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Delta MELD as a predictor of early outcome in adult-to-adult living donor liver transplantation
No full textBackground/Aims: An increased post-operative mortality risk has been reported among patients who undergo living donor liver trans?plantation (LDLT) with higher model for end-stage liver disease (MELD) scores. In this study, we investigated the effect of MELD score reduction on post-operative outcomes in patients with a high MELD (?20) score by pre-transplant management. Materials and Methods: We retrospectively analyzed 386 LDLT cases, and patients were divided into low-MELD (<20, n=293) vs. high?MELD (?20, n=93) groups according to their MELD score at the time of index hospitalization. Patients in the high-MELD group were managed specifically according to a treatment algorithm in an effort to decrease the MELD score. Patients in the high-MELD group were further divided into 2 subgroups: (1) responders (n=34) to pre-transplant treatment with subsequent reduction of the MELD score by a minimum of 1 point vs. (2) non-responders (n=59), whose MELD score remained unchanged or further increased on the day of LDLT. Responders vs. non-responders were compared according to etiology, demographics, and survival
STATE OF NATIONAL AND ESO CERTIFICATIONS FOR STROKE CENTRES/UNITS AMONG ESO MEMBERS
No full textBar, Michal/0000-0002-5049-5844WOS:000587365201432[No Abstract Available]0119
Imatinib Treatment for Bleomycin-Induced Pulmonary Toxicity
No full textPubMed: 33352104WOS:000600070300016The basic treatment for bleomycin-induced pulmonary toxicity is corticosteroids. However, unresponsiveness to corticosteroid treatment can be observed in some cases. We present a case of a 51-year-old man, diagnosed with seminoma, who was receiving a combination treatment of bleomycin, etoposide, and cisplatin when admitted to the hospital with progressive cough and exercise-induced dyspnea. The patient's computed thorax tomography imaging showed bilateral consolidation of lungs, bronchoalveolar lavage (BAL) showed neutrophilia, and transbronchial biopsy showed fibroblastic proliferation. The sputum and BAL cultures were all sterile, and the patient was treated with methylprednisolone for the diagnosis of acute interstitial pneumonia. However, despite the corticosteroid treatment, patient suffered a respiratory failure. On the sixteenth day, imatinib 300 mg/day was added to the corticosteroid treatment. The result of the combination therapy was successful; therefore, corticosteroid and imatinib were stopped at the fifth and ninth month of the combination treatment, respectively. The patient, who is still under follow-up without any therapy until now, demonstrated that in cases of bleomycin-induced pulmonary toxicity that is unresponsive to corticosteroids, addition of imatinib to the treatment can be an alternative option
Prevalence of PTEN mutations in Turkish children with autism spectrum disorders and macrocephaly
No full textWOS:000598482603194[No Abstract Available]E-P09.58'PTEN Research' in London, UKGrant for this study is awarded by 'PTEN Research' in London, UK
VASKÜLER RİSK FAKTÖRLERİNİN KOGNİTİF DURUMLA İLİŞKİSİ
No full textGiriş: Vasküler risk faktörlerinin kognitif bozukluğun değiştirilebilir risk faktörlerinden olduğu öne sürülmektedir. Çalışmamızda, kardiyovasküler hastalık ve demans öyküsü olmayan, 60 yaş ve üzerindeki bireylerde on yıllık koroner kalp hastalığı ve inme risk skorları ile kognitif durum arasındaki ilişki araştırıldı. Gereç ve Yöntem:İnme Merkezi “İnme ve Demans Primer Koruma Polikliniği” ne ardışık olarak başvurmuş olan bireylerin verileri retrospektif olarak incelendi. On yıllık koroner kalp hastalığı ve inme risklerini değerlendirmek amacıyla sırasıyla Framingham Risk Skoru (FRS) ve ModifiyeFramingham İnme Risk Profili (FSRP) kullanıldı. Kognitif fonksiyonlar Montreal Bilişsel Değerlendirme Ölçeği (MoCA) ile değerlendirilmişti. Bu testin Türkiye standardizasyon çalışmasına göre MoCA≤ 21 olanlar kognisyonu bozuk olarak kabul edildi. Kognitif durum ile vasküler risk arasındaki ilişki multivariat lojistik regresyon analizi ile araştırıldı. Yaş, cinsiyet, eğitim düzeyi, diğer kognisyonla ilişkili olabilecek etkenler, antihiperlipidemik, antidiyabetik