Advances in pharmacotherapy for postpartum depression: a structured review of standard-of-care antidepressants and novel neuroactive steroid antidepressants

Postpartum depression is one of the most common morbidities of childbearing, yet it is underdiagnosed and undertreated with negative consequences for mother and offspring. Despite the widespread use of standard-of-care antidepressants as the mainstay of treatment for postpartum depression, there is limited evidence on their safety and efficacy due to their slow onset of action and suboptimal outcomes. The emergence of gamma-aminobutyric acidergic neuroactive steroids may offer faster response and remission times and improved patient outcomes. This article reviews the evidence base for the efficacy of standard-of-care antidepressants, hormonal therapeutics including progestins and estradiol, and gamma-aminobutyric acidergic neuroactive steroids in the treatment of postpartum depression, as well as the safety of infant exposure to these agents during lactation.

Multivalent counterions diminish the lubricity of polyelectrolyte brushes

Polyelectrolyte brushes provide wear protection and lubrication in many technical, medical, physiological, and biological applications. Wear resistance and low friction are attributed to counterion osmotic pressure and the hydration layer surrounding the charged polymer segments. However, the presence of multivalent counterions in solution can strongly affect the interchain interactions and structural properties of brush layers. We evaluated the lubrication properties of polystyrene sulfonate brush layers sliding against each other in aqueous solutions containing increasing concentrations of counterions. The presence of multivalent ions (Y³⁺, Ca²⁺, Ba²⁺), even at minute concentrations, markedly increases the friction forces between brush layers owing to electrostatic bridging and brush collapse. Our results suggest that the lubricating properties of polyelectrolyte brushes in multivalent solution are hindered relative to those in monovalent solution.

Fusion of bolaamphiphile micelles: a method to prepare stable supported biomimetic membranes

Supported biomimetic membranes (SBMs) on solid substrates have been commonly prepared from vesicle-forming double-tail lipids, such as zwitterionic phospholipids, using the method of vesicle fusion. Here we report on the preparation of SBMs on silica surfaces via a similar process of "micelle fusion" from a cationic single-tail bolaamphiphile GLH-20 that forms spherical and elongated thread-like micelles in solution. We demonstrate that, in contrast to zwitterionic phospholipids, GLH-20 self-assembles into a stable contiguous SBM at both low and high ionic strengths. The cationic charge of GLH-20 promotes the formation of a stable SBM through enhanced double-layer interactions with the negatively charged silica surface. It is also shown that spinach aquaporin PM-28 was successfully incorporated within bolaamphiphile SBM in a manner similar to SBMs prepared by vesicle/proteoliposome fusion; thereby the inherent curvature of the micelle surface does not inhibit protein reconstitution. The results suggest that SBMs based on charged bolaamphiphiles might be an attractive platform for applications such as water purification and biosensors, where the stability and low defect rate of SBMs in diverse conditions are crucial for achieving desired performance.

C20-D3-vitamin A slows lipofuscin accumulation and electrophysiological retinal degeneration in a mouse model of Stargardt disease

Stargardt disease, also known as juvenile macular degeneration, occurs in approximately one in 10,000 people and results from genetic defects in the ABCA4 gene. The disease is characterized by premature accumulation of lipofuscin in the retinal pigment epithelium (RPE) of the eye and by vision loss. No cure or treatment is available. Although lipofuscin is considered a hallmark of Stargardt disease, its mechanism of formation and its role in disease pathogenesis are poorly understood. In this work we investigated the effects of long-term administration of deuterium-enriched vitamin A, C20-D(3)-vitamin A, on RPE lipofuscin deposition and eye function in a mouse model of Stargardt's disease. Results support the notion that lipofuscin forms partly as a result of the aberrant reactivity of vitamin A through the formation of vitamin A dimers, provide evidence that preventing vitamin A dimerization may slow disease related, retinal physiological changes and perhaps vision loss and suggest that administration of C20-D(3)-vitamin A may be a potential clinical strategy to ameliorate clinical symptoms resulting from ABCA4 genetic defects.

