Plasma transthyretin (TTR, formerly called prealbumin) is a 55-kd protein that participates in the plasma transport of both thyroxine and retinol (vitamin A). TTR concentrations are disproportionately high in human ventricular CSF, suggesting that TTR is either selectively transported across or synthesized de novo within the blood-CSF barrier. To address this question, we adopted a molecular genetic approach; after isolating a cDNA clone encoding human TTR, we previously demonstrated specific TTR messenger RNA (mRNA) synthesis in rat choroid plexus. We have now extended these investigations to the human brain. Northern analysis of postmortem brain homogenates revealed abundant TTR mRNA in choroid plexus, but not in cerebellum or cerebral cortex. Choroid plexus mRNA was readily translated into TTR preprotein in an in vitro translation system. An immunocytochemical survey of human postmortem brain sections revealed the presence of TTR protein specifically and uniquely in the cytoplasm of choroid plexus epithelial cells; these results were corroborated at the mRNA level by an extensive survey of whole rat-brain sections by in situ hybridization. Therefore, within the mammalian CNS, TTR is the first known protein synthesized solely by the choroid plexus, suggesting a special role for TTR in the brain or CSF. Whether this function differs from its established plasma transport functions is presently unknown.

The authors did not find significant evidence to contraindicate the use of subcutaneous epinephrine in older patients who are not known to have coronary artery disease, who present with either asthma or allergic reactions.

OBJECTIVES: To characterize reproductive hormone levels, symptoms, and attitudes related to menopause among healthy, menstruating white and African-American women aged 44 to 49 years. DESIGN: Pilot study; cross-sectional survey.SETTING: Community-based convenience sample of women in the Philadelphia metropolitan area.PARTICIPANTS: Thirty-three African-American and 35 white women. MEASUREMENTS:The survey instrument collected demographic data, medical and reproductive history, health practices and behaviors. It included previously validated function, depression, and quality-of-life instruments, and a Menopause Attitude Scale that included two factors, attitudes toward the menopause and attitudes toward medical therapy. Anthropometric measurements were taken at enrollment, and reproductive hormones and daily symptom logs were followed over two menstrual cycles. MAIN RESULTS:The two groups were comparable in mean age (African-American 46.2 years, white 46.9 years). Serum levels of estradiol, follicle-stimulating hormone, dihydroepiandrosterone-sulfate, and progesterone were comparable. Symptoms were similar in type and frequency. However, the African-American women had significantly more positive attitudes toward menopause, were more likely to rely on family for information about menopause, and were less likely to have been recommended hormone replacement therapy by their physicians. A majority of women in each group expressed satisfaction with the care they had received. CONCLUSIONS: Perimenopausal African-American and white women have different expectations of menopause and the role of medical care in menopause. This bears directly on women's acceptance of hormone replacement therapy. Conclusions are limited by the small sample size and convenience nature of the study population: further work with larger samples is needed to confirm these apparent differences. KEY WORDS: menopause; hormone replacement therapy; African-American women, white women, attitudes. J GEN INTERN MED 1997;12:230-236.he decline of ovarian function among women in their thirties and forties has been implicated in the development of physiologic changes that are widely observed a decade later, including body mass and composition, osteoporosis, cardiovascular disease, and psychological distress. Existing data regarding normal reproductive aging derive primarily from white, reproductive-age women with infertility, 1 postmenopausal women, 2 or small clinical samples of women seeking medical treatment. 3,4 It is not known whether the pattern of hormonal changes are similar in African-American and white women. African-American women have higher rates of obesity, cardiovascular disease, and stroke, 5,6 but lower rates of osteoporosis and vertebral or hip fractures. 7,8 Several studies have shown that menopausal symptoms vary across cultural groups 9,10 and socioeconomic strata 9,11,12 and can be linked to differing societal attitudes toward women's changing roles during and after menopause. [13][14][15][16][17][18][19][20] The overall prevalence of aff...

OBJECTIVES:To characterize reproductive hormone levels, symptoms, and attitudes related to menopause among healthy, menstruating white and African-American women aged 44 to 49 years. DESIGN: Pilot study; cross-sectional survey. SETTING:Community-based convenience sample of women in the Philadelphia metropolitan area. PARTICIPANTS:Thirty-three African-American and 35 white women. MEASUREMENTS:The survey instrument collected demographic data, medical and reproductive history, health practices and behaviors. It included previously validated function, depression, and quality-of-life instruments, and a Menopause Attitude Scale that included two factors, attitudes toward the menopause and attitudes toward medical therapy. Anthropometric measurements were taken at enrollment, and reproductive hormones and daily symptom logs were followed over two menstrual cycles. MAIN RESULTS:The two groups were comparable in mean age (African-American 46.2 years, white 46.9 years). Serum levels of estradiol, follicle-stimulating hormone, dihydroepiandrosterone-sulfate, and progesterone were comparable. Symptoms were similar in type and frequency. However, the African-American women had significantly more positive attitudes toward menopause, were more likely to rely on family for information about menopause, and were less likely to have been recommended hormone replacement therapy by their physicians. A majority of women in each group expressed satisfaction with the care they had received. he decline of ovarian function among women in their thirties and forties has been implicated in the development of physiologic changes that are widely observed a decade later, including body mass and composition, osteoporosis, cardiovascular disease, and psychological distress. Existing data regarding normal reproductive aging derive primarily from white, reproductive-age women with infertility, 1 postmenopausal women, 2 or small clinical samples of women seeking medical treatment. 3,4 It is not known whether the pattern of hormonal changes are similar in African-American and white women. African-American women have higher rates of obesity, cardiovascular disease, and stroke, 5,6 but lower rates of osteoporosis and vertebral or hip fractures. 7,8 Several studies have shown that menopausal symptoms vary across cultural groups 9,10 and socioeconomic strata 9,11,12 and can be linked to differing societal attitudes toward women's changing roles during and after menopause. [13][14][15][16][17][18][19][20] The overall prevalence of affective disorders is slightly less in African-American women than white women, 21 and postmenopausal African-American women are less frequently diagnosed with depression. 22 Similarly, attitudes toward hormone replacement therapy (HRT) might vary among cultural groups. Most recent investigations of HRT use have involved primarily white women. [23][24][25][26][27][28][29][30][31] The aims of this preliminary study were to assess the physiologic and clinical characteristics of healthy premenopausal African-American and white wo...

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The literature indicates that health professional students tend to favor biological over population content in clinical cases. We illustrate how population content can be represented in specifically designed cases.