ve antihipertansif tedavi kullanımı analize alındı. Bulgular: Örneklem 167 bireyden (40 erkek ve 127 kadın) oluşmaktaydı. Ortalama yaş 68 (SD: 6 Aralık: 28) idi. Ortalama FRS ve FSRP sırasıyla 8(20-3) ve 7(11-4) idi. Elli beş kişinin (%33) kognitif durumu bozuktu. Framingham Risk Skorundaki her %10’ luk artış kognisyonun bozuk olmasıyla ilişkiliydi (OR:1,669, 95%CI 1,038-2,682). İleri yaş, düşük eğitim düzeyi, alkol ve antihiperlipimik tedavi kullanmıyor olmak da ilişkili diğer bağımsız faktörlerdi. Ancak FSRP ile kognitif durum arasında ilişki saptanmadı. Sonuç: Kardiyovasküler hastalık öyküsü olmayan yaşlı bireylerde, FRS ile ölçülen global vasküler risk kognitif bozuklukla ilişkiliyken FSRP ile benzer ilişki saptanmamıştır. Bu ilişki, rutin klinik değerlendirmede kullanılan ve hafif kognitif bozukluğa duyarlı nöropsikolojik bir test olan MoCA ile gösterilmiştir
Multi-parametric evaluation of autologous cultivated Limbal epithelial cell transplantation outcomes of Limbal stem cell deficiency due to chemical burn
No full textGurdal, Mehmet/0000-0003-1226-1737WOS: 000561115700003PubMed: 32762738Background the sparsity of established tools for the grading of limbal stem cell deficiency hinder objective assessments of the clinical outcome of cultivated limbal epithelial cell transplantation. To advance towards the development of standards for the comparison of the outcomes of these bio-surgical protocols we have now applied a battery of recognized objective and patient-declared subjective outcome criteria to the autologous modality of cultivated limbal epithelial cell transplantation. Methods the prospective study involved ten patients (M/F = 9/1; mean age = 42.1 years) displaying overt unilateral limbal stem cell deficiency complying with the inclusion criteria described in Methods. Limbal biopsies were obtained from the contralateral eye and their outgrowths after 2-week cultures were transplanted on the affected eye after pannus resection. Outcomes were followed up for 12 months. the objective tests were scores for best-corrected visual acuity (BCVA); using the LogMAR scale, a multiparametric ocular surface score (OSS), and the Schirmer's test. Subjective scores were based on patient answers to a) perception of visual improvement/pain; b) the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ 25); and c) the 12-item Ocular Surface Disease Index Questionnaire (OSDI). All procedures were performed under good manufacture practices using solely xeno-free reagents. in all cases, a single biopsy was divided into two pieces and they were expanded in order to prevent outgrowth failure. in 5 patients, both biopsies generated healthy culture sheet. in those cases the lesser outgrowth were used for immune-histological characterization. Results the experimental parallel outgrowth samples showed a similar percent of p63 alpha(+)cells. PreOp and 12-month PostOp BCVAs and OSSs were, respectively, 1.15 +/- 0.70; 0.21 +/- 0.13 and 7.40 +/- 2.01; 2,30 +/- 1.30, (p < 0.05). Patient's responses to all three question sets except ocular pain were consistent with significant improvement (p < 0.05). Conclusion Objective clinical metrics demonstrate that in patients with limbal stem cell deficiency, cultivated limbal epithelial cell transplantation improves vision and ocular surface health and subjective visual perceptions.Scientific and Technological Research Council of Turkey (TUBITAK)Turkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK) [115S423]; USPHSUnited States Public Health Service [RO1-EY 029279, RO1-EY014878]OBS: the Scientific and Technological Research Council of Turkey (TUBITAK)(Project number:115S423); JMW: USPHS RO1-EY 029279 and RO1-EY014878
Investigation of the relationship between early maladaptive schemas and defense mechanisms in the terms of childhood traumas
