Sex differences in serotonin-hypothalamic connections underpin a diminished sense of emotional well-being with increasing body weight.

BACKGROUND/OBJECTIVES: The neurobiological mechanisms linking obesity to emotional distress related to weight remain largely unknown. PARTICIPANTS/METHODS: Here we combined positron emission tomography, using the serotonin transporter (5-HTT) radiotracer [(11)C]-3-amino-4-(2-dimethylaminomethylphenylsulfanyl)-benzonitrile, with functional connectivity magnetic resonance imaging, the Beck Depression Inventory (BDI-II) and the Impact of Weight on Quality of Life-Lite questionnaire (IWQOL-Lite) to investigate the role of central serotonin in the severity of depression (BDI-II), as well as in the loss of emotional well-being with body weight (IWQOL-Lite). RESULTS: In a group of lean to morbidly obese individuals (n=28), we found sex differences in the 5-HTT availability-related connectivity of the hypothalamus. Males (n=11) presented a strengthened connectivity to the lateral orbitofrontal cortex, whereas in females (n=17) we found strengethened projections to the ventral striatum. Both regions are known as reward regions involved in mediating the emotional response to food. Their resting-state activity correlated positively to the body mass index (BMI) and IWQOL-Lite scores, suggesting that each region in both sexes also underpins a diminished sense of emotional well-being with body weight. Contrarily to males, we found that in females also the BDI-II positively correlated with the BMI and by trend with the activity in ventral striatum, suggesting that in females an increased body weight may convey to other mood dimensions than those weight-related ones included in the IWQOL-Lite. CONCLUSIONS: This study suggests sex differences in serotonin-hypothalamic connections to brain regions of the reward circuitry underpinning a diminished sense of emotional well-being with an increasing body weight.

The central nervous norepinephrine network links a diminished sense of emotional well-being to an increased body weight.

OBJECTIVES: The neurobiological mechanisms linking obesity to emotional distress remain largely undiscovered. METHODS: In this pilot study, we combined positron emission tomography, using the norepinephrine transporter (NET) tracer [(11)C]-O-methylreboxetine, with functional connectivity magnetic resonance imaging, the Beck depression inventory (BDI), and the impact of weight on quality of life-Lite questionnaire (IWQOL-Lite), to investigate the role of norepinephrine in the severity of depression (BDI), as well as in the loss of emotional well-being with body weight (IWQOL-Lite). RESULTS: In a small group of lean-to-morbidly obese individuals (n=20), we show that an increased body mass index (BMI) is related to a lowered NET availability within the hypothalamus, known as the brain's homeostatic control site. The hypothalamus displayed a strengthened connectivity in relation to the individual hypothalamic NET availability to the anterior insula/frontal operculum, as well as the medial orbitofrontal cortex, assumed to host the primary and secondary gustatory cortex, respectively (n=19). The resting-state activity in these two regions was correlated positively to the BMI and IWQOL-Lite scores, but not to the BDI, suggesting that the higher the resting-state activity in these regions, and hence the higher the BMI, the stronger the negative impact of the body weight on the individual's emotional well-being was. CONCLUSIONS: This pilot study suggests that the loss in emotional well-being with weight is embedded within the central norepinephrine network.

Radioligand imaging of α4ß2* nicotinic acetylcholine receptors in Alzheimer's disease and Parkinson's disease.

