Clinical efficacy issues in the treatment of multiple sclerosis: update of natalizumab

Multiple sclerosis is a frequent neurologic disease, which causes sensory impairment, fatigue, cognitive deficits, imbalance, loss of mobility, spasticity, and bladder and bowel dysfunction. Several new therapies have been introduced in the past decade, but additional drugs are needed to slow disease progression and reduce disability. Natalizumab (NA) is an α4 integrin antagonist, effective in decreasing the development of brain lesions in experimental models and in several studies of patients with MS. Six randomized controlled trials of NA in MS have been published in the last 10 years. Overall, 2,688 relapsing-remitting MS subjects have been enrolled in these studies. Hence, there are already sufficient data to draw some conclusions about the effectiveness of NA in the treatment of MS, although for definitive considerations it would be reasonable to wait for the observational phase IV studies of clinical practice to complete. Moreover, the medical community is concerned with the safety of NA, particularly with the risk of developing progressive multifocal leukoencephalopathy while on NA therapy. From the analyses of the six cases, it seems that the overall risk is around 1/1,000 and could increase with the number of NA infusions

CYCLOSTRATIGRAPHY: A METHODOLOGICAL APPROACH

Aim of this study is a synthetic description of the most used methodologies of cylostratigraphic analysis for the astronomical calibration of sedimentary sequences. The different numerical solutions of the insolation curve and, in particular, the most used astronomic curve La90 (1,1) are analyzed. Then, a detailed description of the methodologies for the astronomic calibration of different sedimentary sequences i) on the basis of a litho-stratigraphic approach and ii) on the basis of a spectral analysis applied to faunal and geochemical climate-sensitive records, is proposed.&nbsp

Pain perception and stabilometric parameters in people with chronic low back pain after a pilates exercise program: A randomized controlled trial

Various exercise interventions, such as Pilates exercises and traditional physical therapy methods, are employed to decrease low back pain (LBP). Nonspecific low back pain (NSLBP) is distinct from LBP, however, as the distribution of pain is restricted to the region between the costal margin and the inferior gluteal. The aim of our randomized controlled trial was to evaluate the effects of a program of Pilates exercises on pain perception and stabilometric parameters in patients with NSLBP.Thirty-eight participants were randomly allocated, using a 1:1 scheme, to either the experimental group (EG) or control group (CG). The EG completed a 14-week program of Pilates exercises, performed thrice per week under the supervision of an exercise specialist, while the CG was managed with a social program only. Measures of posturography and Oswestry Disability Index (ODI) for pain perception were obtained at baseline (T0) and after the 14 weeks of intervention (T)1.Posturography measures improved for patients in the EG, with both eyes open and eyes closed (P\u200a<\u200a0.05). There were no statistical differences in posturography in the CG. ODI decreased significantly in both groups over the 14 weeks of the study protocol: EG, T0, 13.7\u200a\ub1\u200a5.0 compared with T1, 6.5\u200a\ub1\u200a4.0 (P\u200a<\u200a0.001); and CG, T0, 10.7\u200a\ub1\u200a7.8 compared with T1, 8.4\u200a\ub1\u200a7.8 (P\u200a<\u200a0.01). A greater extent of reduction in pain was achieved in the EG.The Pilates exercise program yielded improvements in pain and posturography outcomes. Our study also confirms the applicability of posturography in evaluating postural instability in patients with NSLBP. Due to our relatively small study group, future studies would be necessary to confirm our findings

Manometric evaluation of internal anal sphincter after fissurectomy and anoplasty for chronic anal fissure: a prospective study

