The Game of Life and Marfan syndrome: Difference between pages

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{{Infobox_Disease

{{Two other uses|the board game|the cellular automaton|Conway's Game of Life||Game of Life (disambiguation)}}

| Name = Marfan syndrome

{{Infobox Game

| Image = Marfansyndrome.jpg

| title = The Game of Life

| subtitleCaption =

| DiseasesDB = 7845

| image_link = [[Image:Game of life board.jpg|300px]]

| ICD10 = {{ICD10|Q|87|4|q|80}}

| image_caption = Current edition of The Game of Life

| ICD9 = {{ICD9|759.82}}

| designer = [[Reuben Klamer]]

| illustratorICDO =

| OMIM = 154700

| publisher = [[Milton Bradley Company]]

| playersMedlinePlus = 2 to 6= 000418

| eMedicineSubj = ped

| ages = 9 to Adult

| eMedicineTopic = 1372

| setup_time = 15 minutes (approx.)

| eMedicine_mult = {{eMedicine2|orthoped|414}}

| playing_time = 60 minutes (approx.)

| MeshID = C17.300.500

| complexity = Low

| strategy = Low

| random_chance = High (spinning a wheel, card-drawing, luck)

| skills = [[Counting]]

| footnotes =

| bggid = 2921

| bggxrefs =

}}

'''LIFE''' aka '''The Game of Life''' is a [[board game]] originally created in 1861 by [[Milton Bradley]] as '''The Checkered Game of Life'''. The modern version was originally published in 1960 by the [[Milton Bradley Company]] (now a subsidiary of [[Hasbro]]). Two to six players can participate in one game; however, variations of the game have been made to accommodate a maximum of eight or ten players.

'''Marfan syndrome''' is an [[autosomal dominant]] genetic disorder of the [[connective tissue]] characterized by disproportionately long [[limb]]s, long thin fingers, a relatively tall stature, and a predisposition to cardiovascular abnormalities, specifically those affecting the [[heart valves]] and [[aorta]]. The [[disease]] may also affect numerous other structures and organs — including the [[lung]]s, [[eye]]s, dural sac surrounding the [[spinal cord]], and [[hard palate]]. It is named after [[Antoine Marfan]], the [[France|French]] [[pediatrician]] who first described it in 1899.

==History==

[[Image:CheckeredGameofLife.jpg|thumb|The Checkered Game of Life board]]

The game was originally created in 1861 by [[Milton Bradley]] as The Checkered Game of Life. This was the first game created by Bradley, a successful [[lithographer]], whose major product until that time was a portrait of [[Abraham Lincoln]] with a clean shaven face, which did not do very well once the subject grew his famous beard. The game sold 45,000 copies by the end of its first year. Like many games from the [[19th century]], it had a strong [[moral]] message, such as the [[The Mansion of Happiness]] by [[S.B. Ives]] in 1843.

==Epidemiology==

Bradley's game did not include a [[dice|die]], but instead used a [[teetotum]], a six sided [[top]] (dice were considered by many to be wicked items fit only for [[gambling|gamblers]]).

Marfan syndrome affects males and females equally,<ref name="marorg">{{Cite web|url=http://www.marfan.org/nmf/GetSubContentRequestHandler.do?sub_menu_item_content_id=6&menu_item_id=3|title=The role of heredity and family history|accessdate=2007-01-11|publisher=National Marfan Foundation|year=1999}}</ref> and the mutation shows no geographical bias. Estimates indicate that approximately 60 000 (1 in 5000, or 0.02% of the population)<ref name="marorg"/> to 200 000<ref name="mednet">{{Cite web|url=http://www.medicinenet.com/script/main/art.asp?articlekey=63689|title=New, Deadly Relative of Marfan's Syndrome Discovered|accessdate=2007-01-11|publisher=MedicineNet.com|year=2006}}</ref> Americans have Marfan syndrome. Each parent with the condition has a 50% chance of passing it on to a child due to its [[autosomal dominant]] nature. Most individuals with Marfan syndrome have another affected family member, but approximately 15-30% of all cases are due to ''[[de novo mutation|de novo]]'' [[genetic mutation]]s<ref name="robspath">{{cite book | title=Robbins Pathologic Basis of Disease| last=Cotran| coauthors=Kumar, Collins| publisher=W.B Saunders Company| ___location=Philadelphia| id=0-7216-7335-X}}</ref> &mdash; such spontaneous mutations occur in about 1 in 20 000 births. Marfan syndrome is also an example of [[dominant negative mutation]] and [[haploinsufficiency]].<ref name="Judge_et_al_2004">{{cite journal | last = Judge | first = Daniel P. | coauthors = Nancy J. Biery, Douglas R. Keene, Jessica Geubtner, Loretha Myers, David L. Huso, Lynn Y. Sakai, Harry C. Dietz | title = Evidence for a critical contribution of haploinsufficiency in the complex pathogenesis of Marfan syndrome. | journal = The Journal of Clinical Investigation | volume = 114 | issue = 2 | pages = 172-181 | doi = 10.1172/JCI200420641 | id = PMID 15254584 | url = http://www.jci.org/cgi/content/full/114/2/172 | accessdate = 2007-02-15}}</ref><ref name="Judge_et_al_2005">{{cite journal | last = Judge | first = Daniel P. | coauthors = Harry C. Dietz | title = Marfan's syndrome. | journal = Lancet | volume = 366 | issue = 9501 | pages = 1965-76 | year = 2005 | doi = 10.1016/S0140-6736(05)67789-6. | id = PMID 16325700 | url = http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=16325700 | accessdate = 2007-02-15}}</ref> It is associated with [[incomplete penetrance]], therefore not all persons carrying the mutation develop the disease.

