RNA interference mitigates motor and neuropathological deficits in a cerebellar mouse model of machado-joseph disease.

Machado-Joseph disease or Spinocerebellar ataxia type 3 is a progressive fatal neurodegenerative disorder caused by the polyglutamine-expanded protein ataxin-3. Recent studies demonstrate that RNA interference is a promising approach for the treatment of Machado-Joseph disease. However, whether gene silencing at an early time-point is able to prevent the appearance of motor behavior deficits typical of the disease when initiated before onset of the disease had not been explored. Here, using a lentiviral-mediated allele-specific silencing of mutant ataxin-3 in an early pre-symptomatic cerebellar mouse model of Machado-Joseph disease we show that this strategy hampers the development of the motor and neuropathological phenotypic characteristics of the disease. At the histological level, the RNA-specific silencing of mutant ataxin-3 decreased formation of mutant ataxin-3 aggregates, preserved Purkinje cell morphology and expression of neuronal markers while reducing cell death. Importantly, gene silencing prevented the development of impairments in balance, motor coordination, gait and hyperactivity observed in control mice. These data support the therapeutic potential of RNA interference for Machado-Joseph disease and constitute a proof of principle of the beneficial effects of early allele-specific silencing for therapy of this disease.

In vivo reprogramming of circuit connectivity in postmitotic neocortical neurons.

The molecular mechanisms that control how progenitors generate distinct subtypes of neurons, and how undifferentiated neurons acquire their specific identity during corticogenesis, are increasingly understood. However, whether postmitotic neurons can change their identity at late stages of differentiation remains unknown. To study this question, we developed an electrochemical in vivo gene delivery method to rapidly manipulate gene expression specifically in postmitotic neurons. Using this approach, we found that the molecular identity, morphology, physiology and functional input-output connectivity of layer 4 mouse spiny neurons could be specifically reprogrammed during the first postnatal week by ectopic expression of the layer 5B output neuron-specific transcription factor Fezf2. These findings reveal a high degree of plasticity in the identity of postmitotic neocortical neurons and provide a proof of principle for postnatal re-engineering of specific neural microcircuits in vivo.

A new early and automated MRI-based predictor of motor improvement after stroke.

OBJECTIVES: In this study, we investigated the structural plasticity of the contralesional motor network in ischemic stroke patients using diffusion magnetic resonance imaging (MRI) and explored a model that combines a MRI-based metric of contralesional network integrity and clinical data to predict functional outcome at 6 months after stroke. METHODS: MRI and clinical examinations were performed in 12 patients in the acute phase, at 1 and 6 months after stroke. Twelve age- and gender-matched controls underwent 2 MRIs 1 month apart. Structural remodeling after stroke was assessed using diffusion MRI with an automated measurement of generalized fractional anisotropy (GFA), which was calculated along connections between contralesional cortical motor areas. The predictive model of poststroke functional outcome was computed using a linear regression of acute GFA measures and the clinical assessment. RESULTS: GFA changes in the contralesional motor tracts were found in all patients and differed significantly from controls (0.001 ≤ p < 0.05). GFA changes in intrahemispheric and interhemispheric motor tracts correlated with age (p ≤ 0.01); those in intrahemispheric motor tracts correlated strongly with clinical scores and stroke sizes (p ≤ 0.001). GFA measured in the acute phase together with a routine motor score and age were a strong predictor of motor outcome at 6 months (r(2) = 0.96, p = 0.0002). CONCLUSION: These findings represent a proof of principle that contralesional diffusion MRI measures may provide reliable information for personalized rehabilitation planning after ischemic motor stroke. Neurology® 2012;79:39-46.

Effect of RasGAP N2 fragment-derived peptide on tumor growth in mice.

