Striatal activity in borderline personality disorder with comorbid intermittent explosive disorder: sex differences

Borderline Personality Disorder (BPD) is associated with behavioral and emotional dysregulation, particularly in social contexts; however, the underlying pathophysiology at the level of brain function is not well understood. Previous studies found abnormalities in frontal cortical and limbic areas suggestive of poor frontal regulation of downstream brain regions. However, the striatum, which is closely connected with the medial frontal cortices and plays an important role in motivated behaviors and processing of rewarding stimuli, has been understudied in BPD. Here we hypothesized that, in addition to frontal dysfunction, BPD patients may show abnormal striatal function. In this study, 38 BPD patients with intermittent explosive disorder (BPD-IED) and 36 healthy controls (HC) participated in the Point Subtraction Aggression Paradigm (PSAP), a computer game played with a fictitious other player. (18)Fluoro-deoxyglucose positron emission tomography (FDG-PET) measured relative glucose metabolism (rGMR) within caudate and putamen in response to aggression-provoking and non-provoking versions of the PSAP. Male BPD-IED patients had significantly lower striatal rGMR than all other groups during both conditions, although male and female BPD-IED patients did not differ in clinical or behavioral measures. These sex differences suggest differential involvement of frontal-striatal circuits in BPD-IED, and are discussed in relation to striatal involvement in affective learning and social decision-making.     

The carpal boss: an overview of radiographic evaluation

The carpal boss, an unmovable bony protuberance, is located on the dorsum of the wrist at the base of the second and third metacarpals adjacent to the capitate and trapezoid bones. This bony prominence may represent degenerative osteophyte formation and/or the presence of an os styloideum, an accessory ossification center that occurs during embryonic development. When this condition is symptomatic, patients present with complaints of pain and limitation of motion of the affected hand. The symptoms of carpal boss may result from an overlying ganglion or bursitis, an exterior tendon slipping over this bony prominence, or from osteoarthritic changes at this site. Radiographically, the view that best profiles the separate os styloideum is a lateral view utilizing 30 degrees of supination and ulnar deviation of the wrist. Once a diagnosis has been made, treatment can range from the use of nonsteroidal antiinflammatory medication and limited use of the wrist to surgical excision of the anatomic abnormality.     

Tryptophan-hydroxylase 2 haplotype association with borderline personality disorder and aggression in a sample of patients with personality disorders and healthy controls

Background

There is a decreased serotonergic function in impulsive aggression and borderline personality disorder (BPD), and genetic association studies suggest a role of serotonergic genes in impulsive aggression and BPD. Only one study has analyzed the association between the tryptophan-hydroxylase 2 (TPH2) gene and BPD. A TPH2 “risk” haplotype has been described that is associated with anxiety, depression and suicidal behavior.

Methods

We assessed the relationship between the previously identified “risk” haplotype at the TPH2 locus and BPD diagnosis, impulsive aggression, affective lability, and suicidal/parasuicidal behaviors, in a well-characterized clinical sample of 103 healthy controls (HCs) and 251 patients with personality disorders (109 with BPD). A logistic regression including measures of depression, affective lability and aggression scores in predicting “risk” haplotype was conducted.

Results

The prevalence of the “risk” haplotype was significantly higher in patients with BPD compared to HCs. Those with the “risk” haplotype have higher aggression and affect lability scores and more suicidal/parasuicidal behaviors than those without it. In the logistic regression model, affect lability was the only significant predictor and it correctly classified 83.1% of the subjects as “risk” or “non-risk” haplotype carriers.

Conclusions

We found an association between the previously described TPH2 “risk” haplotype and BPD diagnosis, affective lability, suicidal/parasuicidal behavior, and aggression scores.     

Papillary lesions of the breast: evaluation with stereotactic directional vacuum-assisted biopsy.

PURPOSE: To evaluate the use of stereotactic directional vacuum-assisted biopsy (SDVAB) in diagnosing and managing papillary lesions of the breast. MATERIALS AND METHODS: The authors retrospectively reviewed the mammographic and histopathologic findings of 26 cases in which papillary lesions were diagnosed at SDVAB. In all cases, subsequent surgical excision (n = 20) or long-term imaging follow-up (n = 6) was performed and correlated with findings at SDVAB. RESULTS: SDVAB of 26 lesions yielded tissue that was classified as benign in 12, atypical in six, and malignant in eight. Of the 12 lesions that were diagnosed as histologically benign at SDVAB, six were surgically excised. Of these six lesions, five yielded benign correlative results. The sixth lesion was thought to be discordant with the imaging findings, and was surgically excised and determined to be malignant. Of the six benign lesions that were not surgically sampled for biopsy, five decreased in size and one was not seen at radiographic follow-up. Of the six lesions diagnosed as atypical at SDVAB that were surgically excised, one was benign and five were atypical. None proved to be malignant. Of the eight lesions diagnosed as malignant at SDVAB, surgical excision demonstrated ductal carcinoma in situ in all eight; two also had foci of invasive carcinoma. CONCLUSION: Benign and malignant papillary lesions of the breast can be reliably diagnosed at SDVAB when the SDVAB results correlate with the imaging findings. However, the extent of malignant papillary disease may be underestimated at SDVAB; in our study, invasive carcinoma was later discovered in 25% of patients with this diagnosis.     