== Pathogenesis ==

The game board was essentially a modified [[checkerboard]]. The object was to land on the "good" spaces and collect 100 points. A player could gain fifty points toward this goal by reaching "Happy Old Age" in the far corner, opposite "Infancy" where one began.

Marfan syndrome has been linked to a defect in the ''FBN1'' [[gene]] on [[chromosome]] 15,<ref>{{cite journal | author = McKusick V | title = The defect in Marfan syndrome. | journal = Nature | volume = 352 | issue = 6333 | pages = 279-81 | year = 1991 | id = PMID 1852198}}</ref> which [[Genetics|encodes]] a [[glycoprotein]] called [[fibrillin]]-1. Fibrillin is essential for the formation of the [[elastic fiber]]s found in connective tissue, as it provides the scaffolding for [[tropoelastin]].<ref name="robspath">{{cite book | title=Robbins Pathologic Basis of Disease| last=Cotran| coauthors=Kumar, Collins| publisher=W.B Saunders Company| ___location=Philadelphia| id=0-7216-7335-X}}</ref> Elastic fibers are found throughout the body but are particularly abundant in the [[aorta]], [[ligament]]s and the [[Zonule of Zinn|ciliary zonule]]s of the eye, consequently these areas are among the worst affected. Without the structural support provided by fibrillin many connective tissues are weakened, which can have severe consequences for support and stability.

A related disease has been found in [[mouse|mice]], and the study of mouse fibrillin synthesis and secretion, and connective tissue formation, has begun to further our understanding of Marfan syndrome in humans. It has been found that simply reducing the level of normal fibrillin-1 causes a Marfan-related disease in mice.<ref name="micefib">{{cite journal | author=Lygia Pereira, ''et al.''| title=Pathogenetic sequence for aneurysm revealed in mice underexpressing fibrillin-1| journal=Proceedings of the National Academy of Sciences| year=1999| volume=96| issue=7| page=3819-3823| url=http://www.pnas.org/cgi/content/full/96/7/3819}}</ref>

In 1960, the one hundredth anniversary of the game, the form of the game, now known as The Game of Life, was introduced, designed by [[Reuben Klamer]]. There were many re-publishings over the years, including 1866, 1959, 1961, 1978 and 1985.

[[Transforming growth factor]] beta (TGFβ) plays an important role in Marfan syndrome. Fibrillin-1 binds TGFβ and inactivates it. In Marfan syndrome, reduced levels of fibrillin-1 allow activated TGFβ to damage the lungs and heart. A defect in the gene ''TGFβR2'' on [[chromosome]] 3, a [[receptor protein]] of TGFβ, has also been related to Marfan syndrome.<ref name="tgf2beta">{{Cite web|url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=gene&dopt=full_report&list_uids=7048|title=TGFBR2 transforming growth factor, beta receptor II|accessdate=2007-01-11|publisher=NCBI|year=2007|author=Entrez Gene|format=Entrez gene entry}}</ref> Marfan syndrome can often be confused with [[Loeys-Dietz syndrome]], a similar connective tissue disorder resulting from mutations in the TGFβ receptor genes ''TGFβR1'' and ''TGFβR2''.<ref name="loeysdietz">{{Cite web|url=http://www.marfan.org/nmf/GetContentRequestHandler.do?menu_item_id=84|title=Related Disorders: Loeys-Dietz |accessdate=2007-01-11|publisher=National Marfan Foundation}}</ref>

==Setup==

The game consists of a track, on which players travel by spinning a small wheel with spaces numbered 1 through 10, located in the middle of the board. The board also contains small [[mountain]]s, buildings, and other similar pieces, so the playing area does not appear flat. Playing pieces are small, colored plastic [[automobiles]], and each pawn has six holes in the top in which "people pegs" are placed throughout the game as the player "gets married" and has or adopts "children".

==Symptoms==

Each game also includes a setup for a [[bank]], which includes imitation [[money]] (in denominations ranging from $1,000 to $100,000), [[insurance]] policies (automobile, life, fire, and/or homeowners' insurance depending on the version), $20,000 [[promissory note]]s, and [[stock market|stock]] certificates. Other tangibles vary with the game version.

There are no signs or symptoms that are unique to Marfan syndrome. It is usually a single apparent sign or symptom that leads doctors to look for others and eventually to diagnose the syndrome, which affects connective tissue in diverse organs and systems. Even affected individuals in the same family might exhibit various combinations and severities of symptoms.

===Skeletal system===

The most readily visible signs may be associated with the skeletal system. Many individuals with Marfan syndrome grow to larger than normal height and have long, slender limbs, fingers, and toes. An individual's arms may be disproportionately long. In addition to affecting height and limb proportions, Marfan syndrome can produce other skeletal signs. Abnormal curvature of the [[Vertebral column|spine]] ([[scoliosis]]) is common, as is abnormal indentation ([[pectus excavatum]]) or protrusion ([[pectus carinatum]]) of the [[sternum]]. Other signs include abnormal joint flexibility, a high [[palate]], [[malocclusions]], flat feet, stooped shoulders, and unexplained [[stretch marks]] on the skin. Some people with Marfans have [[speech disorder|speech impediments]] resulting from symptomatic high palates and small jaws.

===Eyes===

Marfan syndrome can also seriously affect the eyes and vision. [[myopia|Nearsightedness]] and [[astigmatism]] are common, but farsightedness can also result. Periodic eye exams can lead to an [[ophthalmologist]] or [[optometrist]] discovering dislocation, or [[subluxation]], of the crystalline [[lens (anatomy)|lens]] in one or both eyes ([[ectopia lentis]]) by carefully observing these structures using a [[Slit lamp|slit-lamp]] biomicroscope. This can be differentiated from the similar condition [[homocystinuria]], where the dislocation is inferonasal; in Marfan's the dislocation is superotemporal. Sometimes eye problems appear only after the weakening of connective tissue has caused [[retinal detachment|detachment of the retina]].<ref name="mayo-gen">{{Cite web|url=http://www.mayoclinic.com/health/marfan-syndrome/DS00540/DSECTION=2|title=Marfan Syndrome|accessdate=2007-01-12|publisher=Mayo Clinic}}</ref> Early onset [[glaucoma]] can be another complication.

