Enhanced influenza A H1N1 T cell epitope recognition and cross-reactivity to protein-O-mannosyltransferase 1 in Pandemrix-associated narcolepsy type 1.

Narcolepsy type 1 (NT1) is a chronic neurological disorder having a strong association with HLA-DQB1*0602, thereby suggesting an immunological origin. Increased risk of NT1 has been reported among children or adolescents vaccinated with AS03 adjuvant-supplemented pandemic H1N1 influenza A vaccine, Pandemrix. Here we show that pediatric Pandemrix-associated NT1 patients have enhanced T-cell immunity against the viral epitopes, neuraminidase 175-189 (NA175-189) and nucleoprotein 214-228 (NP214-228), but also respond to a NA175-189-mimic, brain self-epitope, protein-O-mannosyltransferase 1 (POMT1675-689). A pathogenic role of influenza virus-specific T-cells and T-cell cross-reactivity in NT1 are supported by the up-regulation of IFN-γ, perforin 1 and granzyme B, and by the converging selection of T-cell receptor TRAV10/TRAJ17 and TRAV10/TRAJ24 clonotypes, in response to stimulation either with peptide NA175-189 or POMT1675-689. Moreover, anti-POMT1 serum autoantibodies are increased in Pandemrix-vaccinated children or adolescents. These results thus identify POMT1 as a potential autoantigen recognized by T- and B-cells in NT1.

The significance of supportive and undermining elements in the maternal representations of an unborn baby.

OBJECTIVE: The maternal representations of an unborn baby begin to develop during pregnancy. However, the factors that moderate them are not well identified. The objective of this study was to jointly explore supportive and undermining factors in the maternal representations of an unborn baby and motherhood. METHODS: Cross-sectional data comprising 1646 women studied during the third trimester of pregnancy. Maternal expectations were measured using a 12-item self-report questionnaire, Mother's Representations about an Unborn Baby. Depression, anxiety, family atmosphere and adult attachment were measured using standardised questionnaires. Statistical analysis is based on multivariate linear regression analysis. RESULTS: The most powerful predictors of a mother's prenatal expectations were the mother's educational status, age, closeness in adult relationships, higher levels of depressive symptoms and family atmosphere. In accordance with our hypothesis, depression was related to the mother's more negative expectations on their relationship with the unborn baby and on regularity in the baby's sleeping and eating patterns. A positive family atmosphere and the mother's ability for closeness and dependence (i.e. confidence) in adult relationships were related to more positive expectations of the mother-unborn baby relationship. On the other hand, stress, anxiety and adverse life events were not related to the mother's expectations of her unborn baby. CONCLUSIONS: The results may be helpful in identifying families who need early professional support and call for studies where the prenatal phase is explored as a proactive phase for the development of the child-parent relationship.

Subjective daytime sleepiness and its predictors in Finnish adolescents in an interview study.

UNLABELLED: The purpose of this study is to evaluate the predictors of subjective daytime sleepiness (SDS) and its chronicity in adolescents. Two groups of adolescents (107 with SDS and 107 without SDS) from our first questionnaire study were invited to an interview after 3 y. A follow-up questionnaire had been sent to them one year earlier. The interview included questions about sleep, daytime sleepiness, living habits, physical and mental health, and progress at school. The adolescents were also examined clinically. Interviews were conducted with 66 out of 107 subjects with SDS and 64 out of 107 without SDS (age range 12 to 19 y). In this interview 42 out of the 130 adolescents had SDS. A total of 20 adolescents reported SDS in both questionnaire studies and in the interview (chronic SDS). In a multivariate analysis (logistic regression) sleep disorders, frequent medication and depressive emotions were significantly associated with SDS. Chronic SDS was connected in a bivariate analysis (Pearson's chi-square) with excessive night waking, difficulty in falling asleep, dreaming, frequent medication, frequent alcohol drinking, and irregular breakfast eating, and in our previous studies also with delayed sleep rhythm. CONCLUSION: Sleep disorders and health problems were more common causes of SDS than undesirable living habits. However, alcohol drinking and delayed sleep rhythm were associated with chronic SDS in addition to sleep disorders and medication.