Chronic anal fissure (CAF) is a common painful clinical disease and its pathogenesis remains poorly understood. After failure of pharmacological therapy, that is the first-line treatment, sur- gical sphincterotomy remains the treatment of choice although it is followed by a high rate of anal incontinence resulting from the sphincter damage; therefore, the research of a sphincter-saving surgical option has become an important goal. The aim of this study was to evaluate the mano- metric modifications and the incidence of anal incontinence after fissurectomy and anoplasty with advancement skin flap in patients affected by CAF with hypertonia of the internal anal sphincter (IAS). Fifteen patients affected by CAF with hypertonia of IAS, unresponsive to medical therapy, were enrolled. All subjects underwent fissurectomy and anoplasty with advancement skin flap. Anorectal manometry was performed preoperatively and after 6 and 12 months from surgery. Maximum resting pressure (MRP), maximum squeeze pressure (MSP), ultraslow wave activity (USWA), fissure healing, anal continence, and postoperative complications were recorded. All patients healed within 30 days from surgery. No intra- or postoperative complications were recorded except for a case of partial donor site break. No significant modifications of MSP were detected. Six months after surgery, MRP was higher with respect to healthy subjects but signif- icantly reduced in comparison to baseline levels. At 12 months, it was higher have versus 6-month values but significantly lower versus preoperative values. USWA was significantly represented in patients with CAF versus healthy subject. Both at 6 and 12 months, they decreased significantly with respect to preoperative values without significant differences versus healthy subjects. Both at 6 and 12 months, anal continence did not differ with respect to preoperative time. The fissurectomy with anoplasty resulted in a high healing rate without surgical sequelae or anal incontinence. Also, it was able to reduce IAS pressure in the same manner as surgical sphincterotomy or forceful dilatation

Evaluation of Fitness and the Balance Levels of Children with a Diagnosis of Juvenile Idiopathic Arthritis: A Pilot Study

Background: Juvenile idiopathic arthritis is a main cause of physical disability and has high economic costs for society. The purpose of this study was to assess the fitness levels and the postural and balance deficits with a specific test battery. Methods: Fifty-six subjects were enrolled in this study. Thirty-nine healthy subjects were included in the control group and seventeen in the juvenile idiopathic arthritis group. All subjects were evaluated using a posturography system. The fitness level was evaluated with a battery of tests (Abalakov test, sit-up test, hand grip test, backsaver sit and reach, the toe touch test). An unpaired t-test was used to determine differences. Pearson's correlation coefficient was used to evaluate the correlation between the tests. Results: The battery of tests demonstrated that subjects in the juvenile idiopathic arthritis group have lower fitness levels compared to the control group. The juvenile idiopathic arthritis group showed low postural control with respect to the control group. Pearson analysis of the juvenile idiopathic arthritis group data showed significant correlations between variables. Pearson's results from the control group data showed a similar trend. Conclusions: The results suggest that the battery of tests used could be an appropriate tool. However, we highlight that these conclusions need to be supported by other studies with a larger population scale

Importancia de los fenómenos físicos y la disponibilidad de nutrientes en el control de la concentración de clorofila estimada por satélite en el área costera de afloramiento del Canal de Sicilia

The northern sector of the Sicilian Channel is an area of favourable upwelling winds, which ought to support primary production. However, the values for primary production are low when compared with other Mediterranean areas and very low compared with the most biologically productive regions of the world’s oceans: California, the Canary Islands, Humboldt and Benguela. The aim of this study was to identify the main factors that limit phytoplankton biomass in the Sicilian Channel and modulate its monthly changes. We compared satellite-based estimates of chlorophyll a concentration in the Strait of Sicily with those observed in the four Eastern Boundary Upwelling Systems mentioned above and in other Mediterranean wind-induced coastal upwelling systems (the Alboran Sea, the Gulf of Lions and the Aegean Sea). Our results show that this low level of chlorophyll is mainly due to the low nutrient level in surface and sub-surface waters, independently of wind-induced upwelling intensity. Further, monthly changes in chlorophyll are mainly driven by the mixing of water column and wind-induced and/or circulation-related upwelling processes. Finally, primary production limitation due to the enhanced stratification processes resulting from the general warming trend of Mediterranean waters is not active over most of the coastal upwelling area off the southern Sicilian coast.El sector norte del Canal de Sicilia es un área de vientos favorables para el afloramiento, lo cual debe favorecer la producción primaria. Sin embargo, los valores de producción primaria son bajos comparados con otras áreas del Mediterráneo y muy bajos comparados con las regiones biológicamente más productivas de los océanos a nivel mundial: California, Canarias, Humboldt y Benguela. El objetivo de este estudio fue identificar los principales factores que limitan la biomasa del fitoplancton y modulan sus cambios mensuales. Comparamos estimas de la concentración de clorofila a basadas en satélite en el estrecho de Sicilia, con las observadas en los cuatro sistemas orientales de afloramiento mencionados anteriormente y en otros sistemas costeros del Mediterráneo en los que el viento favorece los afloramientos (Mar del Alborán, Golfo de León y Mar Egeo). Nuestros resultados muestran que la baja producción primaria es debida principalmente a la baja entrada de nutrientes en aguas superficiales, independientemente de la intensidad del afloramiento causado por el viento. Por otro lado, los cambios mensuales en la producción primaria se deben a la mezcla de la columna de agua y afloramientos asociados al viento y/o procesos de circulación en la zona. Finalmente, la limitación de la producción primaria debida al aumento del proceso de estratificación resultante de la tendencia general de calentamiento de las aguas del Mediterráneo, no es activa a lo largo de la mayor parte del área de afloramiento en la costa sur de Sicilia