===Cardiovascular system===

==1960s version==

The most serious conditions associated with Marfan syndrome involve the cardiovascular system. Undue fatigue, shortness of breath, [[heart palpitations]], [[tachycardia|racing heartbeats]], or [[angina|pain in the left chest, back, shoulder, or arm]], can bring an individual into the doctor's office. A [[heart murmur]] heard on a [[stethoscope]], an abnormal reading on an [[electrocardiogram]], or symptoms of [[angina]] can lead a doctor to order an [[echocardiogram]]. This can reveal signs of leakage or [[prolapse]] of the mitral or aortic [[heart valve|valves]] that control the flow of blood through the heart. However, the major sign that would lead a doctor to consider an underlying condition is a dilated aorta or an [[aortic aneurysm]]. Sometimes, no heart problems are apparent until the weakening of the connective tissue in the [[aorta|ascending aorta]] causes an [[aortic aneurysm]] or even [[aortic dissection]]. During pregnancy, even in the absence of preconceived cardiovascular abnormality, women with Marfan syndrome are at significant risk of acute [[aortic dissection]], which can be lethal if untreated. For this reason, women with Marfan syndrome should recieve a thorough assessment prior to conception, and [[echocardiography]] should be performed every 6-10 weeks during pregnancy, to assess the aortic root diameter. Most women however tolerate pregnancy well and safe vaginal delivery is possible.<ref name="emed">{{Cite web|url=http://www.emedicine.com/ped/fulltopic/topic1372.htm#section~Miscellaneous|title=Marfan Syndrome, special concerns|accessdate=2007-06-25}}</ref>

{{Expand-section|date=January 2007}}

The Game of Life copyrighted by the Milton Bradley company in 1963 had some interesting differences from later versions. For one, once a player reached the Day of Reckoning, he could end up at the "Poor Farm" (not a politically correct term today), or he could become a Millionaire Tycoon and move on to Millionaire Acres. For some reason later versions renamed this Millionaire Estates; a fact unknown by the millions of new players every year.

===Lungs===

This version had [[Art Linkletter]] as the spokesman and included his picture on the cover of the box and on the $100,000 bills. It was advertised as a "Milton Bradley 100th Anniversary Game" and as "A Full 3-D Action Game."

Marfan syndrome is a [[risk factor]] for spontaneous [[pneumothorax]]. In spontaneous unilateral pneumothorax, air escapes from a lung and occupies the [[pleural]] space between the chest wall and a [[lung]]. The lung becomes partially compressed or collapsed. This can cause pain, shortness of breath, [[cyanosis]], and, if not treated, death. Marfan syndrome has also been associated with [[sleep apnea]] and [[idiopathic]] obstructive lung disease.

===Central nervous system===

==1970s/1980s version==

Another condition that can reduce the quality of life for an individual, though not life-threatening, is [[dural ectasia]], the weakening of the connective tissue of the dural sac, the membrane that encases the [[spinal cord]]. Dural ectasia can be present for a long time without producing any noticeable symptoms. Symptoms that can occur are lower [[back pain]], leg pain, [[abdominal pain]], other neurological symptoms in the lower extremities, or [[headaches]]. Such symptoms usually diminish when the individual lies flat on his or her back. These types of symptoms might lead a doctor to order an [[X-ray]] of the [[lumbar|lower spine]]. Dural ectasia is usually not visible on an X-ray in the early phases. A worsening of symptoms and the lack of finding any other cause should eventually lead a doctor to order a upright [[MRI]] of the lower spine. Dural ectasia that has progressed to the point of causing these symptoms would appear in a upright MRI image as a dilated pouch that is wearing away at the [[lumbar vertebrae]].<ref name="mayo-gen" /> Other spinal issues associated with Marfan include degenerative disk disease and spinal cysts.

''About halfway through the production of this version, the dollar values were increased by approximately double (possibly to reflect [[inflation]]). This description will focus on the later version with the larger dollar amounts.''

===Salaries=Management==

There is no cure for Marfan syndrome, but life expectancy has increased significantly over the last few decades. The syndrome is treated by addressing each issue as it arises, and, in particular, considering prophylactic medication, even for young children, to slow progression of aortic dilation.

To determine one's salary, a player could travel one of two routes at the beginning of the game. The shorter route was entitled ''Business'' and resulted in the player receiving a set salary of $12,000 per Pay Day. The longer route was entitled ''College'' and could earn the player anywhere between $16,000 and $50,000 per Pay Day. Both of these initial routes joined back together at the first Pay Day.

Regular checkups by a [[cardiologist]] are needed to monitor the health of the heart valves and the aorta. The goal of treatment is to slow the progression of aortic dilation and damage to heart valves by eliminating [[Cardiac arrhythmia|arrythmias]], minimizing the [[heart rate]], and minimizing [[blood pressure]]. [[Beta blocker]]s have been used to control [[Cardiac arrhythmia|arrythmias]] and slow the [[heart rate]]. Other medications might be needed to further minimize [[blood pressure]] without slowing the [[heart rate]], such as [[ACE inhibitors]] and [[angiotensin II receptor antagonist]]s, also known as angiontensin receptor blockers (ARBs). If the dilation of the aorta progresses to a significant diameter [[aneurysm]], causes a dissection or a rupture, or leads to failure of the aortic or other valve, then surgery (possibly a composite aortic valve graft [CAVG] or valve-sparing procedure) becomes necessary. Although aortic graft surgery (or any vascular surgery) is a serious undertaking it is generally successful if undertaken on an elective basis. Surgery in the setting of acute aortic dissection or rupture is considerably more problematic. Elective aortic valve/graft surgery is usually considered when aortic root diameter reaches 50 millimetres, but each case needs to be specifically evaluated by a qualified cardiologist. New valve-sparing surgical techniques are becoming more common.<ref name="mayo-heart">{{Cite web|url=http://www.mayoclinic.org/marfan-syndrome/heartsurgery.html|title=Heart Surgery for Marfan Syndrome|accessdate=2007-01-12|publisher=Mayo Clinic}}</ref> As Marfan patients live longer, other vascular repairs are becoming more common, e.g. repairs of descending thoractic aortic aneurysms and aneurysms of vessels other than the aorta.

