Changing EDSS progression in placebo cohorts in relapsing MS: A systematic review and meta-regression

Background: Recent systematic reviews of randomised controlled trials (RCTs) in relapsing multiple sclerosis (RMS) revealed a decrease in placebo annualized relapse rates (ARR) over the past two decades. Furthermore, regression to the mean effects were observed in ARR and MRI lesion counts. It is unclear whether disease progression measured by the expanded disability status scale (EDSS) exhibits similar features. Methods: A systematic review of RCTs in RMS was conducted extracting data on EDSS and baseline characteristics. The logarithmic odds of disease progression were modelled to investigate time trends. Random-effects models were used to account for between-study variability; all investigated models included trial duration as a predictor to correct for unequal study durations. Meta-regressions were conducted to assess the prognostic value of a number of baseline variables. Results: The systematic literature search identified 39 studies, including a total of 19,714 patients. The proportion of patients in placebo controls experiencing a disease progression decreased over the years (p<0.001). Meta regression identified associated covariates including the size of the study and its duration that in part explained the time trend. Progression probabilities tended to be lower in the second year compared to the first year with a reduction of 24% in progression probability from year 1 to year 2 (p=0.014). Conclusion: EDSS disease progression exhibits similar behaviour over time as the ARR and point to changes in trial characteristics over the years, questioning comparisons between historical and recent trials.Comment: 17 pages, 2 figure

Is induced abortion a risk factor in subsequent pregnancy?

Objective: To determine whether a history of terminations of pregnancy influences subsequent pregnancies in terms of pregnancy risks, prematurity and neonatal biometrics. Patients and methods: Based on the perinatal statistics of eight German federal states, data of 247,593 primiparous women with singleton pregnancies born between 1998 and 2000 were analyzed. The control group consisted of primiparous women without previous induced abortions. Maternal age was adjusted for. Results: There was an overall trend towards an increased rate of preterm delivery at &lt;= 36 weeks' gestation and early preterm delivery at &lt;= 31 weeks' gestation in women who had previous pregnancy terminations. For the cohort of 28-30 years, the observed rates of prematurity in women with one and with &gt;= 2 previous induced abortions were 7.8% and 8.5%, respectively, compared to 6.5% in the control population (P=0.015). Preceding terminations of pregnancy did not alter the rate of small-for-gestational-age newborns. Psychosocial stress and symptoms associated with prematurity such as cervical incompetence and vaginal bleeding before and after 28 weeks of gestation occurred more frequently in women with previous induced abortion compared to the control group (P&lt;0.0001). Conclusion: The rate of preterm births increases with the number of preceding abortions. Similarly, symptoms associated with prematurity are more common. The rate of small-for-gestational-age newborns was not affected by preceding terminations of pregnancy

A novel point-to-point length measurement concept based on range-resolved interferometry

In many fields of research and high-value industry, the estimation of distances and displacements is crucial. Due to their extremely high spatial resolution and flexible application possibilities interferometers are cross-sectorally used in measurement practice. However, classical length measuring interferometers are subject to two residual restrictions. On the one hand, only displacements that are exactly aligned to the interferometer optical axis can be measured. On the other hand, deviating refractive indices in the measuring and reference arm due to different atmospheric conditions represent an accuracy-limiting disturbance. In this paper, a new interferometric concept for length measurement is presented. The concept is based on the range-resolved interferometry technology which enables the simultaneous readout and evaluation of two symmetrical interferometric signals which result from the superposition of two non-collimated spherical wavefronts. This allows a point-to-point measurement between two optical fiber ends and the separation of undesired changes of the optical path length outside the measurement cavity and within the measurement cavity

Risks of pregnancy and birth in obese primiparous women: an analysis of German perinatal statistics

