Neuronal clusterin expression is associated with cognitive protection in amyotrophic lateral sclerosis.

AIMS: Clusterin is a topologically dynamic chaperone protein with the ability to participate in both intra- and extacellular proteostasis. Clusterin has been shown to be upregulated in the spinal cord of patients with amyotrophic lateral sclerosis (ALS) and has been shown to protect against TDP-43 protein misfolding in animal and cell models. Previous studies have demonstrated an association between the pathological burden of TDP-43 misfolding and cognitive deficits in ALS, demonstrating high specificity, but correspondingly low sensitivity owing to a subset of individuals with no evidence of cognitive deficits despite a high burden of TDP-43 pathology, called mismatch cases. METHODS: Hypothesizing that differences in the ability to cope with protein misfolding in these cases may be due to differences in expression of protective mechanisms such as clusterin expression, we assessed the spatial expression of clusterin and another chaperone protein, HspB8, in post mortem brain tissue of mismatch cases. We employed a modified in situ hybridization technique called BaseScope, with single cell, single transcript resolution. RESULTS: Mismatch cases demonstrated differential spatial expression of clusterin, with a predominantly neuronal pattern, compared to cases with cognitive manifestations of their TDP-43 pathology who demonstrated a predominantly glial distribution of expression. CONCLUSIONS: Our data suggest that, in individuals with TDP-43 pathology, predominantly neuronal expression of clusterin in extra-motor brain regions may indicate a cell protective mechanism delaying clinical manifestations such as cognitive dysfunction.

Validation of the new consensus criteria for the diagnosis of corticobasal degeneration.

BACKGROUND: Corticobasal degeneration (CBD) is a complex neurodegenerative disorder. Accurate diagnosis is increasingly important, with the advent of clinical trials of drugs aimed at modifying the underlying tau pathology. CBD often presents with a 'corticobasal syndrome' including impairments of movement and cognition. However, patients with similar corticobasal syndromes can have neurodegenerative pathologies that are not CBD. In addition, patients with CBD may present with aphasia or behavioural change. The clinical diversity of CBD and mimicry by non-CBD pathologies hinders accurate diagnosis. METHODS: We applied the new consensus criteria of Armstrong and colleagues et al 1 to a cohort of patients with detailed longitudinal clinical evaluation and neuropathology. RESULTS: In patients with pathologically confirmed CBD, accuracy of diagnosis was similar under the new and previous criteria: 9/19 (47%) met criteria for probable CBD at presentation, 13/19 (68%) at last clinical assessment. Patients with a corticobasal syndrome but without CBD pathology all (14/14) met the new diagnostic criteria of probable or possible CBD, demonstrating that the new criteria lacks the necessary specificity for an accurate ante mortem clinical diagnosis of CBD. None of the clinical features used in the new criteria were more common in the patients with CBD pathology (n=19) than without (n=14). CONCLUSIONS: The Armstrong criteria usefully broadens the recognised clinical phenotype of CBD but does not sufficiently improve the specificity of diagnosis to increase the power of clinical trials or targeted applications of tau-based disease-modifying therapies. Further work is required to show whether biomarkers could be more effective than clinical signs in the diagnosis of CBD.

Sirolimus reduces the risk of significant hepatic fibrosis after liver transplantation for hepatitis C virus: a single-center experience.