Cognitive and brain function in schizotypal personality disorder

Schizotypal personality disorder, a diagnosis defined partially in terms of a genetic relatedness to schizophrenia, has begun to receive extensive investigative study. While the exact etiologic relationship between schizotypal personality disorder and schizophrenia remains to be determined, three models have been considered: (1) the two may be distinct disorders, (2) they may be essentially identical disorders but expressed with different degrees of severity, or (3) they may be related disorders with a partially overlapping etiology that might account for the many similarities yet the lack of psychosis or severe deficits in schizotypal individuals. Some of the recent research in the structural and functional neuroanatomy, neurochemistry, cognitive function, and pharmacology of schizotypal personality disorder is reviewed with citation of the most recent findings from our laboratory and others. Both schizotypal and schizophrenic subjects appear to show abnormalities in temporal lobe volume, but schizotypal subjects do not appear to show the volumetric decreases in frontal cortex that schizophrenic patients evidence. Abnormalities in thalamic nuclei parallel these findings-the pulvinar, which projects to temporal association and sensory cortices, is reduced in both disorders, but the mediodorsal nucleus, which projects extensively to the frontal cortex, is reduced in schizophrenic patients but not in schizotypal patients. Functional imaging studies suggest that there may be abnormalities in frontal activation in both disorders, but that schizotypal individuals can recruit alternative regions to accomplish tasks requiring frontal lobe activation that may help compensate. Imaging studies of the subcortex including FDG/PET imaging of metabolic activity during a verbal learning task, SPECT imaging studies which measure binding of IBZM and its displacement following amphetamine administration, and plasma HVA determinations following 2-deoxyglucose administration all suggest the possibility of relatively reduced dopaminergic subcortical activity in schizotypal individuals compared to schizophrenic patients. Cognitive function is also impaired in the areas of working memory, verbal learning, and attention in schizotypal patients, as in schizophrenic patients, and they may be particularly susceptible to cognitive tasks with high context dependence, as in schizophrenia. Preliminary trials of catecholaminergic agents suggest that these agents may be able to improve these impaired cognitive functions.     

建立猪血管内皮细胞对人血清适应的模型及其评估

目的:观察人免疫球蛋白G、免疫球蛋白M和正常人AB型血清诱导猪血管内皮细胞适应状态的效果。方法:实验于2002-05/2003-02在解放军第四军医大学分子生物学实验室完成。①正常人AB型血清和猪血清制备:取健康AB血型成年人血,每次50mL,置于干燥管内,垂直静置6h,3000r/min离心10min,取上清。操作4℃条件下进行,以保证补体的活性。获得血清于-20℃保存备用,用前0.22μm滤膜过滤除菌。猪血清制备同上。②猪血管内皮细胞培养、纯化及鉴定:取体质量3kg实验用乳猪,自左侧髂总动脉向心侧插入大隐静脉导管20cm,注射肝素500U后持续滴注含肝素抗生素盐水(肝素1×105U/L,青霉素4×107U/L),取腹主动脉和胸主动脉,以4℃含肝素抗生素盐水冲洗管腔和外膜后注入37℃预热的10g/LⅠ型胶原酶,消化5min后收集消化液,以1000r/min离心5min,收集细胞放于CO2孵箱内培养并传代,第3代以后不再使用抗生素。在光学显微镜下观察细胞生长形态,进行培养细胞类型的鉴定。③正常人血清对猪血管内皮细胞溶解试验:将猪血管内皮细胞制成浓度5×106L-1的细胞悬液,接种于96孔培养板,每孔200μL,培养至第4天细胞基本铺满培养板底部后加入含正常人AB型血清的培养液,终浓度分别为5%、10%、25%、40%,以相应浓度猪血清为对照,每组各取3孔。放入37℃孵箱内孵育2h后以四唑盐比色试验测各孔的吸光度值。④猪血管内皮细胞对人血清适应模型的建立及评估:培养猪血管内皮细胞,分别以免疫球蛋白G、免疫球蛋白M和低浓度正常人AB型血清诱导猪血管内皮细胞6d,以四唑盐比色法检测细胞存活率,并以免疫组化方法检测其血红素氧合酶1表达的情况。结果:①接种细胞形态呈圆形、三角形或短梭形,胞体丰满、胞浆均匀、核仁清晰。部分细胞呈团块样,大部分细胞为单细胞分布,其间混杂有少许血细胞,说明培养细胞为血管内皮细胞,无明显杂细胞污染。②在25%的正常人AB型血清作用下,猪血管内皮细胞的存活率为(71±22)%。与对照组相比较,100mg/L免疫球蛋白M和5%、10%正常人AB型血清诱导猪血管内皮细胞存活率分别为(81±31)%,(93±25)%,(90±42)%。③诱导后猪血管内皮细胞胞浆内血红素氧合酶1的表达明显增加。结论:100mg/L免疫球蛋白M和正常人AB型血清能够诱导猪血管内皮细胞的适应,后者效果更为明显。