Le funzioni metaboliche ed endocrinologiche nella narcolessia con cataplessia

Poco più di dieci anni fa, nel 1998, è stata scoperta l’ipocretina (ovvero orexina), un neuropeptide ipotalamico fondamentale nella regolazione del ciclo sonno-veglia, dell’appetito e della locomozione (de Lecea 1998; Sakurai, 1998; Willie, 2001). La dimostrazione, pochi mesi dopo, di bassi livelli di ipocretina circolanti nel liquido cefalo-rachidiano di pazienti affetti da narcolessia con cataplessia (Mignot 2002) ha definitivamente rilanciato lo studio di questa rara malattia del Sistema Nervoso Centrale, e le pubblicazioni a riguardo si sono moltiplicate. In realtà le prime descrizioni della narcolessia risalgono alla fine del XIX secolo (Westphal 1877; Gélineau 1880) e da allora la ricerca clinica è stata volta soprattutto a cercare di definire il più accuratamente possibile il fenotipo del paziente narcolettico. Accanto all’alterazione del meccanismo di sonno e di veglia, e dell’alternanza tra le fasi di sonno REM (Rapid Eye Movement) e di sonno non REM, sui quali l’ipocretina agisce come un interruttore che stimola la veglia e inibisce la fase REM, sono apparse evidenti anche alterazioni del peso e del metabolismo glucidico, dello sviluppo sessuale e del metabolismo energetico (Willie 2001). I pazienti narcolettici presentano infatti, in media, un indice di massa corporea aumentato (Dauvilliers 2007), la tendenza a sviluppare diabete mellito di tipo II (Honda 1986), un’aumentata prevalenza di pubertà precoce (Plazzi 2006) e alterazioni del metabolismo energetico, rispetto alla popolazione generale (Dauvilliers 2007). L’idea che, quindi, la narcolessia abbia delle caratteristiche fenotipiche intrinseche altre, rispetto a quelle più eclatanti che riguardano il sonno, si è fatta strada nel corso del tempo; la scoperta della ipocretina, e della fitta rete di proiezioni dei neuroni ipocretinergici, diffuse in tutto l’encefalo fino al ponte e al bulbo, ha offerto poi il substrato neuro-anatomico a questa idea. Tuttavia molta strada separa l’intuizione di un possibile legame dall’individuazione dei reali meccanismi patogenetici che rendano conto dell’ampio spettro di manifestazioni cliniche che si osserva associato alla narcolessia. Lo studio svolto in questi tre anni si colloca in questa scia, e si è proposto di esplorare il fenotipo narcolettico rispetto alle funzioni dell’asse ipotalamo-ipofisi-periferia, attraverso un protocollo pensato in stretta collaborazione fra il Dipartimento di Scienze Neurologiche di Bologna e l’Unità Operativa di Endocrinologia e di Malattie del Metabolismo dell’Ospedale Sant’Orsola-Malpighi di Bologna. L’ipotalamo è infatti una ghiandola complessa e l’approccio multidisciplinare è sembrato essere quello più adatto. I risultati ottenuti, e che qui vengono presentati, hanno confermato le aspettative di poter dare ulteriori contributi alla caratterizzazione della malattia; un altro aspetto non trascurabile, e che però verrà qui omesso, sono le ricadute cliniche in termini di inquadramento e di terapia precoce di quelle alterazioni, non strettamente ipnologiche, e però associate alla narcolessia.

Single-cell gene-expression profiling reveals qualitatively distinct CD8 T cells elicited by different gene-based vaccines

CD8 T cells play a key role in mediating protective immunity against selected pathogens after vaccination. Understanding the mechanism of this protection is dependent upon definition of the heterogeneity and complexity of cellular immune responses generated by different vaccines. Here, we identify previously unrecognized subsets of CD8 T cells based upon analysis of gene-expression patterns within single cells and show that they are differentially induced by different vaccines. Three prime-boost vector combinations encoding HIV Env stimulated antigen-specific CD8 T-cell populations of similar magnitude, phenotype, and functionality. Remarkably, however, analysis of single-cell gene-expression profiles enabled discrimination of a majority of central memory (CM) and effector memory (EM) CD8 T cells elicited by the three vaccines. Subsets of T cells could be defined based on their expression of Eomes, Cxcr3, and Ccr7, or Klrk1, Klrg1, and Ccr5 in CM and EM cells, respectively. Of CM cells elicited by DNA prime-recombinant adenoviral (rAd) boost vectors, 67% were Eomes(-) Ccr7(+) Cxcr3(-), in contrast to only 7% and 2% stimulated by rAd5-rAd5 or rAd-LCMV, respectively. Of EM cells elicited by DNA-rAd, 74% were Klrk1(-) Klrg1(-)Ccr5(-) compared with only 26% and 20% for rAd5-rAd5 or rAd5-LCMV. Definition by single-cell gene profiling of specific CM and EM CD8 T-cell subsets that are differentially induced by different gene-based vaccines will facilitate the design and evaluation of vaccines, as well as enable our understanding of mechanisms of protective immunity.