INTRODUCTION: Hepatitis C virus (HCV) recurrence following orthotopic liver transplantation is an expected outcome in all patients transplanted for a primary diagnosis of HCV. HCV recurrence has been shown to be associated with graft fibrosis and graft loss. Recent studies suggest that sirolimus (SRL) therapy may slow or inhibit hepatic fibrosis following liver transplant in patients positive for HCV at the time of transplant. METHODS: Among 313 patients who underwent orthotopic liver transplantation for HCV between 2000 and 2009, 251 qualified for inclusion in the study. Per protocol liver biopsies were performed on all patients at 1 year following liver transplantation and/or at the time of a clinical diagnosis of HCV recurrence. Biopsies were scored for fibrosis using the Batts-Ludwig staging system (0-4); significant fibrosis was defined as fibrosis ≥ stage 2. RESULTS: Overall, there was no difference in overall survival or graft loss in the SRL compared with the control group. Multivariate analysis revealed SRL therapy to be associated with decreased odds of significant hepatic fibrosis at year 1 postoperatively and over the study duration. CONCLUSIONS: This retrospective, single-center study showed sirolimus-based immunosuppression to be associated with a lower risk of significant graft fibrosis, both at year 1 and throughout the study period, following liver transplantation in HCV-infected recipients.

Autobiographical memory in progressive supranuclear palsy.

BACKGROUND: We aimed to investigate recall of autobiographical memories across lifetime periods in patients with progressive supranuclear palsy (PSP). METHOD: Patients with PSP (n = 10) were given a test of autobiographical and personal semantic information and the Addenbrooke's Cognitive Examination (ACE). The result was compared to 30 matched neurologically intact participants. RESULT: A mild autobiographical memory impairment was observed in PSP without a temporal gradient for the recall of autobiographical or personal semantic information. Performance correlated with verbal fluency in ACE. CONCLUSION: Patients with PSP show mild deficits in autobiographical memory, which is likely to reflect a frontal retrieval deficit.

Emotion recognition in progressive supranuclear palsy.

Progressive supranuclear palsy (PSP) is an atypical parkinsonian syndrome characterised by akinesis, rigidity, falls, supranuclear gaze palsy and cognitive, particularly executive, dysfunction. This study examined the extent to which emotion recognition is affected by PSP. Although deficits in the recognition of emotion have been reported in several diseases which share clinicopathological characteristics with PSP, it has never been studied systematically in PSP. Twenty-four patients with probable or definite PSP and matched healthy controls were studied using tests of facial identity and facial emotion recognition. Patients were not impaired in recognising famous faces, but they showed significant deficits in the recognition of emotions, particularly negative emotions. Moreover, emotion recognition was strongly correlated with the severity of other cognitive deficits in PSP, but not disease duration. Deficits in emotion recognition form an integral part of the cognitive spectrum of the disease. The findings point to the pathological involvement of key regions necessary for the processing of emotions and to a subtype of PSP with cognitive and emotion recognition impairments. The acknowledgement of deficits in emotion recognition is important for management of both patients and their carers.

Liver transplantation for primary biliary cirrhosis: results of aggressive corticosteroid withdrawal.

INTRODUCTION: A subset of patients with primary biliary cirrhosis (PBC) may require long-term corticosteroid (CS) therapy following liver transplantation (OLT) due to concern over the possibility of recurrence. Our center has attempted to minimize CS use in all of our OLT recipients. In this study, we review our experience in this cohort to determine (1) patient outcome including PBC recurrence following transplantation and (2) the long-term requirement for CS use in PBC patients. METHODS: From 1988 to 2006, 1102 OLTs were performed in 1032 adults at the University of Colorado, of which 70 patients (6.8%) with PBC received 74 allografts. Bivariate and multivariate analyses were used to evaluate predictors of CS withdrawal. Thirteen potential predictors of CS discontinuation were considered: age, gender, body mass index (BMI), race, type of graft (cadaveric or living donor [LD]), recurrence of PBC, warm ischemia time, and immunosuppressant. RESULTS: Overall survival at 5 years was 85%. The 1-, 5-, and 10-year recurrence-free survivals were 90%, 72%, and 54%, respectively. PBC recurred in 18 patients (25.7%). Of these, none received a second transplant due to disease recurrence. At the time of last follow-up, 73% of recipients were steroid free. Independent predictors of CS discontinuation are age (>54; P = .0059) and LD graft type (P = .0008). Conversely, cyclosporine (P = .0007), female gender (P = .0216), and BMI > 31 (P = .0306) were negatively associated with CS withdraw. Importantly, steroid discontinuation did not influence PBC recurrence. CONCLUSIONS: While long-term outcomes in PBC patients are favorable, disease recurrence can generally be managed medically without the need for a second transplant. Using an aggressive CS minimization approach, nearly three-quarters of the patients were CS free at the time of last follow-up. Increasing age and LD grafts were associated with successful CS withdraw. Conversely, cyclosporine use, female gender, and increasing BMI were associated with unsuccessful steroid discontinuation.

