Peripheral Diseases Research Articles

Long-term changes in cerebellar activation during functional recovery from transient peripheral motor paralysis

Localized altered cerebellar cortical activity can be associated with short-term changes in motor learning that take place in the course of hours, but it is unknown whether it can be correlated to long-term recovery from transient peripheral motor diseases, and if so, whether it occurs concomitantly in related brain regions. Here we show in a longitudinal fMRI study of patients with unilateral Bell's palsy that increases in ipsilateral cerebellar activity follow the recovery course of facial motor functions over at least one and a half years. These findings hold true for changes in brain activity related to both oral and peri-orbital activation, even though these processes are differentially mediated by unilateral and bilateral brain connectivities, respectively. Activation of non-facial musculature, which was studied for control, does not show any change in cerebellar activity over time. The localized changes in cerebellar activities following activation of facial functions occur concomitantly with increases in activity of the facial region in the contralateral primary motor cortex suggesting that the cerebellum acts together with the cerebral cortex in long-term adaptation to transient pathological sensorimotor processing.

In vivoimaging of pulmonary alveolar proteinosis using confocal endomicroscopy

To the Editors: Fibred confocal fluorescence microscopy (FCFM) is a new technology that can provide microscopic imaging of a living tissue through a 1-mm flexible fibreoptic miniprobe 1, 2. To image the alveolar structures in vivo , the miniprobe is advanced through the working channel of the bronchoscope down to the alveolar ducts and sacs. In nonsmoking subjects, the FCFM is able to image the peripheral elastin framework of the alveolar ducts 3. In active smokers, the technique also images fluorescent alveolar macrophages which contain tobacco tar 3. The technique has the potential to improve the in vivo diagnosis of peripheral lung diseases during bronchoscopy. Herein we report the use of FCFM during bronchoscopy on a smoking patient presenting with diffuse alveolar and interstitial opacities on chest radiograph. The in vivo confocal fluorescence endomicroscopy in real-time showed the globular lipoproteinaceous material which is typical of pulmonary alveolar proteinosis (PAP). This diagnosis was confirmed by cytological analysis of the bronchoalveolar lavage (BAL) fluid, and by the presence of high levels of anti-granulocyte-macrophage colony-stimulating factor (GM-CSF) serum antibodies. This is the first report of the in vivo confocal microscopic appearance of lipoproteinaceous material during bronchoscopy, which appears to be typical of PAP. A 42-yr-old, 25 pack-yr, active smoking male presented with a 4-month history of increasing breathlessness on exertion and dry cough. He reported a history of heavy and short household plaster dust exposure preceding the onset of symptoms. The physical examination was unremarkable. The chest radiograph showed bilateral alveolar and interstitial opacities. A high-resolution computed …

Our experience of the thoracoscopic sympathectomy in case of the periferial arteries diseases

Investigated the results of thoracoscopic sympathectomy at 107 patients with peripheral arteries diseases. The best results in post operation period observed in patients with Raynaud’s disease and syndrome, which efficacy reached up to 100%. In the long follow up period efficacy of operation observed 100% and 90% accordingly. At obliterating endarteritis and an atherosclerosis we fought followed preservation of the basic functions of the extremities. In conclusion in postoperative period this parameter was 73.2% and 62.5% accordingly and in the long follow up period extremities could be saved 62% and 25% accordingly.

Peripheral Protein Quality Control Removes Unfolded CFTR from the Plasma Membrane

Therapeutic efforts to restore biosynthetic processing of the cystic fibrosis transmembrane conductance regulator lacking the F508 residue (DeltaF508CFTR) are hampered by ubiquitin-dependent lysosomal degradation of nonnative, rescued DeltaF508CFTR from the plasma membrane. Here, functional small interfering RNA screens revealed the contribution of chaperones, cochaperones, and ubiquitin-conjugating and -ligating enzymes to the elimination of unfolded CFTR from the cell surface, as part of a peripheral protein quality-control system. Ubiquitination of nonnative CFTR was required for efficient internalization and lysosomal degradation. This peripheral protein quality-control mechanism probably participates in the preservation of cellular homeostasis by degrading damaged plasma membrane proteins that have escaped from the endoplasmic reticulum quality control or are generated by environmental stresses in situ.