===Types of spaces===

Most of the spaces on the game board were various shades of yellow and orange; the instructions on these spaces were only followed if they were landed on. The "Pay Day" spaces, and a few others, were red (including "Taxes Due" in which the player had to pay half of his salary to the bank); any red space impacted the player regardless if they landed on or passed such space. Also in the game were a handful of white spaces; landing on or passing one of these resulted in the player being given the choice whether or not to follow the instructions. Examples of these spaces included deciding whether or not to buy insurance or stock.

The skeletal and ocular manifestations of Marfan syndrome can also be serious, although not life-threatening. These symptoms are usually treated in the typical manner for the appropriate condition. This can also affect height, arm length, and life span. The [[Nuss procedure]] is now being offered to people with Marfan syndrome to correct 'sunken chest' or ([[pectus excavatum]]).<ref name="chkd">{{Cite web|url=http://www.chkd.org/services/nussprocedure/Overview.aspx|title=Overview of the Nuss Procedure for Pectus Excavatum|accessdate=2007-01-12|publisher=Children's Hospital of The King's Daughters}}</ref> Because Marfan may cause spinal abnormalities that are asymptomatic, any spinal surgery contemplated on a Marfan patient should only follow detailed imaging and careful surgical planning, regardless of the indication for surgery.

==="Share the Wealth" cards===

Distributed with this game were a number of "Share the Wealth" cards. Each player started out with one, and earned another card each time he landed on "Pay Day" by exact count. There were three types: Collect, Pay, and Exemption, and they were used as follows:

* If a player landed on a space in which he collected money from the bank, or received a Pay Day, an opponent with a Collect card could steal half the collected money from that player.

* If a player landed on a space in which he had to pay money from the bank, or had to pay Taxes, he could present a Pay card to an opponent, who immediately had to pay half of that player's penalty.

* If a player had an Exemption Card, he could cancel out a Share the Wealth card levied against him; both cards were then removed from the game.

Clinical trials have been conducted of the drug [[acetazolamide]] in the treatment of symptoms of [[dural ectasia]]. The treatment has demonstrated significant functional improvements in some sufferers.<ref name="spine">{{Cite web|url=http://www.spineuniverse.com/displayarticle.php/article922.html|title=Dural Ectasia in the Marfan Spine: Symptoms and Treatment|accessdate=2007-01-12|publisher=Scoliosis Research Society}}</ref> Other medical treatments, as well as physical therapy, are also available.

===Life Events===

Upon adding a member to the family (getting married, having children, etc.) the player "collected presents" from each of the other players. At marriage, this amount was determined by spinning the wheel: spinning 1, 2, or 3 was worth $2,000 per opponent; 4, 5, or 6 was worth $1,000; 7 through 10 earned nothing. In the case of children, the player was awarded a flat $1,000; if the player had twins or adopted two children, the amount was doubled. A house cost a flat $40,000, and buying one was one of the red spaces (i.e. all players had to buy a house at the time they landed on or passed this space.)

i need to go to the toliet

Treatment of a spontaneous [[pneumothorax]] is dependant on the volume of air in the pleural space and the natural progression of the individual's condition. A small pneumothorax might resolve without active treatment in 1 to 2 weeks. Recurrent pneumothoraxes might require chest surgery. Moderately sized pneumothoraxes might need [[Chest tube|chest drain]] management for several days in hospital. Large pneumothoraxes are likely to be medical emergencies requiring emergency decompression.

===Insurance and Stock===

In this version, the three insurance policies (automobile, life, and fire) prevented the player from being affected by a number of "tragedy" spaces throughout the board (house fires, car wrecks, etc.) which cost the player a significant amount of money if he/she landed on it if not insured. Buying life insurance activated certain spaces which awarded dividends if landed on. Automobile and fire insurance could be lost permanently if the player landed on a "careless" or "reckless driver" space. Life insurance had the possibility of "maturing" with large financial gains if a person so equipped landed on the corresponding space.

Research in laboratory [[mouse|mice]] has suggested that the [[angiotensin II receptor antagonist]] [[losartan]], which appears to block TGF-beta activity, can slow or halt the formation of aortic aneurysms in Marfan syndrome.<ref name="scimag">{{Cite journal | last = Habashi | first = Jennifer P. | coauthors = Daniel P. Judge, Tammy M. Holm, Ronald D. Cohn, Bart L. Loeys, Timothy K. Cooper, Loretha Myers, Erin C. Klein, Guosheng Liu, Carla Calvi, Megan Podowski, Enid R. Neptune, Marc K. Halushka, Djahida Bedja, Kathleen Gabrielson, Daniel B. Rifkin, Luca Carta, Francesco Ramirez, David L. Huso, and Harry C. Dietz | date = [[April 7]], [[2006]] | title = Losartan, an AT1 Antagonist, Prevents Aortic Aneurysm in a Mouse Model of Marfan Syndrome | volume = 312 | issue = 5770 | pages = 117 - 121 | doi = 10.1126/science.1124287 | url = http://www.sciencemag.org/cgi/content/full/312/5770/117 | abstract = http://www.sciencemag.org/cgi/content/abstract/sci;312/5770/117 | news = http://www.news-medical.net/?id=17249}}</ref> A large [[clinical trial]] sponsored by the [[National Institutes of Health]] comparing the effects of losartan and [[atenolol]] on the aortas of Marfan patients is scheduled to begin in early 2007, coordinated by Johns Hopkins.<ref name="trial">{{Cite web|url=http://www.marfan.org/nmf/GetSubContentRequestHandler.do?sub_menu_item_content_id=147&menu_item_id=91|title=Atenolol vs. Losartan in Individuals with Marfan Syndrome Clinial Trial|accessdate=2007-01-12|publisher=National Marfan Foundation}}</ref>

