Celiachia e difetti dello smalto in età evolutiva: correlazione tra periodo di esposizione al glutine, forme cliniche di celiachia e aplotipo HLA

The association between celiac disease (CD) and dental enamel defects (DED) is well known. AIM: This study was designed to investigate the prevalence of DED in CD children and to specifically find a possible correlation between DED and gluten exposure period, CD clinical forms, HLA class II haplotype. MATERIALS AND METHODS: This study was designed as a matched case-control study: 374 children were enrolled (187 celiac and 187 non celiac). Data about age at CD diagnosis, CD clinical form and HLA haplotype were recorded. RESULTS: DED were detected in 87 celiac subject while no dental lesions were found in the remaining 100 patients; in 187 healthy controls enamel lesion were significantly less frequent (5.3 % versus 46.5% ; p<0.005).We found a correlation between DED and gluten exposure period, since among CD patients the mean age at CD diagnosis was significantly (p= 0.0004) higher in the group with DED (3.41± 1.27) than without DED (1.26± 0.7). DED resulted more frequent in atypical and silent forms than in the typical one. The presence of HLA DR 52-53 and DQ7 antigens significantly increased the risk of DED (p=0.0017). CONCLUSIONS: Our results confirmed a possible correlation between CD clinical form, age at CD diagnosis, HLA antigens and DED. The origin of DED in CD children is due to multifactorial events and further studies are needed to investigate other determinants.

Funktionelle Analyse der beiden Zinkfinger-Homöodomänentranskriptionsfaktoren Zfh-1 und Zfh-2 während der Entwicklung des Nervensystems von Drosophila melanogaster

Diese Arbeit charakterisiert die Funktion und das Expressionmuster der beiden Zinkfinger-Homöodomänentranskriptionsfaktoren zfh1 und zfh2 von Drosophila melanogaster. Das zfh2 Gen wurde hierbei vor allem molekular charakterisiert. Es wurden eine Vielzahl möglicher Spleißformen identifiziert, welche das regulatorische Potential von Zfh2 enorm erweitern. Für Überexpressionsexperimente wurde zudem erstmalig die cDNA des längsten zfh2-Transkriptes kloniert. Durch Analysen an zfh1 Mutanten konnte gezeigt werden, dass zfh1 sowohl notwendig ist für die embryonale Entwicklung von Motoneuronen, als auch das larvale Wachstum motoneuronaler Endplatten reguliert. Wegen weit reichender pleiotroper Effekte, die zfh1 Funktionsverlustmutanten haben, war es notwendig, neben dem Einsatz hypomorpher Allele auf die Analyse genetischer Mosaike auszuweichen. Die als MARCM-Technik (Lee und Luo, 1999) bezeichnete Methode zur Erzeugung genetischer Mosaike wurde modifiziert um in dieser Arbeit erstmals für die Analyse mutanter larvaler Motoneurone eingesetzt werden zu können. Weitergehend konnte gezeigt werden, dass Zfh1 notwendig ist für die larvale Expression des Neuropeptides FMRFamid. Anhand von Sequenzvergleichen und durch Verwendung eines fmrfamid-Promoterkonstruktes (Benveniste et al., 1998) konnten Hinweise dafür gesammelt werden, dass die Zfh1-abhängige Regulation sehr wahrscheinlich direkter Natur ist. Bei fmrfamid handelt es sich somit um das erste identifizierte neurale Zielgen von Zfh1, an dem sich zudem modellhaft der molekulare Wirkmechanismus von Zfh1 erforschen lässt.

