Acute Myocardial Infarction Manifested with Headache

We report a very rare case of a patient who presented with headache as the sole symptom of an acute myocardial infarction (AMI). The patient underwent primary percutaneous coronary angioplasty followed by drug-eluting stent implantation and the headache was immediately relieved. The pathophysiologic explanation of the occurrence of headache as a sole manifestation of an AMI is discussed

Bidirectional Psychoneuroimmune Interactions in the Early Postpartum Period Influence Risk of Postpartum Depression

More than 500,000 U.S. women develop postpartum depression (PPD) annually. Although psychosocial risks are known, the underlying biology remains unclear. Dysregulation of the immune inflammatory response and the hypothalamic–pituitary–adrenal (HPA) axis are associated with depression in other populations. While significant research on the contribution of these systems to the development of PPD has been conducted, results have been inconclusive. This is partly because few studies have focused on whether disruption in the bidirectional and dynamic interaction between the inflammatory response and the HPA axis together influence PPD. In this study, we tested the hypothesis that disruption in the inflammatory-HPA axis bidirectional relationship would increase the risk of PPD. Plasma pro- and anti-inflammatory cytokines were measured in women during the 3rd trimester of pregnancy and on Days 7 and 14, and Months 1, 2, 3, and 6 after childbirth. Saliva was collected 5 times the day preceding blood draws for determination of cortisol area under the curve (AUC) and depressive symptoms were measured using the Edinburgh Postpartum Depression Survey (EPDS). Of the 152 women who completed the EPDS, 18% were depressed according to EDPS criteria within the 6 months postpartum. Cortisol AUC was higher in symptomatic women on Day 14 (p = .017). To consider the combined effects of cytokines and cortisol on predicting symptoms of PPD, a multiple logistic regression model was developed that included predictors identified in bivariate analyses to have an effect on depressive symptoms. Results indicated that family history of depression, day 14 cortisol AUC, and the day 14 IL8/IL10 ratio were significant predictors of PPD symptoms. One unit increase each in the IL8/IL10 ratio and cortisol AUC resulted in 1.50 (p = 0.06) and 2.16 (p = 0.02) fold increases respectively in the development of PPD. Overall, this model correctly classified 84.2% of individuals in their respective groups. Findings suggest that variability in the complex interaction between the inflammatory response and the HPA axis influence the risk of PPD

The relationship between subtypes of depression and cardiovascular disease: a systematic review of biological models

A compelling association has been observed between cardiovascular disease (CVD) and depression, suggesting individuals with depression to be at significantly higher risk for CVD and CVD-related mortality. Systemic immune activation, hypothalamic–pituitary–adrenal (HPA) axis hyperactivity, arterial stiffness and endothelial dysfunction have been frequently implicated in this relationship. Although a differential epidemiological association between CVD and depression subtypes is evident, it has not been determined if this indicates subtype specific biological mechanisms. A comprehensive systematic literature search was conducted using PubMed and PsycINFO databases yielding 147 articles for this review. A complex pattern of systemic immune activation, endothelial dysfunction and HPA axis hyperactivity is suggestive of the biological relationship between CVD and depression subtypes. The findings of this review suggest that diagnostic subtypes rather than a unifying model of depression should be considered when investigating the bidirectional biological relationship between CVD and depression. The suggested model of a subtype-specific biological relationship between depression and CVDs has implications for future research and possibly for diagnostic and therapeutic processes