Purpose: To compare risks of pregnancy and birth in obese (body mass index, BMI≥30) and normal weight women (BMI 18.5-24.99) giving birth to their first child. Methods: We analysed data of 243,571 pregnancies in primiparous women from the German perinatal statistics of 1998-2000. We calculated odds ratios (ORs) with 95% confidence intervals (CIs) for selected pregnancy and birth risks. ORs were adjusted for the confounding factors age, smoking status, single mother status, and maternal education. Results: Obesity during pregnancy is common in primiparous women (n=19,130; 7.9% of all cases) and it is significantly associated with a number of risks of pregnancy and birth, including diabetes [OR 3.71 (95% CI 2.93; 4.71); p<0.001], hypertension [OR 8.44 (7.91; 9.00); p<0.001], preecalmpsia/eclampsia [OR 6.72 (6.30; 7.17); p<0.001], intraamniotic infection [OR 2.33 (2.05; 2.64); p<0.001], birth weight ≥4,000g [OR 2.16 (2.05; 2.28); p<0.001], and an increased rate of Caesarean section [OR 2.23 (2.15; 2.30); p<0.001]. Some risks were less frequent in the obese such as cervical incompetence [OR 0.55 (0.48; 0.63); p<0.001] and preterm labour [OR 0.47 (0.43; 0.51); p<0.001]. Conclusions: Obesity during pregnancy is an important clinical problem in primiparous women because it is common and it is associated with a number of risks of pregnancy and birth. Because of these increased risks, obese women need special attention clinically during the course of their first pregnancy. Weight reduction before the first pregnancy is generally indicated in obese women to prevent the above-mentioned complications of pregnancy and birt

Creating Value by Sustainable Manufacturing and Supply Chain Management Practices – a Cross-Country Comparison

Research on the development of multinational companies towards a more sustainable business reveals country specific particularities in this process. In order to build a cross-country collaboration framework, sustainability reports of leading companies from developed and developing countries were analyzed and statistically significant differences identified. The framework contributes to comprehending the variables that influence supply chain and manufacturing performance, supporting the identification of opportunities for value creation through cross-country collaboration towards the development of sustainable innovations

A heterodyne interferometer with separated beam paths for high-precision displacement and angular measurements

As standard concepts for precision positioning within a machine reach their limits with increasing measurement volumes, inverse concepts are a promising approach for addressing this problem. The inverse principle entails other limitations, as for high-precision positioning of a sensor head within a large measurement volume, three four-beam interferometers are required in order to measure all necessary translations and rotations of the sensor head and reconstruct the topography of the reference system consisting of fixed mirrors in the x-, y-, and z-directions. We present the principle of a passive heterodyne laser interferometer with consequently separated beam paths for the individual heterodyne frequencies. The beam path design is illustrated and described, as well as the design of the signal-processing and evaluation algorithm, which is implemented using a System-On-a-Chip with an integrated FPGA, CPU, and A/D converters. A streamlined bench-top optical assembly was set up and measurements were carried out to investigate the remaining non-linearities. Additionally, reference measurements with a commercial homodyne interferometer were executed

Vitamin D and Chronic Pain in Immigrant and Ethnic Minority Patients—Investigation of the Relationship and Comparison with Native Western Populations

Vitamin D deficiency has been implicated in chronic pain. Immigrant and ethnic minority populations have been shown to have lower vitamin D levels than native Western populations and often to be vitamin D deficient. This systematic review investigates the relationship between vitamin D and chronic pain in immigrant and ethnic minority populations. Included were studies reporting on 25-OH vitamin D levels in immigrant/ethnic minority populations affected by chronic pain, and/or reporting on the treatment of chronic pain with vitamin D preparations in such populations. We found that 25-OH vitamin D levels were low and often deficient in immigrant/ethnic minority populations. Vitamin D levels depended on the latitude of the study location and hence sunlight exposure. There was insufficient evidence to reach a verdict on the value of treating chronic pain in immigrant/ethnic minority patients with vitamin D preparations because the studies were few, small, and of low quality

Self-reported muscle pain in adolescents with migraine and tension-type headache

Aim: To identify possible associations between muscular pain and headache in adolescents in a large population-based sample. Methods: Grammar school students were invited to fill in a questionnaire on headache and associated lifestyle factors. Headache was classified according to the German version of the International Classification of Headache Disorders (2nd edition). Muscular pain was assessed via denoting affected areas in schematic drawings of a body and via provoked muscular pain on controlled movements of head, neck and shoulder regions. Results: Prevalence of any headache within the previous 6 months exceeded 80%. In all subjects muscular pain or pain on movement was most prominent in the neck and shoulder region, ranging from 9% to 27% in the non-headache population to up to 63% for individuals with migraine or mixed migraine and tension-type headache (TTH). Frequency of muscular pain increased significantly with growing chronicity of TTH. Interpretation: A strong association between muscle pain in the neck/shoulder region and headache was observed, pointing to the importance of muscular pain for headache in adolescents. Also, in this age group muscular pain appears to be of particular importance in chronic TTH and – unexpectedly – in migraine, which is the most important new finding in our study