Serum levels of brain-derived neurotrophic factor in remission, but not the acute phase, may predict the development from depression to dementia

OBJECTIVES

Depression may be a risk factor or a prodromal symptom of dementia, and decreased serum levels of brain-derived neurotrophic factor (BDNF) have been observed in both depression and dementia. The aim of the present study was to determine whether serum levels of BDNF in the remitted or acute phase of depression predicted the transition from depression to dementia.

METHODS

Serum levels of BDNF were measured in the acute phase of depression (n = 204) and after remission (n = 117), and we followed (mean: 24.3 months) the participants to assess the subsequent onset of dementia or mild cognitive impairment (MCI).

RESULTS

Serum levels of BDNF after remission, but not those in the acute depressive phase, predicted the future development of dementia or MCI.

CONCLUSIONS

Patients with low serum BDNF levels, even after depression remission, might have an increased risk of developing dementia. These findings suggest a potential association between residual low serum BDNF levels after remission and the prodromal state of dementia, or the involvement of BDNF in the transition from depression to dementia. However, given that this study is low-powered and preliminary, interpretation of the results should be approached with caution.

Clinical course and serum amyloid β levels in elderly patients with major depressive disorder

BACKGROUND

Depression is known to be a risk factor for Alzheimer's disease (AD). Changes in amyloid β protein (Aβ) metabolism have been speculated as a factor contributing to the transition from depression to AD. The aim of this study is to reveal the time course and state-dependency of Aβ metabolism.

METHODS

Serum Aβ levels in 277 elderly (≥60 years) patients with depression (both early- and late-onset) were measured at admission, immediately after remission, and 1 year after remission, and compared them with 178 healthy subjects.

RESULTS

The analysis revealed decreased Aβ42 levels and increased Aβ42/40 ratios in elderly patients with depression at admission compared with healthy subjects. These changes in the acute phase of depression were not normalized immediately after remission; however, they recovered to healthy levels 1 year after remission.

LIMITATIONS

There is a possibility that the results may be influenced by antidepressants.

CONCLUSIONS

These results suggest that altered Aβ metabolism caused by depression may ameliorate, although after a lengthy period of time after remission. Our findings also suggest that the AD-related pathological changes caused or increased by depression can be reduced by maintaining remission for an extended period of time.

Randomized clinical trial of duct-to-mucosa versus invagination pancreaticojejunostomy after pancreatoduodenectomy

BACKGROUND

The postoperative pancreatic fistula (POPF) rate for duct-to-mucosa and invagination anastomosis after pancreatoduodenectomy is still debated. The aim of this RCT was to investigate the POPF rate for duct-to-mucosa versus invagination pancreaticojejunostomy.

METHODS

Patients were stratified by pancreatic texture and diameter of the main pancreatic duct and randomized to the duct-to-mucosa or invagination group. The primary endpoint was the rate of clinically relevant POPF (defined as grade B or C). Secondary endpoints were suture material cost for pancreaticojejunostomy, drain insertion duration and duration of postoperative hospital stay.

RESULTS

Some 120 patients undergoing pancreatoduodenectomy were included following consent. Clinically relevant POPF developed in six of 59 patients (10 per cent) in the invagination group and in 14 of 61 patients (23 per cent) in the duct-to-mucosa group (P = 0·077). Duration of drain insertion (6 versus 7 days respectively; P = 0·027) and postoperative hospital stay (19 versus 24 days; P = 0·015) were shorter in the invagination group. Subgroup analysis for 61 patients with a soft pancreas revealed a lower rate of clinically relevant POPF in the invagination group (10 per cent versus 42 per cent in the duct-to-mucosa group; P = 0·010). Among 20 patients with a clinically relevant POPF, the six patients in the invagination group had a shorter duration of drain insertion (38·5 days versus 49 days for 14 patients in the duct-to-mucosa group; P = 0·028) and postoperative hospital stay (42 versus 54·5 days respectively; P = 0·028).

CONCLUSION

This study did not demonstrate a superiority of invagination over duct-to-mucosa pancreaticojejunostomy in the risk of POPF. However, in high-risk patients with a soft pancreas, invagination may reduce the risk of clinically relevant POPF compared with duct-to-mucosa. Registration number: UMIN000005890 (http://www.umin.ac.jp).

[A case of essential thrombocythemia with clonal evolution in the terminal phase]

This 50-year-old male was admitted to the hospital on April 1983 with complaints of severe chest pain attacks 2 weeks previously. Laboratory data: On admission the blood findings were Hb 14.3 Gm/dl of blood, RBC 4.70 million/mm3, WBC 11,600/mm3 and a platelet count of 1.1 million/mm3. ECG showed elevation of ST-T in V1 to V4. Serum LDH and CPK levels were high. He was diagnosed as acute myocardial infarction with thrombocythemia. Three days after admission he abruptly fell into a semicomatose state and left hemiplesia. Head computed tomography showed a large, low-density lesion in the right mid-cerebral artery area, and we also diagnosed cerebral infarction. He was given nimustine (ACNU) 100 mg/week three times as remission induction therapy. For maintenance chemotherapy, at first we administered mitobronitol (DBM) 150 mg/day then changed to intermittent administration of ACNU 100 mg. On September 1991, the patient was admitted to the hospital with progressive anemia and uncontrollable thrombocythemia. Bone marrow chromosome analysis revealed aneuploidy. The patient received interferon alpha 3 million unit/day. The thrombocythemia could be controlled but his general condition deteriorated. On April 1992, he died of interstitial pneumonia.

Amyloidomas in the cerebellopontine angle and jugular foramen. Case report

The 47-year-old man reported here showed large encapsulated masses in the left cerebellopontine angle and 6 years later in the enlarged left jugular foramen. Histologically, the tumors demonstrated a large deposit of amyloid composed of immunoglobulin light chain-derived proteins (AL). There was no evidence of chronic inflammatory or infectious processes or immunoglobulin abnormalities.

Immunohistochemical study of fibronectin in hemangioblastomas and hemangiopericytomas

Eight hemangioblastomas and two hemangiopericytomas were studied using indirect immunoperoxidase stains for fibronectin (FN) and glial fibrillary acidic protein (GFAP) in formalin-fixed, paraffin-embedded surgical specimens. Stromal cells in hemangioblastomas were GFAP-negative and showed variable FN expression, while GFAP-positive cells were FN-negative, thus suggesting that the stromal cells are not derived from astrocytes. Hemangiopericytoma cells were poorly to intermediately FN-positive. The origin of stromal cells is discussed in the light of their fine structure and the immunohistochemical stains with other cell markers.

Membrane structures of human oligodendroglioma

Plasma membrane particles of four human oligodendrogliomas were distributed at random, and their average number per micronm2 plasma membrane was 1090+/-233 on face A and 230+/-46 on face B. Gap junction was occasionally visible, usually small in size and composed of a polygonal aggregate of several subunits: isodiametric particles, about 70-80 A in diameter, on face A and pits, about 30-40 A in diameter, on face B. Tight junction in two oligodendrogliomas was characterized by a meshwork of circular or ramifying crests on face A and complementary furrows on face B. It was often continuous in distribution, consisting of 5 or more strands. In addition, many particulate structures, occasionally fibrillar ones, of ridge materials were often visible in the bottoms of furrows, and a few particles were scatteredly found on the tops of crests. The ridge materials, if added together on crests and furrows, were linearly continuous in some case and discontinuous in other.