•Multiple Sclerosis places a huge economic burden on healthcare models and societies.•The estimated total annual cost per patient in Europe is 40,303€.•Costs of drugs were main the cost determinants ...for less severe cases of MS.•Informal care and production losses were the main cost for the most severe cases of MS.•Eastern European countries face the smallest costs.
Multiple sclerosis has both high healthcare and social impacts.
The purpose of this article is to analyse the available literature describing the economic burden of multiple sclerosis and to compare costs among studies examining main cost drivers.
A literature search on studies published in English on cost-of-illness of multiple sclerosis included in this review using PubMed, the Cochrane Library, SCOPUS and Web of Science includes a retrospective horizon and it describes direct and indirect costs in patients categorized into severity groups.
Several papers were obtained from the database search (n=37). Additionally, results from “hand searching” were also included, where a wider horizon was considered. Cost estimates were compared among studies that used a societal perspective on costs, time-period studied, and year of price level used. The estimated total annual cost per patient in Europe is on average 40,300€ (n=20). In addition, differences by geographic areas and severity groups are also considered. All in all, the higher the severity, the higher the associated costs.
This systematic review provides one clear finding: multiple sclerosis places a huge economic burden on healthcare models and societies due to productivity losses and caregiver burden. Moreover, costs of drugs were main cost determinants for less severe cases of multiple sclerosis and informal care and production losses for the most severe cases of multiple sclerosis.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Abstract Background aims Cell therapy with autologous mesenchymal stromal cells (MSCs) in patients with spinal cord injury (SCI) is beginning, and the search for its better clinical application is an ...urgent need. Methods We present a phase 2 clinical trial in patients with chronic SCI who received three intrathecal administrations of 100 x 106 MSCs and were followed for 10 months from the first administration. Efficacy analysis was performed on nine patients, and safety analysis was performed on 11 patients. Clinical scales, urodynamic, neurophysiological and neuroimaging studies were performed previous to treatment and at the end of the follow-up. Results The treatment was well-tolerated, without any adverse event related to MSC administration. Patients showed variable clinical improvement in sensitivity, motor power, spasms, spasticity, neuropathic pain, sexual function or sphincter dysfunction, regardless of the level or degree of injury, age or time elapsed from the SCI. In the course of follow-up three patients, initially classified as ASIA A, B and C, changed to ASIA B, C and D, respectively. In urodynamic studies, at the end of follow-up, 66.6% of the patients showed decrease in postmicturition residue and improvement in bladder compliance. At this time, neurophysiological studies showed that 55.5% of patients improved in somatosensory or motor-evoked potentials, and that 44.4% of patients improved in voluntary muscle contraction together with infralesional active muscle reinnervation. Conclusions The present guideline for cell therapy is safe and shows efficacy in patients with SCI, mainly in recovery of sphincter dysfunction, neuropathic pain and sensitivity.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Soils provide key ecosystem services and are crucial to combat climate change. Agriculture provides important ecosystem services but also causes negative environmental effects depending on ...agricultural management. In this regard, crop diversification is a promising sustainable land management strategy to combat soil erosion and degradation, mitigate climate change and ensure food security. Here, we assess the combined short-term effects of crop diversification and no tillage on several key soil physico-chemical parameters related to soil functioning as well as on crop yields in a rainfed almond (Prunus dulcis Mill.) orchard under semiarid Mediterranean conditions. Almond trees were inter-cropped with Capparis spinosa L. (caper) or Thymus hyemalis Lange (winter thyme) and compared with the almond monocrop system. The experimental design consisted of three plots in a randomized-block design, with three replicates for each crop management treatment (almond monocrop, almond inter-cropped with caper, and almond inter-cropped with winter thyme). Along with crop yields, the combined effects of crop diversification and no tillage on a range of soil quality and health indicators including soil physical (bulk density, aggregate stability, water retention and availability) and chemical (total and particulate organic carbon and nitrogen, ammonium and nitrate content, available macro- and micro-nutrients) properties were monitored in the topsoil and subsoil (at 0–10 and 10–30 cm depth, respectively) one and three years from establishment.
