Reconstitution of Ceruloplasmin by the Cu(I)-Glutathione Complex: EVIDENCE FOR A ROLE OF Mg2+ AND ATP

The copper-glutathione complex (Cu(I)-GSH) efficiently acted in vitro as the source of Cu(I) in the reconstitution of apoceruloplasmin. Copper was found to reinstate in the various sites in a multistep process, with metal entry into the protein in a first phase, and a second step involving conformational changes of the protein leading to the recovery of the native structural and functional properties. This latter phase was found to be strongly facilitated by Mg2+ or Ca2+ and by ATP. Both Mg2+ and ATP had to be present for optimal reconstitution. These results may shed some light on the mechanisms governing the biosynthesis of ceruloplasmin in vivo. Cu(I)-GSH was the only complex able to reconstitute ceruloplasmin at neutral pH. Glutathione may thus function to shuttle the metal from the membrane copper pump, as the Wilson disease ATPase, and ceruloplasmin in the secretory compartments of the cell. The finding that ceruloplasmin acquires the native conformation after metal entry through a complex pathway triggered by Mg2+ and ATP suggests that they may act as physiological modulators of this process in vivo

Towards fully-facilitated DES modelling:a successful project

The literature suggests that increasing stakeholder engagement in modelling has a positive impact on healthcare improvement projects using discrete-event simulation (DES). This suggests analysts should strive for the ‘fully-facilitated’ mode of simulation, meaning conducting the whole simulation project together with stakeholders. This paper investigates whether this might be possible in practice. This work arose from a research project with an Italian hospital. The paper describes a simulation project that succeeds in being fully-facilitated through all stages as far as the implementation stage, through combining Business Process Model and Notation (BPMN) and DES. We believe it is the first time that a fully-facilitated DES project in healthcare has been described

CSF levels of CXCL12 and osteopontin as early markers of primary progressive multiple sclerosis

Background and objectives: To evaluate the extent of intrathecal inflammation in patients with primary progressive MS (PPMS) at the time of diagnosis and to define markers and a specific inflammatory profile capable of distinguishing progressive from relapsing-remitting multiple sclerosis (RRMS). Methods: Levels of 34 pro- and anti-inflammatory cytokines and chemokines in the CSF were evaluated at the diagnosis in 16 patients with PPMS and 80 with RRMS. All patients underwent clinical evaluation, including Expanded Disability Status Scale assessment and a 3T brain MRI to detect white matter and cortical lesion number and volume and global and regional cortical thickness. Results: Higher levels of CXCL12 (odds ratio [OR] = 3.97, 95% CI [1.34-11.7]) and the monocyte-related osteopontin (OR = 2.24, 95% CI [1.01-4.99]) were detected in patients with PPMS, whereas levels of interleukin-10 (IL10) (OR = 0.28, 95% CI [0.09-0.96]) were significantly increased in those with RRMS. High CXCL12 levels were detected in patients with increased gray matter lesion number and volume (p = 0.001, r = 0.832 and r = 0.821, respectively). Pathway analysis confirmed the chronic inflammatory processes occurring in PPMS. Conclusions: At the time of diagnosis, a specific CSF protein profile can recognize the presence of early intrathecal inflammatory processes, possibly stratifying PPMS with respect to RRMS. Elevated CSF levels of CXCL12 and osteopontin suggested a key role of brain innate immunity and glia activity in MS. These molecules could represent useful candidate markers of MS progression, with implications for the pathogenesis and treatment of progressive MS. Classification of evidence: This study provides Class III evidence that CXCL12 and monocyte-related osteopontin may be correlated with PPMS, and IL-10 may be related to RRMS. It is may be correlated due to Bonferroni correction negating the statistical correlations found in the study

Cerebrospinal fluid IgM levels in association with inflammatory pathways in multiple sclerosis patients

