Description of Lyme disease-like syndrome in Brazil: is it a new tick borne disease or Lyme disease variation?

An emerging clinical entity that reproduces clinical manifestations similar to those observed in Lyme disease (LD) has been recently under discussion in Brazil. Due to etiological and laboratory particularities it is named LD-like syndrome or LD imitator syndrome. The condition is considered to be a zoonosis transmitted by ticks of the genus Amblyomma, possibly caused by interaction of multiple fastidious microorganisms originating a protean clinical picture, including neurological, osteoarticular and erythema migrans-like lesions. When peripheral blood of patients with LD-like syndrome is viewed under a dark-field microscope, mobile uncultivable spirochete-like bacteria are observed. PCR carried out with specific or conservative primers to recognize Borrelia burgdorferi sensu stricto or the genus Borrelia has been negative in ticks and in biological samples. Two different procedures, respectively involving hematoxylin and eosin staining of cerebrospinal fluid and electron microscopy analysis of blood, have revealed spirochetes not belonging to the genera Borrelia, Leptospira or Treponema. Surprisingly, co-infection with microorganisms resembling Mycoplasma and Chlamydia was observed on one occasion by electron microscopy analysis. We discuss here the possible existence of a new tick-borne disease in Brazil imitating LD, except for a higher frequency of recurrence episodes observed along prolonged clinical follow-up

NEUROBORRELIOSI DI LYME E MALATTIA DI PARKINSON: STUDIO DI UN CASO POST-MORTEM

n/

On the Effect of the Reaction Medium on the HydroClaus Process: A Novel Sustainable H2S Valorization Strategy

Hydrogen sulfide (H2S) is becoming a critical issue to manage, due to the increasing sulfur content in the processed gas together with the stricter environmental regulations. Novel alternatives are being developed for the H2S abatement and conversion to valuable chemicals. Among them, the HydroClaus process, patented by Eni S.p.A., deserves attention. This technology aims at converting H2S and SO2 into a hydrophilic mixture of sulfur and sulfur-rich compounds, polythionates, to be used as a fertilizer. An improved configuration for an efficient water management is proposed in this work. The process operability has been demonstrated at the bench scale, through an ad hoc experimental campaign. For the technology scale-up, a flowsheet has been set up and its performances have been assessed in terms of heat and material balances and CO2 emissions. Results reveal that the modified HydroClaus process can be a valid solution for an effective H2S valorization, also considering that no direct CO2 emissions are released. Moreover, since only electric power is required, a further reduction of the indirect CO2 emissions is expected, if renewable sources can be exploited for this purpose

Neural Circuitry of Novelty Salience Processing in Psychosis Risk: Association With Clinical Outcome

Psychosis has been proposed to develop from dysfunction in a hippocampal-striatal-midbrain circuit, leading to aberrant salience processing. Here, we used functional magnetic resonance imaging (fMRI) during novelty salience processing to investigate this model in people at clinical high risk (CHR) for psychosis according to their subsequent clinical outcomes. Seventy-six CHR participants as defined using the Comprehensive Assessment of At-Risk Mental States (CAARMS) and 31 healthy controls (HC) were studied while performing a novelty salience fMRI task that engaged an a priori hippocampal-striatal-midbrain circuit of interest. The CHR sample was then followed clinically for a mean of 59.7 months (~5 y), when clinical outcomes were assessed in terms of transition (CHR-T) or non-transition (CHR-NT) to psychosis (CAARMS criteria): during this period, 13 individuals (17%) developed a psychotic disorder (CHR-T) and 63 did not. Functional activation and effective connectivity within a hippocampal-striatal-midbrain circuit were compared between groups. In CHR individuals compared to HC, hippocampal response to novel stimuli was significantly attenuated (P = .041 family-wise error corrected). Dynamic Causal Modelling revealed that stimulus novelty modulated effective connectivity from the hippocampus to the striatum, and from the midbrain to the hippocampus, significantly more in CHR participants than in HC. Conversely, stimulus novelty modulated connectivity from the midbrain to the striatum significantly less in CHR participants than in HC, and less in CHR participants who subsequently developed psychosis than in CHR individuals who did not become psychotic. Our findings are consistent with preclinical evidence implicating hippocampal-striatal-midbrain circuit dysfunction in altered salience processing and the onset of psychosis

