Cerebrospinal fluid and serum MHPG improve Alzheimer's disease versus dementia with Lewy bodies differential diagnosis

Introduction: Given the challenges concerning the differential diagnosis of dementia, we investigated the possible added value of monoaminergic compounds to the standard cerebrospinal fluid (CSF) Alzheimer's disease (AD) biomarkers. Particularly, regarding the AD versus dementia with Lewy bodies (DLB) comparison, monoamines or their metabolites might have added discriminative value as there is a more severe neuropathological burden in the locus coeruleus of DLB patients, the principal site of noradrenaline synthesis. Methods: We applied enzyme-linked immunosorbent assay (ELISA) to analyze CSF amyloid β peptide of 42 amino acids, total tau, and tau phosphorylated at threonine 181, in patients with AD, frontotemporal dementia, DLB/Parkinson's disease dementia, and controls. Reversed-phase high-performance liquid chromatography with electrochemical detection was implemented to study monoamine and metabolite levels in CSF and serum. Stepwise forward conditional logistic regression and receiver operating characteristic (ROC) curve analyses were performed to assess the diagnostic accuracy of these newly fitted models containing the most discriminative indicators of disease status. Results: Most significant differences in CSF and serum were confined to the noradrenergic system. More specifically, CSF 3-methoxy-4-hydroxyphenylglycol (MHPG) levels were higher, whereas serum MHPG levels were lower, in DLB patients compared with all other groups. Addition of CSF and serum MHPG levels to the CSF AD biomarker panel significantly increased diagnostic accuracy between DLB/Parkinson's disease dementia and AD. Interestingly, a model only including CSF and serum MHPG without the classic AD biomarker panel reached similar area under the curve values. Discussion: We hypothesize that varying degrees of neuronal loss in the locus coeruleus of DLB/Parkinson's disease dementia versus AD patients result in differentially altered MHPG levels, making this metabolite a valuable biomarker

Cerebrospinal fluid P-tau(181P):biomarker for improved differential dementia diagnosis

The goal of this study is to investigate the value of tau phosphorylated at threonine 181 (P-tau(181p)) in the Alzheimer's disease (AD) cerebrospinal fluid (CSF) biomarker panel for differential dementia diagnosis in autopsy confirmed AD and non-AD patients. The study population consisted of 140 autopsy confirmed AD and 77 autopsy confirmed non-AD dementia patients. CSF concentrations of amyloid-beta peptide of 42 amino acids (A(beta 1-42)), total tau protein (T-tau), and P-tau(181p) were determined with single analyte ELISA-kits (INNOTEST, Fujirebio, Ghent, Belgium). Diagnostic accuracy was assessed through receiver operating characteristic (ROC) curve analyses to obtain area under the curve (AUG) values and to define optimal cutoff values to discriminate AD from pooled and individual non-AD groups. ROC curve analyses were only performed on biomarkers and ratios that differed significantly between the groups. Pairwise comparison of AUG values was performed by means of DeLong tests. The A(beta 1-42)/P-tau(181p) ratio (AUG = 0.770) performed significantly better than A(beta 1-42) (AUG = 0.677, P = 0.004), T-tau (AUG = 0.592, P <0.001), and A beta(1-42)/T-tau (AUG = 0.678, P = 0.001), while Ptau(181p) (AUG = 0.720) performed significantly better than T-tau (AUG = 0.592, P <0.001) to discriminate between AD and the pooled non-AD group. When comparing AD and the individual non-AD diagnoses, A beta(1-42)/P-tau(181P) (AUG =0.894) discriminated AD from frontotemporal dementia significantly better than A(beta 1-42) (AUG = 0.776, P = 0.020) and T-tau (AUG = 0.746, P = 0.004), while P-tauisip/T-tau (AUG = 0.958) significantly improved the differentiation between AD and Creutzfeldt-Jakob disease as compared to A beta(1-42) (AUG = 0.688, P = 0.004), T-tau (AUG = 0.874, P = 0.040), and A beta(1-42)/P-tau(181P) (AUG = 0.760, P = 0.003). In conclusion, this study demonstrates P-tau(181P) P is an essential component of the AD CSF biomarker panel, and combined assessment of A beta(1-42), Ttau, and P-tau(181p) renders, to present date, the highest diagnostic power to discriminate between AD and non-AD dementias