The Stock certificate played a much more important (and realistic) role in this version than in later versions. Purchasing a Stock certificate cost $50,000; however, many of the high-payout spaces (such as "striking oil" with its $480,000 payout) were only active if the player owned stock. In addition, a couple of white spaces allowed the player the opportunity to "play the market" if he so desired, in a game similar to the Lucky Day space (explained below). If the bearer landed on a space indicating a rise in stock prices, the player collected money accordingly, and if he/she landed on a "stock prices drop" space, he likewise lost money.

Genetic counseling and specialized clinics are available at many academic medical centers for affected persons and family members.

===Lucky Day===

Several of the spaces were marked "Lucky Day"; if the player landed on a Lucky Day, he/she immediately received $20,000 (paid with two $10,000 bills.) The player could keep the money or gamble it for the chance to turn it into $300,000. To gamble, the player placed each of the $10,000 bills on one of the numbers printed on a large "number strip" provided with the game, and spun the wheel. If it landed on an empty number, the player lost the $20,000; however, if it landed on a number on which he placed a $10,000 bill, he/she was given $300,000.

==Well known people==

===Retirement===

Below is a list of prominent figures known or believed to have had Marfan syndrome:

When a player reached the end of the game, he could retire to the "Millionaire" space if he thought he had the most money. In normal circumstances, all players would retire here after reaching the end of the game, at which point they would count their money. The player with the most money won the game.

* [[Euell Gibbons]], outdoorsman & health food proponent.

* [[Flo Hyman]], silver medal in Women's Volleyball (1984 Olympics)<ref name="flo">{{Cite web|url=http://www.volleyhall.org/hyman.html|title=Flo Hyman|accessdate=2007-01-11|publisher=Volleyball Hall of Fame}}</ref>

* [[Jonathan Larson]], Tony Award-winning playwright ([[Rent (musical)|Rent]]); he died in 1996 of [[aortic dissection]] on the eve of his musical's premiere<ref name="larson">{{Cite web|url=http://www.wnbc.com/drmaxgomez/5421112/detail.html|title=Marfan's Syndrome Is Deadly, Elusive|accessdate=2007-01-11|publisher=WNBC.com}}</ref>

* [[Robert Johnson (musician)|Robert Johnson]], blues singer and guitarist<ref name="robertj">{{Cite journal | last = Connel | first = David | date = [[September 2]], [[2006]] | title=Retrospective blues: Robert Johnson—an open letter to Eric Clapton | journal = British Medical Journal | volume = 333 | issue = 7566 | pages = 489 | url=http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1557967|accessdate=2007-01-11}}</ref>

*[[Mike Dunleavy]], professional basketball player for the [[Portland Trailblazers]]

* [[Vincent Schiavelli]], actor<ref name="schiavelli">{{Cite web|url=http://www.marfan.org/nmf/PreviewPressReleaseInfoRequestHandler.do?press_release_id=24|title=NMF Mourns the Loss of its Honorary Co-Chair, Vincent Schiavelli|accessdate=2007-01-11|publisher=National Marfan Foundation}}</ref>

* [[Sir John Tavener]],<ref name="bbc">Richard Morrison, ''99 Names for God: John Tavener turns his back on Orthodoxy'', BBC Music, November 2004, page 30</ref> contemporary British composer

* Bradford Cox, frontman of the punk rock band [[Deerhunter]]<ref name="deerhunter">{{Cite web|url=http://www.pitchforkmedia.com/article/feature/43085-interview-deerhunter|title=Pitchfork Feature: Interview: Deerhunter}}</ref>

* [[Joey Ramone]], of the punk rock band [[The Ramones]].

===Spurious or conjectural claims===

If a player felt like he was trailing severely at the point he retired, he could make one final gamble in an attempt to become the "Millionaire Tycoon". He selected one number on the number strip, and placed his car here. He spun the wheel; if the number was ''anything but'' the one he selected, he was banished to the "Bankrupt" space and lost the game. If, however, he landed on the number he previously chose, he became the Millionaire Tycoon and automatically won the game.

There are a number of historical persons believed to have suffered from Marfan's syndrome, but as proper Marfan diagnosis was not available before well into the 20th century most such claims can only be considered as speculation based on sparse medical records and pictures.

* [[Akhenaten]], Egyptian Pharaoh, who was the father of King [[Tutankhamun]] (spurious claim based on early Amarna art style. Tutankhamun, who didn't have syndrome, was also portrayed this way)<ref name="pharaoh">{{Cite web|url=http://www.marfan.ca/pharaoh.html|title=Did Akhenaten Suffer from Marfan's Syndrome?|accessdate=2007-01-11|publisher=Canadian Marfan Association}}</ref>

==1992 Version==

''The Game of Life'' was updated in [[1992]] to reward players for "good" behavior, such as recycling trash and helping the homeless (spaces which cost players a good deal of money in previous versions.) The 1992 version of the game proceeds as follows:

* [[Osama bin Laden]] may suffer from Marfan Syndrome (speculation based on tall size, use of cane and rumoured heart-disease; almost certainly in error)<ref>http://archive.salon.com/people/feature/2001/11/09/marfan/index.html</ref>

===Careers and Salaries===

There are still two routes at the beginning of the game, now labeled ''Career'' and ''College''. Selecting the College route now places the player in debt from the very start; however, the probability of landing a better job and a higher salary is much better than selecting the Career route. If the person lands on a trade a salary card space, you can trade it or keep it, whatever you choose. At the shared end of both paths, the player's career and salary are decided by chance. A Career Card (with such occupations as a teacher, police officer, athlete, and travel agent), as well as a Salary Card (ranging in $10,000 increments between $20,000 and $100,000) are selected, as outlined below.

