Cell type-specific and sexually dimorphic expression of transcription factor AP-2 in the adult mouse brain.

Expression of transcription factor AP-2 family genes in adult mouse brain regions was examined at RNA and protein levels and in tissue sections. AP-2 family RNA transcripts, nuclear AP-2 DNA binding activity, and AP-2 immunoreactivity were greatest in hindbrain and midbrain regions. Cells expressing AP-2 were predominantly differentiated neurons and were abundant in the solitary tract nucleus, hypoglossal nucleus, locus coeruleus, cerebellar molecular layer, superior colliculus, mitral cell layers of the main and accessory olfactory bulbs, and in some divisions of the bed nucleus of the stria terminalis. Sexually dimorphic expression of AP-2 was seen in the bed nucleus of the stria terminalis, a forebrain region required for regulation of gender-specific reproductive and social behaviors. In males, AP-2 expressing neurons were present in supracapsular, lateral ventral, and medial ventral divisions of the bed nucleus of the stria terminalis. In contrast, females had AP-2 expressing neurons in the lateral ventral division, but not the supracapsular division, and AP-2 expression in medial ventral division neurons oscillated during the estrus cycle. With the exception of the bed nucleus of the stria terminalis, forebrain regions generally lacked cells with high levels of AP-2. However, a small population of cells co-expressing low levels of AP-2 and Notch1 was sparsely distributed in the cerebral cortex and hippocampal dentate gyrus subgranular zone. Based on their variable levels of NeuN, a marker for differentiated neurons, these cells may include nascent neurons. A subset of cerebellar Purkinje cells also co-expressed low levels of AP-2 and Notch1. Together, the adult brain regions with AP-2 expressing neurons are notable for their importance in pathways that integrate sensory and neuroendocrine information for regulation of reproductive, social, and feeding behaviors. Our data suggest that AP-2 transcription factors contribute at multiple levels to adult brain function including regulation of gender-specific behavior.

Complications following transjugular intrahepatic portosystemic shunt: a retrospective analysis.

Transjugular intrahepatic portosystemic shunt (TIPS) has been the therapeutic option for severe decompensation of chronic liver disease and as a bridge to liver transplantation. The aim of this study was to analyze the complications of this procedure. The records of 47 patients (39 men) of mean age 48 years underwent TIPS procedures from 1998 to 2003 were reviewed. Forty-one patients received 45 successful TIPS; it failed in six patients. Improvement was observed in 20 of 28 patients with upper gastrointestinal bleeding (71%); 9 of 11 with ascites (82%); and 5 of 8 with impaired renal function (62%). The Child-Pugh scores improved in 6 of the 47 patients (13%). Transplantation was performed in 11 patients (23%). The complications were: encephalopathy (49%); infection (19%); renal failure (17%); TIPS migration to the portal vein (4%) and to the right atrium (4%). Mortality was 32% (15/47) over 3 months. Eight patients developed active bleeding during TIPS installation requiring mechanical ventilation and intensive care, and died within the first week. Other causes of death were sepsis (n = 2), liver failure (n = 1), accidental puncture of the Glisson's capsule leading to intra-abdominal bleeding (n = 1) and refractory upper gastrointestinal bleeding (n = 3). The latter four patients had TIPS placement failure. In conclusion, TIPS produced clinical improvement among 51% of patients with complications in 49%. The main complications were encephalopathy (49%), infection (19%), and renal failure (17%). The 3-month mortality rate after TIPS placement was 32%.