142 research outputs found
Soluble TREM2 distinguishes neuromyelitis optica spectrum disorder from MOG antibody disease
No full text[no abstract available
Treatment decisions in multiple sclerosis-insights from real-world observational studies
No full textThe complexity of multiple sclerosis (MS) treatment means that doctors and decision-makers need the best available evidence to make the best decisions for patient care. Randomized controlled trials (RCTs) are accepted as the gold standard for assessing the efficacy and safety of any new drug, but conclusions of these trials do not always aid in daily decision-making processes. Indeed, RCTs are usually conducted in ideal conditions, so can measure efficacy only in restricted and unrepresentative populations. In the past decade, a growing number of MS databases and registries have started to produce long-term outcome data from large cohorts of patients with MS treated with disease-modifying therapies in real-world settings. Such observational studies are addressing issues that are otherwise difficult or impossible to study. In this Review, we focus on the most recently published observational studies designed to identify predictors of poor outcome and treatment response or failure, and to evaluate the relative and long-term effectiveness of currently used MS treatments. We also outline the statistical approaches that are most commonly used to reduce bias and limitations in these studies, and the challenges associated with the use of 'big MS data' to facilitate the implementation of personalized medicine in MS
MSJ877810_supplementary_table_1 – Supplemental material for The long-term outcomes of CIS patients in the Barcelona inception cohort: Looking back to recognize aggressive MS
No full textSupplemental material, MSJ877810_supplementary_table_1 for The long-term outcomes of CIS patients in the Barcelona inception cohort: Looking back to recognize aggressive MS by Mar Tintore, Georgina Arrambide, Susana Otero-Romero, Pere Carbonell-Mirabent, Jordi Río, Carmen Tur, Manuel Comabella, Carlos Nos, María Jesús Arévalo, Elisenda Anglada, Rebeca Menendez, Luciana Midaglia, Ingrid Galán, Angela Vidal-Jordana, Joaquin Castilló, Patricia Mulero, Ana Zabalza, Breogan Rodríguez-Acevedo, Marta Rodriguez, Carmen Espejo, Joao Sequeira, Raquel Mitjana, Andrea de Barros, Deborah Pareto, Cristina Auger, Santiago Pérez-Hoyos, Jaume Sastre-Garriga, Alex Rovira and Xavier Montalban in Multiple Sclerosis Journal</p
MSJ877810_supplementary_table_2 – Supplemental material for The long-term outcomes of CIS patients in the Barcelona inception cohort: Looking back to recognize aggressive MS
No full textSupplemental material, MSJ877810_supplementary_table_2 for The long-term outcomes of CIS patients in the Barcelona inception cohort: Looking back to recognize aggressive MS by Mar Tintore, Georgina Arrambide, Susana Otero-Romero, Pere Carbonell-Mirabent, Jordi Río, Carmen Tur, Manuel Comabella, Carlos Nos, María Jesús Arévalo, Elisenda Anglada, Rebeca Menendez, Luciana Midaglia, Ingrid Galán, Angela Vidal-Jordana, Joaquin Castilló, Patricia Mulero, Ana Zabalza, Breogan Rodríguez-Acevedo, Marta Rodriguez, Carmen Espejo, Joao Sequeira, Raquel Mitjana, Andrea de Barros, Deborah Pareto, Cristina Auger, Santiago Pérez-Hoyos, Jaume Sastre-Garriga, Alex Rovira and Xavier Montalban in Multiple Sclerosis Journal</p
Priority setting: women’s health topics in multiple sclerosis
No full textCancer; Multiple sclerosis; Women’s healthCàncer; Esclerosi múltiple; Salut de la donaCáncer; Esclerosis múltiple; Salud de la mujerBackground: A scoping review found that most studies on women’s health in multiple sclerosis (MS) focused on pregnancy, fetal/neonatal outcomes and sexual dysfunction. Few studies addressed menopause, contraception, gynecologic cancers/cancer screening. However, the perceived relative importance of these knowledge gaps to people living with MS and other partners is unknown. We engaged a range of partners, including people living with MS, health care providers, researchers, and patient advocacy groups, to set priorities for future research in women’s health in MS.