Entrapment neuropathy and beyond

Entrapment neuropathies, including carpal tunnel syndrome, are some of the most common neurological disorders. The old notion has been that they result from focal compression of a nerve, which first produces a local demyelination through intussusceptions of the myelin sheath, and then produces Wallerian degeneration by disruption of the nerve. Their physiological diagnosis therefore rests upon delayed conduction velocities and conduction block in the early phase and decrease of the response amplitude reflecting loss of axons in the late stage of illness. Characteristic clinical symptoms of carpal tunnel syndrome are pain and numbness in the hand, which often aggravate at night (nocturnal acroparesthesia), the latter believed to be caused by nerve ischaemia. In a recent issue of The Journal of Physiology, Han et al. (2010) have reported on a physiological model of focal nerve compression using threshold tracking techniques. Although there has been a study on a model of generalized ischaemia in the limb (Bostock et al. 1991), their technique is unique in that the model reproduces transient focal nerve compression. Their series of studies depict membrane depolarization, depolarizing conduction block, and the mechanism of pain and numbness associated with ectopic impulse generation, all of which would otherwise be unrecognized. Accumulating evidence on axonal membrane potentials, ion channels and ‘positive phenomena’ such as fasciculation and numbness in health and disease has been obtained using these threshold tracking techniques; the mechanism of spontaneous firing of motor and sensory nerves was clarified in peripheral neuropathies (Kaji, 2003), and will be studied in amyotrophic lateral sclerosis with fasciculation as the initial presenting symptom that characterizes the disease. In the future, the molecular bases of peripheral neuropathies and motor neuron diseases should be determined not only in cultured cells but also in human nerves in vivo.

Pulsatile shear and Gja5 modulate arterial identity and remodeling events during flow-driven arteriogenesis

In the developing chicken embryo yolk sac vasculature, the expression of arterial identity genes requires arterial hemodynamic conditions. We hypothesize that arterial flow must provide a unique signal that is relevant for supporting arterial identity gene expression and is absent in veins. We analyzed factors related to flow, pressure and oxygenation in the chicken embryo vitelline vasculature in vivo. The best discrimination between arteries and veins was obtained by calculating the maximal pulsatile increase in shear rate relative to the time-averaged shear rate in the same vessel: the relative pulse slope index (RPSI). RPSI was significantly higher in arteries than veins. Arterial endothelial cells exposed to pulsatile shear in vitro augmented arterial marker expression as compared with exposure to constant shear. The expression of Gja5 correlated with arterial flow patterns: the redistribution of arterial flow provoked by vitelline artery ligation resulted in flow-driven collateral arterial network formation and was associated with increased expression of Gja5. In situ hybridization in normal and ligation embryos confirmed that Gja5 expression is confined to arteries and regulated by flow. In mice, Gja5 (connexin 40) was also expressed in arteries. In the adult, increased flow drives arteriogenesis and the formation of collateral arterial networks in peripheral occlusive diseases. Genetic ablation of Gja5 function in mice resulted in reduced arteriogenesis in two occlusion models. We conclude that pulsatile shear patterns may be central for supporting arterial identity, and that arterial Gja5 expression plays a functional role in flow-driven arteriogenesis.