Towards understanding the DOQ Priorat terroirs: A multivariate GIS analysis

The notion of terroir covers the interaction between the natural, the cultural conditions and the grape vine itself relative to the character of the final wine product. It is about a dynamic chain whose factors get different weights in each wine region and this results in the typicality of the different terroir wine products. The Old World wine regions have been for many years occupied with the terroir research in order to explain the uniqueness and the specificities of their wine products. Nowadays, more and more wine regions are interested in such kind of investigations in order to highlight their distinct products, expose their originality and get a place in the wine market. DOQ Priorat is located in South Catalonia in Spain and is a wine region that has recently been nominated a label of originality for its products. Such a denomination made the region’s cultivators interested to learn more about the natural conditions of the area in a try to explain the success of their products and with the prospect to preserve the quality of their wines. In these terms, Geographical Information Systems (GIS), providing the ability for spatial, statistical analysis and visualisation, have been considered important tools for the DOQ Priorat’s natural conditions’ analysis and diverse terroir investigation. Previous research has indicated topography, the soil properties and the climate of a region to define the natural conditions of a region and therefore being the factors of interest/effect in the wine terroir. These three factors can be described by specific attributes. For instance, elevation and ground inclination for topography, PH and texture for soil, temperature and precipitation for climate. The distribution of such attributes and many others that characterize the aforementioned natural conditions, has been studied in the DOQ Priorat territory in order to examine the resemblance of the DOQ Priorat vine growing conditions to the conditions that are considered beneficial from international research. The correspondence of the DOQ Priorat conditions to the standards for vine growing has been treated by means of a multivariate GIS analysis. The DOQ Priorat topographic and soil attributes have been evaluated relative to their suitability for vine growing and different suitability classes have been defined. Moreover, the growing season temperature distribution and its capability to define conditions of viability for specific grape varieties, has been used to define two major terroir units in DOQ Priorat. The suitability of the DOQ Priorat land for cultivation of specific varieties has been assessed through the topographic-soil composite suitability in relation to the teroir units defined. DOQ Priorat’s greatest extend has been classified in intermediate and intermediate to high vine growing suitability classes relative to its topography and soil conditions. The shallow and dry soils as well as the steep slopes visited in the area seem to contradict to what is considered beneficial for vine growing. In terms of climate however, the whole area presents ideal conditions for a wide variety of grape cultivations whereas most of these varieties proposed to fit the area are already cultivated today. Even though the current vineyard cultivations still present conditions of intermediate and intermediate-high suitability relative to what is considered beneficial from international vine growing research, the quality of the wines produced in DOQ Priorat is indisputable; there are therefore some unique features in the DOQ Priorat terroirs. The DOQ Priorat vines are cultivated in higher elevations and in soils shallower and less fine textured than what is considered to fit for vine growing internationally. That is what gives the DOQ Priorat wines their unique character and these are finally the conditions that are considered ideal for Priorat wines. Such a conclusion, leads to the confirmation of the dynamic nature of terroir, whose factors and attributes cannot be strictly defined and quantified for every wine region. New vine growing standards could be defined for several wine regions relative to their specificities whereas it is mostly the try, the result and the experience that define good and bad terroirs. The DOQ Priorat case has been a very nice example of a region going against the vine cultivation pattern whereas obtaining high quality and recognised wine products.GeomaticsGIS technologyOTB Research Institute for the Built Environmen

Pharmacological and Nonpharmacological Interventions to Arrest Neuroprogression in Psychiatric Disorders

The concept of neuroprogression describes the progressive course of the disorder and stresses the progressive, recurrent, and chronic course of the disease entity under consideration. It subsumes clinical manifestations of the disease process and may also entail morphological, biochemical, neurochemical, immunological, physiological, and genetic aspects that contribute to the progressive course of the disease in question. In an attempt to identify the appropriate agent or method that could arrest neuroprogression in psychiatric patients, we conducted an evaluation of the use of anti-inflammatory drugs under the perspective of current pharmacological and neurophysiological data. This evaluation included the use of nonsteroidal anti-inflammatory drugs (NSAIDs) as adjunctive treatment to conventional pharmacotherapy as well as the use of natural products exerting anti-inflammatory properties (i.e., ω-3 fatty acids) given as adjunctive or monotherapeutic treatments in less severe cases. The therapeutic significance of nonpharmacological methods, such as psychotherapy, physical exercise, and body-mind therapies, was also considered and will be discussed in this chapter. In conclusion, the role of psychotropic and select anti-inflammatory drugs in arresting neuroprogression is a very promising new frontier in psychiatric research and clinical practice. Modulators of a specific prostanoid synthase or receptor across the cyclooxygenase (COX)-2 downstream pathway along with new multitarget NSAIDs are expected to be tested by the pharmaceutical industry as potential agents to antagonize neuroprogression. Meanwhile, salicylates and selective COX-2 inhibitors could still be used in carefully selected subgroups of patients. Psychotherapy and nonpharmacological, stress-relieving methods should be considered as adjunctive tools to aid in arresting neuroprogression. © 2017 S. Karger AG, Basel

