Role for kisspeptin/neurokinin B/dynorphin (KNDy) neurons in cutaneous vasodilatation and the estrogen modulation of body temperature

Estrogen withdrawal in menopausal women leads to hot flushes, a syndrome characterized by the episodic activation of heat dissipation effectors. Despite the extraordinary number of individuals affected, the etiology of flushes remains an enigma. Because menopause is accompanied by marked alterations in hypothalamic kisspeptin/neurokinin B/dynorphin (KNDy) neurons, we hypothesized that these neurons could contribute to the generation of flushes. To determine if KNDy neurons participate in the regulation of body temperature, we evaluated the thermoregulatory effects of ablating KNDy neurons by injecting a selective toxin for neurokinin-3 expressing neurons [NK₃-saporin (SAP)] into the rat arcuate nucleus. Remarkably, KNDy neuron ablation consistently reduced tail-skin temperature (T_SKIN), indicating that KNDy neurons facilitate cutaneous vasodilatation, an important heat dissipation effector. Moreover, KNDy ablation blocked the reduction of T_SKIN by 17β-estradiol (E₂), which occurred in the environmental chamber during the light phase, but did not affect the E₂ suppression of T_SKIN during the dark phase. At the high ambient temperature of 33 °C, the average core temperature (T_CORE) of ovariectomized (OVX) control rats was significantly elevated, and this value was reduced by E₂ replacement. In contrast, the average T_CORE of OVX, KNDy-ablated rats was lower than OVX control rats at 33 °C, and not altered by E₂ replacement. These data provide unique evidence that KNDy neurons promote cutaneous vasodilatation and participate in the E₂ modulation of body temperature. Because cutaneous vasodilatation is a cardinal sign of a hot flush, these results support the hypothesis that KNDy neurons could play a role in the generation of flushes.     

Physician and Patient Barriers to Breast Cancer Preventive Therapy

The uptake of selective estrogen receptor modulators (SERMs) and aromatase inhibitors (AIs) for the primary prevention of breast cancer is low, despite their proven efficacy in several randomized clinical trials. This review summarizes the latest data on physicians’ and women’s barriers to breast cancer preventive therapy. Physicians’ challenges include: identifying suitable candidates for preventive therapy, inadequate training and confidence in risk assessment and counselling, insufficient knowledge of risk-reducing medications, and lack of time. High-risk women fear medication side effects, and they often weigh experiences of others more heavily than statistical probabilities to guide their decision-making. Despite decision aid interventions to help women make an informed decision, acceptance of preventive therapy will remain low until: risk/benefit profiles are more favorable, physicians are better educated and skilled in having these discussions, and suitable biomarkers to monitor drug efficacy and better clinical risk prediction models to assess true individual risk are available.     

Stroke risk after nonstroke emergency department dizziness presentations

Neuroimaging of older adults commonly reveals abnormality (leukoaraiosis) in the cerebral white matter. Studies have established that extensive leukoaraiosis predicts dementia and disability, but the pathogenesis of leukoaraiosis remains unclear. We recruited 5 patients with leukoaraiosis and performed magnetic resonance mapping of the brain for 16 consecutive weeks. We observed tiny lesions arising de novo in the cerebral white matter. These lesions were clinically silent. They had the signature features of acute ischemic stroke. With time, the characteristics of these lesions approached those of pre‐existing leukoaraiosis. Together, these findings suggest that tiny silent acute infarcts are a cause of leukoaraiosis. Ann Neurol 2014;76:899–904     

The Protective Influence of Family Bonding on Smoking Initiation in Adolescents by Racial/Ethnic and Age Subgroups

Using data from the National Longitudinal Study of Adolescent Health, this study examined the associations among family bonding factors and the initiation of smoking by race/ethnicity and age group among nonsmokers at Wave 1. Overall, 18% of the sample initiated smoking by Wave 2. For younger African American and Hispanic youth, high maternal satisfaction with the relationship was significantly protective of smoking initiation. For older Hispanics, high parental presence and high parent-family connectedness were protective against smoking initiation while lack of awareness about the adolescent's whereabouts was a risk factor for initiation in both younger and older Caucasians, and in the older Hispanics. Our results underscore the importance of maintaining high levels of family bonding with the adolescent throughout early and late adolescence in order to decrease tobacco initiation.     

Development of a Shared Decision Making Model in a Community Mental Health Center

Shared Decision Making (SDM) is an essential component of recovery oriented treatment for clients with severe and persistent mental illnesses. SDM has been found to be effective in improving outcome of treatment of non-psychiatric ailments, and studies of SDM in community mental health settings are limited. We designed and implemented a low tech SDM program in a non-academic community mental health center and evaluated the outcome on decisional certainty and satisfaction with services. The results suggest that SDM can be effectively integrated with evidence based psychiatric rehabilitation practices utilizing already existing resources.