Depression in Mild Cognitive Impairment is associated with Progression to Alzheimer's Disease:A Longitudinal Study

Background: Behavioral and psychological signs and symptoms of dementia (BPSD) belong to the core symptoms of dementia and are also common in mild cognitive impairment (MCI).Objective: This study would like to contribute to the understanding of the prognostic role of BPSD in MCI for the progression to dementia due to Alzheimer's disease (AD).Methods: Data were generated through an ongoing prospective longitudinal study on BPSD. Assessment was performed by means of the Middelheim Frontality Score, Behave-AD, Cohen-Mansfield Agitation Inventory, Cornell Scale for Depression in Dementia (CSDD), and Geriatric Depression Scale 30-questions (GDS-30). Cox proportional hazard models were used to test the hypothesis that certain BPSD in MCI are predictors of developing AD.Results: The study population consisted of 183 MCI patients at baseline. At follow-up, 74 patients were stable and 109 patients progressed to AD. The presence of significant depressive symptoms in MCI as measured by the CSDD (HR: 2.06; 95% CI: 1.23-3.44; p = 0.011) and the GDS-30 (HR: 1.77; 95% CI: 1.10-2.85; p = 0.025) were associated with progression to AD. The severity of depressive symptoms as measured by the GDS-30 was a predictor for progression too (HR: 1.06; 95% CI: 1.01-1.11; p = 0.020). Furthermore, the severity of agitated behavior, especially verbal agitation and the presence of purposeless activity, was also associated with progression, whereas diurnal rhythm disturbances were associated with no progression to AD.Conclusion: Depressive symptoms in MCI appear to be predictors for progression to AD.</p

The Athena x-ray optics development and accommodation

The Athena mission, under study and preparation by ESA as its second Large-class science mission, requires the largest X-ray optics ever flown, building on a novel optics technology based on mono crystalline silicon. Referred to as Silicon Pore Optics technology (SPO), the optics is highly modular and benefits from technology spin-in from the semiconductor industry. The telescope aperture of about 2.5 meters is populated by around 700 mirror modules, accurately co-aligned to produce a common focus. The development of the SPO technology is a joint effort by European industrial and research entities, working together to address the challenges to demonstrate the imaging performance, robustness and efficient series production of the Athena optics. A technology development plan was established and is being regularly updated to reflect the latest developments, and is fully funded by the ESA technology development programmes. An industrial consortium was formed to ensure coherence of the individual technology development activities. The SPO technology uses precision machined mirror plates produced using the latest generation top quality 12 inch silicon wafers, which are assembled into rugged stacks. The surfaces of the mirror plates and the integral support structure is such, that no glue is required to join the individual mirror plates. Once accurately aligned with respect to each other, the surfaces of the mirror plates merge in a physical bonding process. The resultant SPO mirror modules are therefore very accurate and stable and can sustain the harsh conditions encountered during launch and are able to tolerate the space environment expected during operations. The accommodation of the Athena telescope is also innovative, relying on a hexapod mechanism to align the optics to the selected detector instruments located in the focal plane. System studies are complemented by dedicated technology development activities to demonstrate the capabilities before the adoption of the Athena mission

Naturally Occurring Lipid A Mutants in Neisseria meningitidis from Patients with Invasive Meningococcal Disease Are Associated with Reduced Coagulopathy

