MR影像学分型:闭合型(Ⅰ型)、间隙型(Ⅱ型)、扩张型(Ⅲ型)、囊肿(Ⅳ型)和畸形变异(Ⅴ型)5个类型,分别占比4.5%(9/200)、91.5%(183/200)、1.5%(3/200)、1.5%(3/200)和1.0%(2/200)。CV按影像学可分为:单独出现或者与CSP融合,各占比1.0%(2/200)和1.5%(3/200)。最常见的CSP间隙型(Ⅱ型)的三维形态学测量,MRI可见的长、宽、高,均值为2.3 mm、1.5 mm、3.6 mm。结论 CSP在MRI呈现多种形态,体积大小差别不一。术前通过MRI判断CSP是否存在以及CSP分型,可以作为选择透明隔分离方式和手术路径的重要参考指标。     

On the cavum septi pellucidi and the cavum Vergae

A cavum septi pellucidi continuous with a cavum Vergae, of the noncommunicating type, was found in a human brain and is described in detail. Out of 89 brains that were examined, a cavum septi pellucidi was present in 16 brains, an incidence of 17.97%; the cavum septi pellucidi and cavum Vergae were both in one brain, an incidence of 1.12%. The cavum Vergae never occurred alone in any of the specimens studied. A review of the literature is made and the following concepts are advanced: 4 types of cava are suggested, including the noncommunicating form which, anatomically, is the typical cavum; these noncommunicating cavities contain cerebrospinal fluid that filters through the septal laminae and is reabsorbed by capillaries and veins of the septa. The main aspects regarding the anatomy, histology and embryology of these cavities is reviewed. The cavum septi pellucidi and the cavum Vergae occur undetected in many instances, and when they are apparent it is because they are part of a wide spectrum of defects in the central nervous system and in other organ systems. At present, the existence and diagnostic significance of these ventricular cavities is becoming recognized by modern procedures, such as computed tomographic scanning.     

Neurologische und psychiatrische Komplikationen nach Herzoperationen

Summary In 63 patients undergoing heart operations with extracorporeal circulation (47 males, 16 females, mean age 54 years; coronary artery bypass in 38 cases, valvular surgery in the rest) postoperative neurological and psychiatric complications were evaluated. 18 patients (29%) had no complications, whereas 35 patients (56%) showed minor or transient neurological symptoms, and 9 patients (14%) exhibited severe symptoms. Nine of the patients had slight psychiatric disturbances (affective disturbances, desorientation). No correlation was found between risk factors (age, nicotine abuse, hypertension, hypercholesteremia, neurologic and cardiac history), intraoperative parameters (duration of extracorporeal bypass, aortic clamp time, deviation of mean arterial pressure), postoperative parameters (internal complications) and the complication rate. Therefore no predisposing factors could be identified.

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Clinical Specificity of the Enzyme Immunoassay Test for Coccidioidomycosis Varies According to the Reason for Its Performance

The diagnosis of coccidioidomycosis relies heavily on serologic test results in addition to clinical history, physical examination, and radiographic findings. Use of the enzyme immunoassay (EIA) has increased because it is rapidly performed and does not require referral to a reference laboratory, as do complement fixation and immunodiffusion tests. However, interpretation of immunoglobulin M (IgM) reactivity by EIA in the absence of immunoglobulin G (IgG) reactivity has been problematic. We conducted a retrospective medical record review of all patients with such IgM reactivity at our institution to identify situations where the finding was more likely to be clinically specific for coccidioidal infection. From 1 January 2004 through 31 December 2008, a total of 1,117 patients had positive EIA coccidioidal serology or EIA IgM-only reactivity; of these, 102 patients (9%) had EIA IgM-only reactivity. Among the 102 patients with EIA IgM-only reactivity, 60 were tested to evaluate symptomatic illness, 13 for follow-up of previously abnormal serology, and 29 for screening purposes. Of the 102 patients, 80 (78%) had positive serologic findings by other methods or had positive culture or histology. Fifty-four (90%) of the 60 patients whose serology was performed to evaluate symptomatic illness had coccidioidal infection, whereas 13 (45%) of 29 patients whose serology was performed for screening purposes had coccidioidal infection. Of the 102 patients with isolated IgM reactivity by EIA, 12 later seroconverted to IgG and IgM reactivity. The use of EIA for screening in 29 asymptomatic persons was associated with unconfirmable results in 13 (45%). Although the majority of patients in our study with isolated IgM reactivity by EIA had probable or confirmed coccidioidomycosis, this result must be interpreted with caution for asymptomatic patients.     

