Criteria For MS Research Articles

Movement Speed and Accuracy in Space and Time: The Complementarity of Error Distributions

ABSTRACTMovement speed-accuracy trade-off is a function of the space-time constraints of the task. We investigated the space-time account of Hancock and Newell (1985) and the hypothesis of complementarity between the four moments of the error distribution in space and time. Twelve participants performed 15 conditions in a line drawing task composed of different spatial (10, 20, and 30 cm) and temporal (250 to 2,500 ms) criteria. The results showed that all moments of distributions changed systematically between conditions but there were some departures from the Hancock and Newell predictions. In contrast, individual analysis revealed the complementarity of the spatial and temporal error including a trade-off between the four moments of error. These findings support a complementary space-time account of movement speed and accuracy.

Comparison of Visceral Fat Accumulation and Metabolome Markers among Cats of Varying BCS and Novel Classification of Feline Obesity and Metabolic Syndrome.

As in humans, obesity and its associated diseases represent the most significant threat to the health of veterinary populations. Previous human studies have provided insights into the risk factors of obesity, complex pathogenesis of obesity-associated diseases, and their life-threatening consequences. In humans, the “metabolic syndrome” represents a cluster of metabolic risk factors associated with the development of cardiovascular disease. Risk factors for metabolic syndrome, such as diabetes, obesity, high blood pressure, and its complications increase health-care utilization and medical expenses. Early diagnosis and intervention through preemptive approach is in need, and the new International Diabetes Federation definition of MS serves as the universally accepted diagnostic tool that is accessible in clinical settings. In veterinary populations, especially in cats, similar pathophysiological path and disease progression to the development of MS, such as adipokine dysregulations, chronic inflammation, lipotoxicity, are expected. The aim of this manuscript is twofold. First of all, it presents our preliminary feline obesity study that serves as the basis for discussion of obesity and its metabolic impact on feline population. In this study, we observed the effects of weight gain on energy metabolism using metabolome markers, such as adiponectin (ADN) and proinflammatory cytokines, in correlation with other common biochemical parameters in 14 clinically healthy cats of varying weight status. Further, we evaluated the visceral fat accumulation in three subjects of varying Body Condition Scores via computed tomography imaging and laparoscopic examination, and assessed the adipocyte type and size histologically. Mutually antagonizing changes in ADN and visceral adipose tissue (VAT) reflected the pathophysiological derangements leading to MS earlier than the common biochemical predictors such as glucose, liver values, and lipid markers. Second, it proposes the novel diagnostic and classification method of feline obesity and MS, based on the established diagnostic criteria of human MS and the presented study results. The results supported our novel “classification of feline obesity” and “Feline MS diagnostic criteria,” suggesting the need to complement ADN measurement with VAT volume to better understand the pathogenesis of metabolic disturbances in the feline population.

Vitamin D receptor gene polymorphisms are associated with multiple sclerosis in Mexican adults

BackgroundMultiple sclerosis (MS) is the most prevalent autoimmune inflammatory demyelinating disease of the central nervous system (CNS) in young adults. More than 50 genomic regions have been associated with MS susceptibility.Due the important immune-modulating properties of Vitamin D, Vitamin D receptor (VDR) gene polymorphisms – which interfere with the actions of Vitamin D- could be related to increased risk of MS. MethodsWe studied 120 patients fulfilling the McDonald criteria for MS (81 females and 39 males) and 180 healthy unrelated controls, nested in a case-Control study, and were recruited from the National Institute of Neurology and Neurosurgery, Manuel Velasco Suárez in Mexico City. Genotyping of VDR gene polymorphisms BsmI (rs1544410) and TaqI (rs731236) was performed using TaqMan SNP Genotyping Assay which consists of a predesigned mix of unlabeled polymerase chain reaction (PCR) primers and the TaqMan minor groove binding group (MGB) probe (FAM dye-labeled). ResultsThere was a statistically significant, positive association between MS and the T/T genotype of BsmI polymorphism (OR=4.15; 95%CI 1.83–9.39), showing also a significant positive trend across genotypes (p<0.01). This association was also present evaluating the recessive inheritance model of the polymorphism (OR=3.91; 95%CI 1.77–8.64). When evaluating the association by alleles, the statistically significant positive association seen by genotypes was confirmed in the T allele carriers, showing an OR of 1.83 (95%CI 1.27–2.65) for MS. ConclusionsWe found a positive association of the genetic VDR polymorphisms TaqI (rs731236) and BsmI (rs1544410), with the risk of MS in a sample of Mexican adults.

