Altered blood coagulation in patients with posttraumatic stress disorder

OBJECTIVE: Posttraumatic stress disorder (PTSD) has been associated with an increased cardiovascular risk, though the pathophysiologic mechanisms involved are elusive. A hypercoagulable state before occurrence of coronary thrombosis contributes to atherosclerosis development. We investigated whether PTSD would be associated with increased coagulation activity. METHODS: We measured resting plasma levels of clotting factor VII activity (FVII:C), FVIII:C, FXII:C, fibrinogen, and D-dimer in 14 otherwise healthy patients with PTSD and in 14 age- and gender-matched, trauma-exposed non-PTSD controls. Categorical and dimensional diagnoses of PTSD were made using the Clinician-Administered PTSD Scale (CAPS) interview. We also investigated to what extent the relationship between PTSD and coagulation measures would be confounded by demographics, cardiovascular risk factors, lifestyle variables, time since trauma, and mood. RESULTS: Coagulation factor levels did not significantly differ between patients with a categorical diagnosis of PTSD and controls while controlling for covariates. In all subjects, FVIII:C was predicted by hyperarousal severity (beta = 0.46, p = .014) independent of covariates and by overall PTSD symptom severity (beta = 0.38, p = .045); the latter association was of borderline significance when separately controlling for gender, smoking, exercise, and anxiety (p values <.07). In patients, fibrinogen was predicted by hyperarousal severity (beta = 0.70, p = .005) and by overall PTSD symptom severity (beta = 0.61, p = .020), with mood partially affecting these associations. FVII:C, fibrinogen, and D-dimer showed no independent association with PTSD symptoms. CONCLUSIONS: PTSD may elicit hypercoagulability, even at subthreshold levels, offering one psychobiological pathway by which posttraumatic stress might contribute to atherosclerosis progression and clinical cardiovascular disease.

Anticipatory cognitive stress appraisal and the acute procoagulant stress response in men

OBJECTIVE: Acute mental stress elicits blood hypercoagulability. Following a transactional stress model, we investigated whether individuals who anticipate stress as more threatening, challenging, and as exceeding their coping skills show greater stress reactivity of the coagulation activation marker D-dimer, indicating fibrin generation in plasma. METHODS: Forty-seven men (mean age 44 +/- 14 years; mean blood pressure [MBP] 101 +/- 12 mm Hg; mean body mass index [BMI] 26 +/- 3 kg/m(2)) completed the Primary Appraisal Secondary Appraisal (PASA) scale before undergoing the Trier Social Stress Test (combination of mock job interview and mental arithmetic task). Heart rate, blood pressure, plasma catecholamines, and D-dimer levels were measured before and after stress, and during recovery up to 60 minutes poststress. RESULTS: Hemodynamic measures, catecholamines, and D-dimer changed across all time points (p values <.001). The PASA "Stress Index" (integrated measure of transactional stress perception) correlated with total D-dimer area under the curve (AUC) between rest and 60 minutes poststress (r = 0.30, p = .050) and with D-dimer change from rest to immediately poststress (r = 0.29, p = .046). Primary appraisal (combined "threat" and "challenge") correlated with total D-dimer AUC (r = 0.37, p = .017), D-dimer stress change (r = 0.41, p = .004), and D-dimer recovery (r = 0.32, p = .042). "Challenge" correlated more strongly with D-dimer stress change than "threat" (p = .020). Primary appraisal (DeltaR(2) = 0.098, beta = 0.37, p = .019), and particularly its subscale "challenge" (DeltaR(2) = 0.138, beta = 0.40, p = .005), predicted D-dimer stress change independently of age, BP, BMI, and catecholamine change. CONCLUSIONS: Anticipatory cognitive appraisal determined the extent of coagulation activation to and recovery from stress in men. Particularly individuals who anticipated the stressor as more challenging and also more threatening had a greater fibrin stress response.

