Do patients' and referral centers' characteristics influence multiple sclerosis phenotypes? Results from the Italian multiple sclerosis and related disorders register.

BACKGROUND: Multiple sclerosis (MS) is characterized by phenotypical heterogeneity, partly resulting from demographic and environmental risk factors. Socio-economic factors and the characteristics of local MS facilities might also play a part. METHODS: This study included patients with a confirmed MS diagnosis enrolled in the Italian MS and Related Disorders Register in 2000-2021. Patients at first visit were classified as having a clinically isolated syndrome (CIS), relapsing-remitting (RR), primary progressive (PP), progressive-relapsing (PR), or secondary progressive MS (SP). Demographic and clinical characteristics were analyzed, with centers' characteristics, geographic macro-areas, and Deprivation Index. We computed the odds ratios (OR) for CIS, PP/PR, and SP phenotypes, compared to the RR, using multivariate, multinomial, mixed effects logistic regression models. RESULTS: In all 35,243 patients from 106 centers were included. The OR of presenting more advanced MS phenotypes than the RR phenotype at first visit significantly diminished in relation to calendar period. Females were at a significantly lower risk of a PP/PR or SP phenotype. Older age was associated with CIS, PP/PR, and SP. The risk of a longer interval between disease onset and first visit was lower for the CIS phenotype, but higher for PP/PR and SP. The probability of SP at first visit was greater in the South of Italy. DISCUSSION: Differences in the phenotype of MS patients first seen in Italian centers can be only partly explained by differences in the centers' characteristics. The demographic and socio-economic characteristics of MS patients seem to be the main determinants of the phenotypes at first referral.

Modulation of the central memory and Tr1-like regulatory T cells in multiple sclerosis patients responsive to interferon-beta therapy.

BACKGROUND: Interferon-beta is used to reduce disease activity in multiple sclerosis, but its action is incompletely understood, individual treatment response varies among patients, and biological markers predicting clinical benefits have yet to be identified. Since it is known that multiple sclerosis patients have a deficit of the regulatory T-cell subsets, we investigated whether interferon-beta therapy induced modifications of the two main categories of regulatory T cells (Tregs), natural and IL-10-secreting inducible Tr1 subset, in patients who are biologically responsive to the therapy. METHODS: T-cell phenotype was determined by flow cytometry, while real-time PCR was used to evaluate interferon-beta bioactivity through MxA determination, and to measure the RNA for IL-10 and CD46 molecule in peripheral blood mononuclear cells stimulated with anti-CD46 and anti-CD3 monoclonal antibodies, which are known to expand a Tr1-like population. RESULTS: Interferon-beta induced a redistribution of natural Treg subsets with a shift of naive Tregs towards the 'central memory-like' Treg population that expresses the CCR7 molecule required for the in vivo suppressive activity. Furthermore, in a subgroup of treated patients, the CD46/CD3 co-stimulation, probably through the Tr1-like subset modulation, increased the production of RNA for IL-10 and CD46. The same group showed a lower median EDSS score after two years of therapy. CONCLUSIONS: The selective increase of 'central memory-like' subset and the involvement of the Tr1-like population may be two of the mechanisms by which interferon-beta achieves its beneficial effects. The quantification of RNA for IL-10 and CD46 could be used to identify patients with a different response to interferon-beta therapy.

[Comparative evaluation of cholecystography, cholangiography, echotomography and cholescintigraphy in surgical disorders of the bile ducts]. / Valutazione comparativa fra colecistografia, colangiografia, ecotomografia e colesintigrafia nelle affezioni chirurgiche delle vie biliari.

The results of a multidiscipline trial conducted on 70 patients with cholecyst or bile duct diseases, including 20 complicated by icterus, are presented. the diagnostic significance of cholecystography and cholangiography supplemented by echotomography and HIDA cholescintigraphy was assessed. A personally employed protocol for the diagnosis of patients with cholecyst and bile duct disorders, covering both simple lithiasis and cases complicated by icterus, is proposed.

[Appendiceal mucocele]. / Il mucocele appendicolare.

The authors, starding from their own clinical casuistry, critically review the literature, and suggest a new classification of appendicular mucocele based upon the anatomo-pathological aspects. They, moreover, analyse the clinical-therapeutical aspects, and hope the histologic testing of appendix becomes a routine practise.

[Non-neoplastic pathology of the last ileal ansa (anatomo-surgical problems)]. / La patologia non neoplastica dell'ultima ansa ileale (problemi anatomo-chirurgici).