Novel CSF Biomarkers Tracking Autoimmune Inflammatory and Neurodegenerative Aspects of CNS Diseases

The accurate diagnosis of neuroinflammatory (NIDs) and neurodegenerative (NDDs) diseases and the stratification of patients into disease subgroups with distinct disease-related characteristics that reflect the underlying pathology represents an unmet clinical need that is of particular interest in the era of emerging disease-modifying therapies (DMT). Proper patient selection for clinical trials and identifying those in the prodromal stages of the diseases or those at high risk will pave the way for precision medicine approaches and halt neuroinflammation and/or neurodegeneration in early stages where this is possible. Towards this direction, novel cerebrospinal fluid (CSF) biomarker candidates were developed to reflect the diseased organ’s pathology better. Μisfolded protein accumulation, microglial activation, synaptic dysfunction, and finally, neuronal death are some of the pathophysiological aspects captured by these biomarkers to support proper diagnosis and screening. We also describe advances in the field of molecular biomarkers, including miRNAs and extracellular nucleic acids known as cell-free DNA and mitochondrial DNA molecules. Here we review the most important of these novel CSF biomarkers of NIDs and NDDs, focusing on their involvement in disease development and emphasizing their ability to define homogeneous disease phenotypes and track potential treatment outcomes that can be mirrored in the CSF compartment

Cytokine production in bipolar affective disorder patients under lithium treatment

Background: Our knowledge concerning immune functioning in bipolar affective disorder (BAD) is limited, while lithium's immunomodulatory effects seem multiple and conflicting. Our aim was to evaluate cytokine production and lithium's effect on it in BAD patients, using ELISPOT technique as a sensitive tool. Methods: Cytokine (IL-2, IL-6, IL-10 and IFN-γ) production from isolated peripheral blood lymphocytes (PBLs) was evaluated (ELISPOT technique) in 40 euthymic BAD patients under chronic lithium treatment, in 20 healthy volunteers, and in 10 never medicated BAD patients before and after the introduction of lithium therapy. In all cases, cytokine plasma levels were also measured using ELISA. Results: BAD patients under chronic lithium treatment had significantly lower numbers of IL-2, IL-6, IL-10 and IFN-γ secreting cells compared to healthy volunteers. The number of cytokine secreting cells decreased in never medicated patients after 3 months of lithium treatment. In vitro stimulation of PBLs with lithium did not affect the number of cytokine secreting cells either in the patients or in the healthy volunteers. Conclusions: The significantly lower number of PBLs producing cytokines (IL-2, IL-6, IL-10 and IFN-γ) in euthymic BAD patients under chronic lithium treatment result from the long-term (over 3 months) lithium administration. In vitro stimulation of PBLs with lithium did not change the number of cytokine producing cells. Our findings may be useful in elucidating possible downregulatory effects of lithium in humans. © 2004 Elsevier B.V. All rights reserved

The Association of Human Herpesviruses with Malignant Brain Tumor Pathology and Therapy: Two Sides of a Coin

The role of certain viruses in malignant brain tumor development remains controversial. Experimental data demonstrate that human herpesviruses (HHVs), particularly cytomegalovirus (CMV), Epstein–Barr virus (EBV) and human herpes virus 6 (HHV-6), are implicated in brain tumor pathology, although their direct role has not yet been proven. CMV is present in most gliomas and medulloblastomas and is known to facilitate oncomodulation and/or immunomodulation, thus promoting cancer cell proliferation, invasion, apoptosis, angiogenesis, and immunosuppression. EBV and HHV-6 have also been detected in brain tumors and high-grade gliomas, showing high rates of expression and an inflammatory potential. On the other hand, due to the neurotropic nature of HHVs, novel studies have highlighted the engagement of such viruses in the development of new immunotherapeutic approaches in the context of oncolytic viral treatment and vaccine-based strategies against brain tumors. This review provides a comprehensive evaluation of recent scientific data concerning the emerging dual role of HHVs in malignant brain pathology, either as potential causative agents or as immunotherapeutic tools in the fight against these devastating diseases