Reactivity of titanium dioxide with oxygen at room temperature and the related charge transfer.

The measurements of electron work function were applied for in situ monitoring of the charge transfer during oxidation and reduction for well-defined titanium dioxide, TiO 2, at room temperature. The TiO 2 specimen was initially standardized at 1173 K in the gas phase of controlled oxygen activity, at p(O 2) = 10 Pa, and then cooled down in the same gas phase. The work function changes were monitored during oxidation at room temperature at p(O 2) = 75 kPa and subsequent reduction at p(O 2) = 10 Pa. It is shown that oxidation of TiO 2 at room temperature results in fast oxygen chemisorption, involving initially the formation of singly ionized molecular oxygen species, followed by the formation of singly ionized atomic oxygen species, and subsequent slow oxygen incorporation. Although all these processes lead to work function increase, the components of the work function changes related to the individual processes may be distinguished based on different kinetics. The obtained work function data indicate that oxidation results in rapid surface coverage with singly ionized molecular oxygen species, which are subsequently dissociated leading to the formation of singly ionized atomic species. The related chemisorption equilibria are established within 2 and 5 h, respectively. Oxygen incorporation leads to slow work function changes, which achieve a maximum within 100 h. The determined work function data were assessed by using a theoretical model that describes the electrical effects related to different mechanisms of TiO 2 oxidation. The work function data indicate that oxygen incorporation leads to structural changes of the outermost surface layer resulting, in consequence, in a change of the external work function component. Reimposition of the initial gas phase, p(O 2) = 10 Pa, leads to partial desorption of weakly adsorbed molecular species formed during oxidation.

Focal cortical presentations of Alzheimer's disease.

To determine the frequency of Alzheimer's disease (AD) pathology in patients presenting with progressive focal cortical syndromes, notably posterior cortical atrophy (PCA), corticobasal syndrome (CBS), behavioural variant frontotemporal dementia (bvFTD), progressive non-fluent aphasia (PNFA) (or a mixed aphasia) and semantic dementia (SD); and to compare the age of onset, evolution and prognosis in patients with focal cortical presentations of AD versus more typical AD and those with non AD pathology. From a total of 200 patients with comprehensive prospective clinical and pathological data we selected 120 : 100 consecutive cases with focal cortical syndromes and 20 with clinically typical AD. Clinical files were reviewed blind to pathological diagnosis. Of the 100 patients with focal syndromes, 34 had AD as the primary pathological diagnosis with the following distribution across clinical subtypes: all 7 of the PCA (100%); 6 of 12 with CBS (50%); 2 of 28 with bvFTD (7.1%); 12 of 26 with PNFA (44.1%); 5 of 7 with mixed aphasia (71.4%) and 2 of 20 with SD (10%). Of 20 with clinically typical AD, 19 had pathological AD. Age at both onset and death was greater in the atypical AD cases than those with non-AD pathology, although survival was equivalent. AD is a much commoner cause of focal cortical syndromes than previously recognised, particularly in PCA, PNFA and CBS, but rarely causes SD or bvFTD. The focal syndrome may remain pure for many years. Patients with atypical AD tend to be older than those with non-AD pathology.

Electrical properties of niobium-doped titanium dioxide. 1. Defect disorder.