Borrelia Lyme Group

Borreliaceae is a family of the phylum Spirochaetales and includes two genera, Borrelia and Cristispira genus. Borrelia genus is divided into three groups, namely Lyme group (LG), Echidna‐Reptile group (REPG) and Relapsing Fever group (RFG). All Borrelia species have an obligate parasitic lifestyle, as they depend on their hosts for most of their nutritional needs. Borreliæ are transmitted among vertebrate hosts by arthropod vectors (ticks and lice). Transtadial transmission within their carriers occurs for the Borreliæ RF Group, while this does not (or rarely occurs) for the Borreliæ Lyme Group. Phylogenetic data demonstrated that these two groups are genetically similar but distinct, forming independent clades sharing a common ancestor. In nature, the vectors of LB belong to the genus Ixodes spp. frequently found in the Northern Hemisphere, while the vectors of RF are usually the soft-ticks (Ornithodoros spp.). Borreliae share a unique genomic structure consisting of a single highly conserved linear chromosome and several linear and circular extrachromosomal plasmids which can vary widely between strains. In addition to Lyme and RF borreliosis, an intermediate group, called Echidna-Reptile borreliosis, has recently been identified. Lyme disease (LD) is caused by the spirochæte Borrelia burgdorferi sensu lato (s.l.) and transmitted to humans by the bite of a hard tick of the genus Ixodes, and LD reservoir are usually small rodents. LD is present in America, Eurasia, Africa, while its presence in Australia is not yet well documented. Not all Borreliæ Lyme Groups cause this disease in humans. Of the 23 Borreliæ burgdorferi s.l. currently known only 9 have been identified in human infection, namely Borrelia burgdorferi sensu stricto, B. afzelii, B. bavarensis, B. bissettii, B. garinii, B. lusitaniae, B. spielmani, B. valaisiana, and B. mayonii. LD is an organotropic infection, but there is also a spirochætemic form, caused by Borrelia mayonii, which gives fever similarly to the Borreliosis RF Group. A third variant of LD is Baggio-Yoshinari Syndrome (BYS), which is transmitted by another hard tick, Amblyomma cajennense. This Borrelia has not been isolated in culture, therefore its membership in the Lyme Group is not yet proven. All three of these Sub-Groups can manifest early with erythema migrans. Clinical features of LD are wide and variable, with clinical manifestations linked to distinct tissue tropisms of specific Borrelia burgdorferi s.l. genospecies. The early infection is localized and, in the absence of treatment, the spirochete can spread. The organs most frequently involved are skin, joints, muscles, nervous system, heart and eyes. B. burgdorferi s.s. is more often associated with Lyme arthritis, Borrelia garinii with neuroborreliosis and B. afzelii with acrodermatitis chronica atrophicans

Reproducibility of the WHO histological criteria for the diagnosis of Philadelphia chromosome-negative myeloproliferative neoplasms.

This study, performed on behalf of the Italian Registry of Thrombocythaemias (Registro Italiano Trombocitemie), aimed to test the inter-observer reproducibility of the histological parameters proposed by the WHO classification for the diagnosis of the Philadelphia chromosome-negative myeloproliferative neoplasms. A series of 103 bone marrow biopsy samples of Philadelphia chromosome-negative myeloproliferative neoplasms consecutively collected in 2004 were classified according to the WHO criteria as follows: essential thrombocythaemia (n=34), primary myelofibrosis (n=44) and polycythaemia vera (n=25). Two independent groups of pathologists reviewed the bone marrow biopsies. The first group was asked to reach a collegial 'consensus' diagnosis. The second group reviewed individually all the cases to recognize the main morphological parameters indicated by the WHO classification and report their results in a database. They were subsequently instructed to individually build a 'personal' diagnosis of myeloproliferative neoplasms subtype just assembling the parameters collected in the database. Our results indicate that high levels of agreement ( 6570%) have been reached for about all of the morphological features. Moreover, among the 18 evaluated histological features, 11 resulted statistically more useful for the differential diagnosis among the different Philadelphia chromosome-negative myeloproliferative neoplasms. Finally, we found a high percentage of agreement (76%) between the 'personal' and 'consensus' diagnosis (Cohen's kappa statistic >0.40). In conclusion, our results support the use of the histological criteria proposed by the WHO classification for the Philadelphia chromosome-negative myeloproliferative neoplasms to ensure a more precise and early diagnosis for these patients

Applicazione ai Tissue Microarray delle tecniche di immunoistochimica e di Ibridazione In Situ Fluorescente per la caratterizzazione immunofenotipica e citogenetica di linfoma a grandi cellule B diffuso

