Archivio Istituzionale della Ricerca- Università degli Studi di Foggia
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Identifying Cladribine prescription pattern in MS: an Italian multicentre study
No full textBackground: Characterizing Cladribine tablets prescription pattern in daily clinical practice is crucial for optimizing multiple sclerosis (MS) treatment.
Objectives: To describe efficacy, safety profile and new disease-modifying therapy (DMT) prescriptions following Cladribine treatment.
Design: Independent retrospective cohort study in patients followed at six Italian MS centres.
Methods: Patients diagnosed with relapsing MS (RMS) according to 2017 McDonald criteria, who initiated Cladribine between January 2019 and May 2023, were included. A generalized linear regression model was built for the outcome DMT after Cladribine course. Heatmaps were generated based on weighted pivot tables to visualize the proportion of patients requiring DMT post-Cladribine.
Results: A total cohort of 352 patients was enrolled, 134 naïve to any DMT, 218 switchers from other DMTs. The last DMT was an injectable first-line DMT for 48 (22%) patients, oral first-line DMT for 141 (64.7%) patients, SP1 inhibitor-Fingolimod for 23 (10.6%) patients, and Natalizumab for 6 (2.7%) patients. Overall, Cladribine was efficacious and well tolerated, 12% of patients required a new DMT prescription after a median time of 24 months. The regression model revealed that patients aged >40 years at Cladribine prescription had a 16% decrease in likelihood of receiving a new DMT. Heatmaps showed patients previously on Fingolimod had a lower rate (72.2%) of being free from therapy after Cladribine.
Conclusion: In our multicentric real-world Italian study, Cladribine therapy is generally effective during the investigated follow-up period. Understanding key characteristics of patients responding best to Cladribine can help tailor therapeutic strategies for optimal outcomes.
Keywords: cladribine; long-term management; multiple sclerosis; prescription pattern
Circulating Tumor DNA: A New Research Frontier in Urological Oncology from Localized to Metastatic Disease
No full textBackground and objective: Circulating tumor DNA (ctDNA) testing provides valuable prognostic and predictive information for guiding therapeutic choices and monitoring disease progression and drug resistance for urological tumors. Our review focuses on emerging opportunities for ctDNA analysis in urological tumors and the development of potential circulating biomarkers within a multidisciplinary framework to improve personalized treatment. Methods: A nonsystematic literature review was conducted in the PubMed and MEDLINE databases. Prospective and retrospective peer-reviewed studies, review articles, and research abstracts on the use of ctDNA for urological tumors were included. Key findings and limitations: Several studies have demonstrated that ctDNA analysis is a promising tool that can help clinicians in the diagnosis and clinical management of urological tumors. In prostate and urothelial cancers, the ctDNA fraction increases proportionally from localized to metastatic disease, indicating a higher tumor burden and more aggressive behavior. Thus, ctDNA seems to be a useful tool for improving prognostic risk stratification and treatment selection. Data on the use of liquid biopsy in renal cell carcinoma are still limited, and assessment of prognostic and predictive biomarkers is a critical unmet need. Conclusions and clinical implications: ctDNA analysis promises to revolutionize the management of urological tumors in different disease settings. Integration of ctDNA testing in routine clinical practice will require a multidisciplinary approach that involve patients, clinicians, and molecular biologists. Patient summary: We reviewed how testing for tumor DNA in blood (circulating tumor DNA, ctDNA) is used in urological cancers. A great deal of evidence supports the usefulness of this noninvasive test. However, further research via a multidisciplinary approach is needed before ctDNA testing becomes part of routine patient care
Influences of the second motion probing gradient b-value and T2 relaxation time on magnetic resonance diffusion-derived ‘vessel density’ (DDVD) calculation: the examples of liver, spleen, and liver simple cyst
No full textBackground: Magnetic resonance (MR) diffusion-derived ‘vessel density’ (DDVD) is calculated according to: DDVDb0b2 = Sb0/ROIarea0 − Sb2/ROIarea2, where Sb0 and Sb2 refer to the tissue signal when b-value is 0 or 2 s/mm2. Sb2 and ROIarea2 can also be approximated by other low b-values diffusion-weighted imaging (DWI). This study investigates the influence of the second motion probing gradient b-value and T2 on DDVD calculations of the liver, spleen, and liver simple cyst. Literature analysis shows the liver and spleen have very similar amounts of perfusion. At 3T, liver and spleen have a T2 of around 42 and 60 ms respectively, while cyst has a very long T2. Methods: Twenty-eight subjects had 1.5T DWI data with b-values of 0, 1, 2, 15, 20, 30 s/mm2. Twenty-one subjects had 3.0T DWI data with b-values of 0, 2, 4, 7, 10, 15, 20, 30 s/mm2. DDVDb0b1, DDVDb0b2, DDVDb0b4, DDVDb0b7, DDVDb0b10, DDVDb0b15, DDVDb0b20, and DDVDb0b30 were calculated from b=0 and b=1 images, b=0 and b=2 images, b=0 and b=4 images, b=0 and b=7 images, b=0 and b=10 images, b=0 and b=15 images, b=0 and b=20 images, b=0 and b=30 s/mm2 images, respectively. For liver simple cyst, two cysts totaling