Peptides that interfere with the natural resistance of cancer cells to genotoxin-induced apoptosis may improve the efficacy of anticancer regimens. We have previously reported that a cell-permeable RasGAP-derived peptide (TAT-RasGAP(317-326)) specifically sensitizes tumor cells to genotoxin-induced apoptosis in vitro. Here, we examined the in vivo stability of a protease-resistant D-form of the peptide, RI.TAT-RasGAP(317-326), and its effect on tumor growth in nude mice bearing subcutaneous human colon cancer HCT116 xenograft tumors. After intraperitoneal injection, RI.TAT-RasGAP(317-326) persisted in the blood of nude mice for more than 1 hour and was detectable in various tissues and subcutaneous tumors. Tumor-bearing mice treated daily for 7 days with RI.TAT-RasGAP(317-326) (1.65 mg/kg body weight) and cisplatin (0.5 mg/kg body weight) or doxorubicin (0.25 mg/kg body weight) displayed reduced tumor growth compared with those treated with either genotoxin alone (n = 5-7 mice per group; P = .004 and P = .005, respectively; repeated measures analysis of variance [ANOVA, two-sided]). This ability of the RI.TAT-RasGAP(317-326) peptide to enhance the tumor growth inhibitory effect of cisplatin was still observed at peptide doses that were at least 150-fold lower than the dose lethal to 50% of mice. These findings provide the proof of principle that RI.TAT-RasGAP(317-326) may be useful for improving the efficacy of chemotherapy in patients.

Metadifferentiation of iris nevi after iridectomy: a clinicopathological small case series

Abstract Purpose Iridectomy of suspicious pigmented tumors provides the presumed advantage of both a histopathological diagnosis and treatment of the lesion. We present 2 patients that developed an iris melanoma with extrascleral extension at the site of their iridectomy of a histopathologically proven nevus, 46 and 2.5 years later. Methods Retrospective, clinicopathological small case series of 2 patients. Results Two patients underwent iridectomy for a suspicious tumor, the first in 1963 and the second in 2006. Pathological diagnosis was a benign and a borderline nevus respectively. In 2009, both patients presented with a recurrent melanocytic iridociliary tumor with an extrascleral extension adjacent to the surgical scar. Pathological examination confirmed melanoma. Consequently, the two patients underwent proton beam therapy of the whole anterior segment, with limbus deposition and reposition. Conclusion Iridectomy of a histopathologically proven nevus doesn't exclude the possibility of a metadifferentiation of remaining nevus cells into melanoma, even after 46 years. Additionally, treatment in case of a recurrence is more complicated than a primary radiotherapy of the unbiopsied iris tumor, with clinical proof of growth, would have been.

