•Patient's age is the most important factor in DMTs choice•Choice of oral drugs vs self-injectables ones is driven by unfavorable prognostic factors•Natalizumab preferred in early stage of severe ...disease and in younger patients
The approval of an increasing number of disease modifying drugs for the treatment of Multiple Sclerosis (MS) creates new challenges for patients and clinicians on the first treatment choice. The main aim of this study was to assess factors impacting first therapy choice in a large Italian MS cohort.
Newly diagnosed relapsing-remitting (RR) MS patients (2010-2018) followed in 24 Italian MS centres were included in the study. We evaluated the association of baseline demographics, clinical and MRI characteristics to the first treatment choice by logistic regression models applied to pre-defined binary alternatives: dimethyl fumarate vs injectables (interferon and glatiramer acetate), teriflunomide vs injectables, fingolimod vs dimethyl fumarate and fingolimod vs natalizumab.
We enrolled 3025 patients in the period between January 2010 and June 2018. Relapses in the previous year (OR = 2.75; p = 0.001), presence of spinal cord lesions (OR = 1.80; p = 0.002) and higher number (>9) of T2 lesions on the baseline brain MRI scan (OR = 1.65; p = 0.022) were the factors associated to dimethyl fumarate choice as first therapy vs an injectable drug. Older age (OR = 1.06; p < 0.001), male sex (OR = 2.29; p = 0.001) and higher EDSS (OR = 1.36; p < 0.001) were the factors associated with the choice of teriflunomide vs injectables. In more recent years, dimethyl fumarate (OR = 3.23; p < 0.001) and teriflunomide (OR = 2.53; p < 0.001) were chosen more frequently than injectables therapies. The main determinant for the choice of fingolimod as compared with dimethyl fumarate was a higher EDSS (OR = 1.56; p = 0.001), while there was a weak association with a longer disease duration (p = 0.068) and a longer time from onset to diagnosis (p = 0.085). Compared to fingolimod, natalizumab was preferred in patients with a younger age (OR = 0.95; p = 0.003) and higher EDSS (OR = 1.45; p = 0.007) and a shorter disease duration (OR = 0.52; p = 0.076).
Many factors guided therapeutic decision for our Italian cohort of MS patients; they are mainly related to MS disease activity, baseline EDSS, disease duration and age.
Psoriasis is associated with multiple comorbidities, including cardiovascular disease. Identifying biomarkers such as N-terminal fragment of the BNP precursor (NT-pro-BNP) with preventive, ...diagnostic, and prognostic implications in the cardiovascular diseases of psoriatic patients may be helpful in these patient's management. However, their predictive ability for future cardiovascular events in psoriatic patients is still unknown. Therefore, the study aimed to determine whether NT-pro-BNP levels were increased in psoriatic patients.
One hundred forty psoriatic patients without cardiovascular disease and 140 healthy control patients were enrolled.
The NT-pro-BNP level was significantly correlated with lipid profile but not with disease duration; or the ongoing biologic therapy.
Our work demonstrates that pro-BNP values are higher in patients with psoriasis than in controls and emphasizes the correlation between psoriasis and cardiovascular disease and the importance of biomarkers that can identify those patients most at risk of developing cardiovascular disease.
Since the Tortonian, the geodynamic evolution of the Tyrrhenian Sea has been driven by an eastward roll-back of the entire Apennine subduction system, triggering distinct episodes of back-arc basin ...formation with spots of oceanic crust. Major structural differences are observed between northern and southern portions of the Tyrrhenian Sea, reflecting two distinct evolution stages of the Ionian slab retreat. In the central portion of the Tyrrhenian Sea, the seafloor morphology is characterized by a set of magmatic intrusions and structural highs associated to an Ee W magnetic lineament along the 41 st geographical parallel. The Vercelli seamount represents one example of structural highs correlated to Miocene magmatic episodes along the 41 st parallel zone. In this study, we discuss the results of new high resolution magnetic data and morphological mapping of the Vercelli seamount acquired during the VER2010 cruise. The seamount represents the relict part of a granitic intrusion emplaced during the Tortonian phase of Tyrrhenian rifting. Tectonic and deep-sea erosive processes have jointly modified the seamount structure that can be observed nowadays. Cumulative gradient analysis highlights an asymmetric morphology of the flanks as a result of erosive action of opposite water mass gyres which modelled the southern portion of the seamount. The joint interpretation of magnetic and bathymetric datasets identifies a high magnetized source laying close to the base of the seamount and located in correspondence to a small basin. This structure has been modelled as a post-Tortonian lava sequence emplaced between structural highs in correspondence of Ne S elongated flat sedimentary basin.Modelling of new geophysical data highlights the relationship between crustal setting and magnetic evidences of the central Tyrrhenian Sea, providing a new interpretation of the 41 st magnetic lineament.
We present the first density model of Stromboli volcano (Aeolian Islands, Italy) obtained by simultaneously inverting land-based (543) and sea-surface (327) relative gravity data. Modern positioning ...technology, a 1×1m digital elevation model, and a 15×15m bathymetric model made it possible to obtain a detailed 3-D density model through an iteratively reweighted smoothness-constrained least-squares inversion that explained the land-based gravity data to 0.09mGal and the sea-surface data to 5mGal. Our inverse formulation avoids introducing any assumptions about density magnitudes. At 125m depth from the land surface, the inferred mean density of the island is 2380kgm−3, with corresponding 2.5 and 97.5 percentiles of 2200 and 2530kgm−3. This density range covers the rock densities of new and previously published samples of Paleostromboli I, Vancori, Neostromboli and San Bartolo lava flows. High-density anomalies in the central and southern part of the island can be related to two main degassing faults crossing the island (N41 and N64) that are interpreted as preferential regions of dyke intrusions. In addition, two low-density anomalies are found in the northeastern part and in the summit area of the island. These anomalies seem to be geographically related with past paroxysmal explosive phreato-magmatic events that have played important roles in the evolution of Stromboli Island by forming the Scari caldera and the Neostromboli crater, respectively.
•First density model of Stromboli volcano obtained by 3-D inversion of gravity data.•Density model agrees with bulk densities of rock samples.•The main high density anomalies are related to dyke intrusions.•Low-density anomalies are related to paroxysmal explosive phreato-magmatic events.•Volcano-structural evolution of Stromboli revealed by gravity data.
The TOMO-ETNA experiment was devised for the investigation of the continental and oceanic crust beneath Mt. Etna volcano and northeastern Sicily up to the Aeolian Islands, through an active source ...study. In this experiment, a large amount of geophysical data was collected both inland and in the Ionian and Tyrrhenian Seas for identifying the major geological and structural features offshore Mt. Etna and NE Sicily. One of the oceanographic cruises organized within the TOMO-ETNA experiment was carried out on the hydrographic vessel “Galatea” by Italian Navy. During the cruise a detailed magnetic survey and a set of ROV (remotely operated vehicle) dives were performed offshore Mt. Etna. The magnetic survey allowed the compilation of a preliminary magnetic map revealing a clear direct relationship between volcanic structures and high frequency magnetic anomalies. Significant positive magnetic anomalies were identified offshore the Timpa area and along the easternmost portion of the Riposto Ridge and correlated to a primitive volcanic edifice and to shallow volcanic bodies, respectively. On the whole, the magnetic anomaly map highlights a clear SW-NE decreasing trend, where high amplitude positive magnetic anomaly pattern of the SW sector passes, northeastwardly, to a main negative one. ROV dives permitted to directly explore the shallowest sectors of the Riposto Ridge and to collect several videos and seafloor samples, allowing us to identify some locally developed volcanic manifestations.
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