La représentation du pathétique masculin dans le roman sentimental européen: une réflexion sur l'imaginaire littéraire

Ce travail est une analyse de la représentation du pathétique masculin dans le roman dit sentimental dans la deuxième moitié du dix-huitième siècle en Europe, ou plutôt dans les littératures anglaise, française, allemande et italienne. La thèse soutenue est celle de la dérivation du pathétique romanesque de l’âge des Lumières des pratiques de prédication religieuse du siècle précédent et donc de la valeur normative du roman sentimental à ses débuts : celui-ci aurait relayé le rôle des manuels de conduite des siècles précédents et se serait posé comme un répertoire d’exempla comportementaux adaptés aux différentes situations de la vie. Nous avons suivi les évolutions historiques du genre à travers l’analyse thématique du motif des larmes masculines. Pour ce faire, nous avons examiné la complexe proxémique de représentation de l’émotion et la diégèse qui en résulte, qui peut être nuancée, selon une terminologie récente, en pathétique attendrissant, sentimental et spectaculaire. Cela a entraîne la prise en compte de diverses formes artistiques, de la peinture au théâtre. La méthodologie utilisé conjugue l’histoire des idées et l’étude des formes de l’imaginaire, le pathétique appartenant au domaine de la philosophie autant qu’à celui de la représentation artistique : le concept glisse au dix-huitième siècle du champ rhétorique et stylistique à une dimension esthétique et anthropologique. Le travail a donc été divisé en trois grandes parties qui analysent les trois dimensions anthropologiques fondamentales : l’imaginaire religieux et l’héritage des anciens, c’est–à-dire le rapport que l’époque établit avec la tradition culturelle qui la précède ; l’imaginaire amoureux, qui se concentre sur les rapports entre les deux sexes et sur la « féminisation » du héros romanesque sentimental ; l’imaginaire familial, qui aborde les conséquences de ce changement dans la représentation de la masculinité au sein de la représentation de la famille et des rapports intergénérationnels.

Decorso delle coliti severe: un confronto tra colite ulcerosa e di Crohn

Pochi sono i dati disponibili sul decorso clinico della malattia di Crohn del colon severa(CD). L'obiettivo è quello di descrivere il decorso clinico della colite di Crohn severa (CC) in una coorte di pazienti isolata con CD del colon o ileocolica, e di confrontarlo con il decorso clinico di pazienti affetti da colite ulcerosa severa (UC). 34 pazienti con CC severa sono stati identificati retrospettivamente nella nostra coorte di 593 pazienti ricoverati (2003-2012) attraverso la valutazione di CDAI score e HBI. 169 pazienti con UC severa sono stati identificati retrospettivamente in una coorte di 449 pazienti ricoverati (2003-2012) attraverso la valutazione del score di Lichtiger e di Truelove-Witts. Abbiamo valutato questi risultati: risposta agli steroidi, risposta ai farmaci biologici, tasso di colectomia acuta, tasso di colectomia durante il follow-up, megacolon e tasso di infezione da citomegalovirus. Non abbiamo trovato differenze significative nella risposta agli steroidi e biologici, della percentuale di infezione da citomegalovirus e di megacolon, mentre il tasso di colectomia in acuto è risultato essere maggiore nei pazienti con CC rispetto ai pazienti con UC; anche la differenza tra i tassi di colectomia alla fine del follow-up è risultata non significativa. Con l'analisi univariata la giovane età alla diagnosi è associata ad un aumentato rischio di colectomia in assoluto (p = 0,024) e in elezione (p = 0.022), ma non in acuto. Il tasso globale di colectomia nei pazienti con CC severa è superiore a quella dei pazienti con UC severa , ma questo dato non è supportato da una diversa risposta clinica alla terapia steroidea o terapia di salvataggio con biologici. Il vero decorso clinico della colite di Crohn severa necessita di essere chiarito da studi prospettici che includano un numero maggiore di pazienti con questo sottogruppo di malattia.