Autosomal Recessive Cerebellar Ataxia type 1 mimicking multiple sclerosis: A report of two siblings with a novel mutation in SYNE1 gene in a Saudi family

Autosomal Recessive Cerebellar Ataxia type 1 (ARCA1), also known as recessive ataxia of Beauce, is an adult onset pure cerebellar ataxia that typically presents with cerebellar ataxia and/or dysarthria. A mutation in the synaptic nuclear envelope protein 1 (SYNE1) gene that is located on chromosome 6p25 results in premature termination of the protein. It was first reported in 2007 as the first identified gene responsible for a recessively inherited pure cerebellar ataxia. In this article, we are presenting two brothers with ARCA1 who were misdiagnosed and treated as multiple sclerosis for more than a decade. We are not only presenting a rare mutation in a Saudi family, but we are also expanding on the heterogeneity of the clinical presentation of this disorder and elaborating on the pathophysiology of neurological involvement. These cases illustrate that white matter abnormalities on MRI may occur in ARCA1. The clinical and radiological spectrum of ARCA1 indicate that this disease is more than a pure cerebellar degeneration. ARCA1 should be considered in the differential diagnosis of patients diagnosed with MS especially in the presence of strong family history. The disease is gradually progressive, and clinical features are atypical for MS. Applying diagnostic criteria for MS is extremely important for confirming or excluding the diagnosis. Detailed history and physical examination are of paramount importance to score the final diagnosis. Another less likely possibility is a chance association, which may question the biological relevance of our data. To confirm or exclude this possibility, further studies reporting different cohorts need to be conducted.

Components of metabolic syndrome in the first trimester of pregnancy as predictors of adverse perinatal outcome.

It is the prospective observational study aimed at early prediction of pregnancy complications in women with symptoms of MS. 124 Caucasian women in singleton pregnancies 11th to the 13th wks 6 days of gestation with MS criteria compared to 30 healthy controls. Perinatal maternal and fetal results were analyzed. Increased in the MS group were: age (32.9 y vs. 28.6 y; p = 0,00), weight 11 to 13 + 6 weeks of gestation (79.0 kg vs. 59.7 kg; p = 0.00), BMI (29 kg/m² vs. 21.6 kg/m²; p = 0.00), waist-hip ratio (WHR) (0.9 vs. 0.8; p = 0.00). Maternal serum parameters were higher in the MS group: LDL-cholesterol (124.1 vs. 109.6 mg/dL; p = 0.02), t-PA (2556.8 vs. 1949.5 pg/mL; p < 0.00), GGTP (16.8 vs. 13.3 IU/L; p = 0.02) and lower values for: adiponectin (6.4 vs. 7.5 μg/mL; p = 0.01), SHBG (273.4 vs. 338.4 nmol/L; p = 0.001). MS group neonates higher body weight (3594.4 vs. 3312.2 g; p = 0.01), significantly frequent macrosomic neo-nates (> 4000 g) (20.9% vs. 6.6%; p = 0.042), GDM (12% vs. 0; p = 0.019). Higher E-selectin serum concentration, GGTP and lower SHBG in first trimester are additionally to fasting maternal glucose, higher BMI and maternal age predictive for GDM. Higher E-selectin, fasting glucose, increased BMI and lower adiponectin serum concentration in first trimester are significant predictors of fetal macrosomia. Maternal BMI > 24.5 kg/m² is the best predictor of increased risk of fetal macrosomia and gestational diabetes mellitus.

Morphological stability of a solid–liquid interface growing in a cylindrical mold

The morphological stability of the planar interface of dilute alloys solidifying in a cylindrical mold is analyzed based on the perturbation model presented by Mullins and Sekerka under the assumption that the interface crosses the mold wall at right angles, to examine the effect of the inside diameter of the mold. When the interface grows in a mold of a larger inside diameter, the stability-instability criterion of the planar interface is coincident with the MS criterion. On the other hand, in a mold of a smaller diameter, the rippled interface is permitted to take a frequency of discrete values (the permitted frequency), and the planar interface grows stably under thermal conditions slightly exceeding the MS criterion. Also, there exists a minimum permitted frequency ωmin, and the critical inside diameter dc is derived from ωmin. When the alloy solidifies in a mold of an inside diameter less than dc, the interface grows stably under thermal conditions in which the MS model predicts unstable growth of the interface. Moreover, there is a lower limit dG in dc, and when the alloy solidifies in a mold of an inside diameter less than dG, the interface grows stably even at a zero temperature gradient in the liquid.