The surgery of the last ileal ansa in case of non-neoplastic pathology bears some problems of technical nature, bound to the remarkable anatomic variabilities in the arterial blood supply to terminal ileum. The authors report the observation of three cases of non-neoplastic pathology of the last ileal ansa, treated with different technique in relation to the type of arterial blood supply remarked. In a case an ileum resection with termino-terminal anastomosis was performed, and in the other two cases a resection of the last ileal ansa, followed by an ileo-caecal reimplantation, was effected.

[Initial therapeutic evaluations of 141 patients with carcinoma of the breast under 40 years of age]. / Prime valutazioni terapeutiche su 141 pazienti affette da carcinoma della mammella con età inferiore a 40 anni.

The Authors, considering 141 cases of patient women under 40, suffering from breast cancer, analyse the prognostic factors in relation to the different therapeutical approach, histologic type, dimensions of T, and presence or absence of metastases at the axillary lymph nodes. They, moreover, appraise the actuarial global survival with no disease (NED) of this group of patients as compared with the survival of women in more advanced age.

[Fertility and migration: an analysis of women included in the 1981 census in the province of Milan]. / Fecondita e migrazioni: un'analisi delle donne censite nel 1981 in provincia di Milano.

The relationship between fertility and migration patterns in the Italian province of Milan is analyzed. "The own-children method is used to obtain retrospective fertility measurements by the linkage of the young children enumerated in the census to their mothers, classified by different mobility characteristics (such as place of birth, present and previous place of residence)." (SUMMARY IN ENG AND FRE)

[Fertility, employment, and migration. Differential fertility according to migration experience using census data]. / Fecondita, lavoro e migrazioni. Fecondita differenziale secondo esperienze di mobilita da dati di censimento.

Differential fertility in Italy by occupation is analyzed using census data. The author uses the own-children method to develop retrospective estimates of period fertility for women in 1976 and 1981. The occupational status categories used are "employed in the same sector, employed in a different sector, no longer employed, new employed, never employed. A strong relation appears between work status changes and fertility trends: the women who recently obtained a new job touch the lowest level of fertility, while those who left their job reach the highest level." The impact of migration and nuptiality is also considered. (SUMMARY IN ENG AND FRE)

[Spatial mobility projections of the population census: comparison with other sources]. / La mobilita territoriale rilevata dal censimento della popolazione: confronto con altre fonti.

This paper considers the descriptive capacity of Italian census data on spatial mobility. A systematic comparison is carried out between the Italian census and traditional sources--particularly the population register. The discussion concerns the items collected and published as well as the measurements obtained, their meaning, and their comparability. Many examples are presented, especially on migration flows during the 1976-1981 period, as recorded by the 1981 Italian population census, applied to the whole country as well as the regions, with particular reference to the Veneto region.

[Administrative archives and population studies]. / Archivi amministrativi e studio della popolazione.

PIP: The author discusses alternative sources of data for use in population studies, with a focus on Italian sources. (ANNOTATION)^ieng

Swallowing disorders in patients with blepharospasm

El blefaroespasmo es una distonía focal caracterizada por el cierre involuntario de los ojos debido a la contracción anormal de los músculos orbiculares de los párpados. Cuando el blefaroespasmo se asocia a la presencia de movimientos involuntarios oromandibulares se denomina síndrome de Meige. El objetivo de este estudio fue investigar la presencia de alteraciones deglutorias en pacientes con blefaroespasmo y síndrome de Meige. Se incluyeron 20 pacientes consecutivos que fueron estudiados mediante vídeo fluoroscopia con técnica de bario. Se investigaron las 4 etapas de la deglución. El 90% de los pacientes (18 casos) presentó trastornos en la deglución. Las alteraciones más comúnmente halladas fueron caída prematura del alimento, 15 casos (83%) y resíduos valeculares, 14 casos (78%). El 67% de anormalidades se observó en la tercera etapa de la deglución. El 89% de los pacientes (16) presentó más de un trastorno deglutorio. Se observó una correlación positiva y estadísticamente significativa entre el número de hallazgos patológicos y la edad de los pacientes y la duración de la enfermedad. De acuerdo a lo publicado, la prevalencia de desórdenes de la deglución en pacientes sanos de edad avanzada es del 44%. En nuestra serie alcanzó el 90%, lo cual sugiere que nuestros hallazgos podrían estar relacionados no sólo con la edad, sino también con la posibilidad de que el compromiso distónico en pacientes con blefaroespasmo sea mayor de lo que se aprecia clínicamente extendiéndose más allá de los músculos orofaciales.