Associations of ESR2 AluI (G/A) polymorphism with ischemic stroke in Caucasians

Raising interest towards genes implicates the effect of estrogen receptor-alpha (ESR1) gene on cerebrovascular disease, but data are lacking regarding the effect of estrogen receptor-beta (ESR2) gene. We assessed the hypothesis that AluI (G/A) polymorphism of the ESR2 gene (rs 4986938) is associated with ischemic stroke in a Caucasian population. Four hundred twenty four consecutive stroke patients and 430 age and gender-matched controls were enrolled in three stroke centers in Greece over one-year period. Patients and controls were compared in regard to the prevalence of the aforementioned polymorphism. No association was found between variations in the ESR2 gene and risk of stroke or stroke subtype in men and women. Of note, a gender-specific association of G allele with the onset of stroke at a younger age in male patients was found (63.68 ± 12.687 years in G allele (GG+AG) carriers vs. 68.95 ± 10.757 years in non-carriers (AA), p=0.008). Further population independent studies are needed to establish the role of ESR2 gene polymorphisms in relation to ischemic stroke in both genders. Such studies could lead to ERβ agonists being validated in individuals with certain genotypes and/or alleles towards the development of efficient strategies to preventing ischemic stroke in both men and women.     

The validity of the diagnosis of chronic obstructive pulmonary disease in general practice.

AIM: To determine the validity of the diagnosis of chronic obstructive pulmonary disease (COPD) in general practice in patients given a diagnosis of COPD and treated with bronchodilators. METHODS: From the medical records of eight Health Centres in Northern Greece, 319 subjects aged over 40 years and diagnosed as "COPD" were entered into the study. All filled in a special questionnaire and were subjected to spirometry, rhinomanometry and chest X-ray. RESULTS: One hundred and sixty patients (50.2%) met the GOLD criteria for COPD. Twenty-six of them were non-smokers and underwent further evaluation: blood eosinophil count, serum IgE assay, high resolution computed tomography (HRCT) scan of the chest, and echocardiography; 16 were given a different diagnosis. One hundred and fifty-nine subjects (49.8%) with an FEV1/ FVC ratio >0.7 did not meet the GOLD criteria for COPD; 71 suffered from nasal obstruction, 13 from asthma, six had restrictive pulmonary disease and 69 had no respiratory disease. CONCLUSION: Diagnostic errors in patients with respiratory symptoms in the primary healthcare setting are frequent. Patients suspected to have COPD should undergo spirometry testing after bronchodilation. An alternative diagnosis must be sought for non-smoking patients with irreversible airway obstruction.     

Centenary of Christfried Jakob's discovery of the visceral brain: an unheeded precedence in affective neuroscience

The benchmark discovery of the cingulate gyrus as a brain structure receiving stimuli from muscles and viscera (proprioception and interoception) is traced to a 1907/1908 article by neuropathologist Christfried Jakob. Further, the involvement of the mamillary bodies, anterior thalamic nucleus, cingulate cortex and hippocampus in the circuitry of the emotive brain (i.e. all elements of the 1937 'circuit of Papez') was published by Jakob in his 1911 and 1913 monographs on human and comparative neuroanatomy. In those works, Jakob also described the thalamocingulate projection, commonly attributed to a 1933 study by Le Gros Clark and Boggon, and introduced the term 'visceral brain', commonly attributed to a 1949 paper by MacLean. The present article includes the first English translations of Jakob's relevant passages, which incontrovertibly document his chronological priority in discovering the visceral brain and some of its key constituent elements.     

Tissue Doppler echocardiography reveals insufficient contractile reserve recruitment during effort in subjects with mitral valve prolapse and those with thick mitral valve

OBJECTIVE: To assess by tissue Doppler echocardiography (TDE), the tissue velocities, both at rest and after exercise stress testing, in subjects with mitral valve prolapse (MVP) and those with thick mitral valve (TMV). METHODS: Twenty individuals with typical MVP, 30 with TMV, and 30 healthy controls were enrolled. TDE was performed at the basal-inferior wall and the parameters evaluated were the S, Em, and Am velocities, as well as the Em/Am ratio. RESULTS: The mean S-wave at rest was higher in subjects with MVP compared to that of the TMV (P < 0.01) and the control groups (P = 0.00005), whereas after exercise it was higher in the control group compared to either MVP (P = 0.013) or TMV group (P = 0.00002). The mean Em wave at rest was higher in the control individuals both at rest (P = 0.007 compared with MVP group and P = 0.013 compared with TMV group), and after exercise (P = 0.0002 and 0.0009, respectively). The Am wave in the MVP group was higher compared with TMV and control subjects at rest (P = 0.022 and 0.00001, respectively) but it was not after exercise (P = ns for both comparisons). The Em/Am ratio of the control group at rest was higher than that of the MVP (P = 0.0000) and TMV (P = 0.00028) groups. However, after exercise, it was higher only when compared with the MVP group (P = 0.016). CONCLUSIONS: Subjects with MVP and those with TMV exhibit a less effective contractile response to exercise compared to healthy individuals. Some degree of diastolic dysfunction, particularly after exercise, was also detected in the individuals with MVP.