Data monitoring roadmap. The experience of the Italian Multiple Sclerosis and Related Disorders Register

Introduction Over the years, disease registers have been increasingly considered a source of reliable and valuable population studies. However, the validity and reliability of data from registers may be limited by missing data, selection bias or data quality not adequately evaluated or checked.This study reports the analysis of the consistency and completeness of the data in the Italian Multiple Sclerosis and Related Disorders Register.MethodsThe Register collects, through a standardized Web-based Application, unique patients.Data are exported bimonthly and evaluated to assess the updating and completeness, and to check the quality and consistency. Eight clinical indicators are evaluated.ResultsThe Register counts 77,628 patients registered by 126 centres. The number of centres has increased over time, as their capacity to collect patients.The percentages of updated patients (with at least one visit in the last 24 months) have increased from 33% (enrolment period 2000-2015) to 60% (enrolment period 2016-2022). In the cohort of patients registered after 2016, there were >= 75% updated patients in 30% of the small centres (33), in 9% of the medium centres (11), and in all the large centres (2).Clinical indicators show significant improvement for the active patients, expanded disability status scale every 6 months or once every 12 months, visits every 6 months, first visit within 1 year and MRI every 12 months.ConclusionsData from disease registers provide guidance for evidence-based health policies and research, so methods and strategies ensuring their quality and reliability are crucial and have several potential applications

Multi-messenger observations of a binary neutron star merger

On 2017 August 17 a binary neutron star coalescence candidate (later designated GW170817) with merger time 12:41:04 UTC was observed through gravitational waves by the Advanced LIGO and Advanced Virgo detectors. The Fermi Gamma-ray Burst Monitor independently detected a gamma-ray burst (GRB 170817A) with a time delay of ~1.7 s with respect to the merger time. From the gravitational-wave signal, the source was initially localized to a sky region of 31 deg2 at a luminosity distance of 40+8-8 Mpc and with component masses consistent with neutron stars. The component masses were later measured to be in the range 0.86 to 2.26 Mo. An extensive observing campaign was launched across the electromagnetic spectrum leading to the discovery of a bright optical transient (SSS17a, now with the IAU identification of AT 2017gfo) in NGC 4993 (at ~40 Mpc) less than 11 hours after the merger by the One- Meter, Two Hemisphere (1M2H) team using the 1 m Swope Telescope. The optical transient was independently detected by multiple teams within an hour. Subsequent observations targeted the object and its environment. Early ultraviolet observations revealed a blue transient that faded within 48 hours. Optical and infrared observations showed a redward evolution over ~10 days. Following early non-detections, X-ray and radio emission were discovered at the transient’s position ~9 and ~16 days, respectively, after the merger. Both the X-ray and radio emission likely arise from a physical process that is distinct from the one that generates the UV/optical/near-infrared emission. No ultra-high-energy gamma-rays and no neutrino candidates consistent with the source were found in follow-up searches. These observations support the hypothesis that GW170817 was produced by the merger of two neutron stars in NGC4993 followed by a short gamma-ray burst (GRB 170817A) and a kilonova/macronova powered by the radioactive decay of r-process nuclei synthesized in the ejecta

Remineralization of particulate organic carbon in an ocean oxygen minimum zone

This work was funded by a NERC standard grant NE/E01559X/1

Overlapping pK a of the Multiprotic Hemostyptic Eltrombopag using UV–Vis Multiwavelength Spectroscopy and Potentiometry

pH-potentiometric and WApH-spectrophotometric titrations of the multiprotic hemostyptic Eltrombopag for dissociation constants determination were compared. Hemostyptic and hemostatic Eltrombopag treats low blood platelet counts in adults with chronic immune idiopathic thrombocytopenia ITP. Eltrombopag exhibits five protonatable sites in a pH range of 2 to 10, where only two pK are well separated (ΔpK > 3), while the other three are near dissociation constants of overlapping equilibria. According to MARVIN prediction, in the neutral medium Eltrombopag occurs in the slightly water soluble form LH3 that can be protonated to the soluble species LH4 and LH5 The molecule LH3 can be dissociated to still difficultly soluble species LH2, LH and L. Due to limited solubility of Eltrombopag above pH 9.5 the protonation was studied up to pH 10. Five dissociation constants can be reliably determined with REACTLAB and SQUAD84 leading to the same value. From a dependence on ionic strength the thermodynamic dissociation constants were estimated at 25°C: pKa1T = 2.69, pKa2T = 6.97, pKa3T = 7.13, pKa4T = 7.65, pKa5T = 8.30. Since pH above 10 and pH down 5 occurs in a titrated solution the very fine precipitate of Eltrombopag which is initially forming a slight opalescence, this part of the potentiometric titration curve pH over 9 and pH below 5 was not taken into regression analysis to estimate pKa2 = 6.53(01), pKa3 = 7.60(04), pKa4 = 9.62(59), pKa5 = 10.55(340) at 25°C with ESAB and HYPERQUAD.Byly porovnávány potenciometrické hodnoty pH a WApH spektrofotometrické titrace multiprotického hemostyptického Eltrombopagu pro stanovení disociačních konstant. Hemostyptický a hemostatický Eltrombopag léčí nízké počty krevních destiček u dospělých pacientů s chronickou imunitní idiopatickou trombocytopenií ITP. Eltrombopag vykazuje pět protonovatelných míst v rozmezí pH od 2 do 10, kde jsou jen dva pK dobře oddělené (ΔpK> 3), zatímco ostatní tři jsou téměř disociační konstanty překrývající se rovnováhy. Podle predikce společnosti MARVIN se v neutrálním prostředí Eltrombopag vyskytuje ve formě lehce rozpustné ve vodě LH3, která může být protonována na rozpustné druhy LH4 a LH5. Molekula LH3 může být disociována na stále obtížně rozpustné druhy LH2, LH a L. Vzhledem k omezenému rozpustnosti Eltrombopagu nad pH 9,5 byla zkoumána protonace až na pH 10. Pět disociačních konstant může být spolehlivě stanoveno pomocí REACTLAB a SQUAD84, což vede k stejné hodnotě. Ze závislosti na iontové síle byly termodynamické disociační konstanty odhadnuty na 25 ° C: pKa1T = 2,69, pKa2T = 6,97, pKa3T = 7,13, pKa4T = 7,65, pKa5T = 8,30. Vzhledem k tomu, že pH v hodnotě nad 10 a pH 5 se vyskytuje v titrovaném roztoku, velmi jemná sraženina Eltrombopagu, která zpočátku vytváří mírnou opalescenci, tato část potenciometrické titrační křivky pH nad 9 a pH pod 5 nebyla převzata do regresní analýzy k odhadu pKa2 = 6,53 (01), pKa3 = 7,60 (04), pKa4 = 9,62 (59), pKa5 = 10,55 (340) při 25 ° C pomocí ESAB a HYPERQUAD