The impact of perinatal loss on adjustment to subsequent pregnancy.

The current study compared the emotional adjustment of pregnant couples with and without a history of perinatal loss. Thirty-one pregnant women with a history of perinatal loss and 31 pregnant women with an unremarkable reproductive history were assessed between their 10th and 24th week of gestation. Partners were also recruited. Twenty-eight men were in the loss group and 23 men in the comparison group. Couples with a history of loss reported significantly more depressive symptomatology and pregnancy-specific anxiety than couples in the comparison group. Women reported more depressive symptomatology than men. Regression analyses revealed that for the group with a previous loss, depressive symptomatology was significantly associated with self-criticism, interpersonal dependency and number of previous losses. For the comparison group, depressive symptomatology was significantly associated dyadic adjustment. Pregnancy-specific anxiety of women with a previous loss was associated with their belief that their behavior affects fetal health; for women in the comparison group, pregnancy-specific anxiety was associated with the belief that health professionals' behavior affects fetal health. Implications for practice of health care professionals are discussed. The importance of early intervention to reduce distress is highlighted by the finding that alterations in mood are apparent in the early stages of pregnancy for both women and men who have experienced a previous perinatal loss. While carefully reducing personal responsibility for fetal health in women with a previous loss may reduce their pregnancy-specific anxiety, women with an unremarkable obstetrical history may benefit from an approach diminishing their perception of the power that medical staff has on fetal health.     

Wiring cost and topological participation of the mouse brain connectome

Brain connectomes are topologically complex systems, anatomically embedded in 3D space. Anatomical conservation of “wiring cost” explains many but not all aspects of these networks. Here, we examined the relationship between topology and wiring cost in the mouse connectome by using data from 461 systematically acquired anterograde-tracer injections into the right cortical and subcortical regions of the mouse brain. We estimated brain-wide weights, distances, and wiring costs of axonal projections and performed a multiscale topological and spatial analysis of the resulting weighted and directed mouse brain connectome. Our analysis showed that the mouse connectome has small-world properties, a hierarchical modular structure, and greater-than-minimal wiring costs. High-participation hubs of this connectome mediated communication between functionally specialized and anatomically localized modules, had especially high wiring costs, and closely corresponded to regions of the default mode network. Analyses of independently acquired histological and gene-expression data showed that nodal participation colocalized with low neuronal density and high expression of genes enriched for cognition, learning and memory, and behavior. The mouse connectome contains high-participation hubs, which are not explained by wiring-cost minimization but instead reflect competitive selection pressures for integrated network topology as a basis for higher cognitive and behavioral functions.Network organization of the brain is fundamental to the emergence of complex neuronal dynamics, cognition, learning, and behavior. Modern concepts of anatomical network connectivity originated in the 19th and early 20th century with the ascendancy of the neuron theory: the concept of discrete nerve cells contiguously connected via axonal projections and synaptic junctions (1, 2). In the last decade, the connectome has emerged as a new word to define the complete structural “wiring diagram” of a nervous system or brain (3). At the small scale of synaptically connected neurons, the connectome has only been completely mapped for the 302-neuron nervous system of the roundworm Caenorhabditis elegans, using serial electron microscopy and painstaking visual synaptic reconstruction (4). At the large scale of axonally connected brain regions, draft connectomes have been mapped for the cat and macaque, by collation of primary tract-tracing studies (5–7), and for the human, using in vivo diffusion-weighted magnetic resonance imaging measures of white matter tract organization (8), or interregional covariation measures of cortical thickness or volume (9).Topological analyses of these connectomes have consistently demonstrated a repertoire of complex network properties, including the simultaneous presence of modules and hubs (10). The seemingly ubiquitous appearance of these topological features, e.g., both at the cellular scale of the worm brain and at the areal scale of the human brain, supports scale- and species- invariant organizational principles of nervous systems, consistent with Ramón y Cajal’s seminal “laws of conservation for time, space and material” (1, 11–13). Anatomically localized and functionally specialized modules conserve space and (biological) material by reducing the average length of axonal projections, or wiring cost; anatomically distributed and functionally integrative hubs conserve (conduction) time by reducing the average axonal delay, or speed of interneuronal communication. The simultaneous presence of modules and hubs supports a contemporary reformulation of Ramón y Cajal’s laws as a trade-off between minimization of wiring cost and maximization of topological integration.Magnetic resonance imaging (MRI) allowed for testing such organizational principles in large-scale mammalian connectomes with high throughput whole-brain imaging. However, MRI methods measure anatomical connectivity indirectly and at low (millimeter scale) spatial resolution (14). In contrast, tract tracing methods measure anatomical connectivity directly, by detecting axonally mediated propagation of injected tracer, and at higher (micrometer scale) spatial resolution. Tract-tracing methods represent the current “gold standard” for mapping mammalian connectomes. However, most tract-tracing connectome studies to date have been limited to metaanalyses of primary datasets with limited brain coverage and variable definitions of brain regions and interregional connections (6, 7). Tract-tracing methods for comprehensive and systematic mapping of the connectome did not exist until recently (15–18).The recent step change in the quality and quantity of available tract-tracing measurements in mammalian species, such as the macaque and the mouse, provides a crucial opportunity to test theories of connectome organization more rigorously. Some of the first systematic high-quality tract tracing studies in the macaque have revealed many previously unreported weak and long-range axonal projections (19, 20). These studies have also shown that spatial constraints on wiring cost, modeled by an exponential decay weight–distance relationship, can account for many important aspects of the macaque connectome (21, 22).We therefore considered it important to comprehensively evaluate the design principles of the mouse connectome in a systematically acquired dataset of axonal tract-tracing experiments (17). We measured the topological and spatial properties of this connectome and compared these properties to equivalent properties of reference lattice and random graphs. We hypothesized that the connectome would have a complex topology and include integrative hubs inexplicable by minimization of wiring cost. We also explored the neurobiological substrates of the mouse connectome by correlating topological properties with histological and gene-expression properties quantified from independently acquired datasets.     