Methods: We employed a three-step global engagement process. First, we identified which broad research topics relevant to women’s health in MS were of highest priority using two surveys. Second, we developed specific research questions within these topics using focus groups. Finally, we prioritized the research questions with a third survey.
Results: Overall, 5,266 individuals responded to the initial surveys [n = 1,430 global survey, mean (SD) age 50.0 (12.6), all continents; n = 3,836 North American Research Committee on Multiple Sclerosis survey, mean (SD) age 64.8 (9.6), United States]. Menopause, sexual dysfunction, pregnancy, gynecologic cancer/cancer screening, hormones and parenthood were identified as the most important topics. Focus groups generated 80 potential research questions related to these topics. In the final survey 712 individuals prioritized these questions. The highest priority questions in each research topic were: (i) How do perimenopause and menopause affect disease activity, course, response to disease-modifying treatment and quality of life in MS; (ii) What are the most effective strategies for managing issues around sexual intimacy, including related to low sexual desire, changes in physical function, and MS symptoms; (iii) Are there long-term effects of disease-modifying therapies on the children of persons with MS; (iv) What are the short and long-term effects of disease-modifying drugs on gynecologic cancer risk, particularly for high efficacy disease-modifying drugs and hematopoietic stem cell transplantation; (v) Are there hormone related treatments that can stabilize fluctuations in MS symptoms; and (vi) How does MS fatigue impact parenting strategies.
Conclusion: Priorities for research relating to women’s health issues for persons with MS have been delineated using a collaborative process with key partners. Alignment of future research with these priorities should be monitored.The author(s) declare financial support was received for the research, authorship, and/or publication of this article. The International Advisory Committee on Clinical Trials in MS is sponsored by the European Committee for Treatments and Research in MS and the National Multiple Sclerosis Society. NARCOMS is a project of the Consortium of Multiple Sclerosis Centers (CMSC). NARCOMS is funded in part by the CMSC and the Foundation of the CMSC. The study was also supported in part by the Waugh Family Chair in Multiple Sclerosis (to RM). The funding source(s) had no role in the study design, collection, analysis or interpretation of the data, nor in the decision to submit the article for publication
Mesoscale subduction at the Almeria-Oran front. Part 1: ageostrophic flow
No full textThis paper presents a detailed diagnostic analysis of hydrographic and current meter data from three, rapidly repeated, fine-scale surveys of the Almeria-Oran front. Instability of the frontal boundary, between surface waters of Atlantic and Mediterranean origin, is shown to provide a mechanism for significant heat transfer from the surface layers to the deep ocean in winter. The data were collected during the second observational phase of the EU funded OMEGA project on RRS Discovery cruise 224 during December 1996. High resolution hydrographic measurements using the towed undulating CTD vehicle, SeaSoar,. traced the subduction of Mediterranean Surface Water across the Almeria-Oran front. This subduction is shown to result from a significant baroclinic component to the instability of the frontal jet. The Q-vector formulation of the omega equation is combined with a scale analysis to quantitatively diagnose vertical transport resulting from mesoscale ageostrophic circulation. The analyses are presented and discussed in the presence of satellite and airborne remotely sensed data; which provide the basis for a thorough and novel approach to the determination of observational error
Prognostication and contemporary management of clinically isolated syndrome
No full textClinically isolated syndrome (CIS) patients present with a single attack of inflammatory demyelination of the central nervous system. Recent advances in multiple sclerosis (MS) diagnostic criteria have expanded the number of CIS patients eligible for a diagnosis of MS at the onset of the disease, shrinking the prevalence of CIS. MS treatment options are rapidly expanding, which is driving the need to recognise MS at its earliest stages. In CIS patients, finding typical MS white matter lesions on the patient's MRI scan remains the most influential prognostic investigation for predicting subsequent diagnosis with MS. Additional imaging, cerebrospinal fluid and serum testing, information from the clinical history and genetic testing also contribute. For those subsequently diagnosed with MS, there is a wide spectrum of long-term clinical outcomes. Detailed