Hamartomas of mature cardiac myocytes: report of 7 new cases and review of literature

Only 8 cases of hamartomas of mature cardiac myocytes have been reported. The aim of the study was to describe 7 new cases and provide clinicopathologic correlation. Our anatomical pathology database was searched for all cases of cardiac hamartoma, of which 7 represented mature myocyte type. Medical records were reviewed for clinical information, and microscopic slides were evaluated for extent of characteristics. Five males and 2 females ranged in age from 6 months to 74 years (mean, 23 years). There were 11 ventricular hamartomas (8 left free wall, 2 right free wall, 1 septum). Death in 3 infants was unrelated to incidental hamartomas discovered at autopsy. A 10- and 16-year-old were asymptomatic but had abnormal electrocardiogram (ECG) results, which led to detection of cardiac masses by imaging studies. Two adult males had only mild coronary disease angiographically. The 57-year-old, who died suddenly, had a 7-year history of abnormal ECG results. The 74-year-old, who died after aortic surgery, had a 3-year history of chest discomfort. Their hamartomas were identified at autopsy and contributed to sudden death in 1. Microscopically, all hamartomas were involved by myocyte hypertrophy and disarray, without inflammation or calcification. Myocyte vacuolization and venular dilatation occurred only in the pediatric cases, and interstitial adipose tissue only affected 1 adult. In conclusion, hamartomas of mature cardiac myocytes may be detected at any age. They primarily affect males, arise predominantly in the left ventricle, are asymptomatic, may have nonspecific ECG findings, and rarely may be associated with sudden death. Microscopic findings in infants differ from older patients.     

Xq28 duplication including MECP2 in six unreported affected females: what can we learn for diagnosis and genetic counselling?

Duplication of the Xq28 region, involving MECP2 (dupMECP2), has been primarily described in males with severe developmental delay, spasticity, epilepsy, stereotyped movements and recurrent infections. Carrier mothers are usually asymptomatic with an extremely skewed X chromosome inactivation (XCI) pattern. We report a series of six novel symptomatic females carrying a de novo interstitial dupMECP2, and review the 14 symptomatic females reported to date, with the aim to further delineate their phenotype and give clues for genetic counselling. One patient was adopted and among the other 19 patients, seven (37%) had inherited their duplication from their mother, including three mildly (XCI: 70/30, 63/37, 100/0 in blood and random in saliva), one moderately (XCI: random) and three severely (XCI: uninformative and 88/12) affected patients. After combining our data with data from the literature, we could not show a correlation between XCI in the blood or duplication size and the severity of the phenotype, or explain the presence of a phenotype in these females. These findings confirm that an abnormal phenotype, even severe, can be a rare event in females born to asymptomatic carrier mothers, making genetic counselling difficult in couples at risk in terms of prognosis, in particular in prenatal cases.     

OCCLUSION OF THE BASILAR ARTERY

The present report dealt with thirteen autopsied cases of basilar artery occlusion. The age of the patients ranged from fifty one to seventy six years with a mean age of fifty six years, and there were eleven males and two females. Basilar artery occlusion was found in one in every 160 autopsies. The average length of the clinical course of the disease was five months. Many patients had a history of hypertension, diabetes mellitus, and cerebrovascular attacks. The neurological signs and symptoms of basilar artery occlusion extremely varied and were complicated. In our series, occular bobbing, palatal myoclonus, Foville syndrome, and Millard-Gubler syndrome are significant. Arteriosclerotic thrombosis is the most important etiologic factor. The site of occlusion was most frequently encountered in the lower third of the basilar artery. Areas of softening were prominent in the midbrain and the pons. In the cerebellum, softenings were present particularly in the areas supplied by the superior cerebellar artery. Infarcts in the thalamus and the temporo-occipital lobes supplied by the posterior cerebral artery were observed very frequently. The distribution of softening was related to the site of occlusion of the basilar artery and the collateral circulation through the Willis ring.     

Dermatoglyphic findings in patients with fragile X-chromosome

Finger- and palmar prints of hemi- and heterozygote fragile X-patients with mental retardation (10 males and 5 females) were compared to dermatoglyphic findings in 20 mentally retarded patients (10 males and 10 females) without fragile X and to 200 healthy unrelated persons (100 males and 100 females). Characteristic whorls and double-loops with high ridge-counts on finger-tips and a pronounced transversal course of palmar ridges were restricted to males with fragile X. Female carriers of fragile X showed, corresponding to male patients, some abnormalities of the digital- and palmar ridge-pattern. Contrary to males, in carriers as well as in mentally retarded females without fragile X, fingerprints with low ridge-counts were found. Common to all mentally retarded patients, but more pronounced in males with fragile X, abnormal palmar creases and hand-measurements were observed. These findings probably are related to prenatal retarded growth of the length of the palma and of the middle-finger.     