Bunch frequency multiplication by RF injection into an isochronous ring

La collaboration CLIC (Compact LInear Collider, collisionneur linéaire compact) étudie la possibilité de réaliser un collisionneur électron-positon linéaire à haute énergie (3 TeV dans le centre de masse) et haute luminosité (1034 cm-2s-1), pour la recherche en physique des particules. Le projet CLIC se fonde sur l'utilisation de cavités accélératrices à haute fréquence (30 GHz). La puissance nécessaire à ces cavités est fournie par un faisceau d'électrons de basse énergie et de haute intensité, appelé faisceau de puissance, circulant parallèlement à l'accélérateur linéaire principal (procédé appelé « Accélération à Double Faisceau »). Dans ce schéma, un des principaux défis est la réalisation du faisceau de puissance, qui est d'abord généré dans un complexe accélérateur à basse fréquence, puis transformé pour obtenir une structure temporelle à haute fréquence nécessaire à l'alimentation des cavités accélératrices de l'accélérateur linéaire principal. La structure temporelle à haute fréquence des paquets d'électrons est obtenue par le procédé de multiplication de fréquence, dont la manipulation principale consiste à faire circuler le faisceau d'électrons dans un anneau isochrone en utilisant des déflecteurs radio-fréquence (déflecteurs RF) pour injecter et combiner les paquets d'électrons. Cependant, ce type de manipulation n'a jamais été réalisé auparavant et la première phase de la troisième installation de test pour CLIC (CLIC Test Facility 3 ou CTF3) a pour but la démonstration à faible charge du procédé de multiplication de fréquence par injection RF dans un anneau isochrone. Cette expérience, qui a été réalisée avec succès au CERN au cours de l'année 2002 en utilisant une version modifiée du pré-injecteur du grand collisionneur électron-positon LEP (Large Electron Positron), est le sujet central de ce rapport. L'expérience de combinaison des paquets d'électrons consiste à accélérer cinq impulsions dont les paquets d'électrons sont espacés de 10 cm, puis à les combiner dans un anneau isochrone pour obtenir une seule impulsion dont les paquets d'électrons sont espacés de 2 cm, multipliant ainsi la fréquence des paquets d'électrons, ainsi que la charge par impulsion, par cinq. Cette combinaison est réalisée au moyen de structures RF résonnantes sur un mode déflecteur, qui créent dans l'anneau une déformation locale et dépendante du temps de l'orbite du faisceau. Ce mécanisme impose plusieurs contraintes de dynamique de faisceau comme l'isochronicité, ainsi que des tolérances spécifiques sur les paquets d'électrons, qui sont définies dans ce rapport. Les études pour la conception de la Phase Préliminaire du CTF3 sont détaillées, en particulier le nouveau procédé d'injection avec les déflecteurs RF. Les tests de haute puissance réalisés sur ces cavités déflectrices avant leur installation dans l'anneau sont également décrits. L'activité de mise en fonctionnement de l'expérience est présentée en comparant les mesures faites avec le faisceau aux simulations et calculs théoriques. Finalement, les expériences de multiplication de fréquence des paquets d'électrons sont décrites et analysées. On montre qu'une très bonne efficacité de combinaison est possible après optimisation des paramètres de l'injection et des déflecteurs RF. En plus de l'expérience acquise sur l'utilisation de ces déflecteurs, des conclusions importantes pour les futures activités CTF3 et CLIC sont tirées de cette première démonstration de la multiplication de fréquence des paquets d'électrons par injection RF dans un anneau isochrone.<br/><br/>The Compact LInear Collider (CLIC) collaboration studies the possibility of building a multi-TeV (3 TeV centre-of-mass), high-luminosity (1034 cm-2s-1) electron-positron collider for particle physics. The CLIC scheme is based on high-frequency (30 GHz) linear accelerators powered by a low-energy, high-intensity drive beam running parallel to the main linear accelerators (Two-Beam Acceleration concept). One of the main challenges to realize this scheme is to generate the drive beam in a low-frequency accelerator and to achieve the required high-frequency bunch structure needed for the final acceleration. In order to provide bunch frequency multiplication, the main manipulation consists in sending the beam through an isochronous combiner ring using radio-frequency (RF) deflectors to inject and combine electron bunches. However, such a scheme has never been used before, and the first stage of the CLIC Test Facility 3 (CTF3) project aims at a low-charge demonstration of the bunch frequency multiplication by RF injection into an isochronous ring. This proof-of-principle experiment, which was successfully performed at CERN in 2002 using a modified version of the LEP (Large Electron Positron) pre-injector complex, is the central subject of this report. The bunch combination experiment consists in accelerating in a linear accelerator five pulses in which the electron bunches are spaced by 10 cm, and combining them in an isochronous ring to obtain one pulse in which the electron bunches are spaced by 2 cm, thus achieving a bunch frequency multiplication of a factor five, and increasing the charge per pulse by a factor five. The combination is done by means of RF deflecting cavities that create a time-dependent bump inside the ring, thus allowing the interleaving of the bunches of the five pulses. This process imposes several beam dynamics constraints, such as isochronicity, and specific tolerances on the electron bunches that are defined in this report. The design studies of the CTF3 Preliminary Phase are detailed, with emphasis on the novel injection process using RF deflectors. The high power tests performed on the RF deflectors prior to their installation in the ring are also reported. The commissioning activity is presented by comparing beam measurements to model simulations and theoretical expectations. Eventually, the bunch frequency multiplication experiments are described and analysed. It is shown that the process of bunch frequency multiplication is feasible with a very good efficiency after a careful optimisation of the injection and RF deflector parameters. In addition to the experience acquired in the operation of these RF deflectors, important conclusions for future CTF3 and CLIC activities are drawn from this first demonstration of the bunch frequency multiplication by RF injection into an isochronous ring.<br/><br/>La collaboration CLIC (Compact LInear Collider, collisionneur linéaire compact) étudie la possibilité de réaliser un collisionneur électron-positon linéaire à haute énergie (3 TeV) pour la recherche en physique des particules. Le projet CLIC se fonde sur l'utilisation de cavités accélératrices à haute fréquence (30 GHz). La puissance nécessaire à ces cavités est fournie par un faisceau d'électrons de basse énergie et de haut courant, appelé faisceau de puissance, circulant parallèlement à l'accélérateur linéaire principal (procédé appelé « Accélération à Double Faisceau »). Dans ce schéma, un des principaux défis est la réalisation du faisceau de puissance, qui est d'abord généré dans un complexe accélérateur à basse fréquence, puis transformé pour obtenir une structure temporelle à haute fréquence nécessaire à l'alimentation des cavités accélératrices de l'accélérateur linéaire principal. La structure temporelle à haute fréquence des paquets d'électrons est obtenue par le procédé de multiplication de fréquence, dont la manipulation principale consiste à faire circuler le faisceau d'électrons dans un anneau isochrone en utilisant des déflecteurs radio-fréquence (déflecteurs RF) pour injecter et combiner les paquets d'électrons. Cependant, ce type de manipulation n'a jamais été réalisé auparavant et la première phase de la troisième installation de test pour CLIC (CLIC Test Facility 3 ou CTF3) a pour but la démonstration à faible charge du procédé de multiplication de fréquence par injection RF dans un anneau isochrone. L'expérience consiste à accélérer cinq impulsions, puis à les combiner dans un anneau isochrone pour obtenir une seule impulsion dans laquelle la fréquence des paquets d'électrons et le courant sont multipliés par cinq. Cette combinaison est réalisée au moyen de structures déflectrices RF qui créent dans l'anneau une déformation locale et dépendante du temps de la trajectoire du faisceau. Les résultats de cette expérience, qui a été réalisée avec succès au CERN au cours de l?année 2002 en utilisant une version modifiée du pré-injecteur du grand collisionneur électron-positon LEP (Large Electron Positon), sont présentés en détail.

