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

Le « Voyage de Naple » (1719) de Ferdinand Delamonce

Il n'y a jamais eu une image française de l'Italie. Même à l'intérieur de la catégorie fortunée que représentent les voyageurs, nous n'aurons pas les mêmes impressions chez "l'antiquaire", comme on disait alors, chez l'artiste, l'architecte, l'homme politique ou le diplomate, l'ecclésiasique, le militaire, chez celui qu'intéressent les problèmes de l'économie etc. De surcroît, les temps changent et, pour prendre un exemple précis, le jugement sur Naples des voyageurs du xviie siècle n'a rien à voir avec celui qu'aura le Siècle des Lumières qui, à son tour, sera différent de celui de la génération romantique. Et il serait facile de multiplier les exemples. Mais, s'il n'y a pas une image française de l'Italie, il y a, nous le savons tous, des images françaises stéréotypées de l'Italie, comme il y a des images italiennes stéréotypées de la France, sur lesquelles il n'est pas inutile non plus de méditer. Mais, pour cerner ces images, pour voir comment elles sont nées et comment elles se sont transmises, il ne faut pas se limiter aux "grands auteurs", au lyrisme stendhalien pour qui l'Italie signifiait le bonheur de vivre, ni aux phrases acerbes d'un Président de Brosses qui ne perdait pas une occasion d'exercer avec talent un esprit critique développé. Il faut feuilleter ces "textes anodins", comme dit Marguerite Yourcenar, qui, de fait, sont, le plus souvent, loin d'être des chefs-d'oeuvre ; il faut les feuilleter en essayant de discerner ce qui a été vécu et ce qui a été inventé, ce qui est impression authentique et ce qui a été copié dans les livres, et surtout en essayant de comprendre comment, dans ces lentes stratifications, apparaissent un certain nombre de traits qui, malgré tout, peuvent être considérés, je crois, comme des constantes

Regarding "The effect of an Enhanced Recovery Program in elective retroperitoneal abdominal aortic aneurysm repair" - Reply

No abstract availabl

Genetic delineation of venous leg ulcer and clinical implication

The recognition that functional gene variants, mainly single nucleotide polymorphisms significantly involved in venous ulcer establishment and in wound healing, have an extraordinary role in the prognosis, diagnosis and treatment of chronic wounds. • Single nucleotide polymorphisms in hemochromatosis and coagulation factor XIII genes can be used as molecular markers or prognostic tools. This allows the development of strategies to predict patients at increased risk of developing severe complications of chronic venous disorders and to predict healing time after superficial venous surgery. • Clinical practice could be strongly influenced by the results of an hemochromatosis genetic screening test. A positive test would strengthen the indications and priorities for surgical correction of superficial venous insufficiency. Primary varicose veins could be treated more appropriately before any lesions develop in patients with a genetic haplotype associated with an increased risk of lesion development

Inflammation in venous disease.

Chronic venous disease (CVD), mainly due to venous reflux or, sometimes, to venous outflow obstruction, produces a microcirculatory overload leading to the impairment of venous drainage. Venous drainage depends primarily on a major hemodynamic parameter called trans-mural pressure (TMP). TMP is increased in patients affected by CVD, leading to impaired tissue drainage, and, consequently, facilitating the beginning of the inflammatory cascade. Increased TMP determines red blood cell extravasation and either dermal hemosiderin deposits or iron laden-phagocytes. Iron deposits are readily visible in the legs of all patients affected by severe CVD. Local iron overload could generate free radicals or activate a proteolytic hyperactivity of metalloproteinases (MMPs) and/or downregulate tissue inhibitors of MMPs. These negative effects are particularly evident in carriers of the common HFE gene's mutations C282Y and H63D, because intracellular iron deposits of mutated macrophages have less stability than those of the wild type, inducing a significant oxidative stress. It has been demonstrated that such genetic variants increase the risk of ulcers and advance the age of ulcer onset, respectively. The iron-dependent vision of inflammation in CVD paves the way to new therapeutic strategies including the deliberate induction of iron deficiency as a treatment modality for non-healing and/or recurrent venous leg ulcers. The inflammatory cascade in CVD shares several aspects with that activated in the course of multiple sclerosis, an inflammatory and neurodegenerative disease of unknown origin in which the impairment of cerebral venous outflow mechanisms has been recently demonstrated

Double Right Bronchial Artery Aneurysm Treated with Combined Procedures

Purpose Bronchial artery aneurysms occur rarely. We present an unusual case. Case report We present a patient with double right bronchial artery aneurysms that were treated with a combination of endovascular and surgical procedures. Conclusion This case report illustrates the treatment options for this unusual problem

La Riabilitazione della persona affetta da arteriopatia periferica

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