The present work reports the electrical conductivity and thermoelectric power for Nb-doped TiO(2) at elevated temperatures (1073-1298 K) in the gas phase of controlled oxygen activity, 10(-14) Pa < p(O(2)) < 75 kPa. It is shown that in reduced conditions the Nb-doped TiO(2) exhibits metallic-type conductivity. This finding paves the way for the development of high-performance photoelectrodes with substantially reduced internal energy losses during charge transport. The present work also determined the equilibrium constant for the formation of oxygen vacancies and titanium vacancies for Nb-doped TiO(2).

Electrical properties of niobium-doped titanium dioxide. 2. Equilibration kinetics.

The present work reports isothermal gas/solid equilibration kinetics for Nb-doped TiO(2) (0.65 atom %) at elevated temperatures (1073-1298 K) within narrow ranges of oxygen activity spanning between 10(-13) Pa and 75 kPa. The equilibration kinetics were monitored using electrical conductivity measurements. The kinetic data were used to determine the chemical diffusion coefficient (D(chem)). D(chem) as a function of p(O(2)) exhibits a complex dependence, which is considered in terms of defect disorder and the related concentrations of electronic charge carriers. The activation energy of D(chem) in the p(O(2)) range 10 Pa < p(O(2)) < 75 kPa varies in the range 88.0-98.2 kJ/mol. It is important to note that the chemical diffusion coefficient in strongly reduced conditions [p(O(2)) = 10(-9) Pa] exhibits a negative temperature dependence of D(chem) (-67.2 kJ/mol). This finding indicates that under these conditions transport in a chemical potential gradient is consistent with metallic charge transport.

Defect disorder of titanium dioxide.

The present work derived defect disorder diagram representing the effect of oxygen activity on the concentration of both ionic and electronic defects for undoped TiO2. This diagram was determined using the equilibrium constants derived in the present work, including (i) the intrinsic electronic equilibrium constant, (ii) the equilibrium constant for the formation of oxygen vacancies, and (iii) equilibrium constant for the formation of titanium vacancies. These equilibrium constants are consistent with three properties determined independently, including: electrical conductivity, thermoelectric power and change of mass determined by thermogravimetry. The derived defect disorder diagram may be used for tailoring semiconducting properties of TiO2 that are desired for specific applications through the selection of optimized processing conditions.

TiO2 surface active sites for water splitting.

The mechanism of photoreactivity between the TiO(2) surface and H(2)O, and the related charge transfer, is considered in terms of both collective and local properties. It is shown that the effective charge transfer between TiO(2) and water requires the presence of surface active sites that are able to provide electron holes to adsorbed water molecules. Titanium vacancies located at or near the surface are identified as the active sites for water adsorption leading to the formation of an active complex and resulting, in consequence, in water splitting. A model of the photoreactivity between the TiO(2) surface and water is proposed. This model indicates that the photoreactivity of the TiO(2)-based photoelectrode may be enhanced through imposition of the surface active sites (Ti vacancies) in a controlled manner by surface engineering.

Outcomes of donor evaluations for adult-to-adult right hepatic lobe living donor liver transplantation.

The purpose of this study is to determine the role of liver biopsy and outcome of patients undergoing donor evaluation for adult-to-adult right hepatic lobe living donor liver transplantation (LDLT). Records of patients presenting for a comprehensive donor evaluation between 1997 and February 2005 were reviewed. Liver biopsy was performed only in patients with risk factors for abnormal histology. Two hundred and sixty patients underwent a comprehensive donor evaluation and 116 of 260 (45%) were suitable for donation, 14 of 260 (5.4%) did not complete evaluation and 130 of 260 (50%) were rejected. Four patients underwent unsuccessful hepatectomy surgery due to discovery of intraoperative abnormalities. Between 1997 and 2001, the acceptance rate of donor candidates (63%) was higher than 2002-2005 (36%), p < 0.0001. Sixty-six of the 150 eligible patients (44%) fulfilled criteria for liver biopsy and 28 of 66 (42%) had an abnormal finding. Less than half of the patients undergoing donor evaluation were suitable donors and the donor acceptance rate has declined over time. A large proportion of the patients undergoing liver biopsy have abnormal findings. Our evaluation process failed to identify 4 of 103 who had aborted donor surgeries.