Optimizing the Anti-VEGF Treatment Strategy for Neovascular Age-Related Macular Degeneration: From Clinical Trials to Real-Life Requirements.

NlmCategory="UNASSIGNED">This Perspective discusses the pertinence of variable dosing regimens with anti-vascular endothelial growth factor (VEGF) for neovascular age-related macular degeneration (nAMD) with regard to real-life requirements. After the initial pivotal trials of anti-VEGF therapy, the variable dosing regimens pro re nata (PRN), Treat-and-Extend, and Observe-and-Plan, a recently introduced regimen, aimed to optimize the anti-VEGF treatment strategy for nAMD. The PRN regimen showed good visual results but requires monthly monitoring visits and can therefore be difficult to implement. Moreover, application of the PRN regimen revealed inferior results in real-life circumstances due to problems with resource allocation. The Treat-and-Extend regimen uses an interval based approach and has become widely accepted for its ease of preplanning and the reduced number of office visits required. The parallel development of the Observe-and-Plan regimen demonstrated that the future need for retreatment (interval) could be reliably predicted. Studies investigating the observe-and-plan regimen also showed that this could be used in individualized fixed treatment plans, allowing for dramatically reduced clinical burden and good outcomes, thus meeting the real life requirements. This progressive development of variable dosing regimens is a response to the real-life circumstances of limited human, technical, and financial resources. This includes an individualized treatment approach, optimization of the number of retreatments, a minimal number of monitoring visits, and ease of planning ahead. The Observe-and-Plan regimen achieves this goal with good functional results. Translational Relevance: This perspective reviews the process from the pivotal clinical trials to the development of treatment regimens which are adjusted to real life requirements. The article discusses this translational process which- although not the classical interpretation of translation from fundamental to clinical research, but a subsequent process after the pivotal clinical trials - represents an important translational step from the clinical proof of efficacy to optimization in terms of patients' and clinics' needs. The related scientific procedure includes the exploration of the concept, evaluation of security, and finally proof of efficacy.

Traditional local medicines in the republic of Palau and non-communicable diseases (NCD), signs of effectiveness.

