Depression occurs in about 50% of patients with multiple sclerosis. The aims of this study was to investigate the prevalence of depressive symptoms in a multicenter MS population using the Beck ...Depression Inventory II (BDI II) and to identify possible correlations between the BDI II score and demographic and clinical variables.
Data were collected in a multi-center, cross-sectional study over a period of six months in six MS centers in Italy using BDI II.
1,011 MS patients participated in the study. 676 subjects were female, with a mean age of 34 years (SD 10.8), mean EDSS of 3.3 (0-8.5) and mean disease duration of 10.3 years (range 1-50 years). 668 (%) subjects scored lower than 14 on the BDI II and 343 (33.9%) scored greater than 14 (14 cut-off score). For patients with BDI>14 multivariate analysis showed a significant difference between EDSS and disease course. BDI II scores for subjects with secondary progressive (SP) MS were significantly different from primary progressive (PP) patients (p < 0.001) but similar to relapsing-remitting (RR) patients. Considering subjects with moderate to severe depressive symptoms (BDI II score from 20-63), in relation to disease course, 11.7% (83/710) had RR MS, 40.7% (96/236) SP and 13.6% (6/44) PP.
Using the BDI II, 30% of the current sample had depressive symptoms. BDI II score correlates with disability and disease course, particularly in subjects with SP MS. The BDI II scale can be a useful tool in clinical practice to screen depressive symptoms in people with MS.
Substance use disorder prevention programs are most effective when matched appropriately to the baseline risk of the population. Individuals who misuse opioids often have unique risk profiles ...different from those who use other substances such as alcohol or cannabis. However, most substance use prevention programs are geared toward universal audiences, neglecting key inflection points along the continuum of care. The HEAL Prevention Cooperative (HPC) is a unique cohort of research projects that represents a continuum of care, from community-level universal prevention to indicated prevention among older adolescents and young adults who are currently misusing opioids or other substances. This paper describes the theoretical basis for addressing opioid misuse and opioid use disorder across the prevention continuum, using examples from research projects in the HPC.
Background and purpose
Late‐onset multiple sclerosis (MS) has a prevalence of about 10–20% in natural history MS studies. Few data have been published about the long‐term disease trajectory in the ...cohort of late‐onset relapsing‐remitting MS (LORRMS). The aim of this study was to identify the risk factors for reaching an Expanded Disability Status Scale (EDSS) score of 6.0 in LORRMS (onset at >40 years of age) and young‐onset relapsing‐remitting MS (YORRMS) (onset between 18 and 40 years of age).
Methods
Clinical and radiological magnetic resonance imaging (MRI) of the brain follow‐up data were collected. Disability was assessed by EDSS score. A Cox proportional hazards model was used to evaluate the demographic and clinical predictors of reaching an EDSS score of 6.0 in the two cohorts.
Results
A total of 671 patients with relapsing‐remitting MS were enrolled, 143 (21.3%) with LORRMS and 528 (78.7%) with YORRMS. In LORRMS, age at onset was 47.8 ± 5.3 (mean ± SD) years and duration of follow‐up was 120.7 ± 52.7 months. In YORRMS, age at onset was 27 ± 2.7 years and duration of follow‐up was 149.9 ± 92.7 months. The survival curve analyses showed a higher probability of reaching an EDSS score of 6.0 for LORRMS in a shorter time (months) than for YORRMS (94.2 vs. 103.2 months; log‐rank 8.8; P < 0.05). On MRI, YORRMS showed more brain inflammatory features than LORRMS. In the multivariate Cox model, age at onset Exp(B) value, 6.5; 95% confidence interval, 1.9–22.6; P < 0.001 and male gender Exp(B) value, 1.7; 95% confidence interval, 1.0–2.8; P < 0.05 were the strongest predictors of reaching an EDSS score of 6.0.
Conclusions
The male population with LORRMS reached severe disability faster than those with YORRMS, even when YORRMS showed more brain inflammatory features on MRI.
Objectives: This study aimed to evaluate the impact of different comorbidities on thereflecting its safety profile persistence of biological disease-modifying anti-rheumatic drugs (bDMARDs) in ...rheumatoid arthritis (RA), taking advantage of a retrospective analysis of administrative healthcare databases (AHDs).
Method: A retrospective observational study was conducted on AHDs of the Lombardy region, Italy (2004-2013). Among RA patients treated with bDMARDs, drug survival was estimated using Cox proportional hazard models hazard ratio (HR), 95% confidence interval (CI), crude and adjusted for prespecified confounders (gender, age, disease duration, concomitant use of non-steroidal anti-inflammatory drugs, glucocorticoids, conventional DMARDs, specific bDMARDs), in first-line and subsequent lines of treatment. The role of comorbidities in administration of specific bDMARDs was analysed through multinomial logistic models.