Depression, the metabolic syndrome and cardiovascular risk

BACKGROUND: The relationship between depression and the metabolic syndrome is unclear, and whether metabolic syndrome explains the association between depression and cardiovascular disease (CVD) risk is unknown. METHODS: We studied 652 women who received coronary angiography as part of the Women's Ischemia Syndrome Evaluation (WISE) study and completed the Beck Depression Inventory (BDI). Women who had both elevated depressive symptoms (BDI > or =10) and a previous diagnosis of depression were considered at highest risk, whereas those with one of the two conditions represented an intermediate group. The metabolic syndrome was defined according to the ATP-III criteria. The main outcome was incidence of adverse CVD events (hospitalizations for myocardial infarction, stroke, congestive heart failure, and CVD-related mortality) over a median follow-up of 5.9 years. RESULTS: After adjusting for demographic factors, lifestyle and functional status, both depression categories were associated with about 60% increased odds for metabolic syndrome compared with no depression (p = .03). The number of metabolic syndrome risk factors increased gradually across the three depression categories (p = .003). During follow-up, 104 women (15.9%) experienced CVD events. In multivariable analysis, women with both elevated symptoms and a previous diagnosis of depression had 2.6 times higher risk of CVD. When metabolic syndrome was added to the model, the risk associated with depression only decreased by 7%, and both depression and metabolic syndrome remained significant predictors of CVD. CONCLUSIONS: In women with suspected coronary artery disease, the metabolic syndrome is independently associated with depression but explains only a small portion of the association between depression and incident CVD.

Coagulation activity before and after acute psychosocial stress increases with age

OBJECTIVE: To assess whether stress further increases hypercoagulation in older individuals. We investigated whether acute stress-induced changes in coagulation parameters differ with age. It is known that hypercoagulation occurs in response to acute stress and that a shift in hemostasis toward a hypercoagulability state occurs with age. However, it is not yet known whether acute stress further increases hypercoagulation in older individuals, and thus may increase their risk for cardiovascular disease (CVD). METHODS: A total of 63 medication-free nonsmoking men, aged between 20 and 65 years (mean +/- standard error of the mean = 36.7 +/- 1.7 years), underwent an acute standardized psychosocial stress task combining public speaking and mental arithmetic in front of an audience. We measured plasma clotting factor VII activity (FVII:C), fibrinogen, and D-dimer at rest, immediately, and 20 minutes after stress. RESULTS: Increased age predicted greater increases in fibrinogen (beta = 0.26, p = 0.041; DeltaR(2) = 0.05), FVII:C (beta = 0.40, p = .006; DeltaR(2) = 0.11), and D-dimer (beta = 0.51, p < .001; DeltaR(2) = 0.18) from rest to 20 minutes after stress independent of body mass index and mean arterial blood pressure. General linear models revealed significant effects of age and stress on fibrinogen, FVII:C, and D-dimer (main effects: p < .04), and greater D-dimer stress reactivity with older age (interaction age-by-stress: F(1.5/90.4) = 4.36, p = .024; f = 0.33). CONCLUSIONS: Our results suggest that acute stress might increase vulnerability in the elderly for hypercoagulability and subsequent hemostasis-associated diseases like CVD.

Independent association between lower level of social support and higher coagulation activity before and after acute psychosocial stress

OBJECTIVE: To investigate the relationship between social support and coagulation parameter reactivity to mental stress in men and to determine if norepinephrine is involved. Lower social support is associated with higher basal coagulation activity and greater norepinephrine stress reactivity, which in turn, is linked with hypercoagulability. However, it is not known if low social support interacts with stress to further increase coagulation reactivity or if norepinephrine affects this association. These findings may be important for determining if low social support influences thrombosis and possible acute coronary events in response to acute stress. We investigated the relationship between social support and coagulation parameter reactivity to mental stress in men and determined if norepinephrine is involved. METHODS: We measured perceived social support in 63 medication-free nonsmoking men (age (mean +/- standard error of the mean) = 36.7 +/- 1.7 years) who underwent an acute standardized psychosocial stress task combining public speaking and mental arithmetic in front of an audience. We measured plasma D-dimer, fibrinogen, clotting Factor VII activity (FVII:C), and plasma norepinephrine at rest as well as immediately after stress and 20 minutes after stress. RESULTS: Independent of body mass index, mean arterial pressure, and age, lower social support was associated with higher D-dimer and fibrinogen levels at baseline (p < .012) and with greater increases in fibrinogen (beta = -0.36, p = .001; DeltaR(2) = .12), and D-dimer (beta = -0.21, p = .017; DeltaR(2) = .04), but not in FVII:C (p = .83) from baseline to 20 minutes after stress. General linear models revealed significant main effects of social support and stress on fibrinogen, D-dimer, and norepinephrine (p < .035). Controlling for norepinephrine did not change the significance of the reported associations between social support and the coagulation measures D-dimer and fibrinogen. CONCLUSIONS: Our results suggest that lower social support is associated with greater coagulation activity before and after acute stress, which was unrelated to norepinephrine reactivity.