No full textWOS: 000524024400002Objective: the aim of this study is to examine the relationships between defence mechanisms and early maladaptive schemas in terms of childhood traumas. Methods: 500 people, including 308 women and 192 male students from various universities in Istanbul, participated in the study. Demographic Data Form, Defense Style Test, Young Schema Scale Short Form-3 and Childhood Trauma Questionnaire were applied to participants. Results: As a result significant relations were found between the defense mechanisms, early maladaptive schemas and childhood traumas. the effect of presence or absence of trauma experience has a statistically significant effect on development of defense mechanisms and early maladaptive schemas. Discussion: For psychotherapy of childhood trauma, studying of defense mechanisms and early maladaptive schemes will be useful
Perceptions of gender equity in departmental leadership, research opportunities, and clinical work attitudes: an international survey of 11 781 anaesthesiologists
No full textPubMed: 32005515Background: Women make up an increasing proportion of the physician workforce in anaesthesia, but they are consistently under-represented in leadership and governance. Methods: We performed an internet-based survey to investigate career opportunities in leadership and research amongst anaesthesiologists. We also explored gender bias attributable to workplace attitudes and economic factors. the survey instrument was piloted, translated into seven languages, and uploaded to the SurveyMonkey® platform. We aimed to collect between 7800 and 13 700 responses from at least 100 countries. Participant consent and ethical approval were obtained. A quantitative analysis was done with ?2 and Cramer's V as a measure of strength of associations. We used an inductive approach and a thematic content analysis for qualitative data on current barriers to leadership and research. Results: the 11 746 respondents, 51.3% women and 48.7% men, represented 148 countries; 35 respondents identified their gender as non-binary. Women were less driven to achieve leadership positions (P<0.001; Cramer's V: 0.11). Being a woman was reported as a disadvantage for leadership and research (P<0.001 for both; Cramer's V: 0.47 and 0.34, respectively). Women were also more likely to be mistreated in the workplace (odds ratio: 10.6; 95% confidence interval: 9.4–11.9; P<0.001), most commonly by surgeons. Several personal, departmental, institutional, and societal barriers in leadership and research were identified, and strategies to overcome them were suggested. Lower-income countries were associated with a significantly smaller gender gap (P<0.001). Conclusions: Whilst certain trends suggest improvements in the workplace, barriers to promotion of women in key leadership and research positions continue within anaesthesiology internationally. © 2019 British Journal of AnaesthesiaSociedade Brasileira de Anestesiologia, SBA Suomen Anestesiologiyhdistys International Trauma Anesthesia and Critical Care Society, ITACCS American Society of Regional Anesthesia and Pain Medicine, ASRA Australian and New Zealand College of Anaesthetists, ANZCA Nederlandse Vereniging voor Bloedtransfusie, NVBFor piloting the questionnaire, the authors thank the following (i) anaesthesiologists: Andreja Moller Petrun, Mirt Kamenik, Jozica Wagner Kovacec, Domen Kogler, Marko Lokar, Katarina Katja Primozic, Bogdan Zdravkovic, Barbara Pecovnik, Pieter Mertens, Maria Lurdes Castro, Tina Heidi Pedersen, Beatriz Noronha, Ross Hofmeyr, Thomas Chloros, Filip Depta, Jana Sendreyova, Natalia Bogdanova Kavalcikova, and Chris Martini; and (ii) medical educationalists: Debra Lee Klamen, Heeyoung Han, Leslie Clasina Smith, Shelley Parr, Pat O'Sullivan, Paul de Roos, and Sonia Vaida. For translations, the authors thank Beatriz Noronha, Denis Pizhin, Jekaterina Jagodzinska, Laure Robert-Tissot, Tatjana Dill, David Berger, Alicia Del Moral Olmo, Alejandro Bernasconi, Philippe Dubois, and Societ? Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva. the authors also acknowledge the following (i) supporting international societies: European Airway Management Society and American Society of Regional Anesthesia and Pain Medicine; and (ii) supporting national societies: Societ? Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva (Italy), New Zealand Society of Anaesthetists (New Zealand), South African Society of Anaesthesiologists (South Africa), Oman Society of Anesthesia and Critical Care (Oman), Soci?t? Marocaine d'Anesth?sie R?animation (Morocco), Nigerian Society of Anaesthetists (Nigeria), Kenya Society of Anaesthesiologists (Kenya), Finnish Society of Anaesthesiologists (Finland), Armenian Society of Anaesthesiologists and Intensive Care Specialists (Armenia), Bulgarian Society of Anaesthesiologists (Bulgaria), Sociedade Brasileira de Anestesiologia (Brazil), Romanian Society of Anaesthesia and Intensive Care (Romania), Turkish Anaesthesiology and Reanimation Society (Turkey), ?sterreichische Gesellschaft f?r An?sthesiologie, Reanimation und Intensivmedizin (Austria), Sociedad Espa?ola de Anestesiolog?a, Reanimaci?n y Terap?utica del Dolor (Spain), Soci?t? Fran?aise d'Anesth?sie et de R?animation (France), and Nederlandse Vereniging voor Anesthesiologie (Netherlands). the authors also acknowledge the collaborators, who are listed in the Supplementary material
Atipamezole, a specific alpha(2A) antagonist, suppresses spike-and-wave discharges and alters Ca2+/calmodulin-dependent protein kinase II in the thalamus of genetic absence epilepsy rats
No full textAYDIN, BANU/0000-0002-3267-8620WOS: 000583280100001PubMed: 33098125Objective the role of alpha(2A) adrenergic receptors (alpha(2A)ARs) in absence epilepsy is not well characterized. Therefore, we investigated the outcomes of the specific antagonism of alpha(2A)ARs on the spike-and-wave discharges (SWDs) in genetic absence epilepsy rats from Strasbourg (GAERSs), together with its influence on the behavior and second messenger systems, which may point to the mechanisms to which a possible SWD modulation can be related. Methods Atipamezole, an alpha(2A)AR antagonist, was administered intracerebroventricularly to the adult GAERSs, and electroencephalography (EEG) was conducted. the cumulative duration and number of SWDs, and the mean duration of each SWD complex were counted. the relative power of the EEG frequency bands and behavioral activity after the acute application of two doses (12 and 31 mu g/5 mu L) of atipamezole were evaluated. the levels of cyclic adenosine monophosphate and calcium/calmodulin-dependent kinase II (CaMKII) were measured in the cortex, thalamus, and hippocampus of naive Wistar rats and GAERSs, administered with artificial cerebrospinal fluid (aCSF) as a vehicle, or either acute or chronic atipamezole (12 mu g), the latter being administered for 5 consecutive days. Results Atipamezole significantly suppressed SWDs dose-dependently, without affecting the relative power values of EEG frequency spectrum. the stereotypic activity was significantly lower in both naive Wistar rats and GAERSs receiving the highest dose (31 mu g) of atipamezole compared to GAERSs receiving aCSF. in GAERSs, CaMKII levels were found to be higher in the thalamus after the acute and chronic application of SWD-suppressing doses of atipamezole (12 and 31 mu g) compared to aCSF. Significance This study emphasizes the alpha(2)AR-related modulation of absence epilepsy and particularly the significance of alpha(2)AR antagonism in suppressing SWDs. Atipamezole's SWD-suppressive actions may be through CaMKII-mediated second messenger systems in the thalamus.Marmara UniversitesiMarmara University [BAPKO-SAG-C-BRP-131016-0435, SAG-P-150218-0047]; Marmara UniversityMarmara University [2018]Marmara Universitesi, Grant/Award Number: BAPKO-SAG-C-BRP-131016-0435 and SAG-P-150218-0047; Marmara University, Grant/Award Number: 201
Treatment of MOG antibody associated disorders: results of an international survey
No full textPubMed: 32623595Introduction: While monophasic and relapsing forms of myelin oligodendrocyte glycoprotein antibody associated disorders (MOGAD) are increasingly diagnosed world-wide, consensus on management is yet to be developed. Objective: To survey the current global clinical practice of clinicians treating MOGAD. Method: Neurologists worldwide with expertise in treating MOGAD participated in an online survey (February–April 2019). Results: Fifty-two responses were received (response rate 60.5%) from 86 invited experts, comprising adult (78.8%, 41/52) and paediatric (21.2%, 11/52) neurologists in 22 countries. All treat acute attacks with high dose corticosteroids. If recovery is incomplete, 71.2% (37/52) proceed next to plasma exchange (PE). 45.5% (5/11) of paediatric neurologists use IV immunoglobulin (IVIg) in preference to PE. Following an acute attack, 55.8% (29/52) of respondents typically continue corticosteroids for ? 