Daniello Bartoli, Il Giappone, Edizione critica

La tesi di ricerca ha portato alla realizzazione di un’edizione critica del Giappone di Daniello Bartoli (1660): per la prima volta la «seconda parte» dell’Asia trova, in questo lavoro, una trascrizione integrale condotta con moderni criteri filologi. Quanto all’esegesi la ricerca ha visto la compilazione di tre «Schedari»: un «Indice dei nomi», che vede l’identificazione dei personaggi storici citati esplicitamente nell’opera, ne traccia un rapido profilo biografico e ne fornisce precisa e aggiornata bibliografia. Per quanto riguarda i missionari evocati dall’autore nel testo, questa sezione indica se (e dove) si tratta di personaggio o di fonte (registrando, nel caso, il luogo o i luoghi in cui Bartoli ricorre a tale testimonianza); un «Indice dei luoghi», che dà l’indicazione moderna del luogo citato e ne fornisce il riscontro con i repertori più aggiornati; un «Lessico» riservato ai termini giapponesi presenti nel testo che vengono spiegati e, là dove possibile, studiati nella loro storia, nella loro presenza nella coeva letteratura di viaggio e corredati di utili riferimenti bibliografici. Le pagine introduttive inquadrano l’opera di Bartoli sia nell’orizzonte biografico dell’autore sia nel milieu gesuitico barocco, fornendo puntuali coordinate storiche grazie alle quali recuperare il più ampio contesto delle missioni gesuitiche nell’Estremo Oriente tra Cinque e Seicento. Particolare attenzione è stata riservata al modo di intendere il compito dello storico da parte di Bartoli: una storiografia la sua che s’intreccia in modi affatto peculiari alle diverse forme stilistiche e dinamiche retoriche richieste dalle altre due grandi attività a cui egli dedicò impegno e passione: l’insegnamento e la predicazione.

Analisi di espressione di microRNA in Tumore a Cellule Giganti: identificazione dei target con ruolo di potenziali biomarcatori

Il Tumore a Cellule Giganti dell’osso (TCG) è una rara neoplasia che rappresenta il 5% dei tumori di natura ossea; sebbene venga considerato un tumore a decorso benigno può manifestare caratteri di aggressività locale dando origine a recidive locali nel 10-25% dei casi, e nel 2-4% dei casi metastatizza a livello polmonare. In questo studio è stata valutata l’espressione dei miRNA mediante miRNA microarray in 10 pazienti affetti da TCG, 5 con metastasi e 5 liberi da malattia; sono stati riscontrati miRNA differenzialmente espressi tra i 2 gruppi di pazienti e la successiva validazione mediante Real Time PCR ha confermato una differenza significativa per il miR-136 (p=0.04). Mediante analisi bioinformatica con il software TargetScan abbiamo identificato RANK e NF1B come target del miR-136 e ne abbiamo studiato l’espressione mediante Real Time PCR su una più ampia casistica di pazienti affetti da TCG, metastatico e non, evidenziando una maggior espressione di NF1B nel gruppo di pazienti metastatici, mentre RANK non ha dimostrato una differenza significativa. L’analisi di Western Blot ha rilevato una maggiore espressione di entrambe le proteine nei pazienti metastatici rispetto ai non metastatici. Successivamente è stato condotto uno studio di immunoistochimica su TMA di 163 campioni di pazienti affetti da TCG a diverso decorso clinico che ha dimostrato una maggiore e significativa espressione di entrambe i target nei pazienti con metastasi rispetto ai non metastatici; le analisi di popolazione mediante Kaplan-Meier hanno confermato la correlazione tra over-espressione di RANK, NF1B e ricaduta con metastasi (p=0.001 e p<0.0005 rispettivamente). Lo studio di immunoistochimica è stato ampliato alle proteine maggiormente coinvolte nell’osteolisi che risultano avere un significato prognostico; tuttavia mediante analisi di ROC, la co-over-espressione di RANK, RANKL e NF1B rappresenta il migliore modello per predire la comparsa di metastasi (AUC=0.782, p<0.0005).

Evaluation of Antitumoral activity of bone targeted drugs/conventional chemotherapies and identification of biomarkers for the selection of patients with breast cancer for the bone targeted therapy in adjuvant setting