Deuterium enrichment of vitamin A at the C20 position slows the formation of detrimental vitamin A dimers in wild-type rodents

Degenerative eye diseases are the most common causes of untreatable blindness. Accumulation of lipofuscin (granular deposits) in the retinal pigment epithelium (RPE) is a hallmark of major degenerative eye diseases such as Stargardt disease, Best disease, and age-related macular degeneration. The intrinsic reactivity of vitamin A leads to its dimerization and to the formation of pigments such as A2E, and is believed to play a key role in the formation of ocular lipofuscin. We sought a clinically pragmatic method to slow vitamin A dimerization as a means to elucidate the pathogenesis of macular degenerations and to develop a therapeutic intervention. We prepared vitamin A enriched with the stable isotope deuterium at carbon twenty (C20-D(3)-vitamin A). Results showed that dimerization of deuterium-enriched vitamin A was considerably slower than that of vitamin A at natural abundance as measured in vitro. Administration of C20-D(3)-vitamin A to wild-type rodents with no obvious genetic defects in vitamin A processing, slowed A2E biosynthesis. This study elucidates the mechanism of A2E biosynthesis and suggests that administration of C20-D(3)-vitamin A may be a viable, long-term approach to retard vitamin A dimerization and by extension, may slow lipofuscin deposition and the progression of common degenerative eye diseases.

Doppler and gray-scale sonographic classification of adnexal torsion

OBJECTIVE

To propose, in cases with coiling of the ovarian vessels, a classification of severity of torsion based on Doppler and gray-scale ultrasound findings and to suggest a treatment strategy for each situation.

METHODS

Seventeen patients were examined in a gynecological emergency room between December 1995 and February 2003 due to suspected adnexal torsion. Doppler and gray-scale ultrasound were used to visualize coiling of the ovarian blood vessels. Intraovarian flow was assessed by spectral Doppler and on this basis, along with the patient's clinical condition, the decision was made as to whether surgery was necessary. Findings on surgery were recorded.

RESULTS

All 17 patients showed coiling of the ovarian vessels. Nine had arterial and venous blood flow within the ovary and ultrasound and surgical findings usually demonstrated normal sized or mildly enlarged ovaries. Five had only arterial blood flow within the ovary and surgery usually revealed enlarged ovaries with normal color or mild discoloration. Three had neither arterial nor venous blood flow within the ovary, with vessel coiling evident only on gray-scale and not on Doppler examination, and surgical findings included signs of ovarian ischemia or necrosis.

CONCLUSION

In cases of coiling of the ovarian vessels, Doppler flow analysis of the ovary can help differentiate between ischemic adnexal torsion and coiling of the ovarian blood vessels without strangulation, aiding in the choice of treatment. According to type of blood flow seen on Doppler examination, we suggest the following classification of severity of adnexal torsion and treatment strategy: Class 1, coiling with arterial and venous ovarian blood flow; a conservative approach may be considered if the clinical condition permits; Class 2, coiling with arterial ovarian flow but no venous flow; surgical intervention is required; and Class 3, true strangulation, with no ovarian blood flow; urgent surgical intervention is required.

Coenzyme Q10 in the human retina

PURPOSE

To determine the concentration of coenzyme Q10 (CoQ10) in the human retina.

METHODS

Eye tissues were lyophilized and exhaustively extracted with heptane. The extracts were analyzed for CoQ10 by high-performance liquid chromatography (HPLC).

RESULTS

The average concentration of CoQ10 in the retina was 42+/-11 nanomoles/g dry retina for donors younger than 30 years of age and 24+/-13 nanomoles/g dry retina for donors older than 80 years of age. The average concentrations of CoQ10 in the choroid was 27+/-16 nanomoles/g dry choroid for donors younger than 30 age and 18+/-11 nanomoles/g dry choroid for donors older than 80.

CONCLUSIONS

CoQ10 levels in the retina can decline by approximately 40% with age. This decline may have two consequences: a decrease in antioxidant ability and a decrease in the rate of ATP synthesis in the retina and, as such, this decline may be linked to the progression of macular degeneration.