Fractional factorial design-based optimisation and application of an extraction and UPLC-MS/MS detection method for the quantification of phytosterols in food, feed and beverages low in phytosterols.

Phytosterols are ubiquitous in plants, as they play an important role in cell membrane stability and as signal transducers. Over the last few decades, scientific interest in phytosterols has significantly increased. Most of the interest has focused on the cholesterol-lowering properties of phytosterols, but they may also interfere with endogenous steroid hormone synthesis. Despite this dual interest in phytosterols, accurate and fully validated methods for the quantification of phytosterols in food and feed samples are scarce. During this study an extraction and detection method for the main free phytosterols (β-sitosterol, campesterol, stigmasterol and brassicasterol) was optimised using a fractional factorial design. Detection was carried out on a UPLC-MS/MS triple stage quadrupole apparatus. The extraction and UPLC-MS/MS detection method was fully validated according to EU Council Decision 2002/657 guidelines and Association of Analytical Chemists (AOAC) MS criteria, reaching all evaluated performance parameter requirements. The individual recoveries ranged between 95 and 104%. Good results for repeatability and intralaboratory reproducibility (RSD %) were observed (<10%). Excellent linearity was proven on the basis of determination coefficient (R 2 > 0.99) and lack-of-fit test (F test, alpha = 0.05). The limits of detection (LODs) and lower limits of quantification (LLOQs) in grain matrices were as low as 0.01-0.03mg per 100g and 0.02-0.10mg per 100g. This method allowed quantification of all main, free phytosterols in different grains (oats, barley, corn, malt) and it was shown that the method can be used for other solid food and feed samples as well, including new matrices such as straw, hay, mustard seeds, grass and yellow peas. Additionally, the method was shown to perform well in liquid samples low in phytosterols such as concentrate-based juices, soft drinks and beers (<5μg per 100mL). Graphical Abstract An extraction and detection method for the main free phytosterols (β-sitosterol, campesterol, stigmasterol and brassicasterol) was optimised using a fractional factorial design. Detection was carried out on a UPLC-MS/MS triple stage quadrupole apparatus. The extraction and UPLC-MS/MS detection method was fully validated according to EU Council Decision 2002/657 guidelines and Association of Analytical Chemists (AOAC) MS criteria and applied on different matrices including feed and beverages.

Correlation between metabolic syndrome and uric acid stone composition

Objective To study the relationship between metabolic syndromes and uric acid calculi. Methods We retrospectively analyzed medical records of 640 adult patients, who were diagnosed as renal calculi and finished the stone composition analysis. Among them, 394 cases were male and 246 were female. The average age was (50.9±12.8)years old. According to the diagnostic criteria of the MS, the patients were divided as metabolic syndrome group (metabolic syndrome group /MS group and non-metabolic syndrome group (non MS group); the MS group had a total of 238 cases including 151 males and 87 females. The average age was (54.1±11.0)years old. There were 402 cases in non MS group, including 243 males and 159 females, with an average age of (49.1±13.4)years old. We obtained corresponding metabolic indices. By comparing the differences between each group, the statistic were analyzed with SPSS. Results In the MS group, 42 cases was diagnosed with uric acid stones, and the non-MS group with 8 cases diagnose with uric acid stones. The MS included obesity, elevated blood pressure, elevated fasting plasma glucose, high serum triglycerides. In the patients obtained, 123 had the 4 kinds of metabolic diseases at a time, and 23(18.7%) cases were diagnosed as uric acid stones. 115 patients had the 3 kinds of metabolic diseases in which 19(16.5%) cases were uric acid stones. 190 patients had 2 kinds of metabolic diseases and 5(2.6%) cases were uric acid stones. 137 patients had only one kinds of metabolic disease in which 3 were uric acid stones. The multivariate Logistic regression analysis showed that, after the correction of gender and age, obesity patients own the OR as 1.10(0.98-1.24)(P=0.018), high blood sugar had the OR as 1.72(1.19-1.92)(P=0.006), high glycerin three fat had the OR as 0.71(0.48-1.09)(P=0.032) and high HDL-C was 0.15(0.03-0.65)(P=0.01). Conclusions The metabolic syndromes including obesity, hyperglycemia and dyslipidemia obviously might influenced the formation of uric acid calculi. Key words: Metabolic syndrome; Uric acid calculi; Renal stones

Should the symptomatic region be included in dissemination in space in MRI criteria for MS?