six slices scanned at 1.5T were available for DDVD measurement. Results: At 1.5T, when the second b-value was 1 s/mm2, DDVDspleen value was slightly higher than DDVDliver value; when the second b-value was 2 s/mm2, DDVDliver value was slightly higher than DDVDspleen value. After that, the absolute difference between DDVDliver value and DDVDspleen value became increasingly larger, with DDVDliver value being consistently higher. DDVDcyst showed values close to 0 when the second b-value was 1 s/mm2. When the second b-value was 20 or 30 s/mm2, DDVDcyst value was higher than DDVDliver value. The absolute DDVD values measured higher at 3.0T than at 1.5T. However, the ratio of DDVDspleen to DDVDliver did not apparently differ between 1.5T and 3.0T. From the second b-value being 2 s/mm2 onward, an increasingly larger second b-value was associated with a trend of slow decreasing of the ratio of DDVDspleen to DDVDliver. Conclusions: When a very low second b-value is applied, the liver and spleen measure similar perfusions by DDVD, and cysts measure DDVD close to zero. When a higher second b-value is applied, relative to the liver, the DDVD of spleen is suppressed while the DDVD of cyst is artificially promoted, which we consider are related to the T2 relaxation times of the liver, spleen, and cyst
Evaluating Cognitive Outcomes in Multiple Sclerosis: Real-World Impact of Ozanimod on Processing Speed Using BICAMS
No full textIntroduction: Cognitive dysfunction represents a major burden in multiple sclerosis (MS). The impact on cognitive outcomes of ozanimod in real-world settings remains to be fully elucidated.
Methods: In this single-center observational study, we evaluated cognitive performance in 67 patients with MS (74.6% female) receiving ozanimod (mean treatment duration 17.7 ± 3.0 months). Cognitive assessment was performed using the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) battery, comprising Symbol Digit Modalities Test (SDMT), California Verbal Learning Test-II (CVLT-II), and Brief Visuospatial Memory Test-Revised (BVMT-R) collected at different time points.
Results: Analysis suggested significant improvement in SDMT Z-scores (mean improvement 0.337, SD 0.638; Cohen's d = 0.42, p = 0.00031). Baseline SDMT Z-score emerged as the sole significant predictor of cognitive change (coefficient - 0.345, p < 0.001), accounting for 32.4% of variance. CVLT-II and BVMT-R scores remained stable across time points.
Conclusions: This real-world study suggests that ozanimod treatment is associated with significant improvement in information processing speed, independent of traditional prognostic factors. These findings complement existing clinical trial data and warrant further investigation through larger, multicenter studies with extended follow-up periods to validate these cognitive benefits
Can Agriculture Conserve Biodiversity? Structural Biodiversity Analysis in a Case Study of Wild Bird Communities in Southern Europe
No full textAdopting an Open-Source Processing Strategy for LiDAR Drone Data Analysis in Under-Canopy Archaeological Sites: A Case Study of Torre Castiglione (Apulia)
No full textThis study introduces a methodology for the improvement of the visibility of archaeological features using an open-source probabilistic machine learning framework applied to UAV LiDAR data from the Torre Castiglione site in Apulia, Italy. By leveraging a Random Forest classification algorithm embedded in an open-source software, the approach processes dense LiDAR point clouds to segment out vegetation from the ground and the structures. Key steps include training the classifier, generating digital terrain models, digital feature models, and digital surface models, and enhancing the visibility of archaeological features. This method has proven effective in improving the interpretation of archaeological sites, revealing previously hidden or difficult-to-access microtopographic and structural details, such as the defensive structures, terraces, and ancient paths of the Torre Castiglione site. The results underline this methodology’s ease of use in uncovering archaeological landscapes under a dense canopy. Moreover, the study emphasises the benefits of using open-source tools to enhance the documentation and analysis of remote or difficult archaeological sites
Pain, Function, and Elastosonographic Assessment After Shockwave Therapy in Non-Calcific Supraspinatus Tendinopathy: A Retrospective Observational Study
No full text: Background: Non-calcific supraspinatus tendinopathy (SNCCT) is a frequent cause of shoulder pain, often associated with functional impairment and reduced quality of life. Recent advancements in diagnostic imaging, including shear wave elastography (SWE), provide quantitative data on tendon stiffness and thickness, facilitating more precise evaluations. Extracorporeal shockwave therapy (ESWT) has emerged as a minimally invasive and effective treatment for SNCCT, but its effects on tendon properties measured through SWE require further investigation. Objective: This retrospective observational study aimed to evaluate the impact of ESWT on supraspinatus tendon characteristics in patients with SNCCT by assessing tendon thickness, SWE velocity, and clinical outcomes. Methods: This observational study enrolled 39 patients with SNCCT, aged 30-75 years, who received three ESWT sessions over 3 weeks. The intervention was delivered using a Modulith SLK system at an energy level of 0.20 mJ/mm2 with 2400 pulses per session. SWE and conventional