from this study indicate that soil water retention capacity and water availability for plants were enhanced in both crop diversification systems after three years from their implementation at 0–30 cm depth. Likewise, improvements in particulate organic carbon and available N were observed in the subsoil of both crop diversifications. Crop diversification did not significantly affect the main crop yields, highlighting that crop diversification can be a promising sustainable management practice for improving soil health without compromising food security under semiarid Mediterranean conditions. Indeed, land equivalent ratios (LER) of almond trees inter-cropped with winter thyme were higher than those of their respective monocrop systems for two consecutive years, indicating that inter-cropping with aromatics can improve the productivity of rainfed woody monocrop systems under semiarid conditions. Our results emphasize the importance of selecting an appropriate secondary crop that ensures a permanent soil cover while contributes to enhance the agroecosystem productivity from the first year of establishment onwards to off-set plausible lower yields from the main crop. In this regard, preliminary assessments on soil condition and crop nutrient requirements are encouraged before designing and implementing a crop diversification in these low-input cropping systems.
Likewise, long-term studies are needed to provide evidence on the stability of the production of diversified crop management, particularly in these low-input cropping systems under harsh environmental conditions.
•Crop diversification impacts on land productivity and soil functioning were assessed.•Almond trees were inter-cropped with caper or thyme under semiarid conditions.•Inter-cropping enhanced soil structure and water and nutrient availability for plants.•Inter-cropping with aromatics improved land productivity of a rainfed almond orchard.•Soil and crop nutrient requirement assessments are encouraged before inter-cropping.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
(1) Background: The high prevalence of childhood obesity and its multicausal etiology make it necessary to approach it through different strategies, whose objective is to promote the physical, ...mental, and social well-being of children. Regular physical activity, in addition to having positive effects on the physical environment of those who practice it, influences positively in psychological aspects such as anxiety and depression, which are very frequent in children with obesity and overweight. (2) Objective: To analyze the changes produced by a program of physical exercise based on anthropometric indicators and levels of anxiety and depression in a population of Mexican children with obesity. (3) Methods: A longitudinal study with experimental group (EG) and control group (CG). The analysis population consisted of 105 children with a body mass index (BMI) for their gender and age group above the 95th percentile, of which 60 were girls and 45 were boys, with a mean age of 10.02 years (SD ± 0.79). By randomizing the participants, 54 were part of the EG and 51 of the, CG The EG participated in a physical exercise program, distributed in two weekly sessions, each lasting 50 min, for 20 consecutive weeks. The CG group continued its usual activities during the intervention period. An inferential analysis was performed between the socio-demographic, anthropometric and psychological variables. (4) Results: The implementation of a physical exercise program in children with obesity favors the appearance of positive thoughts, with improvements in their emotional well-being, self-perception and self-concept; although it does not produce significant changes in weight, height, Z-Score, level of anxiety or depressive thoughts. (5) Discussion: Regular physical exercise practice has positive effects on mental health, although new studies are required to analyze specifically its influence on anxiety and depression in children with obesity.
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•Behaviour of FRCM composites depends on mechanical properties of mortar and textile.•The coating of the grid improves the performance of the composite.•FRCM with coated grid and ...enhanced mortars have a trilinear stress–strain curve.•The mean space between cracks is similar between systems with the same textile.•Mean efficiency factor is 683% for coated grid FRCM and 121% for uncoated grid.
Fibre Reinforced Cementitious Matrix (FRCM) systems are composite materials used for retrofitting structures thanks to their high strength-to-weight ratio and their compatibility with different substrates. The mechanical properties of FRCM depend on textile and mortar characteristics and on the interfacial bond behaviour between grid and matrix. In this research, FRCM systems made of two different carbon grids (one impregnated and one unimpregnated) and employing five different mortars were compared to assess the influence of both grid and mortar on the mechanical properties of the reinforcement. Tensile tests were carried out with a displacement and strain monitorization using Digital Image Correlation (DIC). The results reveal a remarkably better performance of the systems with impregnated grid, especially when combined with high strength mortars. The enhancement was particularly observed in terms of ultimate tensile strength, crack spacing, existence of a trilinear stress–strain curve, and efficiency factor (exploitation of the fibres in the composite).