Long-term sleep disturbances in adolescents after minor head injury

It has been demonstrated that patients in the acute phase after minor head injury (MHI) complain of sleep disturbances. The purpose of the present study was to characterize the long-term effects of MHI on sleep in adolescents. Nineteen adolescents who had suffered MHI 3 years before the study and had complained of sleep disturbances completed a sleep questionnaire and were investigated in the sleep laboratory by whole-night polysomnographic recordings and were actigraphically monitored for 5 days at home. Questionnaire results revealed severe complaints regarding sleep behavior. Polysomnographic recordings revealed that in comparison with controls, MHI was associated with lower sleep efficiency (79.8 +/- [9.8]% vs 87.7 +/- [6.8]%; P < 0.005), with more wake time (10.6 +/- [9.0]% vs 3.4 +/- [4.4]%; P < 0.005), and with more awakenings lasting more than 3 minutes (2.1 +/- [1.5] vs 0.6 +/- [0.8]; P < 0.005). These findings were confirmed by actigraphic monitoring that revealed lower sleep efficiency (90 +/- [5]% vs 94 +/- [3]%; P < 0.05), more minutes of wake time (49 +/- [21] min vs 28 +/- [15] min; P < 0.05), and a trend toward more awakenings longer than 5 minutes (1.8 +/- [0.8] vs 1.2 +/- [0.8]; P = 0.063). Our data demonstrated that 3 years after MHI without any discernible clinical sequel, adolescents still complain of sleep disturbances that could be confirmed by both polysomnographic and actigraphic monitoring.

Ionization waves in electron-beam-assisted, shielded capillary discharge

A theory of propagation of cathode-directed ionization waves during the early stages of an electrical breakdown in a shielded, low-pressure capillary is developed. The discharge process occurs due to the ionization of the low-density gas in the capillary by an electron beam that is emanating from a hollow cathode. Due to the strong electric field in the capillary the electrons are in the fast acceleration regime. Consequently, the full momentum equation for the electrons is employed, rather than the electron drift velocity approach. The smallness of the ratio of the capillary radius to the characteristic length of the electric potential variation in the axial direction allows the construction of a quasi-one-dimensional model. The latter retains the important two-dimensional nature of the electron flow as well as the electrodynamic boundary conditions at the capillary wall and the conducting shield and results in a set of one-dimensional, time-dependent partial differential equations for the on-axis distributions of the physical quantities. It is shown that those equations admit self-similar solutions that represent ionization waves propagating with constant velocities. The resulting set of ordinary differential equations is solved numerically for various initial conditions representing a nonperturbed steady state ahead of the ionization front and the resulting features of the ionization waves are investigated and discussed. The obtained solutions describe both ionization growth and virtual anode propagation and represent fast ionization waves in plasma waveguides, for which the maximum value of the mean electron velocity is much higher than the wave velocity. The space-charge distribution associated with the ionization waves is found in the form of plasma oscillations with a continuously increasing frequency and a solitary envelope. The calculated wave velocity increases with the gas pressure and this tendency is in agreement with corresponding experimental observations.

Bilateral focal motor status epilepticus with retained consciousness after stroke

Bilateral motor seizures with retained consciousness are rare and often mistaken for pseudoseizures. In the few reported cases, the seizures were brief and the underlying lesion usually was a tumor. Here the authors describe a patient with bilateral focal motor status epilepticus with retained consciousness after a stroke. A seizure should be considered as the possible cause of continuous bilateral limb movements with retained consciousness.

Use of sky brightness measurements from ground for remote sensing of particulate polydispersions

The software code SKYEAD.pack for retrieval of aerosol size distribution and optical thickness from data of direct and diffuse solar radiation is described; measurements are carried out with sky radiometers in the wavelength range 0.369-1.048 µm. The treatment of the radiative transfer problem concerning the optical quantities is mainly based on the IMS (improved multiple and single scattering) method, which uses the delta-M approximation for the truncation of the aerosol phase function and corrects the solution for the first- and second-order scattering. Both linear and nonlinear inversion methods can be used for retrieving the size distribution. Improved calibration methods for both direct and diffuse radiation, the data-analysis procedure, the results from the proposed code, and several connected problems are discussed. The results can be summarized as follows: (a) the SKYRAD.pack code can retrieve the columnar aerosol features with accuracy and efficiency in several environmental situations, provided the input parameters are correctly given; (b) when data of both direct and diffuse solar radiation are used, the detectable radius interval for aerosol particles is approximately from 0.03 to 10 µm; (c) besides the retrieval of the aerosol features, the data-analysis procedure also permits the determination of average values for three input parameters (real and imaginary aerosol refractive index, ground albedo) from the optical data; (d) absolute calibrations for the sky radiometer are not needed, and calibrations for direct and diffuse radiation can be carried out with field data; (e) the nonlinear inversion gives satisfactory results in a larger radius interval, without the unrealistic humps that occur with the linear inversion, but the results strongly depend on the first-guess spectrum; (f) aerosol features retrieved from simulated data showed a better agreement with the given data for the linear inversion than for the nonlinear inversion.