The α4ß2* nicotinic acetylcholine receptors (α4ß2*-nAChR) are highly abundant in the human brain. As neuromodulators they play an important role in cognitive functions such as memory, learning and attention as well as mood and motor function. Post mortem studies suggest that abnormalities of α4ß2*-nAChRs are closely linked to histopathological hallmarks of Alzheimer's disease (AD), such as amyloid aggregates/oligomers and tangle pathology and of Parkinson's disease (PD) such as Lewy body pathology and the nigrostriatal dopaminergic deficit. In this review we summarize and discuss nicotinic receptor imaging findings of 2-[18F]FA-85380 PET, [11C]nicotine PET and 5-[123I]IA-85380 SPECT studies investigating α4ß2*-nAChR binding in vivo and their relationship to mental dysfunction in the brain of patients with AD and patients out of the spectrum of Lewy body disorders such as PD and Lewy body dementia (DLB). Furthermore, recent developments of novel α4ß2*-nAChR-specific PET radioligands, such as (-)[18F]Flubatine or [18F]AZAN are summarized. We conclude that α4ß2*-nAChR-specific PET might become a biomarker for early diagnostics and drug developments in patients with AD, DLB and PD, even at early or prodromal stages.

Efeito da contagem de células somáticas sobre o rendimento e a composição físico-química do queijo muçarela / The effect of somatic cell count on yield and physico-chemical composition of Mozzarella cheese

Determinou-se o efeito da contagem de células somáticas do leite sobre o rendimento e a composição físico-química do queijo muçarela. Foram selecionadas vacas com contagem de células somáticas (CCS) <200.000 células/mL; CCS >200.000 a <400.000 células/mL; CCS >400.000 células/mL a <750.000 células/mL e CCS >750.000 células/mL e que não receberam tratamento com antimicrobianos nos dias que antecederam a obtenção do leite utilizado no processamento. Os queijos foram avaliados por meio das análises de pH, acidez, umidade, proteína, gordura, extrato seco total e desengordurado. Os queijos elaborados do leite com alta CCS >750.000 cél./mL apresentaram menor teor de proteína, maior umidade e menor rendimento industrial. Conclui-se que a elevação da CCS cursou com alterações na qualidade do queijo muçarela, o que reflete em sua composição nutricional e microbiológica, pois ocorre um incremento na atividade de água, fator intrínseco indispensável para o crescimento microbiano e consequente redução da vida de prateleira...

The effect of somatic cell count (SCC) on the yield and composition of mozzarella cheese was evaluated. Cows with different levels of SCC in their milk (<200.000 cells/mL; >200.000 to <400.000 cells/mL; >400.000 cells/mL to <750.000 cells/mL and >750.000 cells/mL) were selected. The animals had no antimicrobial treatment prior to or on milk sampling day. The mozzarella cheese quality was evaluated analyzing pH, acidity, moisture and protein content, fat, total solids and nonfat solids. The trial was replicated four times and the experimental design was analyzed through randomized blocks. The mozzarella cheese from milk with high SCC (>750.000 cells/mL) had lower protein content, higher moisture content and lower industrial yield, compared to cheese from milk with lower levels of SCC. High numbers of SCC impaired mozzarella cheese quality, which was reflected in its nutritional and microbiological composition. We observed an increase in water activity, an intrinsic and essential factor for microbial growth...

[Peripheral facial palsy accompanied by a vesicular rash on the ear and hard palate]. / Periphere Fazialisparese mit Krusten an der Ohrmuschel und Bläschen am Gaumen. Der pädiatrische PRAXIS-Fall.

Ramsay Hunt syndrome (RHS) is defined as a peripheral facial nerve palsy accompanied by an erythematous vesicular rash on the ear (zoster oticus) and hard palate. It is known that varicella zoster virus (VZV) causes RHS. History and neurological examination remain the mainstay of diagnosis. Prednisolone and acyclovir/valacyclovir is helpful in RHS when given within three days of onset. We report on a 14-year-old boy who had RHS accompanied by meningitis. Polymerase chain reaction identified VZV in exudates from the geniculate zone of the ear, the hard palate and in the CSF.

Atlas vertebra realignment and achievement of arterial pressure goal in hypertensive patients: a pilot study.