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Little is known about the prevalence and impact of risk of malnutrition on short-term mortality among seniors presenting with acute heart failure (AHF) in emergency setting. The objective was to ...determine the impact of risk of malnutrition on 30-day mortality risk among older patients who attended in Emergency Departments (EDs) for AHF.
We performed a secondary analysis of the OAK-3 Registry including all consecutive patients ≥65 years attending in 16 Spanish EDs for AHF. Risk of malnutrition was defined by the Mini Nutritional Assessment Short Form (MNA-SF) < 12 points. Unadjusted and adjusted logistic regression models were used to assess the association between risk of malnutrition and 30-day mortality.
We included 749 patients (mean age: 85 (SD 6); 55.8% females). Risk of malnutrition was observed in 594 (79.3%) patients. The rate of 30-day mortality was 8.8%. After adjusting for MEESSI-AHF risk score clinical categories (model 1) and after adding all variables showing a significantly different distribution among groups (model 2), the risk of malnutrition was an independent factor associated with 30-day mortality (adjusted OR by model 1 = 3.4; 95%CI 1.2–9.7; p = .020 and adjusted OR by model 2 = 3.1; 95%CI 1.1–9.0; p = .033) compared to normal nutritional status.
The risk of malnutrition assessed by the MNA-SF is associated with 30-day mortality in older patients with AHF who were attended in EDs. Routine screening of risk of malnutrition may help emergency physicians in decision-making and establishing a care plan.
•The frequency of risk of malnutrition is high in seniors with acute heart failure.•The risk of malnutrition is associated with 30-day mortality.•The routine screening may help emergency physicians in establishing a care plan.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
and
(
) mutations are the most common mutations in T-cell large granular lymphocytic leukemia (T-LGLL) and chronic lymphoproliferative disorders of NK cells (CLPD-NK), but their clinical impact ...remains unknown. We investigated the frequency and type of
mutations in FACS-sorted populations of expanded T/NK-LGL from 100 (82 clonal; 6 oligoclonal; 12 polyclonal) patients, and its relationship with disease features. Seventeen non-LGL T-CLPD patients and 628 age-matched healthy donors were analyzed as controls.
(
= 30) and
(
= 1) mutations were detected in 28/82 clonal T/NK-LGLL patients (34%), while absent (0/18, 0%) among oligoclonal/polyclonal LGL-lymphocytosis. Mutations were found across all diagnostic subgroups: TCD8
-LGLL, 36%; CLPD-NK, 38%; TCD4
-LGLL, 7%; Tαβ
DP-LGLL, 100%; Tαβ
DN-LGLL, 50%; Tγδ
-LGLL, 44%.
-mutated T-LGLL/CLPD-NK showed overall reduced (
< 0.05) blood counts of most normal leukocyte subsets, with a higher rate (vs. nonmutated LGLL) of neutropenia (
= 0.04), severe neutropenia (
= 0.02), and cases requiring treatment (
= 0.0001), together with a shorter time-to-therapy (
= 0.0001), particularly in non-Y640F
mutated patients. These findings confirm and extend on previous observations about the high prevalence of
mutations across different subtypes of LGLL, and its association with a more marked decrease of all major blood-cell subsets and a shortened time-to-therapy.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Spermatogenic cells express more alternatively spliced RNAs than most whole tissues; however, the regulation of these events remains unclear. Here, we have characterized the function of a ...testis-specific IQ motif-containing H gene (Iqch) using a mutant mouse model. We found that Iqch is essential for the specific expression of RNA isoforms during spermatogenesis. Using immunohistochemistry of the testis, we noted that Iqch was expressed mainly in the nucleus of spermatocyte and spermatid, where IQCH appeared juxtaposed with SRRM2 and ERSP1 in the nuclear speckles, suggesting that interactions among these proteins regulate alternative splicing (AS). Using RNA-seq, we found that mutant Iqch produces alterations in gene expression, including the clear downregulation of testis-specific lncRNAs and protein-coding genes at the spermatid stage, and AS modifications - principally increased intron retention - resulting in complete male infertility. Interestingly, we identified previously unreported spliced transcripts in the wild-type testis, while mutant Iqch modified the expression and use of hundreds of RNA isoforms, favouring the expression of the canonical form. This suggests that Iqch is part of a splicing control mechanism, which is essential in germ cell biology.
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