Seasonality of suicides with and without psychiatric illness in Denmark

This paper studied the seasonality of suicides among persons with and without psychiatric illness in Denmark from 1970 to 1999. A non-homogenous Poisson process was used to examine the data. The seasonality of suicides was shown to be associated with gender and their psychiatric histories with a declining trend of suicide incidence noted over the captured period. A mild seasonal component was reported in the period of the late 70s to early 80s (1975-1984) among females who did not have any psychiatric treatment history, while in the 80s the significant seasonality was mainly contributed by male suicides without a psychiatric history. Another mild possible invoked seasonality in the 90s was in males who suffered from psychiatric illness. The rest could be treated as random events. Apparently, the seasonality among suicides with psychiatric illness exists but its effect could vary in different periods of time and among genders in Denmark.     

老年无症状性脑梗死患者记忆功能的研究

目的 :探讨老年无症状性脑梗死 (ACI)与记忆障碍的关系。方法 :对 5 0例ACI患者进行了临床记忆量表检测 ,同时用韦氏成人智力量表对ACI组进行智力测查。结果 :ACI组各项记忆成绩及MQ均明显低于正常对照组 (P <0 0 1) ,但与症状性脑梗死组 (SCI)比较无差异 ;不同梗死区域有其记忆损伤的特点 ;ACI组中智力障碍者 13例 (2 6% )。MQ在 80以上者均智力正常。结论 :老年ACI存在明显记忆障碍     

Catatonia on the consultation-liaison service.

Catatonia is a syndrome that requires both nonpsychiatric medical and psychiatric evaluation. The authors report on six patients with catatonia that were seen by a psychiatric consultation-liaison service. Five of these patients had medical conditions reported to cause catatonia. Treatment recommendations included the following: 1) subcutaneous heparin for deep venous thrombosis prophylaxis, 2) a trial of lorazepam, and 3) transfer to a medical/psychiatric unit or locked psychiatric unit. Catatonia was most parsimoniously attributed to the primary psychiatric illness in five of the patients and to corticosteroid treatment in the sixth patient. These findings suggest that clinicians should use the proposed criteria, past psychiatric history, physical exam, and laboratory and radiological studies when evaluating patients with symptoms of catatonia.     

Comparison of synaptic changes in the precentral and postcentral cerebral cortex of aging humans: a quantitative ultrastructural study

Ultrastructural quantitative analysis was undertaken to determine whether any age-related synaptic changes occur in cortical layer 1 of the human precentral motor gyrus (Brodmann's area 4) and postcentral somatosensory gyrus (Brodmann's area 3). Immersion fixed, osmicated, uranyl acetate/lead citrate stained (OsUL) preparations of autopsied brains were taken from patients aged 45 to 84 years, with no prior history of neurological or intellectual abnormalities. In the precentral gyrus there was a significant decrease in the number of synapses, which was primarily due to a decrease in asymmetrical axospinous synapses. Symmetrical synapses remained constant in number, while axodendritic synapses showed a small increase with age. Accompanying the decline in synapse number was an increase in mean length of the postsynaptic contact zone. In the postcentral gyrus there were no significant changes in synaptic number or in any of the synaptic parameters measured. The results suggest that the motor cortex of the human brain is capable of synaptic plasticity in response to aging-induced synaptic loss. This plasticity is not apparent in the somatosensory cortex, where there is no age-related synapse loss.     

Neuronal loss in old people: The affects of ageing or disease?

There is abundant evidence to show that the brains of many persons, who do not suffer from overt neurological or psychiatric disease, deteriorate in structure in old age. However, it still remains uncertain as to whether these changes stem from the affects of an ageing process per se or whether they simply reflect the minor pathological results of clinically incipient disorders such as Alzheimer's disease or Parkinson's disease (conditions which become increasingly widespread in later life) or the cerebral manifestations of systemic disease.     

Growth of the second metacarpal according to chronological age and skeletal maturation.

In relation to chronological age and skeletal maturation, the growth of the second metacarpal is discussed based on radiographs of the right hand and wrist in 499 male and 424 female Japanese aged 1 to 18 years. When plotted against age, bone length and width present the general growth pattern of Scammon, the adolescent spurt occurring at about 13 years in the males and 11 years in the females, and the mean values are significantly larger in the males than in the females at age 15 years for length, and age 13 years for width, and later. The growth curves of both sexes are almost parallel to each other for bone length plotted against skeletal maturation. Bone width progresses in parallel in males and females until about adolescence, whereafter there is a more rapid increase in growth in the males than in the females. The mean values for length and width are almost always significantly greater in the males than in the females. The width/length index decreases rapidly until a certain period, the minimum value being at about ten years or a maturity corresponding to that age, and then increase slightly again to reach an equilibrium state on the basis of both age and skeletal maturation. At any given age, the mean values are always greater in the males than in the females. However, according to skeletal maturation, the sex differences are steadily significant at and after the skeletal maturity corresponding to about 12 years in the males and 10 years in the females.     