Electrical properties and defect chemistry of TiO2 single crystal. I. Electrical conductivity.

The present work reports the electrical properties of high-purity single-crystal TiO(2) from measurements of the electrical conductivity in the temperature range 1073-1323 K and in gas phases of controlled oxygen activities in the range 10(-13) to 10(5) Pa. The effect of the oxygen activity on the electrical conductivity indicates that oxygen vacancies are the predominant defects in the studied ranges of temperature and oxygen activities. The electronic and ionic lattice charge compensations were revealed at low and high oxygen activities, respectively. The determined semiconducting quantities include: the activation energy of the electrical conductivity (E(sigma) = 125-205 kJ.mol(-1)), the activation energies of the electrical conductivity components associated with electrons (E(n) = 218 kJ.mol(-1)), electron holes (E(p) = 34 kJ.mol(-1)), and ions (E(i) = 227 kJ.mol(-1)), and the enthalpy of motion for electronic defects (DeltaH(m) = 4 kJ/mol). The electrical conductivity data are considered in terms of the components related to electrons, holes, and ions. The obtained data allow the determination of the n-p demarcation line in terms of temperature and oxygen activities. The band gap determined from the electronic component of the electrical conductivity is 3.1 eV.

Electrical properties and defect chemistry of TiO2 single crystal. II. Thermoelectric power.

The present work reports the thermoelectric power of high-purity single-crystal TiO(2) in the temperature range 1073-1323 K and in gas phases of controlled oxygen activities, p(O(2)), in the range 10(-13) to 7.5 x 10(4) Pa. The thermoelectric power versus log p(O(2)) dependence for strongly reduced TiO(2) at p(O(2)) < 10(-5) Pa may be approximated by a slope of 1/6, which is consistent with the defect disorder governed by electronic charge compensation of oxygen vacancies. The thermoelectric power data confirm that oxygen vacancies are the predominant ionic defects. These data indicate that TiO(2) at high p(O(2)) exhibits p-type properties. It is shown that the p(O(2)) related to the n-p transition increases with increase of temperature.

Electrical properties and defect chemistry of TiO2 single crystal. III. Equilibration kinetics and chemical diffusion.

The equilibration kinetics of high-purity single-crystal TiO(2) were monitored using measurements of electrical conductivity in the temperature range 1073-1323 K and oxygen activity, p(O(2)), range 10(-13) to 75 kPa. The kinetics data were used to determine the chemical diffusion coefficient (D(chem)) within narrow ranges of p(O(2)). There was observed a complex effect of the p(O(2)) on the D(chem), which exhibits a maximum at the n-p transition. The effect of the p(O(2)) on the D(chem) was discussed in terms of the defect disorder and the related semiconducting properties. The activation energy of the D(chem), which also varies with the p(O(2)), exhibits a maximum at p(O(2)) = approximately 10(4) Pa (143 kJ/mol).

Electrical properties and defect chemistry of TiO2 single crystal. IV. Prolonged oxidation kinetics and chemical diffusion.

Measurements of both electrical conductivity and thermoelectric power were used to monitor the equilibration kinetics of undoped single-crystal TiO(2) during prolonged oxidation at 1123 and 1323 K and p(O(2)) = 75 kPa. Two kinetics regimes were revealed: kinetics regime I (rapid kinetics), which is rate-controlled by the transport of oxygen vacancies, and kinetics regime II (slow kinetics), which is rate-controlled by the transport of titanium vacancies. The incorporation of titanium vacancies allows undoped p-type TiO(2) to be processed in a controlled manner. The kinetics data were used to determine the chemical diffusion coefficient (D(chem)) associated with the transport of titanium vacancies, which is equal to D(chem) = 8.9 x 10(-14) m(2) s(-1) and D(chem) = 9.3 x 10(-15) m(2) s(-1) at 1323 and 1123 K, respectively.