Bone metastases are responsible for different clinical complications defined as skeletal-related events (SREs) such as pathologic fractures, spinal cord compression, hypercalcaemia, bone marrow infiltration and severe bone pain requiring palliative radiotherapy. The general aim of these three years research period was to improve the management of patients with bone metastases through two different approaches of translational research. Firstly in vitro preclinical tests were conducted on breast cancer cells and on indirect co-colture of cancer cells and osteoclasts to evaluate bone targeted therapy singly and in combination with conventional chemotherapy. The study suggests that zoledronic acid has an antitumor activity in breast cancer cell lines. Its mechanism of action involves the decrease of RAS and RHO, as in osteoclasts. Repeated treatment enhances antitumor activity compared to non-repeated treatment. Furthermore the combination Zoledronic Acid + Cisplatin induced a high antitumoral activity in the two triple-negative lines MDA-MB-231 and BRC-230. The p21, pMAPK and m-TOR pathways were regulated by this combined treatment, particularly at lower Cisplatin doses. A co-colture system to test the activity of bone-targeted molecules on monocytes-breast conditioned by breast cancer cells was also developed. Another important criticism of the treatment of breast cancer patients, is the selection of patients who will benefit of bone targeted therapy in the adjuvant setting. A retrospective case-control study on breast cancer patients to find new predictive markers of bone metastases in the primary tumors was performed. Eight markers were evaluated and TFF1 and CXCR4 were found to discriminate between patients with relapse to bone respect to patients with no evidence of disease. In particular TFF1 was the most accurate marker reaching a sensitivity of 63% and a specificity of 79%. This marker could be a useful tool for clinicians to select patients who could benefit for bone targeted therapy in adjuvant setting.

Mechanical microcontacts of powder particles studied with the quartz crystal microbalance

Within this work, a particle-polymer surface system is studied with respect to the particle-surface interactions. The latter are governed by micromechanics and are an important aspect for a wide range of industrial applications. Here, a new methodology is developed for understanding the adhesion process and measure the relevant forces, based on the quartz crystal microbalance, QCM. rnThe potential of the QCM technique for studying particle-surface interactions and reflect the adhesion process is evaluated by carrying out experiments with a custom-made setup, consisting of the QCM with a 160 nm thick film of polystyrene (PS) spin-coated onto the quartz and of glass particles, of different diameters (5-20µm), deposited onto the polymer surface. Shifts in the QCM resonance frequency are monitored as a function of the oscillation amplitude. The induced frequency shifts of the 3rd overtone are found to decrease or increase, depending on the particle-surface coupling type and the applied oscillation (frequency and amplitude). For strong coupling the 3rd harmonic decreased, corresponding to an “added mass” on the quartz surface. However, positive frequency shifts are observed in some cases and are attributed to weak-coupling between particle and surface. Higher overtones, i.e. the 5th and 7th, were utilized in order to derive additional information about the interactions taking place. For small particles, the shift for specific overtones can increase after annealing, while for large particle diameters annealing causes a negative frequency shift. The lower overtones correspond to a generally strong-coupling regime with mainly negative frequency shifts observed, while the 7th appears to be sensitive to the contact break-down and the recorded shifts are positive.rnDuring oscillation, the motion of the particles and the induced frequency shift of the QCM are governed by a balance between inertial forces and contact forces. The adherence of the particles can be increased by annealing the PS film at 150°C, which led to the formation of a PS meniscus. For the interpretation, the Hertz, Johnson-Kendall-Roberts, Derjaguin-Müller-Toporov and the Mindlin theory of partial slip are considered. The Mindlin approach is utilized to describe partial slip. When partial slip takes place induced by an oscillating load, a part of the contact ruptures. This results in a decrease of the effective contact stiffness. Additionally, there are long-term memory effects due to the consolidation which along with the QCM vibrations induce a coupling increase. However, the latter can also break the contact, lead to detachment and even surface damage and deformation due to inertia. For strong coupling the particles appear to move with the vibrations and simply act as added effective mass leading to a decrease of the resonance frequency, in agreement with the Sauerbrey equation that is commonly used to calculate the added mass on a QCM). When the system enters the weak-coupling regime the particles are not able to follow the fast movement of the QCM surface. Hence, they effectively act as adding a “spring” with an additional coupling constant and increase the resonance frequency. The frequency shift, however, is not a unique function of the coupling constant. Furthermore, the critical oscillation amplitude is determined, above which particle detach. No movement is detected at much lower amplitudes, while for intermediate values, lateral particle displacement is observed. rnIn order to validate the QCM results and study the particle effects on the surface, atomic force microscopy, AFM, is additionally utilized, to image surfaces and measure surface forces. By studying the surface of the polymer film after excitation and particle removal, AFM imaging helped in detecting three different meniscus types for the contact area: the “full contact”, the “asymmetrical” and a third one including a “homocentric smaller meniscus”. The different meniscus forms result in varying bond intensity between particles and polymer film, which could explain the deviation between number of particles per surface area measured by imaging and the values provided by the QCM - frequency shift analysis. The asymmetric and the homocentric contact types are suggested to be responsible for the positive frequency shifts observed for all three measured overtones, i.e. for the weak-coupling regime, while the “full contact” type resulted in a negative frequency shift, by effectively contributing to the mass increase of the quartz..rnThe interplay between inertia and contact forces for the particle-surface system leads to strong- or weak-coupling, with the particle affecting in three mentioned ways the polymer surface. This is manifested in the frequency shifts of the QCM system harmonics which are used to differentiate between the two interaction types and reflect the overall state of adhesion for particles of different size.rn