3 months; though less commonly when treating children. After an index event, 60% (31/51) usually start steroid-sparing maintenance therapy (MT); after ? 2 attacks 92.3% (48/52) would start MT. Repeat MOG antibody status is used by 52.9% (27/51) to help decide on MT initiation. Commonly used first line MTs in adults are azathioprine (30.8%, 16/52), mycophenolate mofetil (25.0%, 13/52) and rituximab (17.3%, 9/52). in children, IVIg is the preferred first line MT (54.5%; 6/11). Treatment response is monitored by MRI (53.8%; 28/52), optical coherence tomography (23.1%; 12/52) and MOG antibody titres (36.5%; 19/52). Regardless of monitoring results, 25.0% (13/52) would not stop MT. Conclusion: Current treatment of MOGAD is highly variable, indicating a need for consensus-based treatment guidelines, while awaiting definitive clinical trials. © 2020, Springer-Verlag GmbH Germany, part of Springer Nature.MedImmune Chugai Pharmaceutical Eden Hall Foundation, EHF Bundesministerium für Bildung und Forschung, BMBF Klaus Tschira Stiftung, KTS Roche Products Bundesministerium für Bildung und Forschung, BMBF Dietmar Hopp Stiftung 425331/2016-4 National Health and Medical Research Council, NHMRC Deutsche Forschungsgemeinschaft, DFG Medical Research Council, MRC Deutsche Forschungsgemeinschaft, DFG Novartis Deutsche Forschungsgemeinschaft, DFG Bayer Schering Japan Society for the Promotion of Science, KAKEN: KAKENHI 15K19472 17/2551-0001391-3 Dietmar Hopp Stiftung Shire Sanofi Genzyme Bayer Biogen Teva Pharmaceutical Industries National Institute for Health Research, NIHR Genzyme Alexion Pharmaceuticals Merck Guthy-Jackson Charitable Foundation Multiple Sclerosis Society, MS SocietyThe UK Neuromyelitis Optica Diagnostic and Advisory Service is funded by the Highly Specialised Commissioning Division of NHS England. There was no formal sponsorship for this study.D.H. Whittam, E.Gibbons, V. Karthikeayan, R. Kneen, S. Chandratre, J. de Seze, K. Deiva, R.Q. Hintzen, I. Kleiter, K. Rostasy, P. Huppke, F. Paul, A.K. Pröbstel, M.P. Amato, M. Nosadini, M.M. Mancardi, Z. Illes, A. Siva, G. Akman-Demir, L. Pandit, M. Apiwattankul, J.Y. Hor, S. Viswanathan, W. Qiu, H.J. Kim, I. Nakashima, R.C. Dale, M. Boggild, S. Broadley, M.A. Lana-Peixoto, P. Cabre, B.G. Weinshenker, B. Greenberg, M. Matiello, E.C. Klawiter, J.L. Bennett, A.I. Wallach, I. Kister, B.L. Banwell, D. Pohl, M.Levy, M.I. Leite, T. Solomon: nothing to disclose. O. Ciccarelli is a consultant for Roche, Novartis, Teva, Biogen and Merck. B Wildemann has received research grants and/or honoria from Merck Serono, Biogen, Teva, Novartis, Sanofi Genzyme, Bayer Healthcare, and research grants from Bundesministerium für Bildung und Forschung, Deutsche Forschungsgemeinschaft, Dietmar Hopp Foundation and the Klaus Tschira Foundation. S. Jarius’s work was indirectly supported by research grants from Dietmar Hopp Stiftung and from Merck Serono. I.Kleiter has received speaker honoraria and travel funding from Bayer, Biogen, Novartis, Merck, Sanofi Genzyme, Roche; speaker honoraria from Mylan; travel funding from the Guthy-Jackson Charitable Foundation; consulted for Alexion, Bayer, Biogen, Celgene, Chugai, IQVIA, Novartis, Merck, Roche; and research support from Chugai, Diamed. B. Hemmer has served on scientific advisory boards for F. Hoffmann-La Roche Ltd, Novartis, and Bayer AG; he has served as DMSC member for AllergyCare and TG Therapeutics; he or his institution have received speaker honoraria from Medimmune, Novartis, Desitin, and F. Hoffmann-La Roche Ltd; his institution has received research support from Chugai Pharmaceuticals; holds part of two patents; one for the detection of antibodies and T cells against KIR4.1 in a subpopulation of MS patients and one for genetic determinants of neutralizing antibodies to interferon ?. O. Aktas reports grants from the German Research Foundation (DFG) and the German Ministry of Education and Research (BMBF), grants and personal fees from Bayer HealthCare, Biogen, Genzyme, Novartis, Teva and Viela Bio, and personal fees from Almirall, MedImmune, Merck Serono and Roche. G. Arrambide has received compensation for consulting services or participation in advisory boards from