Consensus standards for acquisition, measurement, and reporting of intravascular optical coherence tomography studies: a report from the International Working Group for Intravascular Optical Coherence Tomography Standardization and Validation

The purpose of this document is to make the output of the International Working Group for Intravascular Optical Coherence Tomography (IWG-IVOCT) Standardization and Validation available to medical and scientific communities, through a peer-reviewed publication, in the interest of improving the diagnosis and treatment of patients with atherosclerosis, including coronary artery disease.

Genetic variations in complement factors in patients with congenital thrombotic thrombocytopenic purpura with renal insufficiency.

The congenital form of thrombotic thrombocytopenic purpura (TTP) is caused by genetic mutations in ADAMTS13. Some, but not all, congenital TTP patients manifest renal insufficiency in addition to microangiopathic hemolysis and thrombocytopenia. We included 32 congenital TTP patients in the present study, which was designed to assess whether congenital TTP patients with renal insufficiency have predisposing mutations in complement regulatory genes, as found in many patients with atypical hemolytic uremic syndrome (aHUS). In 13 patients with severe renal insufficiency, six candidate complement or complement regulatory genes were sequenced and 11 missense mutations were identified. One of these missense mutations, C3:p.K155Q mutation, is a rare mutation located in the macroglobulin-like 2 domain of C3, where other mutations predisposing for aHUS cluster. Several of the common missense mutations identified in our study have been reported to increase disease-risk for aHUS, but were not more common in patients with as compared to those without renal insufficiency. Taken together, our results show that the majority of the congenital TTP patients with renal insufficiency studied do not carry rare genetic mutations in complement or complement regulatory genes.

The Impact of Thermal Coupling on Catalyst Behavior in Wall-Coated Heat-Exchanger Microreactors

This thesis presents a numerical study of reaction and diffusion phenomena in wall-coated heat-exchanger microreactors. Specifically, the interactions between an endothermic and exothermic catalyst layer separated by an impermeable wall is studied to understand the inherent behavior of the system. Two modeling approaches are presented, the first under the assumption of a constant thermal gradient and neglecting heat of reaction and the second considering both catalyst layers and reaction heat. Both studies found that thicker, more thermally insulating catalyst layers increase the effectiveness of the exothermic reaction by allowing for accumulation of reaction heat while thinner catalyst layers for the endothermic catalyst allow for direct access of the reactant to higher wall temperatures.

Economic evaluation of latent tuberculosis infection screening among health care workers in Houston

Since interferon-gamma release assays (IGRAs) were introduced in the 2000's, tuberculin skin testing (TST) and IGRAs have been used in various latent tuberculosis infection (LTBI) screening settings. IGRAs are laboratory-based tests and are considered not to be affected by previous Bacille de Calmette et Guérin (BCG) vaccination; however, they are more costly when compared directly with TST, which does not require specimen processing in a laboratory. This study aimed to examine TST and two types of IGRAs, QuantiFERON-TB Gold in Tube (QFT-GIT) and T-SPOT. TB (TSPOT), from an economic viewpoint. Firstly, a systematic literature review was conducted to identify cost related analyses of LTBI screening. Secondly, specific cost information detailing each test's items and labor was collected from an LTBI screening program of health care workers in Houston, and the cost of each test was computed. Thirdly, using the computed cost estimate of each test, cost-effectiveness analyses were conducted to compare TST and IGRAs.^ A literature search showed that a limited number of studies have been conducted, but the IGRA's economic advantages were common among studies. Cost analyses showed that IGRAs were much more costly than TST. The results were consistent with previous studies. In cost-effectiveness analyses, where test cost and consequential TB-related cost were considered, IGRAs showed variable advantages over TST depending on the targeted population. When only non BCG-vaccinated people were considered, TST was the least costly option among the three tests. On the other hand, when only BCG-vaccinated people were considered, IGRAs were less costly options. These results were mostly consistent even with varying assumption parameters.^ IGRAs can be more costly than TST, but their economic disadvantages are alleviated when the target population was BCG-vaccinated. Based on current knowledge, IGRAs may be recommended in a population where the BCG history is mixed. Additional studies are needed to better understand IGRA's reliability among low-incidence and low-risk populations in which background TB prevalence is low.^