Background Intrathecal immunoglobulin M (IgM) synthesis has been demonstrated in the early disease stages of multiple sclerosis (MS) as a predictor factor of a worsening disease course. Similarly, increased cerebrospinal fluid (CSF) molecules related to B-cell intrathecal activity have been associated with a more severe MS progression. However, whether CSF levels of IgM are linked to specific inflammatory and clinical profile in MS patients at the time of diagnosis remains to be elucidated. Methods Using customized Bio-Plex assay, the protein levels of IgG, IgA, IgM, and of 34 other inflammatory molecules, related to B-cell, T-cell, and monocyte/macrophage activity, were analyzed in the CSF of 103 newly diagnosed relapsing-remitting MS patients and 36 patients with other neurological disorders. CSF IgM levels were also correlated with clinical and neuroradiological measures [advanced 3-T magnetic resonance imaging (MRI) parameters], at diagnosis and after 2 years of follow-up. Results A 45.6% increase in CSF IgM levels was found in MS patients compared to controls (p = 0.013). CSF IgM levels correlated with higher CSF levels of CXCL13 (p = 0.039), CCL21 (p = 0.023), interleukin 10 (IL-10) (p = 0.025), IL-12p70 (p = 0.020), CX3CL1 (p = 0.036), and CHI3L1 (p = 0.048) and were associated with earlier age of patients at diagnosis (p = 0.008), white matter lesion (WML) number (p = 0.039) and disease activity (p = 0.033) after 2 years of follow-up. Conclusion IgMs are the immunoglobulins mostly expressed in the CSF of naive MS patients compared to other neurological conditions at the time of diagnosis. The association between increased CSF IgM levels and molecules related to both B-cell immunity (IL-10) and recruitment (CXCL13 and CCL21) and to macrophage/microglia activity (IL-12p70, CX3CL1, and CHI3L1) suggests possible correlation between humoral and innate intrathecal immunity in early disease stage. Furthermore, the association of IgM levels with WMLs and MS clinical and MRI activity after 2 years supports the idea of key role of IgM in the disease course

Changes in cerebrospinal fluid balance of TNF and TNF receptors in naïve multiple sclerosis patients: early involvement in compartmentalised intrathecal inflammation

An imbalance of TNF signalling in the inflammatory milieu generated by meningeal immune cell infiltrates in the subarachnoid space in multiple sclerosis (MS), and its animal model may lead to increased cortical pathology. In order to explore whether this feature may be present from the early stages of MS and may be associated with the clinical outcome, the protein levels of TNF, sTNF-R1 and sTNF-R2 were assayed in CSF collected from 122 treatment-naive MS patients and 36 subjects with other neurological conditions at diagnosis. Potential correlations with other CSF cytokines/chemokines and with clinical and imaging parameters at diagnosis (T0) and after 2 years of follow-up (T24) were evaluated. Significantly increased levels of TNF (fold change: 7.739; p < 0.001), sTNF-R1 (fold change: 1.693; p < 0.001) and sTNF-R2 (fold change: 2.189; p < 0.001) were detected in CSF of MS patients compared to the control group at T0. Increased TNF levels in CSF were significantly (p < 0.01) associated with increased EDSS change (r = 0.43), relapses (r = 0.48) and the appearance of white matter lesions (r = 0.49). CSF levels of TNFR1 were associated with cortical lesion volume (r = 0.41) at T0, as well as with new cortical lesions (r = 0.56), whilst no correlation could be found between TNFR2 levels in CSF and clinical or MRI features. Combined correlation and pathway analysis (ingenuity) of the CSF protein pattern associated with TNF expression (encompassing elevated levels of BAFF, IFN-gamma, IL-1 beta, IL-10, IL-8, IL-16, CCL21, haptoglobin and fibrinogen) showed a particular relationship to the interaction between innate and adaptive immune response. The CSF sTNF-R1-associated pattern (encompassing high levels of CXCL13, TWEAK, LIGHT, IL-35, osteopontin, pentraxin-3, sCD163 and chitinase-3-L1) was mainly related to altered T cell and B cell signalling. Finally, the CSF TNFR2-associated pattern (encompassing high CSF levels of IFN-beta, IFN-lambda 2, sIL-6R alpha) was linked to Th cell differentiation and regulatory cytokine signalling. In conclusion, dysregulation of TNF and TNF-R1/2 pathways associates with specific clinical/MRI profiles and can be identified at a very early stage in MS patients, at the time of diagnosis, contributing to the prediction of the disease outcome

