Parity is associated with a longer time to reach irreversible disability milestones in women with multiple sclerosis

BACKGROUND

Multiple sclerosis (MS) frequently affects women of childbearing age. While short-term effects of pregnancy on MS course are well-known, whether pregnancy may influence long-term disability progression is debated.

METHODS

A two-centre retrospective study to investigate long-term effect of pregnancy on disability was performed in a population of MS women. Survival analyses and multivariate Cox proportional regression models (including early predictors of MS severity and exposure to disease-modifying treatments) were performed to compare time to reach well-established disability milestones in nulliparous women and in those with pregnancies after MS onset ('parous'). Women with pregnancies before MS onset were excluded from analyses as they represent a heterogeneous group.

RESULTS

Data about 445 women (261 nulliparous, 184 'parous') were analysed. A longer time to reach Expanded Disability Status Scale (EDSS) 4.0 and 6.0 was observed in parous women; Cox regression models revealed a lower risk for 'parous' than nulliparous women in reaching EDSS 4.0 and 6.0 (HR = 0.552, p = 0.008 and HR = 0.422, p = 0.012 respectively).

CONCLUSION

Our findings suggest that pregnancy after MS onset is associated with a slower long-term disability progression. Whether this represents a biological/immunological effect, or reflects a higher propensity toward childbearing in women with milder disease, it remains uncertain deserving further investigations.

Noise action plan of agglomerations: sustainable hypothesis or utopy?

European and Italian laws establish that agglomerations of more than 100 000 inhabitants must adopt an action plan in order to manage noise issues and effects. The plan aim is to reduce population exposure to environmental noise, which is defined as the outdoor sound created by human activities, including noise emitted by road traffic, rail traffic and air traffic, and noise from sites of industrial activity. Although acoustic pollution represents one of the main causes of annoyance for inhabitants of urban areas, the political agenda does not acknowledge it among the main environmental issues. Thus, acoustic reclamation is often considered a duty to be accomplished rather than a way to improve quality of life for citizens. Furthermore, financial resources are generally very poor while the acoustic critical situations are numerous and serious in terms of exceeding the limit. In this situation, what is the meaning of an urban area noise action plan? What are the concrete actions that municipalities can realise to reduce urban noise pollution? This study tries to answer these questions, starting from the analysis carried out for the action plan of the city of Turin.

Multiple sclerosis relapses: a multivariable analysis of residual disability determinants

BACKGROUND

Recovery from multiple sclerosis (MS) relapses is variable. The factors influencing persistence of residual disability (RD) after a relapse are still to be thoroughly elucidated.

AIMS OF STUDY

To assess RD after MS relapses and to define the factors associated with persistence of RD.

METHODS

Data were retrospectively collected for all relapses in a population of relapsing-remitting MS patients during 3 years. Relapse severity and RD after 1 year were calculated on Expanded Disability Status Scale basis. A multivariable analysis for factors influencing RD and relapse severity was performed (variables: age, gender, disease duration, oligoclonal bands, relapse severity, monosymptomatic/polysymptomatic relapse, immunomodulating treatment, incomplete recovery at 1 month).

RESULTS

A total of 174 relapses were assessed. RD after 1 year was observed in 54.5% of the relapses. Higher risk of RD was associated with occurrence of a severe relapse (P = 0.024). Incomplete recovery at 1 month was highly predictive of RD at 1 year (P < 0.0001). Risk of a severe relapse was associated with age <or= 30 years (P = 0.025) and inversely associated with the use of immunomodulating treatment (P = 0.006).

CONCLUSIONS

Incomplete recovery at 1 month is a predictor of long-term persistence of RD. Higher relapse severity is associated with higher risk of RD. Risk of severe relapses is lower in patients treated with immunomodulating drugs.

Fertility in patients with multiple sclerosis: current knowledge and future perspectives

The issue of fertility in patients with multiple sclerosis (MS) has not been exhaustively studied. Epidemiological data have suggested that spontaneous fecundity might be reduced; several endocrine and sexual disturbances potentially interfering with reproduction have been evidenced in MS patients of both sexes. Moreover, some medical treatments used in MS (e. g., mitoxantrone, cyclophosphamide) may exert detrimental effects on spermatozoa as well as on oocytes, leading to early impairment of fertility. This review illustrates the factors potentially interfering with fertility in MS and discusses the therapeutic tools that may be used to promote fertility in these patients. The safety of hormonal therapies in MS is also examined. The current applications of assisted reproductive technology (ART) are discussed, including in vitro fertilisation (IVF) techniques. Currently available methods to preserve fertility in patients that undergo cytotoxic treatments by means of sperm/oocyte cryostorage or by ovarian fragment cryopreservation and autografting are considered.

Neutron capture on (180)Ta(m): clue for an s-process origin of nature's rarest isotope

The neutron capture cross section of (180)Ta(m) has been measured in the keV range, yielding a stellar average of 1465+/-100 mb at kT = 30 keV. Though the sample contained only 6.7 mg (180)Ta(m) (at an enrichment of 5.5%), the few capture events could be separated from much larger backgrounds by a unique combination of high efficiency, good energy resolution, and high granularity of the Karlsruhe 4 pi BaF(2) detector. A detailed s-process analysis based on this first experimental value indicates that (180)Ta(m) is predominantly of s-process origin.