assessment at the point of presentation with CIS provides fewer clues to calculate a personalised risk of long-term severe disability. Clinicians should select suitable CIS cases for steroid treatment to speed neurological recovery. Unfortunately, there are still no neuroprotection or remyelination strategies available. The use of MS disease modifying therapy for CIS varies among clinicians and national guidelines, suggesting a lack of robust evidence to guide practice. Clinicians should focus on confirming MS speedily and accurately with appropriate investigations. Diagnosis with CIS provides an opportune moment to promote a healthy lifestyle, in particular smoking cessation. Patients also need to understand the link between CIS and MS. This review provides clinicians an update on the contemporary evidence guiding prognostication and management of CIS
The role of the cerebellum in multiple sclerosis—150 years after Charcot
No full textDespite its functional importance and well known clinical impact in Multiple Sclerosis (MS), the cerebellum has only received significant attention over the past few years. It is now established that the cerebellum plays a key role not only in various sensory-motor networks, but also in cognitive-behavioural processes, domains primarily affected in patients with MS. Evidence from histopathological and magnetic resonance imaging (MRI) studies on cerebellar involvement in MS is increasingly available, however linking these pathological findings with clinical dysfunction remains challenging. There are promising advances in technology that are likely to improve the detection of pathological changes within the cerebellum, which may elucidate how pathology relates to disability
Análisis multiparamétrico y validación de tres simulaciones globales en el Mediterráneo occidental
No full textWe analyse a hierarchy of three 1/4° global numerical simulations (ORCA-025.G70 (G70), ORCA-025.G85 (G85) and GLORYS1V1 (GLORYS)) by assessing their performance against observational data in the western Mediterranean. When compared with the EN3_v2a temperature and salinity database, the simulations are capable of reproducing surface layer temperature interannual variability but G70 is inaccurate with intermediate and deep-layer trends. This aspect is improved by the increased vertical resolution of G85 and by data assimilation in GLORYS. Salinity is the most problematic parameter because of the imbalance of the freshwater budget derived from inaccuracies in the atmospheric forcing parameters. Surface salinity restoring is needed in order to avoid salinity drift and inaccurate sea-level trends. G70, with a stronger relaxation, has a lower trend closer to altimetric measurements than G85. Mean surface circulation is well reproduced for relatively large-scale signals. We further show that G85 and GLORYS provide evidence of the 2004-2005 and 2005-2006 deep convection events in the Gulf of Lion. Finally, transports through the main straits of the western Mediterranean are correct in order of magnitude, direction and seasonal cycle when compared with observations. This study contributes to the improvement of the ORCA hierarchy of simulations and points out the strengths and weaknesses of these simulations in the Mediterranean Sea.Analizamos un conjunto de tres simulaciones numéricas globales de 1/4º (ORCA-025.G70 (G70), ORCA-025.G85 (G85) y GLORYS1V1 (GLORYS)) comparándolas con datos observacionales en el Mediterráneo Occidental (WMED). Contrastando con la base de datos de temperatura y salinidad EN3_v2a las simulaciones son capaces de reproducir la variabilidad superficial en temperatura sin embargo G70 exagera las tendencias en capas intermedias y profundas. Este aspecto es mejorado por la mayor resolución vertical de G85 y la asimilación de datos de GLORYS. La salinidad es el parámetro más problemático debido al desequilibrio del balance de agua dulce procedente de imprecisiones en los parámetros de forzamiento atmosférico. Relajación de salinidad superficial es necesaria para evitar derivas de salinidad y nivel del mar. De hecho G70 con su relajación más intensa tiene una tendencia más baja (y más cercana a mediciones altimétricas) que G85. La circulación promedio en superficie está bien reproducida para señales relativamente grandes. Además, demostramos que G85 y GLORYS muestran evidencia de los eventos de convección profunda de 2004-2005 y 2005-2006 en el Golfo de León. Finalmente, transportes a través de los principales canales y estrechos del Mediterráneo Occidental son correctos cuando se comparan con observaciones, tanto en orden de magnitud y dirección, como en el ciclo estacional. Este estudio contribuye a la mejora del conjunto de simulaciones ORCA y señala las fortalezas y debilidades de estas simulaciones en el Mar Mediterráneo
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