Anatomical abnormalities of the cervical spine at the level of the Atlas vertebra are associated with relative ischaemia of the brainstem circulation and increased blood pressure (BP). Manual correction of this mal-alignment has been associated with reduced arterial pressure. This pilot study tests the hypothesis that correcting mal-alignment of the Atlas vertebra reduces and maintains a lower BP. Using a double blind, placebo-controlled design at a single center, 50 drug naïve (n=26) or washed out (n=24) patients with Stage 1 hypertension were randomized to receive a National Upper Cervical Chiropractic (NUCCA) procedure or a sham procedure. Patients received no antihypertensive meds during the 8-week study duration. The primary end point was changed in systolic and diastolic BP comparing baseline and week 8, with a 90% power to detect an 8/5 mm Hg difference at week 8 over the placebo group. The study cohort had a mean age 52.7+/-9.6 years, consisted of 70% males. At week 8, there were differences in systolic BP (-17+/-9 mm Hg, NUCCA versus -3+/-11 mm Hg, placebo; P<0.0001) and diastolic BP (-10+/-11 mm Hg, NUCCA versus -2+/-7 mm Hg; P=0.002). Lateral displacement of Atlas vertebra (1.0, baseline versus 0.04 degrees week 8, NUCCA versus 0.6, baseline versus 0.5 degrees , placebo; P=0.002). Heart rate was not reduced in the NUCCA group (-0.3 beats per minute, NUCCA, versus 0.5 beats per minute, placebo). No adverse effects were recorded. We conclude that restoration of Atlas alignment is associated with marked and sustained reductions in BP similar to the use of two-drug combination therapy.

An approach to identify dairy cows being responsive to recombinant bovine somatotropin.

Forty-eight primiparous and pregnant Holstein cows at 202 (+/-59) days in milk and average daily milk production (DMP) of 22 (+/-5.3) kg at the beginning of the trial were used to study the possibility of identifying animals that are more responsive to recombinant bovine somatotropin (rbST). Animals were housed in free-stall barns, milked three times a day and fed a total mixed ration. Animals were injected with one dose (500 mg each) of rbST every 21 days during a 105-day total period (five doses in all). Daily milk production was recorded to measure average apparent response (AAR) and peak of apparent response (PAR). Average apparent response was defined as the average increase in milk production, expressed as kilogram per cow per day, for days 0-18 after dosing, as compared to the average production calculated for days -1, -2, -3, 19, 20 and 21 after dosing. Peak of apparent response was calculated as the increase in milk production for each day from 0 to 18 days after dosing as compared to the average production for days -1, -2 and -3. There was a positive linear correlation (r = 0.608; p = 0.0001) between AAR for the first 21 days and AAR for the total 105-day period (AATR). A correlation coefficient was calculated between each individual PAR value and AATR. The highest correlation coefficient (r = 0.511; p = 0.0002) was observed for days 8, 9 and 10, and therefore these days were considered the best estimates for calculating AAR when DMP records are not available. Also, high somatic cells count had a negative impact on milk yield response to treatment (p = 0.0162).

A population-based longitudinal study of cognitive functioning in the menopausal transition.

BACKGROUND: No longitudinal studies have tracked cognitive performance through the menopausal transition and thus the impact of the transition on cognition, independent of aging, is not known. The authors hypothesized that a decline in cognitive functioning occurs as women progress through the menopausal transition, independent of age, educational level, family income, ethnicity, and baseline self-perceived health. METHOD: The authors began a population-based, longitudinal study in January 1996 with yearly follow-up interviews. This report includes follow-up through November 2001. The authors randomly selected African American and white women from a census of two contiguous Chicago communities. After screening for eligibility (age 42 to 52 years, premenopausal or early perimenopausal, no exogenous hormone use in the past 3 months, and no hysterectomy), 868 agreed to participate. Women who became pregnant, had a hysterectomy, or began using hormones were censored from that time onward. This study reports on 803 women for whom cognitive assessments were available. The authors assessed working memory (Digit Span Backward) and perceptual speed (Symbol Digit Modalities Test). RESULTS: Contrary to the hypothesis, the authors found small but significant increases over time during the premenopausal and perimenopausal phases. This trend was not accounted for by chronological age, education, family income, ethnicity, or baseline self-perceived health. CONCLUSIONS: Transition through menopause is not accompanied by a decline in working memory and perceptual speed.

