A diagnostic approach that may help to discriminate inherited thrombocytopenia from chronic immune thrombocytopenia in adult patients

Inherited thrombocytopenia (IT) is a heterogeneous group of rare diseases that are often confused with immune thrombocytopenia (ITP). The objective of this study was to supply clinicobiological elements that allow a distinction to be drawn between IT and chronic ITP. We then compared 23 adult patients with IT and 9 patients with chronic ITP. Our study revealed six discriminating criteria: (i) an age of discovery <34 years: positive predictive value (PPV) = 88.2% [63.6; 98.5], (ii) a family history of thrombocytopenia: PPV = 100.0% [82.4; 100.0], (iii) a personal history of bleeding: PPV = 100% [76.8; 100.0], (iv) a mean platelet volume >11 fL: PPV = 93.3% [68.1; 99.8], (v) an excess of giant platelets on blood smear: 100.0% [76.8; 100.0], and (vi) a percentage >44% of platelets with a surface area >4 µm(2) in electron microscopy: PPV = 83.3% [58.6; 96.4]. If at least three of these criteria were combined, it was possible to distinguish IT from chronic ITP with 91.3% [72.0; 98.9] sensitivity and PPV = 100.0% [66.4; 100.0] specificity. The secondary objective of this study was to assess the prevalence of potential IT diagnosis in patients with chronic thrombocytopenia of uncertain origin. Applying our diagnostic approach to a series of 20 cases allowed us to estimate that 40% of them could be suffering from IT. Finally, our diagnostic approach may help to correctly distinguish IT from chronic ITP, particularly in the context of macrothrombocytopenia.

[New perspectives on the role of αIIbβ3 integrin in defective megakaryopoiesis]

In recent years, the understanding of the molecular mechanisms involved in platelet production (megakaryopoiesis) has extremely increased, thanks to the study of genetic diseases causing inherited thrombocytopenia. Among the wide variety of transmembrane receptors covering the platelet membrane, αIIbβ3 integrin is the major one, allowing platelets to aggregate upon the occurrence of vascular breach. Platelet counts are usually normal in patients with αIIbβ3 deficiency, suggesting that its role for normal platelet production and morphology is very limited. However, recently, new clinical observations of genetic diseases provided evidence against this hypothesis, bringing new data on the role of αIIbβ3 integrin in defective megakaryopoiesis.

The epidemiology of amyotrophic lateral sclerosis in the Mount Etna region: a possible pathogenic role of volcanogenic metals

BACKGROUND AND PURPOSE

Trace elements (TEs) may play a role in the pathogenesis of amyotrophic lateral sclerosis (ALS) and volcanic degassing is the major natural source of TEs. Mount Etna, in the province of Catania, is the largest active volcano in Europe. Our aim was to assess the incidence of ALS in the province of Catania during 2005-2010 and its spatial distribution with respect to volcanic gas deposition.

METHODS

Cases from all neurological centres of the province of Catania and of the boundary provinces were retrospectively collected. Patients who had onset during 2005-2010 and fulfilled the El Escorial revised diagnostic criteria were included. The incidence of ALS was estimated for the entire province and separately for the population living on the eastern and western flank of Mount Etna, respectively, the most and least exposed areas to volcanogenic TEs, considered as a possible risk factor for ALS.

RESULTS

One hundred and twenty-six (57 men) ALS patients were enrolled. The mean annual crude incidence rate was 2.0/100 000 person-years (95% confidence interval 1.7-2.4). A higher incidence rate was found in the population living on the eastern flank compared to the western flank (2.4/100 000 and 0.9/100 000 respectively) with a relative risk of 2.75 (95% confidence interval 1.64-4.89; P < 0.001).

CONCLUSIONS

The incidence of ALS in the province of Catania is close to those reported worldwide. The incidence was higher amongst the population living on the eastern flank of Mount Etna, which could be interpreted as a possible role of volcanogenic TEs. Further research on TEs and genetic factors is necessary to support this assumption.