Beeinflusst Stereotype Threat die Leseleistung von Jungen?

Ein durchgängiger Befund internationaler Schulleistungsvergleichsstudien bezieht sich auf die niedrigere Lesekompetenz von Jungen im Vergleich zu Mädchen (OECD, 2010). Ziel der vorliegenden Arbeit war, zu prüfen, welchen Einfluss negative Stereotype – im Sinne der Stereotype Threat-Theorie (Steele & Aronson, 1995) – auf die Leseleistung von Jungen haben. Basierend auf Befunden aus der Lese- und Stereotype Threat-Forschung wurde ein Mediator-Moderator-Modell des Stereotype Threat-Effekts (vgl. Schmader, Johns & Forbes, 2008) auf die Leseleistung von Jungen abgeleitet und überprüft. Um diese Fragestellungen zu beantworten, wurden zwei quasiexperimentelle Untersuchungen mit Schülern achter und neunter Klassen durchgeführt. An der ersten Untersuchung nahmen insgesamt 167 Schüler (n = 69 Jungen, n = 98 Mädchen) zweier Gymnasien in privater Trägerschaft teil. Um die Fragestellungen an einer weniger selektiven Stichprobe untersuchen zu können, erfolgte eine zweite Untersuchung mit Schülern (N = 441) öffentlicher Schulen und verschiedener Schulformen, wobei der Fokus ausschließlich auf den männlichen Schülern (n = 188 Jungen; n = 122 Gymnasiasten, n = 66 Realschüler plus) lag. Für beide Experimente kann zusammenfassend festgehalten werden, dass sich, entgegen der Erwartungen, kein leistungsmindernder Stereotype Threat-Effekt auf die Leseleistung von Jungen zeigte. Ferner konnten keine signifikante Mediatoren und Moderatoren eines leistungsmindernden Stereotype Threat-Effekts auf die Leseleistung von Jungen identifiziert werden. Ziel zukünftiger Forschung muss sein, den Einfluss negativer Stereotype auf die Leistungen männlicher Probanden im Sinne von Mitgliedern dominanter Gruppen zu untersuchen. Besonderes Augenmerk sollte auf die stereotypisierte Fähigkeitsdomäne gelegt werden. Weiterhin ist wichtig, der Frage nach zugrunde liegenden Prozessen und Voraussetzungen für das Erleben von Stereotype Threat nachzugehen. Studien weisen darauf hin, dass unterschiedlich stigmatisierte Gruppen unterschiedlich auf Stereotype Threat reagieren. Daher sollte der Fokus zukünftiger Forschung darauf liegen, die Prozesse und Voraussetzungen näher zu untersuchen, die für Mitglieder sonst positiv stereotypisierter Gruppen in solchen Situationen zum Tragen kommen.