Sanofi, Merck, and Roche; research support from Novartis; travel expenses for scientific meetings from Novartis, Roche, Stendhal, and ECTRIMS; and speaking honoraria from Sanofi, Merck, and Novartis. M. Tintore has received compensation for consulting services and speaking honoraria from Almirall, Bayer Schering Pharma, Biogen-Idec, Genzyme, Merck-Serono, Novartis, Roche, Sanofi-Aventis, and Teva Pharmaceuticals. MT is co-editor of Multiple Sclerosis Journal-ETC. M. Capobianco received personal honoraria for speaking at meeting or participating in advisory boards from Biogen, Merck, Novartis, Roche, Sanofi, Teva. A. Altintas received travel grants and/or speaker honoraria from Merck, Generica and Novartis. H.J. Kim received research support from the Ministry of Science and ICT, Genzyme, Merck Serono, Teva-Handok, and UCB; received consultancy/speaker fees from Celltrion, Eisai, HanAll BioPharma, MedImmune, Merck Serono, Novartis, Sanofi Genzyme, Teva-Handok, and UCB; serves on a steering committee for MedImmune/VielaBio; is a co-editor for the Multiple Sclerosis Journal—Experimental, Translational, and Clinical, and an associated editor for the Journal of Clinical Neurology. K. Fujihara received consultancy/speaker fees: Alexion Pharmaceuticals, Chugai, Asahi Kasei Medical, Biogen, Eisai, Mitsubishi-Tanabe Pharma, Nihon, Novartis Pharmaceuticals, ONO Pharmaceutical, Takeda, and Teijin. S. Ramanathan has received an Early Career Fellowship from the National Health and Medical Research Council (Australia). D.K. Sato has received a Grants-in-Aid for Scientific Research from the Japan Society for the Promotion of Science (KAKENHI 15K19472); research support from CNPq/Brasil (425331/2016-4), FAPERGS/MS/CNPq/SESRS (17/2551-0001391-3) PPSUS/Brazil, TEVA (research grant for EMOCEMP Investigator Initiated Study), and Euroimmun AG (Neuroimmunological Complications associated with Arboviruses); and speaker honoraria from Biogen, Novartis, Genzyme, TEVA, Merck-Serono, Roche, and Bayer and has participated in advisory boards for Shire, Roche, TEVA, Merck-Serono and Quest/Athena Diagnostics. S. Tenembaum serves as a non-remunerated editorial board member of Neurology: Neuroimmunology & Neuroinflammation. She has received speaker and consulting fees from Biogen-Idec Argentina, Merck Serono LATAM, Genzyme-Sanofi, Novartis, and Teva Neuroscience during the last 3 years. D.M. Wingerchuk received grant support paid to Mayo Clinic from Alexion and TerumoBCT, consultant fees from MedImmune, Celgene, Novartis, and ONO Pharmaceuticals. A. Traboulsee: has received research funding from Chugai, Roche, and Sanofi Genzyme; received honoraria or travel support from Consortium of MS Centers, MS Society of Canada, Biogen, Teva, Roche, Merck/EMD Serono, Sanofi Genzyme, Chugai. J. Palace is partly funded by highly specialised services to run a national congenital myasthenia service and a neuromyelitis optica service. She has received support for scientific meetings and honorariums for advisory work from Merck Serono, Biogen Idec, Novartis, Teva, Chugai Pharma and Bayer Schering, Alexion, Roche, Genzyme, MedImmune, EuroImmun, MedDay, Abide ARGENX, UCB and Viela Bio and grants from Merck Serono, Novartis, Biogen Idec, Teva, Abide, MedImmune, Bayer Schering, Genzyme, Chugai and Alexion. She has received grants from the MS society, Guthrie Jackson Foundation, NIHR, Oxford Health Services Research Committee, EDEN, MRC, GMSI, John Fell and Myaware for research studies. R. Marignier serves on the scientific advisory board for Novartis and Medimmune; received speaker honoraria and travel funding from Novartis, Biogen, Teva, Sanofi-Aventis/Genzyme, Merck. M. Lim has received consultation fees from CSL Behring; received travel grants from Merck Serono; and was awarded educational grants to organize meetings by Novartis, Biogen Idec, Merck Serono and Bayer. S. Huda has received research support from the Neuromyelitis Optica UK charity. A. Jacob served on the scientific advisory board for Shire Pharmaceuticals; received travel funding and/or speaker honoraria from Biogen Idec, Shire, and Terumo BCT; consulted for Shire Pharmaceuticals; and received research support from Biogen, Alexion Pharmaceuticals, NHS, and University of Liverpool