* [[Charles de Gaulle]] (conjectural)<ref>http://archive.salon.com/people/feature/2001/11/09/marfan/index.html</ref>

If a player chooses ''Career'', he takes the shorter path; at the end, he selects one occupation card and one salary card. If the selected Career card says "Degree Required", he must draw another Career Card. The player continues the game with that specific career and salary unless another event affects him.

* [[Nicollo Paganini]] (Conjectural) <ref>[http://tafkac.org/celebrities/paganini_stories_myths.html], main reference being an article in the AMA journal by Dr. Myron R. Shoenfeld dated 2 January, 1978.</ref>

If a player chooses ''College'', he must immediately take two Promissory Notes from the bank for tuition, and must take the longer path (which in this game is also more "dangerous" than the Career path.) However, at the end, he selects three Career cards and three Salary cards, and may choose one from each set after looking at them.

this game is great!

* It was once believed that [[Abraham Lincoln]] suffered from Marfan Sydrome, although recent research has argued that he probably didn't.

===Types of spaces===

As in the 1980s version, most of the spaces on the game board are yellow, and their instructions are only followed if they are landed on. The "Pay Day" spaces are green and impact the player when landed on or passed. Red spaces now always signify a major life event (e.g. [[graduation]], [[marriage]], buying a house, [[retirement]]), and must be stopped on even if the spin is greater than the number needed to land on them. The "decision" spaces are now blue, and if landed on, the player can choose to follow them or do nothing. "Taxes Due" is now a normal yellow space, and is also only active if landed on.

* [[Johnny Appleseed]], a pioneer nurseryman in America living during the 18th century; he has become an almost mythical popular culture icon in America.

===Occupation spaces===

Most of the spaces requiring the player to pay money to the bank have a symbol next to them, each of which corresponds to that on one of the career cards. If any opponent has that career card, the money is paid to that opponent instead of the bank; if the player himself has that career, he does not have to pay anything.

==Related disorders==

====Special Occupations====

The following disorders have similar signs and symptoms of Marfan syndrome:

There is only one space on the board that will award the Police Officer money from another player; this is due to a special rule regarding this career. If any player spins 10 while an opponent is the Police Officer, that opponent may collect a $5,000 "fine" from the spinning player for "speeding".<!--$10,000 is changed during the latest version. It is $5,000 in the 1992 version.-->

*[[Arachnodactyly|Congenital Contractural Arachnodactyly (CCA) or Beals Syndrome]]

Another occupation that has special ability is Computer Technican. If the spin wheel is spinned out of the board or the needle got stuck between 2 numbers, the player who chose to be Computer Technican can fix the spin wheel and collect $5,000 from the bank for "technical support".

*[[Ehlers-Danlos syndrome]]

*[[Homocystinuria]]

*[[Loeys-Dietz syndrome]]

*[[MASS phenotype]]

*[[Stickler syndrome]]

The following conditions that can result from having Marfan syndrome may also occur in people without any known underlying disorder:

===LIFE Tiles===

A major change to the game in this version is the collection of "LIFE Tiles" as one progresses through the game. Every time a player lands on a space marked with the LIFE logo, he/she collects a LIFE tile. (These also replace the previous "collecting presents" rule.) On each of these tiles is a major life event (e.g. climbing [[Mount Everest|Mt. Everest]], curing the [[common cold]], building a better [[mousetrap]], etc.). Each of these tiles bears an amount from $50,000 to $250,000. The tiles are not revealed until all players have "retired", at which point they are flipped over and their total is added to the player's money total.

<div style="width:30%; float:left; padding:0 3% 0 0; border:none; overflow:hidden; clear:left;">

If at any time the draw pile of LIFE Tiles is depleted, a player may steal one from any active player remaining in the game, or certain "retired" players (see ''Retirement'' section below.)

*[[Aortic aneurysm|Aortic aneurysm or dilitation]]

*[[Arachnodactyly]]

*[[Bicuspid aortic valve]]

*[[Cysts]]

*[[Craniosynostosis]]

*[[Cystic medial necrosis]]

*[[Dural ectasia]]

*[[Ectopia lentis]]

</div>

<div style="width:30%; float:left; padding:0 3% 0 0; border:none; overflow:hidden; ">

*[[Flat feet]]

*[[Gigantism]]

*[[Glaucoma]]

*[[Hernias]]

*[[Hyperflex|Hypermobility of the joints]]

*[[Malocclusion]]

*[[Mitral valve prolapse]]

*[[Myopia]]

</div>

<div class="editmode" style="width:30%; float:left; padding:0 3% 0 0; border:none; overflow:hidden; ">

*[[COPD|Obstructive lung disease]]

*[[Osteoarthritis]]

*[[Pectus carinatum]] or [[pectus excavatum|excavatum]]

*[[Pneumothorax]]

*[[Retinal detachment]]

*[[Scoliosis]]

*[[Sleep apnea]]

*[[Stretch marks]]

</div><br clear="left" />

==References==

===Buying a house===

{{reflist|2}}

One of the red spaces in the game is buying a house; at this point in the game, the player must immediately draw one House Deed and pay to the bank whatever that house costs (ranging from a $200,000 Victorian mansion to a $40,000 "split-level" shack.) At this time (or later in the game at any point) he may also buy homeowners' insurance for a price listed on the house deed.