Prenatal genetic counselling: issues and perspectives for pre-conceptional health care in Emilia Romagna (Northern Italy)

Background: there are many reasons why a couple may seek specialist genetic counselling about foetal risk. The referral for prenatal genetic counselling of women with a known risk factor during pregnancy has many disadvantages. Despite this, 10-20% of women seek counselling when already pregnant. Methods: data on 804 pregnant women out of 2 158 (37.3%) referred for genetic counselling in 2010 to three Clinical Genetic Services were retrospectively analysed. Patients referred only for advanced maternal age were analysed in a separate study. Results: the 804 pregnant women were referred for 932 counselling issues. 325 issues (34.9%) were identified during pregnancy and 607 (65.1%) were pre-existing. 81.2% of Italians compared to 41.8% of the non-Italians (P<0.01) had access to counselling before 13 weeks of gestation for risk factors present before pregnancy. An accurate genetic diagnosis was available in 25.0% of cases. In 21.7% of the cases an elevated a priori risk of >10% for the unborn child was established. Conclusions: genetic services provide 37.3% of counselling to pregnant women. Referral for genetic counselling during pregnancy can require considerable resources and pose significant ethical and organizational challenges. New models of pregnancy care in the community need to be developed. General practitioners and gynaecologists have an important role in the referral and in the defence of equity of access and a more structured approach to the participation of medical geneticists to primary practice should be considered

Etna International Training School of Geochemistry. Science meets Practice

Also this year, the “Etna International Training School of Geochemistry. Science meets practice” took place at Mt. Etna, now in its fourth edition. The school was hosted in the historical Volcanological Observatory “Pizzi Deneri”, one of the most important sites of the INGV - Osservatorio Etneo for geochemical and geophysical monitoring. Mount Etna, located in eastern Sicily, is the largest active volcano in Europe and one of the most intensely degassing volcanoes of the world [Allard et al., 1991; Gerlach, 1991]. Mt Etna emits about 1.6 % of global H2O fluxes from arc volcanism [Aiuppa et al., 2008] and 10 % of global average volcanic emission of CO2 and SO2 [D’Alessandro et al., 1997; Caltabiano et al., 2004; Aiuppa et al., 2008; Carn et al., 2017]. Furthermore, Gauthier and Le Cloarec, [1998] underscored that Mt. Etna is an important source of volcanic particles, having a mass flux of particle passively released from the volcano during non-eruptive period estimated between 7 to 23 tons/day [Martin et al., 2008; Calabrese et al., 2011]. In general, Etna is considered to be still under evolution and rather ‘friendly’, which, along with the above, makes it a favorable natural laboratory to study volcanic geochemistry. The Observatory Pizzi Deneri was sponsored by Haroun Tazieff, and it was built in 1978 by the CNR - International Institute of Volcanology under the direction of Prof. Letterio Villari. It is located at the base of the North-East crater (2,850 m a.s.l.), near the Valle del Leone and it was built on the rim of the Ellittico caldera. A picturesque building, consisting of two characteristics domes in front of the breath-taking panorama of the summit craters. Even though it is quite spartan as an accommodation facility, the dormitories, kitchen, seminar room and laboratory are well equipped. In other words, the Pizzi Deneri observatory is a unique place close to the top of the most active volcano of Europe. The observatory lies in a strategic location making it one of the most important sites for monitoring, research and dissemination of the scientific culture. After six field multidisciplinary campaigns (2010-2015) organized by a group of researchers of several institutions (INGV of Palermo, Catania, Naples, Bologna; Universities of Palermo, Florence, Mainz, Heidelberg), the idea of sharing and passing on the experience to the new generation of students has materialized, and the “Etna International Training School of Geochemistry. Science meets practice” was born in 2016. The four editions of the school were partially funded by INGV of Palermo and Catania, European Geoscience Union (EGU), Società Geochimica Italiana (SoGeI) and Associazione Naturalistica Geode. The conceptual idea of the school is to share scientific knowledge and experiences in the geochemical community, using local resources with a low-cost organization in order to allow as many students as possible access to the school. The “Etna International Training School of Geochemistry. Science meets practice” is addressed to senior graduate students, postdoctoral researchers, fellows, and newly appointed assistant professors, aiming to bring together the next generation of researchers active in studies concerning the geochemistry and the budget of volcanic gases. Introduce the participants with innovative direct sampling and remote sensing techniques. Furthermore, it gives young scientists an opportunity to experiment and evaluate new protocols and techniques to be used on volcanic fluid emissions covering a broad variety of methods. The teaching approach includes theoretical sessions (lectures), practical demonstrations and field applications, conducted by international recognized geochemists. We thank all the teachers who helped to make the school possible, among these: Tobias Fischer (University of New Mexico Albuquerque), Jens Fiebig (Institut für Geowissenschaften Goethe-Universität Frankfurt am Main), Andri Stefansson (University of Iceland, Institute of Earth Sciences), Mike Burton (University of Manchester), Nicole Bobrowski (Universität Heidelberg Institute of Environmental Physics and Max Planck Institute for Chemistry), Alessandro Aiuppa (Università di Palermo), Franco Tassi (Università di Firenze), Walter D’Alessandro (INGV of Palermo), Fatima Viveiros (University of the Azores). Direct sampling of high-to-low temperature fumaroles, plume measurement techniques (using CO2/SO2 sensors such as Multi-GAS instruments, MAX-DOAS instruments and UV SO2 cameras, alkaline traps and particle filters), measurement of diffuse soil gas fluxes of endogenous gases (CO2, Hg0, CH4 and light hydrocarbons), sampling of mud volcanoes, groundwaters and bubbling gases. Sampling sites include the active summit craters, eruptive fractures and peripheral areas. The students have shown an active participation both to the lessons and the fieldworks. Most of them describe the school as formative and useful experience for their future researches. Their enthusiasm is the real engine of this school