To investigate whether inclusion of lesions in the symptomatic region influences the performance of dissemination in space (DIS) criteria for a diagnosis of clinically definite multiple sclerosis (CDMS) in patients with a clinically isolated syndrome (CIS). We studied 30 patients with CIS with brainstem/cerebellar and spinal cord syndromes who had MRI scans at the time of CIS and were followed up for the development of CDMS. We retrospectively applied the McDonald 2010 DIS criteria (excluding all lesions in the symptomatic region) to baseline MRI scans and 2 modified DIS criteria: (1) the inclusion of asymptomatic lesions in the symptomatic region in DIS, and (2) the inclusion of any lesion in the symptomatic region in DIS. The performance of the McDonald 2010 DIS criteria and the 2 modified criteria for the development of CDMS was compared. The sensitivity, specificity, and accuracy of the DIS criteria was, respectively, 73%, 73%, and 73% for the McDonald 2010 criteria, 80%, 73%, and 77% when asymptomatic lesions in the symptomatic region were included, and 87%, 73%, and 80% when any lesion in the symptomatic region was included in DIS. Including lesions in the symptomatic region in DIS increases the sensitivity of MRI criteria for diagnosing multiple sclerosis without compromising specificity. These findings may help inform future revisions of the diagnostic criteria for multiple sclerosis. This study provides Class II evidence that for patients with CIS, including lesions in the symptomatic region as part of the criteria for DIS does not significantly increase the accuracy for predicting the development of CDMS. The study lacks the precision to detect an important change in accuracy.

Leptin gene microsatellite polymorphism: Relation to metabolic syndrome

BackgroundMetabolic syndrome (MS) is a cluster of metabolic disorders. Despite its growing prevalence worldwide, there is a great debate regarding its definition, pathogenesis, and prognosis. Leptin gene (OB) gene polymorphism is a highly informative marker of obesity which is a main component of MS. Objective: to elucidate the degree of association of 3’tetranucleotide microsatellite polymorphism of Leptin (tet-LEP) gene with metabolic syndrome and its related disorders. Materials and methodsThe present study included 106 cases fulfilling all the criteria of MS and 134 age and gender matched control subjects. tet-LEP polymorphic region was amplified by using polymerase chain reaction of DNA extracted from peripheral blood samples. The products of reaction have distinguished two groups of alleles (group I= short alleles, and group II = long alleles). Metabolic parameters were estimated in blood serum. Resultsour data indicated the higher frequency of group I containing genotypes [I/I, I/II] in MS cases as compared to control group. Further analysis of the association of tet-LEP microsatellite polymorphism to each component of metabolic syndrome separately have shown significant association of group I alleles with high body mass index and increased risk of hypertension with odd ratio (5.7, 1.26) respectively but no association was noticed with glucose intolerance and dyslipidemia. Conclusion3’tetranucleotide microsatellite polymorphism of LEP gene was found to be linked to occurrence of metabolic syndrome which could be through the effect on body weight.

Chemerin Relationship with Glucose and Lipid Metabolism in Clinically Asymptomatic Patients

Study background: Chemerin is one of the recently discovered adipocytokines, a chemoattractant protein consisting of 131 to 137 amino acids expressing mostly in adipocytes. Chemerin affects adipogenesis and glucose homeostasis, have a direct or indirect impact on the inflammatory response. International scientific literature studies the relationship between chemerin and diabetes, obesity and metabolic syndrome markers. Methods: The study included 159 clinically asymptomatic patients (age 30-45) with an average age of 37.3 ± 4.0 years, in total 79 women. The following anthropometric measurements and biochemical parameters were measured: weight, height, BMI and fasting glucose, insulin, glycated hemoglobin, total cholesterol with its fractions, liver enzymes and immunological marker-serum chemerin. All patients underwent a CT examination of the liver with multilayer spiral computer tomograph. The density of the liver and spleen, liver index and liver/spleen index was determined. Results: Increased BMI correlates with an increased chemerin level, HOMA-IR value and TG level. A chemerin level raise also elevates the ALT and GGT blood levels, as well as the mean liver density among all three groups. The liver index and the liver/spleen index is greater in the normal weight group compared with the overweight and obese groups. HOMA-IR has a medium close-correlation with the chemerin level in the total group and overweight group. CTderived liver indicators (mean liver density, liver index, liver/ spleen index) have a statistically significant but weak correlation with chemerin level both in the total group and overweight group. Conclusion: Chemerin is adipokine, which has a significant, but not yet unambiguous role in the metabolic process. Chemerin correlation with almost all MS criteria show that even asymptomatic patients should pay attention even if only one MS criterion is increased, focusing on checking other criteria.