==External links==

===Insurance and Stock===

*[http://marfanworld.org/ International Federation of Marfan Syndrome Organisations]

In this version, there are two insurance policies (automobile and homeowners') that prevent the player from being affected by a number of "tragedy" spaces throughout the board. Purchasing a Stock certificate still costs $50,000; however, its role is very limited in this series. Upon purchasing stock, the player chooses a stock card numbered between 1 and 9; from that point, any time any player spins that number, the stockholder collects $10,000 from the bank. A player may only hold one stock card at a time unless he hits a space marked "Stock Market Zooms", at which point he selects another stock card free of charge; likewise, "Stock Market Slumps" costs the stockholder one stock card. Each number has only 1 stock and will not be available to others as they are being purchased.

*[http://www.marfan.org/ National Marfan Foundation (USA)]

*[http://www.marfan.org.za/diagnosis.html Marfan diagnosis criteria]

*[http://www.ncbi.nlm.nih.gov/disease/Marfan.html National Institute for Health Marfan syndrome page (USA)]

*[http://www.medicinenet.com/marfan_syndrome/index.htm Marfan Syndrome Center at medicinenet.com]

*[http://marfansyndrome.researchtoday.net/ Marfan Syndrome Research] - recent literature on Marfan Syndrome

*[http://www.supportmarfan.com Marfan support]

*[http://www.marfan.ca/ Canadian Marfan Association]

*[http://www.marfan.org.uk/ Marfan Association UK]

*[http://www.marfan.org.mx/ Marfan de Mexico]

*[http://www.marfan.no/ Norwegian Marfan Organization]

*[http://www.marfanlife.net Marfan Life blog] - mostly links to news articles about Marfan Syndrome

*[http://www.marfanlife.net/lists/ Marfan-List] - email discussion list for people and families with Marfan Syndrome

*[http://www.marfan.org.za/ South African Marfan Syndrome Organisation] - support group for Africa

*[http://www.medstudents.com.br/original/revisao/marfan/marfan.htm Eye Findings in Marfan's syndrome]

[[Category:Cardiology]]

===Retirement===

[[Category:Diseases involving the fasciae]]

When a player reaches the end of the game, he may choose two options to "retire". He may place his car at Millionaire Estates (largely unchanged from the previous version), or he may retire at Countryside Acres (previously the "Bankrupt" space). Each has its benefits and risks.

[[Category:Genetic disorders]]

[[Category:Syndromes]]

[[ar:متلازمة مارفان]]

If a player thinks he will end the game with the most cash, his best option is to retire at Millionaire Estates. Four LIFE Tiles are placed here before the start of the game. After all players have finished the game, they count their cash on hand; whoever has the most cash receives these four tiles (in the rare occurrence of a tie, they are split). However, if other players are still playing the game and the LIFE Tile draw pile is empty, these players may still steal tiles from anyone retired at this space.

[[de:Marfan-Syndrom]]

[[es:Síndrome de Marfan]]

If a player is not confident in his amount of cash on hand, he may retire to Countryside Acres. By retiring here, he automatically collects one LIFE tile, and no other players can steal tiles from him for the remainder of the game.

[[fr:Syndrome de Marfan]]

[[ko:마르팡 증후군]]

After all players have retired, the amounts on the LIFE Tiles are revealed, and whoever has the most money (cash on hand added to the combined total of one's LIFE Tiles) is the winner.

[[it:Sindrome di Marfan]]

[[he:תסמונת מרפן]]

==CD-ROM version==

[[nl:Syndroom van Marfan]]

In [[1998]], a [[CD-ROM]] version of the game was produced by Hasbro which added computerized animations and short animations to the game. An option was also given for players to compete in games over the [[Internet]].

[[ja:マルファン症候群]]

[[nn:Marfans syndrom]]

Two versions of the game were offered on the CD-ROM. The Classic game followed the rules of the current board game. An Enhanced Game was also offered - this version replaced the LIFE Tiles with "[[Life's Little Games]]" (simple arcade-type games which offered the player a chance to win bonus money.) Several features of the 1980s version, such as "collecting presents" for marriage and kids and exacting "Revenge" on other players, were also resurrected for this version of the game. Also, the routine for retiring changed. Retired players still spun the wheel on their turn, this time to gain or lose money. The difference between Countryside Acres and Millionaire Estates is that the former only had one space in which the player could lose money, but the payouts were lower. The latter offered bigger payouts, but also had more numerous and severe penalty spaces, thus adding more risk to retiring here. This changed retiring strategy quite a bit, making come-from-behind victories possible if Millionaire Estate retirees' luck turned for the worse.

[[pl:Zespół Marfana]]

[[pt:Síndrome de Marfan]]

In the Enhanced game, when a player landed on a space that would ordinarily award them a LIFE tile, they instead spun the wheel. Random items were assigned to each space, being either a cash amount or one of "Life's Little Games". The exception was 10, which allowed the player to spin again and multiplied the player's winnings from whatever they landed on. The space started at Double, and the multiplier increased by one for each successive spin of 10.

[[ru:Синдром Марфана]]

[[sr:Марфанов синдром]]

The values used in "Life's Little Games" were typically $5,000, $10,000, $25,000, $50,000, $75,000, and $100,000.

[[fi:Marfanin oireyhtymä]]

[[sv:Marfans syndrom]]

===Safe Cracker===

[[uk:Синдром Марфана]]

The player has four tries to reveal as high an amount as possible. If satisfied that (s)he cannot achieve a higher amount with any remaining attempts, the player clicks DONE and all remaining boxes are revealed.

