BMJ  2006;332:1460 (17 June), doi:10.1136/bmj.332.7555.1460

Minerva

Minerva

Scarcely a year passes without reports of a new function for interleukins, which were originally thought to act only on immune cells. Now they seem to have a pivotal role in regulating energy balance and insulin sensitivity (Nature Medicine 28 May 2006; doi: 10.1038/nm1415). Gene knockout experiments in mice have shown that animals deficient in interleukin 18 develop hyperphagia, pronounced obesity, and insulin resistance. Could this molecule be the next therapeutic target for obesity?

Calcium is an important intracellular signalling molecule, and new research suggests that its actions within the central nervous system could underlie the pathogenesis of bipolar disorder. The calcium sensor protein NCS-1, which is overexpressed in bipolar disorders, interacts with another receptor protein to increase the opening of crucial intracellular calcium channels. Researchers report that lithium (a divalent ion, like calcium) inhibits the enhancing effect of NCS-1, providing a plausible explanation of the effects of lithium in patients with bipolar disorders (Journal of Clinical Investigation 2006;116: 1668-74[CrossRef][ISI][Medline]).

Allograft meniscus transplantation is indicated for patients with symptoms after meniscectomy to prevent the progression of articular degeneration. In a two year follow-up study, meniscus transplantation alone or combined with other reconstructive procedures improved knee pain and function (American Journal of Sports Medicine 2006;34: 919-27[Abstract/Free Full Text]). But the follow-up of this case series from one centre and one surgeon was too short to determine if transplantation really does prevent articular degeneration.

Migrant groups have raised rates of mental disorders and are more likely to commit suicide than indigenous populations. In an attempt to explore this association further, researchers interviewed 360 Irish migrants living in London and found that poorly planned migration was strongly correlated with subsequent depression. However, positive influences after migration—such as adequate social support—can confer some protection against this tendency (British Journal of Psychiatry 2006;188: 560-6[Abstract/Free Full Text]).

The Framingham heart study began almost 60 years ago, and continues to provide useful clinical data. On the basis of data from 1862 study participants, researchers assessed whether single gene mutations have a role in the genesis of left ventricular wall thickening. The answer was not definitive. About 3% of participants had increased wall thickness, of whom 18% had mutations in crucial genes that have been linked to rare familial forms of cardiomyopathy (Circulation 5 June 2006; doi: 10.1161/CIRCULATIONAHA.105.593558[Abstract/Free Full Text]).

Clusters of stem cells have been found in the hearts of normal adult mice. These divide asymmetrically and they give rise to further stem cells and other committed lineages, indicating that they play an important part in the normal turnover of myocardium in the adult heart. Interestingly, the turnover of myocytes regulated by these stem cells is not uniform across the heart—it is faster in the apex and the atria and slower in the base and midregion of the ventricle (Proceedings of the National Academy of Sciences 5 June 2006; doi: 10.1073/pnas.0600635103[Abstract/Free Full Text]).

A pregnant woman who presented with photophobia, vomiting, and left sided weakness was found to be anaemic, with hypokalaemia and raised creatine kinase. These symptoms were caused by geophagia (eating clay), which she had been doing regularly. The clay causes disease by binding to potassium in the gut, which results in increased intestinal excretion of potassium, and the effect is dependent on the amount of clay eaten (Ulster Medical Journal 2006;75: 159).

The tumour suppressor gene p53 is known as "the guardian of the genome." Its role is to regulate and control the cell cycle, but researchers now think this gene might be responsible for the longevity of cancer cells. Cells use energy derived from glycolysis or from mitochondrial respiration. The p53 protein seems to play a crucial role in the balance between these two respiratory path-ways in normal cells. Mutations in p53 could tip the balance in favour of the glycolytic pathway, providing cancer cells with a survival advantage (Science 5 June 2006; doi: 10.1126/science.1126863[Abstract/Free Full Text]).

Don't overdo headache pills or you could end up with "medication overuse headache." Researchers examined more than 1300 patients who had stopped taking drugs for at least two months—45% reported improvements in their condition, 48% reported no significant change, and the rest reported increased frequency of headaches. Analyses indicate that early withdrawal from overuse of drugs could be highly beneficial, especially in patients with migraine who overuse triptans and ergot derivatives (Neurology 17 May 2006; doi: 10.1212/01.wnl.0000217914.30994.bd[Abstract/Free Full Text]).

If you want to persuade people to say "yes," offer them coffee. Australian researchers found that people are more likely to attend to, and agree with, persuasive arguments after consuming caffeine. Participants drank orange juice containing caffeine or placebo before reading persuasive arguments about voluntary euthanasia that were against their own beliefs. Caffeine increased message processing, as shown by increased agreement, greater message related thinking, and better argument recall (European Journal of Social Psychology 5 June 2006; doi: 10.1002/ejsp.347).

A 2 year old child was born with several small, circular, superficially ulcerated scalp defects just lateral to the midline. They were initially mistaken for skin damage due to a fetal scalp electrode or blood sampling during labour. The defects healed over several weeks to form hairless atrophic scars, which became more visible as hair emerged. The most likely diagnosis is the rare condition, congenital aplasia cutis, caused by the mother taking carbimazole during pregnancy, until 35 weeks' gestation. The child has no other apparent congenital abnormalities and is growing and developing normally. Aileen M Brewster (aileen.brewster{at}lothian.scot.nhs.uk), general practitioner, Dunbar Medical Centre, Dunbar, East Lothian EH42 1EE

 

Sexsomnia is thought to be a variant of sleepwalking that manifests as sexual behaviour during sleep. Most people with sexsomnia have a family history of sleepwalking. The range of behaviour includes explicit sexual vocalisations, violent masturbation, and complex sexual acts including anal, oral, and vaginal penetration. A defendant on three charges of rape was recently acquitted on the basis of automatism due to sexsomnia (Journal of Clinical Forensic Medicine 2006;13: 219-24[CrossRef][Medline]).

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Guidance at bmj.com/advice

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