Results: The study included 4657 RA patients. In the first-line treatment strategy, the Charlson Comorbidity Index (CCI) (RA excluded) was significantly associated with an increased rate of bDMARD failure (CCI = 1: HR 1.28, 95% CI 1.13-1.46; CCI ≥ 2: HR 1.26, 95% CI 1.03-1.53). Among selected comorbidities, chronic obstructive pulmonary disease (HR 1.38, 95% CI 1.01-1.91), diabetes (HR 1.18, 95% CI 1.01-1.37), and previous-year bacterial infections (HR 1.18, 95% CI 1.07-1.30) were slightly associated with risk of bDMARD failure, while acute myocardial infarction (HR 1.30, 95% CI 0.97-1.75), mild liver disease (HR 1.21, 95% CI 0.91-1.60), and solid tumours (HR 1.19, 95% CI 0.93-1.53) were not. In the following treatment lines, neoplasms were associated with reduced risk of failure (HR 0.64, 95% CI 0.41-0.99). Multiple comorbidities were associated with first-line abatacept and rituximab administration.
Conclusions: Comorbidities affect treatment decisions in RA and influence bDMARD failure, and should be considered when analysing the persistence of biological therapy.
Metabolic syndrome (MS) is rapidly growing as risk factor for HCC. Liver resection for HCC in patients with MS is associated with increased postoperative risks. There are no data on factors ...associated with postoperative complications.
The aim was to identify risk factors and develop and validate a model for postoperative major morbidity after liver resection for HCC in patients with MS, using a large multicentric Western cohort.
The univariable logistic regression analysis was applied to select predictive factors for 90 days major morbidity. The model was built on the multivariable regression and presented as a nomogram. Performance was evaluated by internal validation through the bootstrap method. The predictive discrimination was assessed through the concordance index.
A total of 1087 patients were gathered from 24 centers between 2001 and 2021. Four hundred and eighty-four patients (45.2%) were obese. Most liver resections were performed using an open approach (59.1%), and 743 (68.3%) underwent minor hepatectomies. Three hundred and seventy-six patients (34.6%) developed postoperative complications, with 13.8% major morbidity and 2.9% mortality rates. Seven hundred and thirteen patients had complete data and were included in the prediction model. The model identified obesity, diabetes, ischemic heart disease, portal hypertension, open approach, major hepatectomy, and changes in the nontumoral parenchyma as risk factors for major morbidity. The model demonstrated an AUC of 72.8% (95% CI: 67.2%-78.2%) ( https://childb.shinyapps.io/NomogramMajorMorbidity90days/ ).
Patients undergoing liver resection for HCC and MS are at high risk of postoperative major complications and death. Careful patient selection, considering baseline characteristics, liver function, and type of surgery, is key to achieving optimal outcomes.
The aim of our retrospective study is to evaluate the prognostic significance of aspirin in patients with advanced HCC treated with sorafenib.
304 patients with HCC,consecutively treated with ...sorafenib from May 2007 to September 2018, were included in the clinical study. Of Them 93 patients token aspirin. Progression-free survival (PFS)and overall survival (OS)were estimated with the Kaplan–Meier method and compared with the log-rank test.
The concomitant use of sorafenib and aspirin was associated with a median OS of 18.3 months compared to 8.8 months of patients who did not receive aspirin (HR 0.57; P < 0.0001). The concomitant use of sorafenib and aspirin was associated with a median PFS of 7.3 months compared to 3.0 months of patients who did not receive aspirin (HR 0.61; P = 0.0003). In the multivariate analysis, the use of aspirin maintained an independent prognostic value for OS(HR 0.61; P = 0.0013). In second line the concomitant use of regorafenib and aspirin was associated with a median OS of 16.9 months compared to 8.0 months of patients who did not receive aspirin (HR 0.30; P = 0.02).
Globally, our data seem to suggest that aspirin use may improve the clinical outcome of patients with advanced hepatocellular carcinoma receiving sorafenib and regorafenib.
Purpose
Climate change is driving strong variations in mountain habitats, such as glacier retreat, which is releasing large surfaces soon colonized by vegetation and attacked by weathering and ...pedogenesis. Many proglacial soil chronosequences have been studied in different parts of the world, but no study is available on early soil development and pedogenesis on serpentinite.