ETHNOPHARMACOLOGICAL RELEVANCE: The aim of this survey was to describe which traditional medicines (TM) are most commonly used for non-communicable diseases (NCD - diabetes, hypertension related to excess weight and obesity) in Pacific islands and with what perceived effectiveness. NCD, especially prevalent in the Pacific, have been subject to many public health interventions, often with rather disappointing results. Innovative interventions are required; one hypothesis is that some local, traditional approaches may have been overlooked. MATERIALS AND METHODS: The method used was a retrospective treatment-outcome study in a nation-wide representative sample of the adult population (about 15,000 individuals) of the Republic of Palau, an archipelago of Micronesia. RESULTS: From 188 respondents (61% female, age 16-87, median 48,), 30 different plants were used, mostly self-prepared (69%), or from a traditional healer (18%). For excess weight, when comparing the two most frequent plants, Morinda citrifolia L. was associated with more adequate outcome than Phaleria nishidae Kaneh. (P=0.05). In case of diabetes, when comparing Phaleria nishidae (=Phaleria nisidai) and Morinda citrifolia, the former was statistically more often associated with the reported outcome "lower blood sugar" (P=0.01). CONCLUSIONS: Statistical association between a plant used and reported outcome is not a proof of effectiveness or safety, but it can help select plants of interest for further studies, e.g. through a reverse pharmacology process, in search of local products which may have a positive impact on population health.

Prevention of vascular dysfunction and arterial hypertension in mice generated by assisted reproductive technologies by addition of melatonin to culture media.

Assisted reproductive technologies (ART) induce vascular dysfunction in humans and mice. In mice, ART-induced vascular dysfunction is related to epigenetic alteration of the endothelial nitric oxide synthase (eNOS) gene, resulting in decreased vascular eNOS expression and nitrite/nitrate synthesis. Melatonin is involved in epigenetic regulation, and its administration to sterile women improves the success rate of ART. We hypothesized that addition of melatonin to culture media may prevent ART-induced epigenetic and cardiovascular alterations in mice. We, therefore, assessed mesenteric-artery responses to acetylcholine and arterial blood pressure, together with DNA methylation of the eNOS gene promoter in vascular tissue and nitric oxide plasma concentration in 12-wk-old ART mice generated with and without addition of melatonin to culture media and in control mice. As expected, acetylcholine-induced mesenteric-artery dilation was impaired (P = 0.008 vs. control) and mean arterial blood pressure increased (109.5 ± 3.8 vs. 104.0 ± 4.7 mmHg, P = 0.002, ART vs. control) in ART compared with control mice. These alterations were associated with altered DNA methylation of the eNOS gene promoter (P < 0.001 vs. control) and decreased plasma nitric oxide concentration (10.1 ± 11.1 vs. 29.5 ± 8.0 μM) (P < 0.001 ART vs. control). Addition of melatonin (10(-6) M) to culture media prevented eNOS dysmethylation (P = 0.005, vs. ART + vehicle), normalized nitric oxide plasma concentration (23.1 ± 14.6 μM, P = 0.002 vs. ART + vehicle) and mesentery-artery responsiveness to acetylcholine (P < 0.008 vs. ART + vehicle), and prevented arterial hypertension (104.6 ± 3.4 mmHg, P < 0.003 vs. ART + vehicle). These findings provide proof of principle that modification of culture media prevents ART-induced vascular dysfunction. We speculate that this approach will also allow preventing ART-induced premature atherosclerosis in humans.

Biological materials in colorectal surgery: current applications and potential for the future.

Biological materials are increasingly used in abdominal surgery for ventral, pelvic and perineal reconstructions, especially in contaminated fields. Future applications are multi-fold and include prevention and one-step closure of infected areas. This includes prevention of abdominal, parastomal and pelvic hernia, but could also include prevention of separation of multiple anastomoses, suture- or staple-lines. Further indications could be a containment of infected and/or inflammatory areas and protection of vital implants such as vascular grafts. Reinforcement patches of high-risk anastomoses or unresectable perforation sites are possibilities at least. Current applications are based mostly on case series and better data is urgently needed. Clinical benefits need to be assessed in prospective studies to provide reliable proof of efficacy with a sufficient follow-up. Only superior results compared with standard treatment will justify the higher costs of these materials. To date, the use of biological materials is not standard and applications should be limited to case-by-case decision.