ultrasound were used to measure tendon thickness and SWEv at baseline (T0) and 6 months post-treatment (T1). Clinical outcomes were assessed using the Visual Analog Scale (VAS), Constant and Murley Score (CMS), and modified Roles and Maudsley scale. Data were analyzed using paired t-tests and correlation analyses. Results: At baseline, affected tendons exhibited increased thickness (7.5 ± 0.9 mm) and reduced SWEv (3.1 ± 0.7 m/s) compared to healthy tendons (4.5 ± 0.7 mm and 6.9 ± 1 m/s, respectively; p < 0.05). Six months after ESWT, tendon thickness decreased significantly (6.2 ± 0.9 mm, p < 0.05), and SWEv increased (5.7 ± 1.8 m/s, p < 0.05), indicating improved elasticity. Clinical outcomes improved significantly, with the VAS scores decreasing from 6.5 ± 1.4 to 3.2 ± 2.1, the CMS score rising from 59.1 ± 17.3 to 78.2 ± 17.7, and the modified Roles and Maudsley scale improving from 2.3 ± 0.6 to 1.5 ± 0.8 (p < 0.05 for all). SWEv positively correlated with the CMS (r = 0.4) and negatively with the VAS and the modified Roles and Maudsley scale (r = -0.6 and r = -0.5, respectively). Conclusions: ESWT significantly reduces tendon thickness and enhances elasticity, correlating with improvements in pain and functional scores. SWE proved to be a reliable method for monitoring structural and clinical changes in SNCCT. Further research, including randomized controlled trials, is recommended to confirm these findings and explore longer-term outcomes
Effective management of invasive alien species in an optimal control framework
No full textInvasive alien species (IAS) pose significant threats to biodiversity, ecosystem stability, and economic sustainability, necessitating effective management strategies. This study explores the use of optimal control models to address IAS management, integrating ecological dynamics with economic considerations to design cost-efficient and ecologically sustainable interventions. We employ a combined approach, utilizing the Hamilton-Jacobi-Bellman framework and dynamic system analysis of the state-control interactions, to examine both density-independent and density-dependent control scenarios. Our analysis highlights the trade-offs between immediate control costs and long-term ecological outcomes, emphasizing the important roles of growth rates, control effectiveness, discount factors, and terminal constraints in shaping optimal strategies. Density-dependent models provide adaptive solutions that respond dynamically to population levels, while density-independent models are suited for uniform or early-stage interventions. Strong terminal constraints drive more aggressive strategies, particularly for larger populations or faster growth rates. The findings underscore the utility of this framework for policymakers, offering practical tools to design cost-effective strategies tailored to specific ecological and economic contexts. Future research could expand on this foundation by addressing spatial dynamics, budget constraints, and multi-stakeholder decision-making, further enhancing its applicability to real-world IAS management challenges
Editorial: Reviews in psychiatry 2023: aging psychiatry
No full textThe world’s population is expected to continue to grow over the next 50 to 60 years,
peaking at around 10.3 billion people in the mid-2080s, up from 8.2 billion in 2024. By the
late 2070s, the number of people aged 65 and over globally is expected to reach 2.2 billion, surpassing the number of people under 18. In fact, by the mid-2030s, there will be 265 million people aged 80 and over, more than the number of people aged 1 year and under. In countries where populations have already peaked or are projected to peak in the coming decades, this has profound implications for health and social care planning and delivery. The most challenging expression of population ageing is the clinical condition of frailty, a state of increased vulnerability to sudden changes in health status triggered by minor stressors, with a resulting increased risk of falls, disability, long-term care, and death. However, if an estimated 31–51 percent of people aged 80 and over are frail, then 49-69 percent of people aged 80 and over may not be frail, raising questions about how frailty develops, how it might be prevented, and how it can be reliably detected. The aging brain is associated with characteristic structural and physiological changes, particularly involving neurons with high metabolic demands, such as the hippocampal pyramidal neurons, that can be affected disproportionally by changes in synaptic function, protein transport, and mitochondrial function. Brain aging is also characterized by structural and functional changes in microglial cells, which are the resident immune cell population of the central nervous system (CNS) and have a macrophage function. They are activated by both brain injury and local and systemic inflammation and become hyper-reactive to even small stimuli with aging, resulting in neuronal damage and death. Growing evidence has supported the hypothesis of a temporal association between frailty, cognitive impairment, and dementia. In particular, evidence from prospective cohort studies showed an independent association between frailty and dementia, where the association of health status deficits that were among the markers of frailty significantly increased the risk of dementia. More specifically, a higher level of physical frailty was associated with a faster decline in cognitive function until the onset of dementia