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We previously demonstrated decreased placental perfusion, reduced amniotic fluid protein content, and increased pregnancy loss in a nonhuman primate model of gestational protein restriction. Here, our objective was to link these detrimental findings with a functional placental assessment. As blood flow is critical to maternal-fetal exchange, we hypothesized that a protein-restricted diet would impair placental taurine uptake. Pregnant rhesus macaques were maintained on either control chow (CON, n = 5), a 33% protein-restricted diet (PR33, n = 5), or a 50% PR diet (PR50, n = 5) prior to and throughout pregnancy. Animals were delivered on gestational day 135 (G135; term is G168). Taurine activity was determined in fresh placental villous explants. Taurine transporter (TauT) protein expression, placental growth factor (PLGF), and insulin-like growth factor (IGF)-1 and IGF-2 protein concentrations were measured, and histological assessment was performed. Fetal body weights and placental weights were comparable between all three groups at G135. Placental taurine uptake was decreased in PR33- and PR50-fed animals compared to CON, yet TauT expression was unchanged across groups. PLGF was significantly increased in PR50 vs. CON, with no change in IGF-1 or IGF-2 expression in placental homogenate from PR-fed animals. Accelerated villous maturation was observed in all PR50 cases, three of five PR33, and was absent in CON. We demonstrate conserved fetal growth, despite a decrease in placental taurine uptake. Increased expression of PLGF and expansion of the syncytiotrophoblast surface area in the severely protein-restricted animals suggest a compensatory mechanism by the placenta to maintain fetal growth.
This chapter reviews the key roles of the different layers of the maternofetal interface in supplying essential nutrients to the developing fetus before the placental circulations are fully established. Focal trophoblastic oxidative damage and progressive villous degeneration trigger the formation of the fetal membranes that remodel the uteroplacental interface. The distribution of the placental-specific protein human chorionic gonadotrophin (hCG) in yolk sac and coelomic fluid samples, and the absence of hCG mRNA expression in yolk sac tissue, suggests the secondary yolk sac (SYS) has an absorptive function. During the 10th week of gestation, the yolk sac starts to degenerate and rapidly ceases to function. The anatomy of the materno-fetal interface in the first trimester is the result of the need for a delicate balance between the metabolic requirements of the developing fetus and the potential harmful effects of oxygen during embryogenesis and organogenesis.
Background. Anxious depression, defined as Major Depressive Disorder (MDD) with high levels of anxiety symptoms, may represent a relatively common depressive subtype, with distinctive features.
Objective. The objective of this study was to determine the prevalence of anxious depression and to define its clinical correlates and symptom patterns.
Method. Baseline clinical and sociodemographic data were collected on 1450 subjects participating in the STAR*D study. A baseline Hamilton Rating Scale for Depression (HAM-D) Anxiety/Somatization factor score of [ges ]7 was considered indicative of anxious depression. The types and degree of concurrent psychiatric symptoms were measured using the Psychiatric Diagnostic Screening Questionnaire (PDSQ), by recording the number of items endorsed by study participants for each diagnostic category. MDD symptoms were assessed by clinical telephone interview with the 30-item Inventory of Depressive Symptomatology (IDS-C30).
Results. The prevalence of anxious depression in this population was 46%. Patients with anxious MDD were significantly more likely to be older, unemployed, less educated, more severely depressed, and to have suicidal ideation before and after adjustment for severity of depression. As far as concurrent psychiatric symptoms are concerned, patients with anxious depression were significantly more likely to endorse symptoms related to generalized anxiety, obsessive compulsive, panic, post-traumatic stress, agoraphobia, hypochondriasis, and somatoform disorders before and after adjustment for severity of depression. Anxious-depression individuals were also significantly less likely to endorse IDS-C30 items concerning atypical features, and were significantly more likely to endorse items concerning melancholic/endogenous depression features.
Conclusion. This study supports specific clinical and sociodemographic correlates of MDD associated with high levels of anxiety (anxious depression).
Objectives: The object of this paper is to evaluate the evidence suggesting an association between the use of the anti-acne agent isotretinoin and the subsequent development of depression.
Method: Three case histories of individuals who had received treatment with isotretinoin and subsequently developed depression are reviewed.
Results: All three individuals were noted to have a depressive illness which was notable by the prominence of symptoms of irritability, agitation and aggression.
Conclusions: The indications from the three cases described suggest that there appears to be an association between depression and the recent use of isotretinoin. This may relate to the ability of isotretinoin to simulate hypovitaminosis A, with aggression, irritability and depression as a direct result of this effect. Young males may be particularly prone to developing this response.