Blood Pressure, Serum Glucose, Cholesterol, and Triglycerides in Dogs with Different Body Scores.

The objective of this research was to determine the frequency for the occurrence of MS in dogs, using the criteria determined, and to correlate the criteria of dogs that would characterize the MS with different body condition score (BCS). 271 dogs with different body scores were studied, with 101 dogs with BCS 4-5; 101 dogs with BCS 6-7; and 69 dogs with BCS 8-9. Among the dogs studied, 62 (22,87%) had two or more inclusion criteria for MS. Of these, 28 had BCS 6-7, while 34 dogs had BCS 8-9. Therefore, 27,72% of overweight dogs had inclusion criteria for MS and 49,27% of obese ones had two or more inclusion criteria for MS. When only overweight and obese dogs were considered as a total population, it was observed that 36,47% got inclusion criteria for the MS. No dog with BCS 4-5 showed two or more inclusion criteria for MS. The metabolic syndrome, according to the parameters for inclusion defined in the literature, was observed in 22,87% of the animals studied and in 36% of dogs overweight or obese. Furthermore, MS was most common in obese (49%) compared to overweight dogs (27%).

A carotid extra-media thickness, PATIMA combined index and coronary artery disease: Comparison with well-established indexes of carotid artery and fat depots

BackgroundThe clinical utility of traditional cardiovascular (CV) risk factors to predict coronary artery disease (CAD) is insufficient and limited. Our aim was to evaluate the association between a novel ultrasound index of periarterial fat and adventitia (carotid extra-media thickness; EMT) and the severity of CAD and to compare this with well-known vascular indexes in patients with high and very high CV risk. Methods and resultsFour hundred twenty two patients scheduled for elective coronary angiography were included in the study (age: 61.3 ± 7.4 years; males 65%). Several clinical parameters of obesity were obtained as well as the following ultrasound indexes: carotid EMT and intima-media thickness (IMT), epicardial and pericardial fat thickness (EFT and PFT), and intra-abdominal fat thickness (IAT). These were then related to CAD severity in all individuals. Our study patients had a very high estimated CV risk (82%), and most (60%) fulfilled the MS criteria. Most individuals (71%) had CAD (≥50% stenosis) with equal rates of one, two, or three-vessel disease, and critical (≥70%) coronary stenosis was found in 40% of patients. Carotid EMT was significantly increased in patients with CAD (812 ± 116 vs 746 ± 131 μm) and patients with critical coronary stenosis (829 ± 119 vs 769 ± 122 μm) compared to the appropriate control groups. Moreover, carotid EMT was significantly associated with the severity of CAD. Carotid IMT and EFT (but not PFT and IAT) also revealed significant relations to the number of diseased vessels. Carotid EMT and the new proposed combined index (PATIMA = EMT/BMIx35 + IMT + EFTx60) were predictive for CAD (AUC: 686 ± 304 and 755 ± 260, sensitivity: 60 and 62%, specificity: 76 and 81% for 772 μm and 2015u). ConclusionsWe present the first study showing that the new vascular index (carotid EMT) and the proposed combined index PATIMA are associated with the presence and the severity of CAD.

Significance of visual evoked potentials in paediatric multiple sclerosis

Diagnostic criteria for MS include clinical and paraclinical procedures: biochemical, neurophysiological and neuroradiological parameters. The aim of our study was to determine the importance of visual evoked potentials (VEP) in diagnosis of MS in developmental age. The study was conducted at the Clinic of Neurology and Psychiatry for Children and Youth. In a retrospective study were analyzed medical records of 11 patients with MS who were treated in the period 2004–2013. The MS diagnosis was based on the revised 2010 McDonalds criteria. All patients at the time of diagnosis had less then 18 years. PR-VEP recordings were performed on all the patients, both binocularly (BE) and monocularly (LE—left eye, RE—right eye), using the standardized checkerboard pattern reversal technique, on a Medelec-Sapphire Premiere apparatus. The study group consisted of 11 patients, 9 (81.8%) females and 2 (18.2%) males. The average age of patients was 16.6 years. The average age of patients at the time of diagnosis was 14.6.years. All patients had pathological VEP findings. Neuroophtalmological examination revealed the existence of retrobulbar neuritis in 6 (54.5%) patients. The results of our study have shown great sensitivity of VEP as a diagnostic procedure in pediatric MS.