Drug hypersensitivity reactions involving skin

Immune reactions to drugs can cause a variety of diseases involving the skin, liver, kidney, lungs, and other organs. Beside immediate, IgE-mediated reactions of varying degrees (urticaria to anaphylactic shock), many drug hypersensitivity reactions appear delayed, namely hours to days after starting drug treatment, showing a variety of clinical manifestations from solely skin involvement to fulminant systemic diseases which may be fatal. Immunohistochemical and functional studies of drug-specific T cells in patients with delayed reactions confirmed a predominant role for T cells in the onset and maintenance of immune-mediated delayed drug hypersensitivity reactions (type IV reactions). In these reactions, drug-specific CD4+ and CD8+ T cells are stimulated by drugs through their T cell receptors (TCR). Drugs can stimulate T cells in two ways: they can act as haptens and bind covalently to larger protein structures (hapten-carrier model), inducing a specific immune response. In addition, they may accidentally bind in a labile, noncovalent way to a particular TCR of the whole TCR repertoire and possibly also major histocompatibility complex (MHC)-molecules - similar to their pharmacologic action. This seems to be sufficient to reactivate certain, probably in vivo preactivated T cells, if an additional interaction of the drug-stimulated TCR with MHC molecules occurs. The mechanism was named pharmacological interaction of a drug with (immune) receptor and thus termed the p-i concept. This new concept may explain the frequent skin symptoms in drug hypersensitivity to oral or parenteral drugs. Furthermore, the various clinical manifestations of T cell-mediated drug hypersensitivity may be explained by distinct T cell functions leading to different clinical phenotypes. These data allowed a subclassification of the delayed hypersensitivity reactions (type IV) into T cell reactions which, by releasing certain cytokines and chemokines, preferentially activate and recruit monocytes (type IVa), eosinophils (type IVb), or neutrophils (type IVd).

Resting tremor in Parkinson disease: a negative predictor of levodopa-induced dyskinesia

It is unclear whether patients with different clinical subtypes of Parkinson disease (PD) differ in their risk of developing levodopa-induced dyskinesia (LID) and whether resting tremor is negatively correlated with this risk.

A navigation system for percutaneous needle interventions based on PET/CT images: design, workflow and error analysis of soft tissue and bone punctures

Percutaneous needle intervention based on PET/CT images is effective, but exposes the patient to unnecessary radiation due to the increased number of CT scans required. Computer assisted intervention can reduce the number of scans, but requires handling, matching and visualization of two different datasets. While one dataset is used for target definition according to metabolism, the other is used for instrument guidance according to anatomical structures. No navigation systems capable of handling such data and performing PET/CT image-based procedures while following clinically approved protocols for oncologic percutaneous interventions are available. The need for such systems is emphasized in scenarios where the target can be located in different types of tissue such as bone and soft tissue. These two tissues require different clinical protocols for puncturing and may therefore give rise to different problems during the navigated intervention. Studies comparing the performance of navigated needle interventions targeting lesions located in these two types of tissue are not often found in the literature. Hence, this paper presents an optical navigation system for percutaneous needle interventions based on PET/CT images. The system provides viewers for guiding the physician to the target with real-time visualization of PET/CT datasets, and is able to handle targets located in both bone and soft tissue. The navigation system and the required clinical workflow were designed taking into consideration clinical protocols and requirements, and the system is thus operable by a single person, even during transition to the sterile phase. Both the system and the workflow were evaluated in an initial set of experiments simulating 41 lesions (23 located in bone tissue and 18 in soft tissue) in swine cadavers. We also measured and decomposed the overall system error into distinct error sources, which allowed for the identification of particularities involved in the process as well as highlighting the differences between bone and soft tissue punctures. An overall average error of 4.23 mm and 3.07 mm for bone and soft tissue punctures, respectively, demonstrated the feasibility of using this system for such interventions. The proposed system workflow was shown to be effective in separating the preparation from the sterile phase, as well as in keeping the system manageable by a single operator. Among the distinct sources of error, the user error based on the system accuracy (defined as the distance from the planned target to the actual needle tip) appeared to be the most significant. Bone punctures showed higher user error, whereas soft tissue punctures showed higher tissue deformation error.