"Trenes de paso hacia ningún lugar" : sobre La vida de frontera de Carlos Marzal

La vida de frontera, publicado en 1991, es el segundo libro del poeta español Carlos Marzal (Valencia, 1961). Todo el poemario es, en primera y última instancia, una íntima y honda reflexión sobre la existencia, sus límites -sus "fronteras"-, su sentido o mejor, su falta de sentido. El pensamiento poético de Marzal responde en este libro a una orientación claramente borgiana que incluye la meditación sobre la reversibilidad del tiempo y del espacio, la fusión entre sueño y vigilia, la contigüidad vertiginosa del Aleph que intenta desbaratar la inevitable sucesividad del tiempo humano, la indagación metapoética a través del tópico de la rosa, la cita de Schopenhauer que introduce el sobresalto metafísico del conflicto entre libre albedrío y predestinación, la pública declaración de amor a las bibliotecas, la fe en el azar, el balance existencial del Borges de "El remordimiento" espejado notablemente en "Acto de contrición". Las conclusiones apuntan a subrayar el carácter de tránsito que el texto exhibe desde su arranque experiencial (propio de la escritura de los '80) hacia una poética que podríamos denominar "del pensamiento."

"Trenes de paso hacia ningún lugar" : sobre La vida de frontera de Carlos Marzal

La vida de frontera, publicado en 1991, es el segundo libro del poeta español Carlos Marzal (Valencia, 1961). Todo el poemario es, en primera y última instancia, una íntima y honda reflexión sobre la existencia, sus límites -sus "fronteras"-, su sentido o mejor, su falta de sentido. El pensamiento poético de Marzal responde en este libro a una orientación claramente borgiana que incluye la meditación sobre la reversibilidad del tiempo y del espacio, la fusión entre sueño y vigilia, la contigüidad vertiginosa del Aleph que intenta desbaratar la inevitable sucesividad del tiempo humano, la indagación metapoética a través del tópico de la rosa, la cita de Schopenhauer que introduce el sobresalto metafísico del conflicto entre libre albedrío y predestinación, la pública declaración de amor a las bibliotecas, la fe en el azar, el balance existencial del Borges de "El remordimiento" espejado notablemente en "Acto de contrición". Las conclusiones apuntan a subrayar el carácter de tránsito que el texto exhibe desde su arranque experiencial (propio de la escritura de los '80) hacia una poética que podríamos denominar "del pensamiento."

"Trenes de paso hacia ningún lugar" : sobre La vida de frontera de Carlos Marzal

La vida de frontera, publicado en 1991, es el segundo libro del poeta español Carlos Marzal (Valencia, 1961). Todo el poemario es, en primera y última instancia, una íntima y honda reflexión sobre la existencia, sus límites -sus "fronteras"-, su sentido o mejor, su falta de sentido. El pensamiento poético de Marzal responde en este libro a una orientación claramente borgiana que incluye la meditación sobre la reversibilidad del tiempo y del espacio, la fusión entre sueño y vigilia, la contigüidad vertiginosa del Aleph que intenta desbaratar la inevitable sucesividad del tiempo humano, la indagación metapoética a través del tópico de la rosa, la cita de Schopenhauer que introduce el sobresalto metafísico del conflicto entre libre albedrío y predestinación, la pública declaración de amor a las bibliotecas, la fe en el azar, el balance existencial del Borges de "El remordimiento" espejado notablemente en "Acto de contrición". Las conclusiones apuntan a subrayar el carácter de tránsito que el texto exhibe desde su arranque experiencial (propio de la escritura de los '80) hacia una poética que podríamos denominar "del pensamiento."