Biopsy correlates of abnormal cervical cytology classified using the Bethesda system.

OBJECTIVE: The goal of this study was to determine the colposcopic findings underlying cytologic abnormalities classified according to the Bethesda system. METHODS: Women undergoing colposcopy for abnormal cytology at an urban teaching hospital between July 1, 1996 and December 31, 1999 had Papanicolaou smears repeated. Results were compared both with biopsy histology and with the worst histology reported after 8-26 months of follow-up. kappa statistics and Spearman's rho were calculated to determine the degree of agreement. RESULTS: Colposcopy was performed for 2263 (94%) women. Referral and repeat Pap smears were reported identically in 493 (25%) of the 1962 women with results for both. No AGUS (atypical glandular cells of uncertain significance) smears were confirmed on repeat smear, and after excluding AGUS, agreement within one grade was found in 1305 of 1854 (70%). Among the 1842 women with squamous cytologic abnormalities, biopsy revealed a lesion more severe than that suggested by referral cytology in 577 (31%) and a less severe lesion in 648 (35%); exact correspondence was found in only 646 (35%). Of 317 women with ASCUS (atypical squamous cells of uncertain significance) on referral Pap smear, a negative repeat smear, and a specific biopsy result, 95 (30%) had true negative histology, while 148 (47%) had condyloma, 56 (18%) had cervical intraepithelial neoplasia (CIN) 1, 8 (3%) had CIN 2, 10 (3%) had CIN 3, and none had cancer. Comparison of repeat smear and colposcopic biopsy yielded a kappa statistic of 0.16. CONCLUSIONS: Cytology classified according to the Bethesda system does not accurately predict histologic diagnosis.

Psychologic distress and natural menopause: a multiethnic community study.

OBJECTIVES: This study examined the association between psychologic distress and natural menopause in a community sample of African American, White, Chinese, Hispanic, and Japanese women participating in a national women's health study. METHODS: A cohort of 16,065 women aged 40 to 55 years provided information on menstrual regularity in the previous year, psychosocial factors, health, and somatic-psychologic symptoms. Psychologic distress was defined as feeling tense, depressed, and irritable in the previous 2 weeks. RESULTS: Rates of psychologic distress were highest in early perimenopause (28.9%) and lowest in premenopause (20.9%) and postmenopause (22%). In comparison with premenopausal women, early perimenopausal women were at a greater risk of distress, with and without adjustment for vasomotor and sleep symptoms and covariates. Odds of distress were significantly higher for Whites than for the other racial/ethnic groups. CONCLUSIONS: Psychologic distress is associated with irregular menses in midlife. It is important to determine whether distress is linked to alterations in hormone levels and to what extent a mood-hormone relationship may be influenced by socioeconomic and cultural factors.

Negative T waves shortly after ST-elevation acute myocardial infarction are a powerful marker for improved survival rate.