Bulbocavernosus Reflex and Pudendal Nerve Somatosensory-Evoked Potentials Responses in Female Patients With Nerve System Diseases

To assess the value of bulbocavernosus reflex (BCR) and pudendal nerve somatosensory-evoked potential (SSEP) in the topical diagnosis of central and peripheral nervous system diseases in female patients. Neuroelectrophysiologic technique was adopted to determine both BCR and SSEP of 41 healthy adult females (control group), 30 female patients with spinal cord lesions (central group), and 50 female patients with peripheral nerve lesions (peripheral group), including nine female patients with acute cauda equina syndrome. The abnormality rates of BCR were 8.33% and 70.00% in the central group and the peripheral group, respectively, and there were statistical differences between the two groups. The abnormality rates of BCR were 72.22% in the patients with acute cauda equina syndrome abnormal, who have at least one side of the abnormal BCR. The abnormality rates of SSEP P41 were 86.67% and 82.00% in the control and peripheral groups, respectively, and there were no statistical differences between the two groups. The abnormality rates of SSEP P41 were 88.89% in the patients with acute cauda equina syndrome abnormal. Also, there were no statistical differences between the peripheral group and the patients with acute cauda equina syndrome in the abnormality rates of SSEP or BCR. Both BCR and SSEP changed in the peripheral group, especially in the patients with acute cauda equina syndrome, but only SSEP changed in the central group. BCR and SSEP are valuable in the topical diagnosis of nervous system diseases in females.

Use of sulodexide in patients with peripheral vascular disease

Sulodexide is a highly purified glycosaminoglycan containing a combination of heparan sulfate with affinity for antithrombin III and dermatan sulfate with affinity for heparin cofactor II. This antithrombotic and antithrombin activity is of great pharmacologic interest and makes sulodexide a suitable drug for the prophylaxis and treatment of arterial and venous peripheral diseases. In arterial pathology, changes in the Winsor Index, improvement in peripheral blood flow, and reduction in pain-free walking distance confirm that treatment with oral sulodexide is effective. Lipid components linked to the genesis of peripheral vascular processes, including triglycerides, total cholesterol, and low-density lipoprotein fractions, as well as plasma and blood viscosity, are reduced by the administration of sulodexide, whereas the high-density lipoprotein fraction increases. Sulodexide inhibits aggregation and adhesion of platelets at the level of the vascular wall, reduces plasma fibrinogen concentrations, reduces plasminogen activator inhibitor-1, and increases tissue plasminogen activator, as well as systemic fibrinolytic and thrombolytic activity, thereby demonstrating efficacy in the treatment of thromboembolic disease. There is no interaction between sulodexide and other drugs used as long-term treatment for peripheral vascular disease. It is well tolerated, and the adverse reactions described after oral administration are related mainly to transient gastrointestinal intolerance, ie, nausea, dyspepsia, and minor bowel symptoms. Sulodexide may become the treatment of choice when dealing with vascular diseases and their complications, as well as for the prevention of venous thromboembolic disease, being particularly indicated in elderly patients, due to its good tolerability and ease of management.

Different types of dizziness in patients with peripheral vestibular diseases – their prevalence and relation to migraine

Conclusions: Besides spontaneous attacks of vertigo or unsteadiness, other symptoms, i.e. drop attacks, lateropulsion, illusions that the room or body is tilted, ‘walking on pillows’ or ‘stepping into a hole’, occur without precipitating head movement in almost 50% of patients with peripheral vestibular dysfunctions. The sensation of static tilt was closely connected to migraine and Meniere's disease (MD). Objectives: To record the prevalence of the different symptoms with respect to vestibular diagnosis and its relation to migraine. Methods: Data from 100 patients with MD, benign paroxysmal positional vertigo (BPPV), or unilateral peripheral vestibular impairment (UPVI) were analyzed with respect to vestibular diagnosis and migraine as a secondary diagnosis. Results: Spontaneous attacks of vertigo or unsteadiness occurred in 74% and 48% of patients, respectively. Vertigo was significantly more often reported in patients with MD and BPPV. In patients with BPPV, the duration of spontaneous vertigo was shorter than in patients with MD. The relative incidence of other symptoms were: unsteadiness, 48%; ‘stepping into a hole’, 46%; lateropulsion, 35%; ‘walking on pillows’, 21%; and drop attacks, 19%. Only the sensation of static tilt, which occurred in 8% of patients, was significantly correlated to MD or to migraine.