Expanding the Mutation Spectrum Affecting αIIbβ3 Integrin in Glanzmann Thrombasthenia: Screening of the ITGA2B and ITGB3 Genes in a Large International Cohort

We report the largest international study on Glanzmann thrombasthenia (GT), an inherited bleeding disorder where defects of the ITGA2B and ITGB3 genes cause quantitative or qualitative defects of the αIIbβ3 integrin, a key mediator of platelet aggregation. Sequencing of the coding regions and splice sites of both genes in members of 76 affected families identified 78 genetic variants (55 novel) suspected to cause GT. Four large deletions or duplications were found by quantitative real-time PCR. Families with mutations in either gene were indistinguishable in terms of bleeding severity that varied even among siblings. Families were grouped into type I and the rarer type II or variant forms with residual αIIbβ3 expression. Variant forms helped identify genes encoding proteins mediating integrin activation. Splicing defects and stop codons were common for both ITGA2B and ITGB3 and essentially led to a reduced or absent αIIbβ3 expression; included was a heterozygous c.1440-13_c.1440-1del in intron 14 of ITGA2B causing exon skipping in seven unrelated families. Molecular modeling revealed how many missense mutations induced subtle changes in αIIb and β3 domain structure across both subunits, thereby interfering with integrin maturation and/or function. Our study extends knowledge of GT and the pathophysiology of an integrin.

Search for long-lived heavy charged particles using a ring imaging Cherenkov technique at LHCb

A search is performed for heavy long-lived charged particles using 3.0 [Formula: see text] of proton-proton collisions collected at [Formula: see text][Formula: see text] 7 and 8  TeV with the LHCb detector. The search is mainly based on the response of the ring imaging Cherenkov detectors to distinguish the heavy, slow-moving particles from muons. No evidence is found for the production of such long-lived states. The results are expressed as limits on the Drell-Yan production of pairs of long-lived particles, with both particles in the LHCb pseudorapidity acceptance, [Formula: see text]. The mass-dependent cross-section upper limits are in the range 2-4 fb (at 95 % CL) for masses between 14 and 309 [Formula: see text].

Evidence for the Strangeness-Changing Weak Decay Ξ_{b}^{-}→Λ_{b}^{0}π^{-}

Using a pp collision data sample corresponding to an integrated luminosity of 3.0  fb^{-1}, collected by the LHCb detector, we present the first search for the strangeness-changing weak decay Ξ_{b}^{-}→Λ_{b}^{0}π^{-}. No b hadron decay of this type has been seen before. A signal for this decay, corresponding to a significance of 3.2 standard deviations, is reported. The relative rate is measured to be f_{Ξ_{b}^{-}}/f_{Λ_{b}^{0}}B(Ξ_{b}^{-}→Λ_{b}^{0}π^{-})=(5.7±1.8_{-0.9}^{+0.8})×10^{-4},where f_{Ξ_{b}^{-}} and f_{Λ_{b}^{0}} are the b→Ξ_{b}^{-} and b→Λ_{b}^{0} fragmentation fractions, and B(Ξ_{b}^{-}→Λ_{b}^{0}π^{-}) is the branching fraction. Assuming f_{Ξ_{b}^{-}}/f_{Λ_{b}^{0}} is bounded between 0.1 and 0.3, the branching fraction B(Ξ_{b}^{-}→Λ_{b}^{0}π^{-}) would lie in the range from (0.57±0.21)% to (0.19±0.07)%.

Search for Hidden-Sector Bosons in B(0)→K(*0)μ(+)μ(-) Decays

A search is presented for hidden-sector bosons, χ, produced in the decay B(0)→K*(892)(0)χ, with K*(892)(0)→K(+)π(-) and χ→μ(+)μ(-). The search is performed using pp-collision data corresponding to 3.0  fb(-1) collected with the LHCb detector. No significant signal is observed in the accessible mass range 214≤m(χ)≤4350  MeV, and upper limits are placed on the branching fraction product B(B(0)→K*(892)(0)χ)×B(χ→μ(+)μ(-)) as a function of the mass and lifetime of the χ boson. These limits are of the order of 10(-9) for χ lifetimes less than 100 ps over most of the m(χ) range, and place the most stringent constraints to date on many theories that predict the existence of additional low-mass bosons.