Subjective daytime sleepiness in schoolchildren.

OBJECTIVES: The aim of this study was to find out how the occurrence of subjective daytime sleepiness (SDS) in schoolchildren had changed after 2 years follow-up and which were the predictors associated with persistence and appearance of SDS. METHODS: A total of 107 schoolchildren with SDS (Group 1) and an equal number without SDS (Group 2) were chosen to take part in the questionnaire study (age range 12-20 years). The questions concerned sleeping habits, sleep disorders and daytime sleepiness of the child and the family, progress at school and TV/video watching of the child, and social background of the family. A bivariate method (Pearson's chi-square) was used as a statistical tool. RESULTS: We received 68 replies (64%) from Group 1 and 75 (70%) from Group 2. Fifty-four schoolchildren were still sleepy in Group 1 and 28% had become sleepy in Group 2. The persistence of SDS in Group 1 was related to older age, irregular sleeping habits, frequent night waking and the fathers' sleep difficulties. The appearance of SDS in Group 2 was related to a high average grade at school. CONCLUSION: A delayed sleep phase rhythm and problems staying asleep are obvious causes of persistent SDS, but the stress of schoolwork can also cause daytime sleepiness in schoolchildren.

A new visual performance test offers new variables for assessing daytime vigilance: short pauses in performance.

A new visual performance test, VigiMouse, was evaluated with the aid of 6 volunteering pediatry residents. The results were compared with a visual analogue scale in differentiating four different states: mild sleep deprivation, low blood alcohol level, a combination of both, and the normal state. A normal night shift at a busy pediatric ward was chosen to represent sleep deprivation. A new set of parameters based on short pauses in performance proved to be more sensitive in detecting small changes in performance than parameters based on reaction times.

Accidental astemizole overdose in young children.

6 cases of accidental astemizole poisoning in children have been reported to the Finnish Poison Information Center. The children were aged 1 year 7 months to 3 years 4 months and had taken doses of 2.5 to 16.7 mg/kg, at least twelve times that recommended. In 2 children the overdose was verified by measurement of drug concentrations. Despite measures to prevent drug absorption prolonged QTc-interval, a sign of cardiac toxicity, was found in all 5 children on whom an electrocardiogram was available for analysis, and severe ventricular arrhythmias developed in 1. Young children with accidental astemizole overdose should be carefully monitored in hospital. Similar precautions may be justified in cases of overdose with other selective H1-histamine receptor antagonists.

Screening a family for hereditary chronic pancreatitis.

Chronic "idiopathic" pancreatitis (CP) in a 7 year-old-boy, whose father has suffered from CP, and whose former grandfather had suffered from pains possibly of pancreatic origin, led us suspect a hereditary etiology. An analysis, extended in a control fashion to the relatives of the healthy spouse of the affected grandfather, surprisingly revealed 2 more proven and 3 more suspected CP, giving the overall number of 8 affected members in this 35-member 3 generation kindred and revealed a maternal heredity instead of paternal heredity (which was first thought to be apparent). We therefore recommend that in a family suspected to suffer from hereditary CP (HCP), a screening should be extended to cover even the unaffected spouse's family--the present extended study revealed for 23 new members them to belong in an affected family. Without an extensive screening advises for family planning, alcohol consumption etc. can not be given. Plain abdominal X-ray accompanied with epigastric ultrasonographic are suitable for screening, which might be extended to every individual in smaller families, but may be safely restricted to the members ever suffered from epigastric pains in the case of a huge family. Pancreatic duct anomalies, hyperlipidaemia, hypercalcaemia, aminoaciduria or hyperimmunoglobulinaemia, all of which have been seen to accompany HCP, were not present in this family. Neither was any linkage found between the penetrance of HCP and ABO/Rh blood groups or HLA haplotypes.