The burden of renal cell cancer : A retrospective longitudinal study on occurrence, outcomes and cost using an administrative claims database

Abstract Objective To assess the burden of renal cell carcinoma (RCC) in epidemiologic and economic terms. Methods Retrospective, naturalistic longitudinal study on the occurrence, outcomes and cost of RCC using an administrative database. We selected residents of Friuli-Venezia-Giulia (FVG), a North-eastern Region of Italy, who had a RCC first hospital admission during the period 2000–2004, and we followed them up until: 30th June 2005, death or transfers. Direct medical costs were quantified in the perspective of FVG Regional Health Service. Results We enrolled 1358 patients (63% male), the 18.8% presenting a metastatic-stage, leading to a crude incidence of 23/100.000 person-years. During the follow-up, 76% of the metastatic patients and 21% of the non-metastatic patients died. Total health care costs per-patient over the maximum of follow-up were 16,090€ for the localised stage group and 17,656€ in the metastatic-stage group. Discussion RCC imposes a significant epidemiologic and economic burden to the healthcare-system and the society

What decentralized clinical trials can mean for patients, the national health service and the country as a whole

The purpose of this paper is to illustrate the broader potential implications, for patients, the National Health Service and the country as a whole, of decentralized clinical trials (DCTs) becoming increasingly common practice

Cushing’s syndrome—an epidemiological study based on a canine population of 21,281 dogs

The epidemiological characteristics of spontaneous hypercortisolism (HC) were derived from 21,281 client-owned dogs selected from four private veterinary clinics and one university reference center for endocrinology. The odds ratio (OR) method was employed to investigate the risk of developing HC related to breed, gender, and sexual status. The estimated prevalence of HC in the four private clinics was 0.20% [95% confidence interval (CI), 0.13–0.27] and was significantly different compared to the university reference center (1.46%; 95% CI, 1.12–1.80). Sex, breed, and age resulted in risk factors for HC. Mean (± SD) age for dogs with HC was 9.8 (± 2.5) yr. Females had higher risk for HC compared to males (OR 1.85; 95% CI, 1.24–2.75); all neutered dogs (both males and females) had higher risk than intact dogs (OR 2.54; 95% CI, 1.72–3.73); and neutered females had higher risk compared to intact females (OR 2.61; 95% CI, 1.54–4.42). Using the mixed breed dogs as a control population (OR = 1), the risk of developing HC was significantly higher in the Standard Schnauzer (OR 58.1; p < 0.0001) and Fox Terrier (OR 20.33; p < 0.0001). With regard to HC, this study identified an overall prevalence of 0.20%. The data support the existence of sex predisposition, with the highest risk for neutered females.Keywords: Cortisol, Hyperadrenocorticism, Hypercortisolism, PD

Cushing’s Syndrome – An epidemiological study based on a canine population of 21,281 dogs

The epidemiological characteristics of spontaneous hypercortisolism (HC) were derived from 21,281 client-owned dogs selected from 4 private veterinary clinics and 1 university reference centre for endocrinology. The odds ratio (OR) method was employed to investigate the risk of developing HC related to breed, gender and sexual status. The estimated prevalence of HC in the 4 private clinics was 0.20% (95% CI, 0.13–0.27) and was significantly different compared to the university reference centre (1.46%; 95%CI, 1.12–1.80). Sex, breed and age resulted in risk factors for HC. Mean (±SD) age for dogs with HC was 9.8 (±2.5) years. Females had higher risk for HC compared to males (OR 1.85; 95%CI, 1.24–2.75); all neutered dogs (both males and females) had higher risk than intact dogs (OR 2.54; 95%CI, 1.72–3.73); and neutered females had higher risk compared to intact females (OR 2.61; 95%CI, 1.54–4.42). Using the mixed breed dogs as a control population (OR=1), the risk of developing HC was significantly higher in the standard schnauzer (OR 58.1; p<0.0001) and fox terrier (OR 20.33; p<0.0001). With regard to HC, this study identified an overall prevalence of 0.20%. The data support the existence of sex predisposition, with the highest risk for neutered females

Prezzo, rimborso e accesso ai farmaci in Italia: le proposte di riforma di quattro panel di esperti

Il presente documento illustra i risultati di un lavoro di quattro panel interdisciplinari e multistakeholder (istituti pubblici, ricercatori, industria) sull’accesso al rimborso e la negoziazione dei prezzi dei farmaci nel Servizio sanitario nazionale, realizzato nell’ambito di un seminario residenziale tenutosi in aprile 2019. In particolare, sono stati discussi i temi a) dell’innovatività dei farmaci, con i relativi vantaggi sull’accesso (fondi dedicati, accesso immediato ai mercati regionali, mancata applicazione di scontistiche obbligatorie); b) del processo e dei criteri di negoziazione di prezzo e rimborso per un nuovo farmaco o una nuova indicazione di un farmaco già presente sul mercato; c) della rinegoziazione dei prezzi, in relazione a modifiche del contesto di mercato ed in presenza di nuove evidenze sul profilo di efficacia e sicurezza e d) della gestione di specifici ambiti di complessità negoziale, rappresentati da farmaci caratterizzati da evidenze molto incerte al momento del lancio, dagli accordi di rimborsabilità condizionata, da terapie combinate e da terapie cosiddette one-shot. I suggerimenti forniti dagli esperti vanno nella direzione di un miglioramento dell’attuale assetto regolatorio, più che di una sua modifica sostanziale e presentano elementi di interesse anche in relazione al successivo decreto ministeriale di revisione del sistema di pricing

Hydrogen peroxide induced by nerve injury promotes axon regeneration via connective tissue growth factor

Abstract Regeneration of the neuromuscular junction (NMJ) leverages on extensive exchange of factors released from motor axon terminals (MATs), muscle fibers and perisynaptic Schwann cells (PSCs), among which hydrogen peroxide (H2O2) is a major pro-regenerative signal. To identify critical determinants of NMJ remodeling in response to injury, we performed temporal transcriptional profiling of NMJs from 2 month-old mice during MAT degeneration/regeneration, and cross-referenced the differentially expressed genes with those elicited by H2O2 in SCs. We identified an enrichment in extracellular matrix (ECM) transcripts, including Connective Tissue Growth Factor (Ctgf), which is usually expressed during development. We discovered that Ctgf levels are increased in a Yes-associated protein (YAP)-dependent fashion in response to rapid, local H2O2 signaling generated by stressed mitochondria in the injured sciatic nerve, a finding highlighting the importance of signals triggered by mechanical force to motor nerve repair. Through sequestration of Ctgf or inactivation of H2O2, we delayed the recovery of neuromuscular function by impairing SC migration and, in turn, axon-oriented re-growth. These data indicate that H2O2 and its downstream effector Ctgf are pro-regenerative factors that enable axonal growth, and reveal a striking ECM remodeling process during nerve regeneration upon local H2O2 signaling. Our study identifies key transcriptomic changes at the regenerating NMJ, providing a rich source of pro-regenerative factors with potential for alleviating the consequences of peripheral nerve injuries