First observation of top quark production in the forward region

Top quark production in the forward region in proton-proton collisions is observed for the first time. The W+b final state with W→μν is reconstructed using muons with a transverse momentum, p_{T}, larger than 25 GeV in the pseudorapidity range 2.0<η<4.5. The b jets are required to have 50<p_{T}<100  GeV and 2.2<η<4.2, while the transverse component of the sum of the muon and b-jet momenta must satisfy p_{T}>20  GeV. The results are based on data corresponding to integrated luminosities of 1.0 and 2.0  fb^{-1} collected at center-of-mass energies of 7 and 8 TeV by LHCb. The inclusive top quark production cross sections in the fiducial region are σ(top)[7  TeV]=239±53(stat)±33(syst)±24(theory)  fb,σ(top)[8  TeV]=289±43(stat)±40(syst)±29(theory)  fb.These results, along with the observed differential yields and charge asymmetries, are in agreement with next-to-leading order standard model predictions.

Measurement of the ratio of branching fractions B(B[over ¯]^{0}→D^{*+}τ^{-}ν[over ¯]_{τ})/B(B[over ¯]^{0}→D^{*+}μ^{-}ν[over ¯]_{μ})

The branching fraction ratio R(D^{*})≡B(B[over ¯]^{0}→D^{*+}τ^{-}ν[over ¯]_{τ})/B(B[over ¯]^{0}→D^{*+}μ^{-}ν[over ¯]_{μ}) is measured using a sample of proton-proton collision data corresponding to 3.0  fb^{-1} of integrated luminosity recorded by the LHCb experiment during 2011 and 2012. The tau lepton is identified in the decay mode τ^{-}→μ^{-}ν[over ¯]_{μ}ν_{τ}. The semitauonic decay is sensitive to contributions from non-standard-model particles that preferentially couple to the third generation of fermions, in particular, Higgs-like charged scalars. A multidimensional fit to kinematic distributions of the candidate B[over ¯]^{0} decays gives R(D^{*})=0.336±0.027(stat)±0.030(syst). This result, which is the first measurement of this quantity at a hadron collider, is 2.1 standard deviations larger than the value expected from lepton universality in the standard model.

Observation of J/ψp Resonances Consistent with Pentaquark States in Λ_{b}^{0}→J/ψK^{-}p Decays

Observations of exotic structures in the J/ψp channel, which we refer to as charmonium-pentaquark states, in Λ_{b}^{0}→J/ψK^{-}p decays are presented. The data sample corresponds to an integrated luminosity of 3 fb^{-1} acquired with the LHCb detector from 7 and 8 TeV pp collisions. An amplitude analysis of the three-body final state reproduces the two-body mass and angular distributions. To obtain a satisfactory fit of the structures seen in the J/ψp mass spectrum, it is necessary to include two Breit-Wigner amplitudes that each describe a resonant state. The significance of each of these resonances is more than 9 standard deviations. One has a mass of 4380±8±29 MeV and a width of 205±18±86 MeV, while the second is narrower, with a mass of 4449.8±1.7±2.5 MeV and a width of 39±5±19 MeV. The preferred J^{P} assignments are of opposite parity, with one state having spin 3/2 and the other 5/2.

Observation of the B(s)(0)→η'η' Decay

The first observation of the B(s)(0)→η'η' decay is reported. The study is based on a sample of proton-proton collisions corresponding to 3.0  fb(-1) of integrated luminosity collected with the LHCb detector. The significance of the signal is 6.4 standard deviations. The branching fraction is measured to be [3.31±0.64(stat)±0.28(syst)±0.12(norm)]×10(-5), where the third uncertainty comes from the B(±)→η'K(±) branching fraction that is used as a normalization. In addition, the charge asymmetries of B(±)→η'K(±) and B(±)→ϕK(±), which are control channels, are measured to be (-0.2±1.3)% and (+1.7±1.3)%, respectively. All results are consistent with theoretical expectations.

Measurement of CP Violation in B0→J/ψK{S}^{0} Decays

Measurements are presented of the CP violation observables S and C in the decays of B(0) and Bover ¯]0 mesons to the J/ψK(S)(0) final state. The data sample corresponds to an integrated luminosity of 3.0  fb(-1) collected with the LHCb experiment in proton-proton collisions at center-of-mass energies of 7 and 8 TeV, and contains a total of 41 560 selected B^{0} and B[over ¯]^{0} decays. The analysis of the time evolution of these decays yields S=0.731±0.035(stat)±0.020(syst) and C=-0.038±0.032(stat)±0.005(syst). In the standard model, S equals sin(2β) to a good level of precision. The values are consistent with the current world averages and with the standard model expectations.