===Up or Down===

There is one of each denomination from $5,000 to $100,000. There is also one of each denomination in the negative, which subtracts this amount from a player's potential gain (and is painted the [[complementary color]]). A player can choose as many spots as seen fit and stop at any time by clicking the DONE box.

===Get a Life===

All letters in the word L-I-F-E must be uncovered in six clicks or fewer. Every letter appears alone in three different spots on the grid, in the form and colors of the Life ident. If the word is revealed in four clicks, the player gains $100 K. In five clicks, the gain is $75,000. In six, it is $50,000. During the course of this game, a corner display, again in the form of the LIFE ident, keeps track of the player's progress by indicating which letters have and have not yet been uncovered.

===Treasure Chest===

There are two of each denomination from $5,000 to $100,000. The player has six tries to reveal two identical amounts. The game ends upon a match or exhausting all six turns.

===Skunk Money===

There are no $75,000 or $100,000 spots on this board. One spot is worth $50,000; two are worth $20,000; six are worth $10,000. One spot reads DOUBLE YOUR WINNINGS and thus doubles the potential amount. The other two spots contain a [[skunk]]. If a skunk is uncovered, the game ends and no money is gained. A player can stop at any time by clicking the DONE box.

===Cannonball===

There are two of each denomination from $5,000 to $100,000. Like Treasure Chest, the idea is to uncover two spots containing the same denomination. Unlike Treasure Chest, a player can keep whatever amounts are matched in a single turn. In this take on the Memory Game, the player has four tries and therefore eight clicks to get as many matches as possible.

===Crane Dump===

Only included in the PC version, this game involved a player moving a crane left or right on top of a game board very similar to [[Plinko]] from ''[[The Price is Right]]''. When the player was satisfied with the crane's position, they dropped the ball into the board, where it would land in a slot on the bottom. The slots were labeled with money amounts ranging from $10,000 to $100,000. No more than one ball at a time could occupy a slot. After six balls, the total winnings were tallied and awarded to the player.

===Trash Can===

Another PC exclusive, this game was essentially the converse of Crane Dump. It involved the player moving a white bucket between the slots of Crane Dump. When they were satisfied with the bucket's position, they dropped the ball from the crane above (the crane in this game was stationary) in hopes that it would land in the bucket. The player was allotted six balls; each ball that successfully landed in the bucket awarded the player $50,000, making the maximum possible winnings $300,000.

==Current Version==

An updated version of the game's 1992 format was released in [[2005]] with a few gameplay changes. The new Game of Life was more realistic and tried to add in extra elements to reduce chance, although it is still primarily chance based and still rewards players for taking chances.

===Starting College===

In the 1992 version one who started College would receive $40,000 in debt. The current version places such a player $100,000 in debt. One still receives the same benefits for starting College as in the 1992 version.

===Career Renovations===

A major addition to the 2005 version is that payscales were divided into four pay groups: yellow, green, purple, and red. Yellow contains only the $100,000 salary while the other three colors each contain 3 different salary cards. The Doctor Career can only get the yellow and green salary cards and if any other salary cards are selected the player must redraw. The Rock Star Career track can only get the lower salary cards for a starting wage. Another addition to the careers was that of special attributes. For instance the Rock Star career track has a special ability that if an 8, 9, or 10 is rolled in two consecutive turns the player gets a "Big Break" and automatically gets the yellow $100,000 salary card. Another special attribute is that the Teacher can get a "Summer Job" which allows them to collect the payment of on-board spots of another career. The Policeman also receives $10,000 instead of $5,000 when a player spins a ten.

===Selling one's house===

There is an addition of a new STOP space where a player can sell his house. The sale price of one's house is determined by the multiplying (or dividing) the original price of the house by an amount determined by spinning the wheel (similar to the enhanced game on the CD-ROM). If a low number is spun, the player loses profit, a mid-range number breaks even, and a high number nets a tremendous profit. If one sells his house in this manner, another house is bought, and the process is repeated (without option) at the end of the game.

===LIFE tile reductions===

In the 1992 version the LIFE tiles would range in value from $50,000 to $250,000. This often changed the course of the game and made the poorest person throughout the game win right at the end when these were redeemed. To alleviate this problem, the LIFE tiles have been reduced in value down to a range between $10,000 and $50,000.

==Notes==

The game was endorsed by [[Art Linkletter]] in the [[1960s]]. It is now part of the permanent collection of the [[Smithsonian Institution|Smithsonian]]'s [[National Museum of American History]]. It spawned a book, ''The Game of Life: How to Succeed in Real Life No Matter Where You Land'' ([[Running Press]]), by [[Lou Harry]].

==Other Versions==

*40th Anniversary Edition (1999)

*The Game of Life in Monstropolis ([[Monsters, Inc|Monsters, Inc.]]) (2001)

*[[The Game of Life Card Game|Card Game]] (2002)

*[[Game of Life Fame Edition|Fame Edition]] (or Game of Life Junior/travel version) (2002)

*A [[Jedi]]'s Path (2002)

*[[Pirates of the Caribbean]] (2004)

*[[The Simpsons]] Edition (2004)

*Bikini Bottom [[SpongeBob SquarePants]] Edition (2004)

*[[Pirates of the Caribbean: Dead Man's Chest]] (2006)

*[[The Game of Life/Yahtzee/Payday]] [[Game Boy Advance]] game

[[Category:Economic simulation board games|Game of Life]]

[[Category:Roll-and-move board games|Game of Life]]

[[Category:1861 introductions|Game of Life]]

{{Link FA|pt}}

[[de:Spiel des Lebens (Brettspiel)]]

[[fr:Destins (jeu)]]

[[nl:Levensweg]]

[[ja:人生ゲーム]]

[[pt:Jogo da vida (jogo de tabuleiro)]]

[[simple:The Game of Life]]