Why Death Matters: Understanding Gameworld Experience

This article presents a study of the staging and implementation of death and the death penalty in a number of popular MMOGs and relates it to players general experience of gameworlds. Game mechanics, writings and stories by designers and players, and the results of an online survey are analysed and discussed. The study shows that the death penalty is implemented much in the same way across worlds; that death can be both trivial and non-trivial, part of the grind of everyday life, or essential in the creation of heroes, depending on context. In whatever function death may serves, it is argued that death plays an important part in the shaping and emergence of the social culture of a world, and in the individual players experience of life within it.

Träume vom Anderen

Die traditionelle japanische Architektur mit ihrer Leere und Sachlichkeit wurde zwischen 1930 und 1950 zu einem Referenzmodell für die Moderne. Doch die Wahrnehmung der gestalterischen Qualitäten der japanischen Baukunst in Europa erfolgte spät. Manfred Speidel untersucht in seinem Beitrag die Schritte und die Motive für die Wahrnehmung der japanischen Baukunst in Deutschland – ein Prozess der bis heute vom "Überraschtsein" erzählt, in Asien grundlegende Ziele der Moderne wiederzufinden.

Ästhetik der Deponie

Der Umgang mit Abfällen ist durch Paradoxien bestimmt: Das urbane Leben erzeugt in unvorstellbarem Ausmaß Abfall, doch Deponien sind selten willkommen; noch seltener werden sie als wichtige Bestandteile der modernen Infrastruktur wahrgenommen und gestaltet. Deponien sind mittlerweile technologisch hochkomplexe Anlagen, im Bewusstsein der Mehrheit werden sie aber ausgeblendet. Dieser Zustand erfordert ein neues Sehen, das die Möglichkeiten von Deponien als Landschaftsbaustellen nutzt und sie zu Infrastrukturprojekten mit erkennbarer Bedeutung gestaltet.

Zerbrochene Spiegel /1

Der Beitrag beschreibt eine doppelte, verfremdete und letztendlich tragische Spiegelung in der Wahrnehmung von Architektur zwischen Europa und Indien: zwischen 1780 und 1856 entstanden in der nordindischen Stadt Lucknow mehrere große Baukomplexe, die von den indisch-islamischen Herrschern der Stadt in europäisch-klassizistischen Formen gestaltet wurden. Nach dem indischen Aufstand, der in den Jahren 1857 und 1858 gegen die britische Herrschaft in Lucknow losbrach, wurden diese Bauten zum Gegenstand einer scharfen europäischen Architekturkritik. Der erste Abschnitt – "Das Eigene und das Fremde" – betrachtet die westliche Rezeption dieser europäisch-klassizistischen Bauten, die über Jahrzehnte durch ein Negativurteil bestimmt war, das sich aus der politischen Interpretation des indischen Aufstands erklärt. Der zweite Abschnitt – "Kopie und Synthese" – geht auf die Suche nach den Zusammenhängen für die positive Europarezeption in Lucknow und für die negative Kritik dieser Bauten in Europa. Es erweist sich, dass die Praxis von Architekturkopie und die Wahrnehmung europäischer Stilformen bei der Übernahme klassizistischer Motive in Indien deutlich anders war als das exakte und moralisch überhöhte Verständnis von Stilformen im Europa nach 1850.