Etna International Training School of Geochemistry. Science meets Practice

Also this year, the \u201cEtna International Training School of Geochemistry. Science meets practice\u201d took place at Mt. Etna, now in its fourth edition. The school was hosted in the historical Volcanological Observatory \u201cPizzi Deneri\u201d, one of the most important sites of the INGV - Osservatorio Etneo for geochemical and geophysical monitoring. Mount Etna, located in eastern Sicily, is the largest active volcano in Europe and one of the most intensely degassing volcanoes of the world [Allard et al., 1991; Gerlach, 1991]. Mt Etna emits about 1.6 % of global H2O fluxes from arc volcanism [Aiuppa et al., 2008] and 10 % of global average volcanic emission of CO2 and SO2 [D\u2019Alessandro et al., 1997; Caltabiano et al., 2004; Aiuppa et al., 2008; Carn et al., 2017]. Furthermore, Gauthier and Le Cloarec, [1998] underscored that Mt. Etna is an important source of volcanic particles, having a mass flux of particle passively released from the volcano during non-eruptive period estimated between 7 to 23 tons/day [Martin et al., 2008; Calabrese et al., 2011]. In general, Etna is considered to be still under evolution and rather \u2018friendly\u2019, which, along with the above, makes it a favorable natural laboratory to study volcanic geochemistry. The Observatory Pizzi Deneri was sponsored by Haroun Tazieff, and it was built in 1978 by the CNR - International Institute of Volcanology under the direction of Prof. Letterio Villari. It is located at the base of the North-East crater (2,850 m a.s.l.), near the Valle del Leone and it was built on the rim of the Ellittico caldera. A picturesque building, consisting of two characteristics domes in front of the breath-taking panorama of the summit craters. Even though it is quite spartan as an accommodation facility, the dormitories, kitchen, seminar room and laboratory are well equipped. In other words, the Pizzi Deneri observatory is a unique place close to the top of the most active volcano of Europe. The observatory lies in a strategic location making it one of the most important sites for monitoring, research and dissemination of the scientific culture. After six field multidisciplinary campaigns (2010-2015) organized by a group of researchers of several institutions (INGV of Palermo, Catania, Naples, Bologna; Universities of Palermo, Florence, Mainz, Heidelberg), the idea of sharing and passing on the experience to the new generation of students has materialized, and the \u201cEtna International Training School of Geochemistry. Science meets practice\u201d was born in 2016. The four editions of the school were partially funded by INGV of Palermo and Catania, European Geoscience Union (EGU), Societ\ue0 Geochimica Italiana (SoGeI) and Associazione Naturalistica Geode. The conceptual idea of the school is to share scientific knowledge and experiences in the geochemical community, using local resources with a low-cost organization in order to allow as many students as possible access to the school. The \u201cEtna International Training School of Geochemistry. Science meets practice\u201d is addressed to senior graduate students, postdoctoral researchers, fellows, and newly appointed assistant professors, aiming to bring together the next generation of researchers active in studies concerning the geochemistry and the budget of volcanic