NAFLD Alone is a Better Predictor than MS (ATP-III) Criteria for Insulin Resistance

NAFLD Alone is a Better Predictor than MS (ATP-III) Criteria for Insulin Resistance

Differential diagnosis of MS

Diagnostic criteria for MS rely on the demonstration of CNS disease in space and time and in reasonable exclusion of other causes. Since McDonald 2001, in patients with a first attack, MRI may provide evidence of diagnosis for dissemination in space and time. The 2010 McDonald criteria selected the Magnims criteria for dissemination in space (DIS). DIS is defined as the presence of ≥1 asymptomatic T2 lesion(s) in at least two of four locations considered characteristic for MS in previous MRI criteria: juxtacortical, periventricular, infratentorial and spinal cord. These criteria simplify the previous Barkhof criteria and highlight the importance of lesion location for MS diagnosis. Moreover, this new definition relies on T2 lesions only. Non-inclusion of gadolinium enhancing lesions seems appropriate since enhancing lesions per se provide information on disease activity and not on dissemination in space. For demonstration of dissemination in time (DIT), an MRI performed at any time demonstrating DIS and showing at least one or more asymptomatic gadolinium enhancing and non-enhancing lesions(s) (this being used as evidence for DIT) would be sufficient to diagnose MS. Although many studies have already shown the importance of CSF study in the diagnosis and differential diagnosis of MS, the presence of oligoclonal bands has not been included in the diagnosis algorithm. These criteria have been adapted to other populations such as patients with primary progressive MS or patients with paediatric MS. An overview of the past diagnostic criteria will also be performed as well as new directions for the future will be considered (intracortical lesions, 3 T MRI, other). One of the problems of the diagnosis of MS is that we should rule out other conditions and this is not always an easy task. Clinical cases to illustrate differential diagnoses will be presented.

Cholesterol control according to the presence of metabolic syndrome in coronary and diabetic patients. Relationship with non-alcoholic fatty liver disease

Background and aimsMetabolic syndrome (MS) is an association of cardiovascular risk factors that increases the risk of coronary disease or type 2 diabetes mellitus (DM2), and has also been associated with the presence of liver steatosis (LS). In this study the relation of MS and LS with cholesterol control was analyzed in very high cardiovascular risk patients (coronary patients and/or DM2). MethodsA cross-sectional epidemiological study including 6988 patients, from whom information was obtained on their characteristics, lipid profile and treatments. Results4455 patients (65%) of the total study population had MS. Of MS criteria, high BP was the criterion most represented in the total population, while high TGs was the least. Within the total population, coronary patients showed a greater proportion of high BP, high TG and low HDL-c than those without coronary disease. Although no influence of MS was seen on the achievement of LDL-c targets (<70mg/dL), the presence of high BP, high blood glucose and low HDL-c was related to poorer control of LDL-c. Finally, patients with MS showed a greater proportion of liver steatosis and this was associated in turn with poorer control of LDL-c. ConclusionsThe criteria for MS are closely related to cholesterol control. LS is more prevalent in patients with MS, and it is associated with poorer control of LDL-c. We should focus on the presence of MS in high and very high CV risk patients in order to improve their lipid control.

Patient subgroup analyses of the treatment effect of subcutaneous interferon β-1a on development of multiple sclerosis in the randomized controlled REFLEX study