BACKGROUND: Recent studies have reported that negative T waves in the setting of acute coronary events are associated with Thrombolysis In Myocardial Infarction flow grade 3 in the infarct-related artery and with improved parameters of ventricular function rather than with ischemia. METHODS: Patients enrolled in the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO-I) angiographic substudy (ie, patients with acute infarction randomly assigned to one of 4 thrombolytic regimens who then underwent coronary angiography) were included in this study if they survived at least 24 hours and had no confounding electrocardiographic factors (n = 1505). RESULTS: More patients had negative T waves develop (NT group, n = 938 [62%]) than not (PT group, n = 567 [38%]). Peak creatine kinase MB, time to thrombolysis, and randomization to accelerated alteplase were no different between the groups. Thirty days after admission, 12 patients in the NT group had died versus 25 patients in the PT group (1.3% vs. 4.4%; P <.001; odds ratio for negative T waves 0.28; 95% confidence interval 0.14-0.56). The difference persisted when only patients who survived at least 3 days were analyzed. After adjusting for relevant covariates (including presence of new Q waves in the follow-up electrocardiogram), negative T waves were an independent predictor for survival (P =. 007; odds ratio for negative T waves 0.38; 95% confidence interval 0. 18-0.78). Patients in the NT group were 35% more likely to have achieved patency of the infarct-related artery, although this difference was not statistically significant. CONCLUSIONS: Negative T waves shortly after acute myocardial infarction treated with thrombolysis were markers for improved 30-day survival rate. This finding merits prospective testing.

Predicting compliance with follow-up recommendations after colposcopy among indigent urban women.

OBJECTIVE: To determine correlates of compliance with follow-up recommendations after colposcopy. METHODS: Between October 1, 1992, and June 30, 1997, management recommendations were made to 451 consecutive women who attended a resident colposcopy clinic. Compliance was determined after 8-12 months. Correlates of compliance were assessed by univariate and multivariate analyses. RESULTS: Recommendations included repeat cytology in 6 months for 252 women, loop excision for 114, conization for 27, repeat colposcopy for 51, other for three, and not recorded for four. Rates of ever complying were 81% for loop excision, 85% for conization, 62% for repeat colposcopy, and 36% for repeat cytology. In multivariate analysis, the only significant predictors of compliance were history of genital herpes simplex infection (odds ratio [OR] 0.20; 95% confidence interval [CI] 0.05, 0.86, P = .03) and the nature of the recommendation (OR 4.73; CI 2.51, 8.92 for loop excision; OR 8.72; CI 2.57, 29.6 for conization; and OR 2.53; CI 1.30, 4.93 for repeat colposcopy, all against observation, P<.001). CONCLUSION: After colposcopy, women were more likely to comply with earlier, more intensive interventions, although the relative effect of follow-up interval and intervention could not be distinguished.

Rehabilitation staff perceptions of characteristics of geriatric rehabilitation patients.

OBJECTIVE: To determine if professionals treating older rehabilitation patients regarded them as having different characteristics than younger rehabilitation patients, to derive factors from these perceptions, and to examine the impact of the discipline of the professional and other factors on these perceptions. DESIGN: Rehabilitation professionals at a random sample of facilities accredited by the Commission on Accreditation of Rehabilitation Facilities were surveyed to determine their level of agreement with 60 items addressing characteristics of older rehabilitation patients. The items were derived from focus groups with rehabilitation staff members. PARTICIPANTS: One thousand sixty-three rehabilitation professionals from nine disciplines (nursing, occupational therapy, physiatry, physical therapy, psychology, social work, speech pathology, therapeutic recreation, and vocational counseling) responded to the questionnaire and were included in the study. RESULTS: There was a wide range of agreement levels across the 60 items (range of median agreement, 12.7% to 93.5%). Factor analysis resulted in six categories of perceptions regarding older rehabilitation patients: (1) physical limitations, (2) motivational deficits, (3) psychological distress/need for support, (4) maturity and positive coping skills, (5) need for privacy/decreased adaptability, and (6) discharge complications. Significant differences across disciplines were found for five of six factors. Nurses agreed more strongly with the negative psychological factors (2, 3, and 5) compared to physical therapists, psychologists, and social workers. Physicians scored significantly higher than two other disciplines on the physical limitations factor. These differences may be related to the distinct role each discipline plays in the rehabilitation process. Older professionals also scored higher on four factors, likely because of personal rather than professional experience with aging. CONCLUSIONS: Treating professionals recognize differences between younger and older rehabilitation patients. Many of these perceived differences can be viewed as variables that require more effort and skill on the part of the treating professional. The training of rehabilitation professionals needs to better prepare individuals from all disciplines to adapt to age-specific differences.