Obbiettivo Lo scopo di questo lavoro \ue8 stato la costruzione di un Tissue Microarray (TMA) pilota per la valutazione immunofenotipica e citogenetica di una casistica di linfoma a grandi cellule B diffuso (DLBCL), tramite analisi immunoistochimiche e di Ibridazione In Situ Fluorescente (FISH). Materiali e Metodi Abbiamo costruito il TMA utilizzando le biopsie linfonodali di 12 pazienti affetti da linfoma a grandi cellule B diffuso; ne abbiamo ottimizzato la costruzione per la lettura al microscopio a fluorescenza distanziando in maniera differenziale i carotaggi dello stesso caso da quelli del casi adiacenti mentre per mantenere la rappresentabilit\ue0 tissutale abbiamo inserito cinque carotaggi da 2 mm per campione. Al TMA abbiamo applicato cinque protocolli immunoistochimici (CD10, BCL6, MUM1, GCET1 e FOXP1) e un protocollo FISH (cMYC). Risultati I dati immunoistochimici sono stati elaborati secondo gli algoritmi di Hans e Choi: secondo il protocollo di Hans sono risultati 8 DLBCL con profilo immunofenotipico centro germinativo simile (GCB) e 4 DLBCL con profilo attivato (ABC); in accordo con l'algoritmo di Choi 7 DLBCL GCB e 5 DLBCL ABC. La conformit\ue0 dei dati immunoistochimici ottenuti \ue8 stata valutata confrontando i risultati con quelli delle indagini immunoistochimiche eseguite su sezione interna, al momento della diagnosi. Abbiamo ottenuto in questo modo una concordanza del 100% con l\u2019algoritmo di Hans e una concordanza del 92% con l\u2019algoritmo di Choi. L\u2019analisi di MYC non ha evidenziato la presenza di traslocazioni ma in tre casi \ue8 stato possibile rilevare polisomie del cromosoma 8. Conclusioni Questo studio ci ha permesso di definire i criteri metodologici per la progettazione e la costruzione di un TMA (con una concordanza del 100% rispetto ai dati ottenuti al momento della diagnosi) che potesse essere letto agevolmente al microscopio a fluorescenza, fornendo cos\uec una piattaforma di analisi ad alta resa per l'esecuzione di indagini immunoistochimiche e citogenetiche FISH

Integrated metastate functional connectivity networks predict change in symptom severity in clinical high risk for psychosis

The ability to identify biomarkers of psychosis risk is essential in defining effective preventive measures to potentially circumvent the transition to psychosis. Using samples of people at clinical high risk for psychosis (CHR) and Healthy controls (HC) who were administered a task fMRI paradigm, we used a framework for labelling time windows of fMRI scans as ‘integrated’ FC networks to provide a granular representation of functional connectivity (FC). Periods of integration were defined using the ‘cartographic profile’ of time windows and k‐means clustering, and sub‐network discovery was carried out using Network Based Statistics (NBS). There were no network differences between CHR and HC groups. Within the CHR group, using integrated FC networks, we identified a sub‐network negatively associated with longitudinal changes in the severity of psychotic symptoms. This sub‐network comprised brain areas implicated in bottom‐up sensory processing and in integration with motor control, suggesting it may be related to the demands of the fMRI task. These data suggest that extracting integrated FC networks may be useful in the investigation of biomarkers of psychosis risk

Towards a Standard Psychometric Diagnostic Interview for Subjects at Ultra High Risk of Psychosis: CAARMS versus SIPS.

Background. Several psychometric instruments are available for the diagnostic interview of subjects at ultra high risk (UHR) of psychosis. Their diagnostic comparability is unknown. Methods. All referrals to the OASIS (London) or CAMEO (Cambridgeshire) UHR services from May 13 to Dec 14 were interviewed for a UHR state using both the CAARMS 12/2006 and the SIPS 5.0. Percent overall agreement, kappa, the McNemar-Bowker χ (2) test, equipercentile methods, and residual analyses were used to investigate diagnostic outcomes and symptoms severity or frequency. A conversion algorithm (CONVERT) was validated in an independent UHR sample from the Seoul Youth Clinic (Seoul). Results. There was overall substantial CAARMS-versus-SIPS agreement in the identification of UHR subjects (n = 212, percent overall agreement = 86%; kappa = 0.781, 95% CI from 0.684 to 0.878; McNemar-Bowker test = 0.069), with the exception of the brief limited intermittent psychotic symptoms (BLIPS) subgroup. Equipercentile-linking table linked symptoms severity and frequency across the CAARMS and SIPS. The conversion algorithm was validated in 93 UHR subjects, showing excellent diagnostic accuracy (CAARMS to SIPS: ROC area 0.929; SIPS to CAARMS: ROC area 0.903). Conclusions. This study provides initial comparability data between CAARMS and SIPS and will inform ongoing multicentre studies and clinical guidelines for the UHR psychometric diagnostic interview.Peer Reviewe