AIM To determine specific cell types and pathways involved in calcification of the developing brain.METHOD We examined the detailed histopathology of samples from 28 autopsied brains aged from 22 weeks' gestation to 14 years. The samples were selected because they showed calcification associated with a range of different diseases. Samples were examined with routine stains as well as stains to show calcification and specific markers for endothelium and macrophages. INTERPRETATION Calcification in the developing brain that is not associated with tissue necrosis is initiated in cells associated with blood vessels. Calcium incrustation of blood vessels imposes rigidity, reduced vascular compliance, and altered permeability. This would explain associated atrophy, gliosis, and (in the developing brain) malformations of the cortex. Our findings suggest that pericytes initiate non-dystrophic brain calcification, but further studies are needed to explore this possibility. RESULTSCalcification in the developing brain is common in both pathological and radiological practice. A recent large, systematic review has described radiological patterns of intracranial calcification in a number of known diseases, but in at least half of radiologically identified cases aetiology cannot be defined and no common pathogenetic mechanism has been suggested. 1,2 Neuropathological descriptions in children are rare and there has been no similar systematic review of the neuropathology of brain calcification in children.Calcification is seen in many conditions including hypoxic ischaemic injury (HII), intrauterine infections, and in genetically determined conditions.3,4 The patterns of brain calcification in these conditions may be particularly difficult to distinguish radiologically, 2,5 which is the basis for the unhelpful term 'pseudo-TORCH' for a heterogeneous group of patients with intracranial calcification, including some with known mutations.More subtle micronodular calcification is a common autopsy finding in foetuses and neonates who may have diffuse white matter disease but sometimes have no other obvious pathology. 6,7 It involves the deep grey and white tissues of the brain and may potentially be a precursor of basal ganglia mineralization in children or adults. 8,9 Some forms of brain calcification specifically involve blood vessels. [10][11][12][13] Those with mutations in genes encoding endothelial tight junction proteins (e.g. OCLN and JAM 3)14,15 or the vascular basement membrane (collagen 4) 3 implicate impaired vascular integrity. Band-like calcification with simplified gyration and polymicrogyria (BCL-PMG) is associated with a mutation in the OCLN gene that encodes occludin, an integral component of endothelial tight junctions. The pathology is of calcification in cells close to blood vessels, sparing endothelium; associated polymicrogyria and cortical atrophy suggest ischaemia at multiple developmental stages, disrupting either corticogenesis or growth. 15 Obliterative vasculopathy with calcification is described in leuko...

Objectives:We aimed to investigate the effectiveness of a day visit in changing attitudes towards a high-security forensic psychiatric hospital, with regard to the current recruitment difficulties in psychiatry.Methods:Broadmoor Hospital, a UK high-security psychiatric hospital, runs day visits for medical students, led by doctors. At the beginning and the end of the day students wrote their responses to the question, ‘What do you think of Broadmoor?’ Attitudes and themes were identified, and their prevalence was analysed.Results:The responses of 296 students were initially analysed; however, 19 responses had to be excluded because they were illegible or incomplete. Before the visit, 15 responses were rated as positive, 169 neutral and 93 negative. After the visit, 205 responses were positive, 69 neutral and three negative. The themes that changed markedly following the visit were those indicating a change to favourable attitude.Conclusions:A single day visit was shown to be effective in altering the attitudes of medical students towards forensic psychiatry within a high-security psychiatric hospital.