gases. Introduce the participants with innovative direct sampling and remote sensing techniques. Furthermore, it gives young scientists an opportunity to experiment and evaluate new protocols and techniques to be used on volcanic fluid emissions covering a broad variety of methods. The teaching approach includes theoretical sessions (lectures), practical demonstrations and field applications, conducted by international recognized geochemists. We thank all the teachers who helped to make the school possible, among these: Tobias Fischer (University of New Mexico Albuquerque), Jens Fiebig (Institut f\ufcr Geowissenschaften Goethe-Universit\ue4t Frankfurt am Main), Andri Stefansson (University of Iceland, Institute of Earth Sciences), Mike Burton (University of Manchester), Nicole Bobrowski (Universit\ue4t Heidelberg Institute of Environmental Physics and Max Planck Institute for Chemistry), Alessandro Aiuppa (Universit\ue0 di Palermo), Franco Tassi (Universit\ue0 di Firenze), Walter D\u2019Alessandro (INGV of Palermo), Fatima Viveiros (University of the Azores). Direct sampling of high-to-low temperature fumaroles, plume measurement techniques (using CO2/SO2 sensors such as Multi-GAS instruments, MAX-DOAS instruments and UV SO2 cameras, alkaline traps and particle filters), measurement of diffuse soil gas fluxes of endogenous gases (CO2, Hg0, CH4 and light hydrocarbons), sampling of mud volcanoes, groundwaters and bubbling gases. Sampling sites include the active summit craters, eruptive fractures and peripheral areas. The students have shown an active participation both to the lessons and the fieldworks. Most of them describe the school as formative and useful experience for their future researches. Their enthusiasm is the real engine of this school

Ocrelizumab reduces cortical and deep grey matter loss compared to the S1P-receptor modulator in multiple sclerosis

Introduction: Ocrelizumab (OCR) and Fingolimod (FGL) are two high-efficacy treatments in multiple sclerosis which, besides their strong anti-inflammatory activity, may limit neurodegeneration. Aim: To compare the effect of OCR and FGL on clinical and MRI endpoints. Methods: 95 relapsing-remitting patients (57 OCR, 38 FGL) clinically followed for 36 months underwent a 3-Tesla MRI at baseline and after 24 months. The annualized relapse rate, EDSS, new cortical/white matter lesions and regional cortical and deep grey matter volume loss were evaluated. Results: OCR reduced the relapse rate from 0.48 to 0.04, FGL from 0.32 to 0.05 (both p < 0.001). Compared to FGL, OCR-group experienced fewer new white matter lesions (12% vs 32%, p = 0.005), no differences in new cortical lesions, lower deep grey matter volume loss (- 0.12% vs - 0.66%; p = 0.002, Cohen's d = 0.54), lower global cortical thickness change (- 0.45% vs - 0.70%; p = 0.036; d = 0.42) and reduced cortical thinning/volume loss in several regions of interests, including those of parietal gyrus (d-range = 0.65-0.71), frontal gyrus (d-range = 0.47-0.60), cingulate (d-range = 0.41-0.72), insula (d = 0.36), cerebellum (cortex d = 0.72, white matter d = 0.44), putamen (d = 0.35) and thalamus (d = 0.31). The effect on some regional thickness changes was confirmed in patients without focal lesions. Conclusions: When compared with FGL, patients receiving OCR showed greater suppression of focal MRI lesions accumulation and lower cortical and deep grey matter volume loss