The REFLEX study (NCT00404352) established that subcutaneous (sc) interferon (IFN) β-1a reduced the risks of McDonald MS (2005 criteria) and clinically definite multiple sclerosis (CDMS) in patients with a first clinical demyelinating event suggestive of MS. The aim of this subgroup analysis was to assess the treatment effect of sc IFN β-1a in patient subgroups defined by baseline disease and demographic characteristics (age, sex, use of steroids at the first event, classification of first event as mono- or multifocal, presence/absence of gadolinium-enhancing lesions, count of <9 or ≥9 T2 lesions), and by diagnosis of MS using the revised McDonald 2010 MS criteria. Patients were randomized to the serum-free formulation of IFN β-1a, 44 μg sc three times weekly or once weekly, or placebo, for 24 months or until diagnosis of CDMS. Treatment effects of sc IFN β-1a on McDonald 2005 MS and CDMS in the predefined subgroups were similar to effects found in the intent-to-treat population. McDonald 2010 MS was retrospectively diagnosed in 37.7 % of patients at baseline. Both regimens of sc IFN β-1a significantly reduced the risk versus placebo of McDonald 2005 MS and CDMS, irrespective of McDonald 2010 status at baseline (risk reductions between 29 and 51 %). The effect of sc IFN β-1a was not substantially influenced by baseline patient demographic and disease characteristics, or baseline presence/absence of McDonald 2010 MS.

Excess body mass index loss predicts metabolic syndrome remission after gastric bypass

BackgroundMetabolic syndrome (MS) is a condition associated with obesity that identifies individuals with increased cardiovascular risk. Gastric bypass improves several MS components, such as glucose, lipid metabolism and hypertension. The aim of this study was to evaluate the effect of long-limb gastric bypass on the remission of MS criteria associated with morbid obesity.MethodsObese patients who met the “harmonized” criteria for MS (n = 153) that underwent laparoscopic Roux-en-Y gastric bypass (LRYGB) with a long biliopancreatic limb were prospectively evaluated with regards to body weight, body mass index (BMI), percentage of excess BMI lost (% EBMIL), fasting glucose, blood pressure and lipid profile up to 36 months after surgery.ResultsBefore surgery, patients had a BMI of 44.3 ± 0.5 kg/m2; 66% were under anti-diabetic treatment; 78.4% were under anti-hypertensive treatment and 44.3% were under anti-dyslipidemic treatment. After a mean follow-up time of 2.4 ± 0.1 years, MS remission rates were 32.7% at 6 months, 69.7% at 12 months, 63.4% at 24 months, and 59.2% at 36 months; when only 32.9%, 43.4% and 15.8% of patients were still under anti-diabetic, anti-hypertensive and anti-dyslipidemic treatment, respectively. The %EBMIL and BMI were the parameters that showed the highest accuracy to predict the MS remission at all-time points after the surgery.ConclusionsLong limb gastric bypass in obese patients results in significant and sustained weight loss which predicts a high remission rate of MS and allows the discontinuation of drug therapy for several metabolic disturbances in most patients.

The prevalence of metabolic syndrome and its predominant components among pre-and postmenopausal Ghanaian women

BackgroundMetabolic Syndrome (MetS) is a clump of risk factors for development of type 2 diabetes mellitus and cardiovascular diseases. Menopause and age are thought to predispose women to the development of metabolic syndrome. This study aimed to estimate the prevalence of MetS and identify its predominant components among pre-and postmenopausal women in the Kumasi Metropolis, Ghana.Two hundred and fifty (250) Ghanaian women were randomly selected for the study. They were evaluated for the prevalence of metabolic syndrome using the World Health Organization (WHO), National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III), International Diabetes Federation (IDF) and Harmonization (H_MS) criteria.ResultsOut of the total subjects, 143 (57.2%) were premenopausal and 107 (42.8%) menopausal. The study population was between the ages of 20–78 years. The overall percentage prevalence of MetS were 14.4%, 25.6%, 29.2% and 30.4% according to the WHO, NCEP-ATP III, IDF and H_MS criteria, respectively. The prevalence was found to increase with age, irrespective of criterion used. Generally, MetS was significantly higher among postmenopausal women (p < 0.05 by all criteria) compared to their premenopausal cohort, but with marked inter-criteria variations. Abdominal obesity, blood pressure, fasting blood glucose, triglyceride, very low density lipoprotein cholesterol, and triglyceride-high density lipoprotein cholesterol ratio were significantly (p < 0.05) different among the two groups of women.Central obesity, higher blood pressure and raised fasting blood glucose were the predominant components that contributed to the syndrome in Ghanaian women.ConclusionThe higher prevalence of the metabolic syndrome in postmenopausal women is an indication that they are at risk of developing cardiovascular disease and type 2 diabetes. Therefore women in that group should be monitored for the two conditions and also be advised to adopt healthy lifestyles to minimize the incidence of these conditions.