Natural killer cell mediated missing-self recognition can protect mice from primary chronic myeloid leukemia in vivo.

Background: Natural Killer (NK) cells are thought to protect from residual leukemic cells in patients receiving stem cell transplantation. However, multiple retrospective analyses of patient data have yielded conflicting conclusions regarding a putative role of NK cells and the essential NK cell recognition events mediating a protective effect against leukemia. Further, a NK cell mediated protective effect against primary leukemia in vivo has not been shown directly.Methodology/Principal Findings: Here we addressed whether NK cells have the potential to control chronic myeloid leukemia (CML) arising based on the transplantation of BCR-ABL1 oncogene expressing primary bone marrow precursor cells into lethally irradiated recipient mice. These analyses identified missing-self recognition as the only NK cell-mediated recognition strategy, which is able to significantly protect from the development of CML disease in vivo.Conclusion: Our data provide a proof of principle that NK cells can control primary leukemic cells in vivo. Since the presence of NK cells reduced the abundance of leukemia propagating cancer stem cells, the data raise the possibility that NK cell recognition has the potential to cure CML, which may be difficult using small molecule BCR-ABL1 inhibitors. Finally, our findings validate approaches to treat leukemia using antibody-based blockade of self-specific inhibitory MHC class I receptors.

Population PK-guided simulation study in children exposed to drugs in human milk

Risks of significant infant drug exposure through human milk arepoorly defined due to lack of large-scale PK data. We propose to useBayesian approach based on population PK (popPK)-guided modelingand simulation for risk prediction. As a proof-of-principle study, weexploited fluoxetine milk concentration data from 25 women. popPKparameters including milk-to-plasma ratio (MP ratio) were estimatedfrom the best model. The dose of fluoxetine the breastfed infant wouldreceive through mother's milk, and infant plasma concentrations wereestimated from 1000 simulated mother-infant pairs, using randomassignment of feeding times and milk volume. A conservative estimateof CYP2D6 activity of 20% of the allometrically-adjusted adult valuewas assumed. Derived model parameters, including MP ratio were consistentwith those reported in the literature. Visual predictive check andother model diagnostics showed no signs of model misspecifications.The model simulation predicted that infant exposure levels to fluoxetinevia mother's milk were below 10% of weight-adjusted maternal therapeuticdoses in >99% of simulated infants. Predicted median ratio ofinfant-mother serum levels at steady state was 0.093 (range 0.033-0.31),consistent with literature reported values (mean=0.07; range 0-0.59).Predicted incidence of relatively high infant-mother ratio (>0.2) ofsteady-state serum fluoxetine concentrations was <1.3%. Overall, ourpredictions are consistent with clinical observations. Our approach maybe valid for other drugs, allowing in silico prediction of infant drugexposure risks through human milk. We will discuss application of thisapproach to another drug used in lactating women.

What is "clinical data"? Why and how can they be collected during field surveys on medicinal plants?

ETHNOPHARMACOLOGICAL RELEVANCE: "Reverse pharmacology", also called "bedside-to-bench" or "field to pharmacy" approach, is a research process starting with documentation of clinical outcome as observed by patients with different therapeutic regimens. The treatment most significantly associated with cure is selected for future studies: first, clinical safety and efficacy; then in vivo and vitro studies. Some clinical data, i.e. details on patient status and progress, can be collected during ethnobotanical surveys; they will help clinical researchers and, once effectiveness and safety are established, will also help users of traditional medicine make safer and more effective choices. To gather clinical data successfully, ethnopharmacologists need to be backed by an appropriate team of specialists in medicine and epidemiology. Ethnopharmacologists can also gather important data on traditional medicine safety. MATERIALS AND METHODS: The first step is to create a consensus on the meaning of "clinical data", their interest and importance. An understanding of why "a cure is not a proof of effectiveness" is a starting point to avoid faulty interpretation of the clinical observations. RESULTS: Experience showed that, with the "bedside-to-bench" approach, a treatment derived from traditional recipe can be scientifically validated (in terms of safety and effectiveness) with a cost of less than a million euros, thus providing an end-product that is affordable, available and sustainable. CONCLUSIONS: With rigorous clinical study results, medicinal plant users gain the possibility to refine heath strategies. The field surveyor may gain a better relationship with the population, once she/he is seen as bringing information useful for the quality of care in the community.