Visuospatial functions in atypical parkinsonian syndromes.

OBJECTIVES: Visuospatial deficits have been occasionally reported but never systematically studied in atypical parkinsonian syndromes. The interpretation of existing studies is complicated by the possible influence of motor and frontal executive deficits. Moreover, no attempt has been made to distinguish visuoperceptual from visuospatial tasks. The aim of the present study was to assess visuoperceptual and visuospatial abilities in three atypical parkinsonian syndromes while minimising the influence of confounding variables. METHODS: Twenty patients with multiple system atrophy (MSA), 43 with progressive supranuclear palsy (PSP), and 25 with corticobasal degeneration (CBD) as well as 30 healthy age matched controls were examined with the Visual Object and Space Perception Battery (VOSP). RESULTS: Visuospatial functions were intact in MSA patients. PSP patients showed mild deficits related to general cognitive decline and the severity of oculomotor symptoms. The CBD group showed the most pronounced deficits, with spatial tasks more impaired than object based tasks. Performance on object based, but not spatial, tasks was related to general cognitive status. The extent of the visuospatial impairment could not be predicted from disease duration or severity. CONCLUSION: Visuospatial functions are not consistently impaired in atypical parkinsonian syndromes. The degree and pattern of impairment varies across the diseases, suggesting that the observed deficits could have a different neural basis in each condition. The distinction between the object based ("ventral stream") and the space oriented ("dorsal stream") processing might be useful in the interpretation of visuospatial deficits in parkinsonian syndromes, especially in CBD.

Ubiquitin-positive inclusions and progression of pathology in frontotemporal dementia and motor neurone disease identifies a group with mainly early pathology.

Frontotemporal lobar degeneration (FTLD) with tau-negative, ubiquitin-positive inclusions has been a topic of major interest in recent years, with this group now accounting for the majority of tau-negative cases of frontotemporal degeneration. The severity of neurodegeneration in FTLD is dependent on the stage of disease and is substantial even in the earliest stages. Elucidating the pathogenesis of FTLD requires evaluation of changes during the earliest possible stage of disease. However, the long survival of most frontotemporal dementia cases means that cases with early neuropathology are not frequently encountered. Cases of FTLD with the shortest survival are those with coexisting motor neurone disease (FTLD + MND), making these the ideal group for studying early FTLD pathology. It is not clear, however, what the pathological contribution of MND is in these cases. This study evaluates the pathology of 20 cases of FTLD (11 with no clinical signs of MND and nine with FTLD + MND) as well as 10 cases of MND without dementia. Our findings indicate that the deposition of ubiquitin does not play a key role in the neurodegenerative process in FTLD, and that the severity of neurodegeneration in FTLD is similar in cases with and without clinical MND.

Subcortical dementia revisited: similarities and differences in cognitive function between progressive supranuclear palsy (PSP), corticobasal degeneration (CBD) and multiple system atrophy (MSA).

To examine the similarities and differences in cognitive function between three predominantly subcortical dementing disorders associated with parkinsonism we compared the profiles of cognitive performance in 39 patients with Progressive Supranuclear Palsy (PSP), 26 patients with Multiple System Atrophy (MSA) and 25 with Corticobasal Degeneration (CBD) with those of 30 patients with classic cortical dementia, Alzheimer's Disease (AD), using two different cognitive screening tests: Dementia Rating Scale (DRS) and Addenbrooke's Cognitive Examination (ACE). The cognitive profile on ACE and DRS subtests distinguished subcortical diseases from each other as well as from AD. All parkinsonian syndromes were characterized by a disproportionate impairment in verbal fluency, particularly letter fluency. The three diseases differed, however, in the degree of language, memory and visuospatial impairment. We conclude that similarities, as well as differences, between PSP, MSA and CBD can be detected using a brief, clinically applicable cognitive screening test. The pattern of cognitive impairment is likely to reflect a different distribution of pathology, in particular a higher degree of cortical involvement in PSP and CBD.