Neisseria meningitidis is a major cause of bacterial meningitis and sepsis worldwide. Lipopolysaccharide (LPS), a major component of the Gram-negative bacterial outer membrane, is sensed by mammalian cells through Toll-like receptor 4 (TLR4), resulting in activation of proinflammatory cytokine pathways. TLR4 recognizes the lipid A moiety of the LPS molecule, and the chemical composition of the lipid A determines how well it is recognized by TLR4. N. meningitidis has been reported to produce lipid A with six acyl chains, the optimal number for TLR4 recognition. Indeed, meningococcal sepsis is generally seen as the prototypical endotoxin-mediated disease. In the present study, we screened meningococcal disease isolates from 464 patients for their ability to induce cytokine production in vitro. We found that around 9% of them were dramatically less potent than wild-type strains. Analysis of the lipid A of several of the low-activity strains by mass spectrometry revealed they were penta-acylated, suggesting a mutation in the lpxL1 or lpxL2 genes required for addition of secondary acyl chains. Sequencing of these genes showed that all the low activity strains had mutations that inactivated the lpxL1 gene. In order to see whether lpxL1 mutants might give a different clinical picture, we investigated the clinical correlate of these mutations in a prospective nationwide observational cohort study of adults with meningococcal meningitis. Patients infected with an lpxL1 mutant presented significantly less frequently with rash and had higher thrombocyte counts, consistent with reduced cytokine induction and less activation of tissue-factor mediated coagulopathy. In conclusion, here we report for the first time that a surprisingly large fraction of meningococcal clinical isolates have LPS with underacylated lipid A due to mutations in the lpxL1 gene. The resulting low-activity LPS may have an important role in virulence by aiding the bacteria to evade the innate immune system. Our results provide the first example of a specific mutation in N. meningitidis that can be correlated with the clinical course of meningococcal disease

Observer variability of absolute and relative thrombus density measurements in patients with acute ischemic stroke

Introduction: Thrombus density may be a predictor for acute ischemic stroke treatment success. However, only limited data on observer variability for thrombus density measurements exist. This study assesses the variability and bias of four common thrombus density measurement methods by expert and non-expert observers. Methods: For 132 consecutive patients with acute ischemic stroke, three experts and two trained observers determined thrombus density by placing three standardized regions of interest (ROIs) in the thrombus and corresponding contralateral arterial segment. Subsequently, absolute and relative thrombus densities were determined using either one or three ROIs. Intraclass correlation coefficient (ICC) was determined, and Bland–Altman analysis was performed to evaluate interobserver and intermethod agreement. Accuracy of the trained observer was evaluated with a reference expert observer using the same statistical analysis. Results: The highest interobserver agreement was obtained for absolute thrombus measurements using three ROIs (ICCs ranging from 0.54 to 0.91). In general, interobserver agreement was lower for relative measurements, and for using one instead of three ROIs. Interobserver agreement of trained non-experts and experts was similar. Accuracy of the trained observer measurements was comparable to the expert interobserver agreement and was better for absolute measurements and with three ROIs. The agreement between the one ROI and three ROI methods was good. Conclusion: Absolute thrombus density measurement has superior interobserver agreement compared to relative density measurement. Interobserver variation is smaller when multiple ROIs are used. Trained non-expert observers can accurately and reproducibly assess absolute thrombus densities using three ROIs

Assessment of Grain Damping Models for Finite Element Analysis of Solid Rocket Motors

The accurate and efficient computational modeling of highly damped structures in transient simulations is critical for design and certification of spacecraft. An important step in the process is indeed the coupled loads analysis of the payload-launcher system subject to time-domain excitations. In order to accurately predict the satellite dynamic mechanical environment, the system damping properties must be correctly taken into account in the numerical models used for transient simulations. Additionally, the damping models must be tailored toward dynamic condensation techniques and efficient solution algorithms in order to allow analysing multiple designs and operating conditions in limited times. This paper reviews existing approaches to damping modeling applied to the transient analysis of highly damped structures described in terms of finite element models. The performance of the examined methods is discussed by correlating numerical and experimental results for a scaled-down test article dynamically representative of a slender launch vehicle with a solid rocket motor stage