Serum netrin-1 in relation to gadolinium-enhanced magnetic resonance imaging in early multiple sclerosis.

BACKGROUND: Netrin-1, a secreted laminin-related protein, is known to regulate not only axonal guidance and neuronal cell migration, but also blood-brain barrier integrity and inflammation. Two preliminary studies reported altered serum netrin-1 levels in multiple sclerosis; however, associations with longitudinal clinical and magnetic resonance imaging activity have not been investigated. OBJECTIVES: We aimed to assess serum netrin-1 in multiple sclerosis and controls with respect to disease activity and its temporal dynamics. METHODS: Serum netrin-1 was assessed by enzyme-linked immunosorbent assay in 79 patients with clinically isolated syndrome or multiple sclerosis, and 30 non-inflammatory neurological disease controls. In patients, serum samples were collected immediately prior to gadolinium-enhanced 3 T magnetic resonance imaging at two time points (initial contrast-enhancing gadolinium+ n = 47, non-enhancing gadolinium- n = 32; reference gadolinium- n = 70; median time-lag 1.4, interquartile range 1.0-2.3 years). RESULTS: Serum netrin-1 levels were similar in clinically isolated syndrome, multiple sclerosis and controls, and gadolinium+ and gadolinium- patients. Among gadolinium+ patients, serum netrin-1 was decreased in clinically active (n = 8) vs non-active patients (n = 39; p = 0.041). Serum netrin-1 showed no temporal dynamics in multiple sclerosis and was unrelated to clinical data. CONCLUSIONS: Serum netrin-1 levels show no multiple sclerosis specific changes and are not sensitive for detection of subclinical disease activity. Netrin-1 changes during relapses may deserve further examination.

Epidemiological aspects of sleep in general public and hospital outpatient samples.

A survey designed to elicit the subjective effect of specific influences on sleep duration and sleep quality was carried out. The sample consisted of 400 individuals selected in a random manner from the general population and a further 400 individuals representing consecutive attenders at the outpatient department of a large teaching hospital. The response rate for the two groups was 97% and 99% respectively. In a question regarding habits which aid in sleep onset, four-fifths of those exercising with a frequency of at least twice per month spontaneously reported exercise as a factor in promoting sleep.

Stability of Le Fort III advancement surgery in children with Crouzon's, Apert's, and Pfeiffer's syndromes.

The records of 19 children who had undergone Le Fort III advancement surgery were used to assess the stability of the midfacial segment following surgery. Cephalometric radiographs of each individual were analyzed longitudinally. The average forward movement of the maxilla at the time of surgery was 12.4 mm. The average amount of relapse for the group was 9.4 percent in the horizontal plane of space and 5.5 percent in the vertical plane of space. The data obtained from this sample indicate that the Le Fort III advancement is a relatively stable procedure. The amount of relapse or stability that occurs following Le Fort III advancement is related to rigid stabilization of the midfacial segment with buttressing bone grafts, transosteotomy wiring, and intermaxillary fixation or bone plating during the postoperative healing phase.

Maxillary growth following LeFort III advancement surgery in Crouzon, Apert, and Pfeiffer syndromes.

This was a cephalometric study of maxillary growth following LeFort III osteotomy in children with Crouzon, Apert, and Pfeiffer (CAP) syndromes. Nineteen children who had undergone LeFort III advancement osteotomies were followed postoperatively for an average of 5.3 years. Data for horizontal and vertical maxillary growth increments were obtained and compared with data of a control group of unoperated CAP children and with normal data. The findings indicate that horizontal maxillary growth following surgical treatment is negligible (less than 0.1 mm/yr), and differs from unoperated CAP children (0.7 mm/yr) and normal children (1.3 mm/yr). Vertical maxillary growth following surgery is identical to that in unoperated CAP and normal children, amounting to 1.3 mm/yr. The LeFort III osteotomy during childhood is a justifiable procedure for physiologic and psychologic reasons. Horizontal maxillary growth, for all practical purposes, is eliminated by this procedure and a subsequent maxillary advancement is invariably required at the completion of growth.