Quantifying psychosocial nursing interventions provided to geropsychiatric inpatients.

The purpose of this pilot study was to develop and test the Geropsychiatric Intervention Checklist (GPIC), a measure designed to quantify psychosocial nursing interventions provided to persons on a geropsychiatric inpatient unit (N = 48). Data were collected by nursing staff, using self-report methods. This pilot study lays the foundation for future research designed to examine the impact of nursing interventions on geropsychiatric inpatient outcomes.

Predicting risk factors for suboptimal excision in women undergoing cold-knife cone biopsy.

OBJECTIVE: Our goal was to identify risk factors for suboptimal excision in relation to a positive endocervical curettage (ECC) after conization or positive specimen margin. MATERIALS AND METHODS: A retrospective review of referral cy-tology and colposcopy results for 280 women undergoing conization at two urban teaching centers was performed. Mann-Whitney or Pearson's chi-square test was used to de-termine significant associations between preoperative variables and positive cone margin, positive intraoperative ECC, and either positive margin or positive intraoperative ECC. RESULTS: Cytology grade, gravidity, parity, and race were not significantly correlated with any outcome variable. Using lo-gistical regression analyses, correlates of positive ECC after conization included increasing age (p = .01), positive colpo-scopic biopsy (p = .01), colposcopic inadequacy (p = .01), and positive preoperative ECC (p = .03). Positive preoperative ECC was the only significant risk factor for positive cone margin (p = .02) or the combination of either positive intraoperative ECC or positive cone margin (p = .0001). Condusion. A positive preoperative ECC is the best predictor of suboptimal excision at conization and should be performed unless contraindi-cated.

Correlating preoperative cytology and colposcopic biopsy with final histology after conization of the cervix.

OBJECTIVES: We set out to evaluate the predictive value of preoperative cytology and colposcopic histology in determining final pathology after conization of the cervix in the era of the Bethesda system. METHODS: A retrospective review of the charts of 280 patients who had cold-knife conization was undertaken. Preoperative cytology and colposcopic biopsy histology were compared to the cone biopsy histology. The Spearman's correlation coefficient was used to determine the correlation between both preoperative cytology and histology and histology of the cone biopsy. RESULTS: Pre-operative cytology matched cone histology in only 56.5% of cases and was within one grade in 92.3% of cases, with a correlation of 0.369. Most outliers were high-grade cytology not confirmed at cone biopsy. Preoperative biopsy correlated even less with cone histology: Exact correlation occurred in 40% of cases, correlation within one grade was seen in 69.4% of cases, and the Spearman correlation coefficient was 0.328. Most outliers were high-grade lesions on cone biopsy that were not detected with colposcopic biopsy. CONCLUSIONS: Pre-operative cytology and histology do not predict final pathology with enough accuracy to allow management to be determined by them. Conization of the cervix remains a useful procedure in the triage of the abnormal cytological smear.

The Big Ten Student Suicide Study: a 10-year study of suicides on midwestern university campuses.

The Big Ten Student Suicide Study was undertaken from 1980-1990 to determine the suicide rates on Big Ten University campuses. The study design attempted to address many of the statistical and epidemiological flaws identified in previous studies of campus student suicides. The 10-year study collected demographic and correlational data on 261 suicides of registered students at 12 midwestern campuses. The largest number of suicides for both males and females were in the 20-24-year-old age group (46%), and amongst graduate students (32%). The overall student suicide rate of 7.5/100,000 is one half of the computed national suicide rate (15.0/100,000) for a matched sample by age, gender, and race. Despite the overall lower suicide rate, the analyses revealed that students 25 and over have a significantly higher risk than younger students. Although women have rates roughly half those of men throughout their undergraduate years, graduate women have rates not significantly different from their male counterparts (graduate women 9.1/100,000 and graduate men 11.6/100,000).