Zerbrochene Spiegel /2

Der Beitrag beschreibt eine doppelte, verfremdete und letztendlich tragische Spiegelung in der Wahrnehmung von Architektur zwischen Europa und Indien: zwischen 1780 und 1856 entstanden in der nordindischen Stadt Lucknow mehre-re große Baukomplexe, die von den indisch-islamischen Herrschern der Stadt in europäisch-klassizistischen Formen gestaltet wurden. Nach dem indischen Auf-stand, der in den Jahren 1857 und 1858 gegen die britische Herrschaft in Lucknow losbrach, wurden diese Bauten zum Gegenstand einer scharfen europäi-scher Architekturkritik. Der erste Abschnitt – "Das Eigene und das Fremde" – betrachtet die westliche Rezeption dieser europäisch-klassizistischen Bauten, die über Jahrzehnte durch ein Negativurteil bestimmt war, das sich aus der politischen Interpretation des indischen Aufstands erklärt. Der zweite Abschnitt – "Kopie und Synthese" – geht auf die Suche nach den Zusammenhängen für die positive Europarezeption in Lucknow und für die negative Kritik dieser Bauten in Europa. Es erweist sich, dass die Praxis von Architekturkopie und die Wahrnehmung europäischer Stilfor-men bei der Übernahme klassizistischer Motive in Indien deutlich anders war als das exakte und moralisch überhöhte Verständnis von Stilformen im Europa nach 1850.

Das kann ich aber auch!

In der Fotografie als reproduktiver Kunst und reproduktiver Technik existiert eine Vielzahl besonderer Umgangs- und Aneignungsformen im Kopieren originaler Bildideen. Das Spektrum reicht von der kreativen Nachstellung bis zum Plagiat. Fotografie ist das einzige Medium, das diese Bandbreite von Möglichkeiten in der Gegenüberstellung von Original und Kopie nutzen kann. Wolfgang Vollmer, Kölner Fotograf und Autor mehrerer Künstlerbücher, die sich kreativ mit Nachbildung und Fortführung von Ikonen der Fotografiegeschichte befassen, systematisiert die möglichen Umgangsformen der Fotografie mit "Vor-Bildern" aus ihrem medialen Bildgedächtnis.

An In Vitro Method to Investigate the Microbicidal Potential of Human Macrophages for Use in Psychosomatic Research

OBJECTIVE: Psychological states relate to changes in circulating immune cells, but associations with immune cells in peripheral tissues such as macrophages have hardly been investigated. Here, we aimed to implement and validate a method for measuring the microbicidal potential of ex vivo isolated human monocyte-derived macrophages (HMDMs) as an indicator of macrophage activation. METHODS: The method was implemented and validated for two blood sampling procedures (short-term cannula insertion versus long-term catheter insertion) in 79 participants (34 women, 45 men) aged between 18 and 75 years. The method principle is based on the reduction of 2-(4-iodophenyl)-3-(4-nitrophenyl)-5-(2,4-dis-ulfophenyl)-2H-tetrazolium, monosodium salt (WST-1) by superoxide anions, the first in a series of pathogen-killing reactive oxygen species produced by phorbol myristate acetate-activated HMDM. Cytochrome c reduction and current generation were measured as reference methods for validation purposes. We further evaluated whether depressive symptom severity (Beck Depression Inventory) and chronic stress (Chronic Stress Screening Scale) were associated with macrophage microbicidal potential. RESULTS: The assay induced superoxide anion responses by HMDM in all participants. Assay results depended on blood sampling procedure (cannula versus catheter insertion). Interassay variability as a measure for assay reliability was 10.92% or less. WST-1 reduction scores correlated strongly with results obtained by reference methods (cytochrome c: r = 0.57, p = .026; current generation: r values ≥ 0.47, p values <.033) and with psychological factors (depressive symptom severity: r = 0.35 [cannula insertion] versus r = -0.54 [catheter insertion]; chronic stress: r = 0.36 [cannula insertion]; p values ≤ .047). CONCLUSIONS: Our findings suggest that the implemented in vitro method investigates microbicidal potential of HMDM in a manner that is valid and sensitive to psychological measures.