Elevated Tribbles homolog 2-specific antibody levels in narcolepsy patients.

Narcolepsy is a sleep disorder characterized by excessive daytime sleepiness and attacks of muscle atonia triggered by strong emotions (cataplexy). Narcolepsy is caused by hypocretin (orexin) deficiency, paralleled by a dramatic loss in hypothalamic hypocretin-producing neurons. It is believed that narcolepsy is an autoimmune disorder, although definitive proof of this, such as the presence of autoantibodies, is still lacking. We engineered a transgenic mouse model to identify peptides enriched within hypocretin-producing neurons that could serve as potential autoimmune targets. Initial analysis indicated that the transcript encoding Tribbles homolog 2 (Trib2), previously identified as an autoantigen in autoimmune uveitis, was enriched in hypocretin neurons in these mice. ELISA analysis showed that sera from narcolepsy patients with cataplexy had higher Trib2-specific antibody titers compared with either normal controls or patients with idiopathic hypersomnia, multiple sclerosis, or other inflammatory neurological disorders. Trib2-specific antibody titers were highest early after narcolepsy onset, sharply decreased within 2-3 years, and then stabilized at levels substantially higher than that of controls for up to 30 years. High Trib2-specific antibody titers correlated with the severity of cataplexy. Serum of a patient showed specific immunoreactivity with over 86% of hypocretin neurons in the mouse hypothalamus. Thus, we have identified reactive autoantibodies in human narcolepsy, providing evidence that narcolepsy is an autoimmune disorder.

Is it really worth the effort to renounce to 5 mm trocars?

Objective: Single port laparoscopy andNOTES aim at decreasing the number¦of trocars, at a price of increased technical difficulty and cost, without until now¦any proof of benefit for the patient.Morbidity related to 5 mm trocar sites (TS)¦is claimed to be low, but there are no good quality data on this topic. The aim¦of the present prospective study is to measure the morbidity and overall specific¦impact related to the 5 mm TS and compare them to larger TS.¦Methods:Wecollected prospectively data on 300 consecutive patients operated¦by laparoscopy in our institution between 2009 and 2010. Pain, morbidity,¦cosmetic, and overall patient discomfort were assessed specifically for each¦TS, using standardized questionnaires, at 3 time points: at discharge from¦the hospital, at 1 month and at 6 months after surgery. Results were compared¦between 5 mmand larger TS (10 mm, 12 mmand 15 mm).Trocar sites replaced¦by a minilaparotomy or a stoma were excluded from analysis. In this study we¦present the short-term results.¦Results: Three-hundred patients (mean age 47·5, women 55%) were operated¦with 1074 TS of which 477(44%) were 5 mm TS. Indication to laparoscopy was¦cholecystectomy (31·3%), appendectomy (26·6%), upper GI surgery (16·3%),¦colon resection (13·3%) or other (12·3%). Follow-up at 1 month was completed¦in 90%.¦The 5 mm TS had an infection rate of 0·2%, and a hematoma rate of 1·7%.¦VAS pain scores at the 5mm TS were ≤3 in 91·6% at rest and in 75·9% upon¦effort at discharge, and in 97% at 1 month. Median patient scar assessment¦score (PSAS) of the 5 mm TS at 1 month was 6 (IQR: 2-9) out of 60 (0 =¦best score). Overall discomfort of the 5 mm TS in a VAS scale was 0 in 77%¦and ≤3 in 95% of patients at 1 month. Morbidity, pain assessments, PSAS, and¦overall discomfort scores were all significantly better for 5 mm TS compared to¦larger TS.¦Conclusion: Morbidity, pain, cosmetic impact and overall patient's discomfort¦related to a 5 mm trocar site is extremely low. For this reason, any potential¦advantage related to omitting 5 mm trocars to perform the same type of surgery¦will be difficult to demonstrate.