Materials and methods
We analysed the development of the main chemical (pH, organic matter, nutrients and exchangeable cations) and morphological properties in three soil chronosequences in the Verra Grande Glacier forefield (Italian side of the Monte Rosa Group, Western Alps), characterized by slightly different parent materials (pure serpentinite or serpentinite with small gneiss inclusions) and topography (steep lateral moraines or flat basal till).
Results and discussion
Organic matter accumulation, acidification and base and metal leaching are the most important pedogenetic processes active during early stages of soil formation on serpentinite in the upper subalpine altitudinal belt. These processes are associated with minor changes in color and structure showing weak mineral weathering. Biocycling of nutrients is limited on pure serpentinite because of weak primary productivity of the plant community. Pedogenesis is quite slow throughout the forefield, and it is slowest on pure serpentinite. On flat surfaces, where slow erosion permits a fast colonization by Ericaceae, the podzolization process begins after few centuries since moraine deposition, while on steep slopes more time is required.
Conclusions
Pedogenesis on serpentinite is extremely slow. The fast colonization by grassland species increases the speed of pedogenetic trends where serpentinitic till is enriched by small quantities of P-rich gneiss. The encroachment of forest-shrub species increases the speed of pedogenetic trends thanks to a strong nutrient biocycling.
Soil types of Aosta Valley (NW-Italy) D'Amico, M. E.; Pintaldi, E.; Sapino, E. ...
Journal of maps,
12/2020, Letnik:
16, Številka:
2
Journal Article
Recenzirano
Odprti dostop
The first soil map of the whole Aosta Valley Region was produced at the 1:100,000 scale. We used 691 soil profiles, attributed to 16 Cartographic (soil) Units, spatialized using a Maximum Likelihood ...Estimation model available in ArcGIS software. Six maps were used as base layers, representing the most important soil-forming factors: parent material, vegetation/land use, mean annual precipitation, elevation, absolute aspect and slope angle. The Maximum Likelihood Estimation was followed by an expert-based check that led to a re-assignment of some wrongly attributed cartographic polygons. The validation process revealed that the User's and Producer's Accuracies were rather high (between 47.5% and 84.4% for common soil types). A particularly high pedodiversity, associated to strong geological, vegetational and climatic gradients was observed.
The psychometric properties and construct validity of the Comprehensive Effects of Alcohol (CEOA) questionnaire were compared with those of the Alcohol Expectancy Questionnaire-Adolescent version ...(AEQ-A) in relation to adolescent alcohol consumption. Both measures of adolescent alcohol expectancies were found to be internally reliable and temporally stable. Alcohol use was significantly associated with subjective evaluations for Cognitive and Behavioral Impairment and Self-Perception on the CEOA and with expected effects for Cognitive and Motor Impairment and Changes in Social Behavior on the AEQ-A. Compared with the AEQ-A, the CEOA explained more variance in quantity (28%) and a similar variance in frequency (15%) for adolescent alcohol use (AEQ-A quantity = 20%, frequency = 15%). Whereas the general content and psychometric properties of the 2 measures are markedly similar, the Likert response format, shorter length, and assessment of both expected effects and subjective evaluations with the CEOA may offer measurement advantages over the AEQ-A.
•Sexual dysfunction prevalence varies according to the instrument and cut-off applied.•Severe involvement of one sexual domain is associated with motor and cognitive function.•Involvement of many ...sexual domains is associated with age, anxiety and cognitive function.•Cognitive preservation and rehabilitation could aid in presence of sexual dysfunction.
Although multiple sclerosis (MS) Intimacy and Sexuality Questionnaire-19 (MSISQ-19) is a widely applied tool, no unique definition of sexual dysfunction (SD) based on its score exists.
To explore the impact of different MSISQ-19 cut-offs on SD prevalence and associated risk factors, providing relevant information for its application in research and clinical settings.
After defining SD according to two different MSISQ-19 cut-offs in 1155 people with MS (pwMS), we evaluated SD prevalence and association with sociodemographic and clinical features, mood status and disability via logistic regression.
Depending on the chosen cut-off, 45% to 54% of pwMS reported SD. SD defined as MSISQ-19 score >30 was predicted by age (OR=1.01, p=0.047), cognition (OR=0.96, p=0.004) and anxiety (OR=1.03, p=0.019). SD defined as a score >3 on any MSISQ-19 item was predicted by motor disability (OR=1.12, p=0.003) and cognition (OR= 0.96, p=0.002).
Applying different MSISQ-19 cut-offs influences both the estimated prevalence and the identification of risk factors for SD, a finding that should be considered during study planning and data interpretation. Preserved cognition exerts a protective effect towards SD regardless from the specific study setting, representing a key point for the implementation of preventive and therapeutic strategies.
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