Stem Cells: An Overview of the Current Status of Therapies for Central and Peripheral Nervous System Diseases

In regenerative medicine, stem cells are currently considered ideal candidates for the treatment of diseases and injuries of the nervous system, for which, at present, there are no effective treatments. Promising results have been shown by clinical trials for neurodegenerative diseases such as Parkinson's diseases, but also for demyelinising disorders and traumatic lesions of the brain and spinal cord. The proof-of-principle is that the replacement of damaged cells and the restoration of function can be accomplished by the transplantation of embryonic or adult stem cells. Advancements in stem cell biology were recently propelled by the ability to generate induced pluripotent stem (iPS) cells from fibroblasts of several neurodegenerative diseases (e.g. Parkinson's and Huntington's diseases, Amyotrophic Lateral Sclerosis and Spinal Muscular Atrophy). In this review, we discuss the molecular basis of stem cell therapy and the advancement of research on regenerative medicine for diseases and injuries of the nervous system.

Efficient retrograde transport of adeno-associated virus type 8 to spinal cord and dorsal root ganglion after vector delivery in muscle.

The peripheral nervous system (PNS), including peripheral nerves and dorsal root ganglion (DRG), is involved in numerous neurological disorders, such as peripheral neuropathies (diabetic neuropathy, chronic pain, etc.) and demyelination diseases (multiple sclerosis, congenital muscular dystrophy, Charcot-Marie-Tooth disease, etc.). Effective clinical interventions for those diseases are very limited. Gene therapy represents a novel therapeutic strategy for the PNS diseases, especially with simply and minimally invasive delivery methods. Previously, we have shown that adeno-associated virus type 8 (AAV8) can efficiently transduce muscles body wide by a simple intraperitoneal injection in neonatal mice. In this study, we investigated the capacity of AAV8 in transducing PNS in neonatal mice by intraperitoneal injection and also in adult mice by intramuscular injection. Efficient and long-term gene transfer was found in the white matter of the spinal cord, DRG neurons, and peripheral nerves in both groups, treated either as neonates or as adults, particularly neonates. In the adult mice injected with AAV8 in tibialis anterior and gastrocnemius muscles in one of the hind legs, more neurons were transduced in the lower part of the spinal cord than in the upper part; the DRG neurons were transduced more on the vector-injected side than in the contralateral uninjected side. Few cells in the gray matter of the spinal cord were transduced regardless of the delivery methods and age of the mice. These results support the mechanism of vector retrograde transport and suggest that AAV8 crosses blood-nerve barrier poorly. Our finding should have important implications in gene therapy for peripheral neurological disorders.

Biological Role of Dystroglycan in Schwann Cell Function and Its Implications in Peripheral Nervous System Diseases

Dystroglycan is a central component of the dystrophin-glycoprotein complex (DGC) that links extracellular matrix with cytoskeleton, expressed in a variety of fetal and adult tissues. Dystroglycan plays diverse roles in development and homeostasis including basement membrane formation, epithelial morphogenesis, membrane stability, cell polarization, and cell migration. In this paper, we will focus on biological role of dystroglycan in Schwann cell function, especially myelination. First, we review the molecular architecture of DGC in Schwann cell abaxonal membrane. Then, we will review the loss-of-function studies using targeted mutagenesis, which have revealed biological functions of each component of DGC in Schwann cells. Based on these findings, roles of dystroglycan in Schwann cell function, in myelination in particular, and its implications in diseases will be discussed in detail. Finally, in view of the fact that understanding the role of dystroglycan in Schwann cells is just beginning, future perspectives will be discussed.

The neurology of balance: Function and dysfunction of the vestibular system in dogs and cats

Disorders affecting the vestibular system are a common neurological problem encountered in small animal practice. As a result, veterinarians are often faced with determining the underlying etiology of affected animals. In order to establish an accurate etiological diagnosis, proper interpretation of neurological deficits and precise neuroanatomical localization are essential. Neurological examination can confirm whether the vestibular dysfunction is of peripheral or central nervous system origin. Peripheral vestibular diseases include idiopathic vestibular syndrome, which has some similarities with vestibular neuritis in humans. Central vestibular diseases in general have a poor prognosis in comparison to those affecting the peripheral vestibular system.