Severe malnutrition due to systemic lupus erythematosus associated protein losing enteropathy

Systemic lupus erythematosus most often targets organs such as joints, serosa, skin, bone marrow, and the kidneys. Gastrointestinal complications are uncommon, and among these, protein losing enteropathy is particularly rare. We present a young woman who suffered from chronic abdominal pain and diarrhea, developed severe malnutrition, and was eventually diagnosed with systemic lupus erythematosus and associated protein losing enteropathy.     

Comparison of various noninvasive techniques for evaluating deep venous thrombosis

A series of noninvasive vascular tests was performed on groups of normal individuals (Group I) and on patients with chronic deep vein thrombophlebitis (Group II) to determine the relative specificity and sensitivity of the tests. Results indicate that the simpler tests, requiring a minimum of equipment and technique are as effective as certain of the more sophisticated procedures.     

Pain, somatic focus, and emotional adjustment in children of chronic headache sufferers and controls

Recent epidemiological studies have indicated that as many as 78% of individuals with chronic pain come from families in which at least one other family member has chronic pain. This suggests that children of individuals with chronic pain may be at particular risk for developing chronic pain conditions in the future. This study examined the relationship between parental chronic pain and children's general adjustment. A group of parents reporting chronic tension or migraine headache and their children were compared to a group of illness-free parents and their children. Results revealed that children of chronic headache sufferers were more somatically focused than their control counterparts. It is suggested that this heightened concern with their health status may be either a reaction to, or a means of coping with ongoing stress. A number of significant correlations between parents' and their children's level of emotional adjustment are also reported. The implications of these findings for general family health status, and characteristic ways of dealing with illness are discussed.     

Aortic and coronary artery dissection during percutaneous coronary intervention: a case report and review article

Coronary artery dissection is an uncommon but potentially serious complication in percutaneous coronary interventions. We treated a 53-year-old female patient with right coronary spasm, which was misdiagnosed as a coronary lesion. The coronary spasm resolved with nitrate administration, but proximal coronary dissection developed during angiography. It progressed anterograde and led to inferior myocardial infarction and severe hemodynamic instability due to right coronary artery occlusion. Percutaneous intervention failed, and it was determined that coronary dissection progressed retrograde, across the truncus of the aorta. Ascending aortic grafting and coronary bypass surgery were performed. The patient recovered and was discharged after 10 days. Close cardiothoracic observation is mandatory in patient evaluation and management.     

Human herpesvirus 8 open reading frame 26 and open reading frame 65 sequences from multiple myeloma patients: a shared pattern not found in Kaposi's sarcoma or primary effusion lymphoma.

Human herpesvirus 8 (HHV-8), also known as Kaposi's sarcoma-associated herpesvirus, has been implicated in the pathogenesis of Kaposi's sarcoma (KS), primary effusion lymphoma (PEL), multicentric Castleman's disease, and recently multiple myeloma (MM). DNA sequence analyses of HHV-8 suggest that multiple HHV-8 strains exist. We extracted DNA from 24 patients with MM and 3 patients with monoclonal gammopathy of undetermined significance and compared HHV-8 open reading frames (ORFs) 26 and 65 sequences with those derived from patients with KS, PEL, and two HHV-8-positive PEL cell lines KS-1 and BC-1. ORF26 sequence data suggest that MM patients are consistently carriers of HHV-8 strain subtype C3. All MM patients also consistently revealed either a single bp deletion or substitution at position 112197 in ORF65. This unique alteration is not present in patients with KS or PEL or in PEL cell lines. It occurs in the portion of ORF65 that is known to be responsible for a serological response to HHV-8.