Organizational Frames for Professional Claims: Private Military Corporations and the Rise of the Military Paraprofessional

Corporations, nongovernmental organizations, and other organizational forms are major players in the sodal world. Recently, sociological scholarship on organizations has converged with research on the professions to discuss the ways in which professions are shaped or influenced by different organizational forms. In this article, I borrows from the notion of framing within social movement research to argue that organizational forms frame the bids of aspiring professionals. More specifically, I argue that certain organizational forms-such as that of the modern corporation-can aid would-be professionals in making their claims for professional recognition. Organizations do this, I argue, by providing aspiring professionals with a ready-made setting, rationale, and guarantees that make the newcomers more easily recognizable as professionals to outside audiences. I explore this argument by examining how the corporate form has facilitated private military contractors in their attempts to legitimate and develop this highly controversial new industry. The data are drawn from my interviews with private military contractors, state officials, and other interested parties surrounding private military corporations, as well as from archival data that detail the rise of the private military industry.

Cortical morphometry in narcolepsy with cataplexy

The sleep-wake disorder narcolepsy with cataplexy is associated with the loss of hypocretin-(orexin-) producing neurons in the lateral hypothalamus. Several studies have reported abnormal cerebral activation in patients with narcolepsy with cataplexy. It remains unclear, however, whether these functional changes are related to structural alterations, particularly at the cortical level. To quantify structural brain changes associated with narcolepsy with cataplexy, we used high-resolution T1-weighted magnetic resonance imaging (MRI) in 12 patients compared with 12 healthy participants matched for age and gender. Subcortical and regional cortical volumes were measured using a method unbiased by non-linear registration. Further whole-brain analyses were conducted, measuring cortical characteristics, such as cortical thickness and gyrification, at thousands of points across each hemisphere using validated algorithms. Statistical analyses accounted for an effect of age and gender. We observed decreased cortical volume in the left paracentral lobule and increased cortical volume in the left caudal part of the middle frontal gyrus in narcoleptic patients compared with controls. Cortical thickness in prefrontal areas was inversely correlated with the severity of narcolepsy. Further, we observed several clusters of cortical thinning in patients with childhood or adolescent onset of narcolepsy compared with patients with adult onset of the disease. Our results suggest that specific anatomical changes may differentiate subgroups of narcolepsy patients with different clinical profiles (such as varying symptom severity or different age at onset). Future studies with larger groups of sleepy patients are required to assess whether distinct patterns of anatomical changes may distinguish narcolepsy from non-hypocretin-deficient hypersomnia disorders.

Circulating DNA and myeloperoxidase indicate disease activity in patients with thrombotic microangiopathies

Thrombotic microangiopathies (TMAs) are a group of life-threatening disorders characterized by thrombocytopenia, fragmentation of erythrocytes, and ischemic organ damage. Genetic disorders, autoimmune disease, and cancer are risk factors for TMAs, but an additional, unknown trigger is needed to bring about acute disease. Recent studies suggest that DNA and histones are released during inflammation or infection and stimulate coagulation, thrombosis, thrombocytopenia, and organ damage in mice. We show that extracellular DNA and histones as well as markers of neutrophils are present in acute TMAs. Analysis of plasma from TMA patients of different clinical categories revealed elevated levels of DNA-histone complexes and myeloperoxidase (MPO) from neutrophil granules as well as S100A8/A9, a heterocomplex abundant in neutrophil cytosol. During therapy of thrombotic thrombocytopenic purpura, a subtype of TMAs often associated with severe ADAMTS13 (a disintegrin and metalloproteinase with thrombospondin type 1 motifs, member 13) deficiency, plasma DNA and MPO were inversely correlated with platelet counts, and their levels indicated amelioration or exacerbation of the disease. ADAMTS13 deficiency together with increased levels of plasma DNA and MPO were characteristic for acute thrombotic thrombocytopenic purpura. A minor infection often precedes acute TMA and extracellular DNA and histones released during the inflammatory response could provide the second hit, which precipitates acute TMA in patients with pre-existing risk factors.