Growth of the second metacarpal according to chronological age and skeletal maturation

In relation to chronological age and skeletal maturation, the growth of the second metacarpal is discussed based on radiographs of the right hand and wrist in 499 male and 424 female Japanese aged 1 to 18 years. When plotted against age, bone length and width present the general growth pattern of Scammon, the adolescent spurt occurring at about 13 years in the males and 11 years in the females, and the mean values are significantly larger in the males than in the females at age 15 years for length, and age 13 years for width, and later. The growth curves of both sexes are almost parallel to each other for bone length plotted against skeletal maturation. Bone width progresses in parallel in males and females until about adolescence, whereafter there is a more rapid increase in growth in the males than in the females. The mean values for length and width are almost always significantly greater in the males than in the females. The width/length index decreases rapidly until a certain period, the minimum value being at about ten years or a maturity corresponding to that age, and then increase slightly again to reach an equilibrium state on the basis of both age and skeletal maturation. At any given age, the mean values are always greater in the males than in the females. However, according to skeletal maturation, the sex differences are steadily significant at and after the skeletal maturity corresponding to about 12 years in the males and 10 years in the females.     

Effects of early environment on granule cell morphology in the dentate gyrus of the guinea-pig

The aim of the present study was to determine whether early environment affects the morphology of the dentate gyrus granule cells in the guinea-pig, a rodent whose brain is at an advanced stage of maturation at birth. Male and female guinea-pigs were assigned at six to seven days of age to either a control (social) or an isolated environment where they remained for 80-90 days. The dendritic tree and somata of the granule cells were quantified in Golgi-Cox-stained brains. The granule cells of isolated males had fewer dendritic branches and a shorter dendritic length than those of control males in the inner two-thirds of the dendritic tree, but a larger number of branches and a larger dendritic length in the distal one-fourth. In contrast, the granule cells of isolated females had a larger number of branches and a larger dendritic length than control females in the inner one-half of the dendritic tree and a reduced number of branches and a shorter dendritic length in the distal one-fourth. The granule cell somata were smaller in isolated than in control males. No such difference was observed in females. Sex differences were found in the granule cell morphology. In the control environment, the granule cells of males had more branches and a greater dendritic length in the inner one-half of the dendritic tree than those of females but fewer dendritic branches and a shorter dendritic length in the distal one-fourth. In the isolated environment, the granule cells of males had fewer branches and a shorter dendritic length in the inner two-thirds of the dendritic tree than females, but more dendritic branches and a greater dendritic length in the distal one-fourth. In the control environment male granule cells had a larger soma than those of females. The opposite occurred in the isolated environment. The results of this study indicate that early isolation induces remarkable structural changes in the granule cells of the dentate gyrus in a rodent whose brain is at an advanced stage of maturation at birth. They also indicate that the effects of environment are different at different levels of the dendritic tree and in the two sexes.     

Season of birth and fluctuating asymmetry.

Fluctuating asymmetry (FA) refers to random, small deviations from perfect bilateral symmetry in morphological traits. These minor deviations from the ideal phenotype reflect environmental and genetic perturbations experienced during ontogeny. FA has been associated with negative health outcomes and many developmental disorders in humans. The prevalence of developmental disorders and adult health vary according to the month of birth, suggesting that seasonal stressors may leave enduring signs in the adult body, marked by high FA. The current study examined the relationship between FA and birth season. Data were collected for 205 males and females (average age = 20.39 years) on FA of 10 bilateral traits (second, third, fourth, and fifth digit length, palm height, wrist diameter, elbow width, ear height, foot breadth, and ankle circumference). Additional relationships were also investigated among FA, testosterone (T), and birth order. Results indicate that ear FA was lower for fall births compared to winter births in males. In females, palm FA was lower for fall births compared to those of the spring. FA of the digits was positively associated with T in males. Average FA, excluding the digits, decreased as the number of maternal siblings increased for both sexes. T concentrations in males were positively associated with the number of younger brothers. Our results generally confirm previous research on seasonal variation in adult longevity and neurological and psychiatric disorders, suggesting that winter and spring births are at risk for asymmetric developmental trajectory.