Life-Threatening Constipation Induced by Intrathecal Baclofen Therapy

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Alcoholic liver cirrhosis, more than a simple hepatic disease – A brief review of the risk factors associated with alcohol abuse

Liver cirrhosis is a significant public health problem, being an important cause of mortality and morbidity, responsible for approximately 1.8% of the total number of deaths in Europe. Chronic alcohol consumption is the most common cause of liver cirrhosis in developed countries. Europe has the highest level of alcohol consumption among all the global World Health Organisation (WHO) regions. In this paper, we briefly review major factors leading to excessive alcohol consumption in order to draw attention to the fact that alcoholic liver cirrhosis is more than a simple liver disease, and if those risk/causal factors can be prevented, the incidence of this disease could be reduced greatly. Although excessive alcohol consumption is regarded as the cause of alcoholic liver cirrhosis, the etiology is complex, involving multiple factors that act in synchrony, and which, if prevented, could greatly reduce the incidence of this disease. Children of addicts are likely to develop an alcohol-related mental disorder; however, there is no “gene for alcoholism”

Acute inflammatory response in the subcutaneous versus periprosthethic space after incisional hernia repair: an original article

BACKGROUND: The acute inflammatory response following mesh implantation has been often evaluated in vitro and in animal models. The aim of this study was to evaluate the acute inflammatory response near the prosthesis in human by analysing some inflammatory indicators.METHODS: We used a cohort of twelve male patients affected by midline incisional hernia, who were admitted for surgical mesh repair. A suction drain was placed between the mesh and rectal muscles whereas, the other one was placed between the subcutaneous tissue and the oblique external sheath. The acute inflammatory response was analyzed by measuring the production of interleukin [IL]-1, IL-10, IL-1ra, C-Reactive Protein (CRP), total proteins, albumin and pH in the drain fluids.RESULTS: The dynamics of CRP and ILs production resulted similar in both drainages. Comparing drain over mesh and subcutaneous drain at all times, IL-1 and CRP values always resulted significantly higher in the first one, whereas IL-1ra and IL-10 values were significantly higher in the last one. Total protein and albumin were similar in both drains at all time; only in the drain over mesh fluid, pH values resulted significantly reduced in the fourth post-operative day.CONCLUSIONS: Our data showed that an acute inflammatory reaction is present in both sites examined. However, it was significantly higher in the space after mesh implantation

Distributed software infrastructure for evaluating the integration of photovoltaic systems in urban districts

Nowadays, the adoption of renewable energy sources distributed across the city is crucial for planning and developing the future Smart City. An accurate simulation and modelling of energy sources, such as Photovoltaic Panels (PV), is necessary to evaluate both economical and environmental benefits. With the growth of renewable sources in the city simulations of energy production became crucial for the DSO for evaluating retrofits or for network balancing events. In this paper, we present a software infrastructure for simulating the solar radiation and estimating the energy production of a district. The infrastructure simulates the PV production and evaluates the integration of such systems considering real electricity consumption data. In its core, the proposed solution models the behaviours of PV systems taking into account the digital surface of rooftops and sub-hourly meteorological data (e.g. solar radiation and temperature) to compute real-sky conditions. Then, such information is used to feed a model of the hardware components of PV systems to gain more accurate estimations of energy production in the district in real-sky conditions