Which parameter is better for assessment of vascular endothelial function: absolute changes of vascular diameter or percentage index of it?

Objective According to the current guideline, mostly is used percentage index of flow-mediated vasodilatation (FMD%), but there are many controversies in literature. Aim of the study was to show whether absolute changes of vascular diameter while reactive hyperemia test (RHtest) or percentage index of it is most valuable parameter for assessment of vascular endothelial function. Methods 57 patients with arterial hypertension (mean age±SD, 51.26±1.94) and 17 healthy controls (mean age±SD, 51±5.41) were included in the study. All the subjects underwent to the investigation of endothelial function via high resolution vascular dopplerechography, ambulatory blood pressure monitoring and investigation of blood rheology. Patients with cardio, peripheral and cerebrovascular diseases, diabetes mellitus, smokers, pregnant, obese as well as those with secondary forms of hypertension, ischemic heart disease and heart failure were excluded from the study. Results Compared with hypertensive population, FMD% as well as the absolute change of vascular diameter after RHtest (ΔD) was higher in healthy subjects (6.49±1.58 vs. 13.73±1.21; P=0.000 and 0.25±0.06 vs. 0.54±0.04; P=0.000; respectively). Correlation analyzes showed, that compared with FMD%, ΔD correlates with blood pressure characteristics, received by ABPM. Correlation between haemorheological parameters and FMD%/ΔD was not practically different in patients with arterial hypertension. Therefore, in contrary to the FMD%, ΔD showed significantly higher correlations with haemorheological characteristics; namely, platelet aggregative activity (r=0.488, P=0.047 vs. r=0.603, P=0.010), platelet adhesive activity (r=0.412, P=NS vs. r=0.537, P=0.026), fibrinogen concentration (r=0.198, P=NS vs. r=0.566, P=0.018), erythrocyte aggregative activity (r=0.049, P=NS vs. r=0.627, P=0.007) and blood viscosity (r=−0.256, P=NS vs. r=0.552, P=0.022). Conclusions In spite of the priority meaning of percentage index of flow-mediated vasodilatation for assessment of endothelial function in the current guideline, our study showed that for the assessment of endothelial function most valuable is to use absolute index of diameter changes, instead of percentage index of it. Objective According to the current guideline, mostly is used percentage index of flow-mediated vasodilatation (FMD%), but there are many controversies in literature. Aim of the study was to show whether absolute changes of vascular diameter while reactive hyperemia test (RHtest) or percentage index of it is most valuable parameter for assessment of vascular endothelial function. Methods 57 patients with arterial hypertension (mean age±SD, 51.26±1.94) and 17 healthy controls (mean age±SD, 51±5.41) were included in the study. All the subjects underwent to the investigation of endothelial function via high resolution vascular dopplerechography, ambulatory blood pressure monitoring and investigation of blood rheology. Patients with cardio, peripheral and cerebrovascular diseases, diabetes mellitus, smokers, pregnant, obese as well as those with secondary forms of hypertension, ischemic heart disease and heart failure were excluded from the study. Results Compared with hypertensive population, FMD% as well as the absolute change of vascular diameter after RHtest (ΔD) was higher in healthy subjects (6.49±1.58 vs. 13.73±1.21; P=0.000 and 0.25±0.06 vs. 0.54±0.04; P=0.000; respectively). Correlation analyzes showed, that compared with FMD%, ΔD correlates with blood pressure characteristics, received by ABPM. Correlation between haemorheological parameters and FMD%/ΔD was not practically different in patients with arterial hypertension. Therefore, in contrary to the FMD%, ΔD showed significantly higher correlations with haemorheological characteristics; namely, platelet aggregative activity (r=0.488, P=0.047 vs. r=0.603, P=0.010), platelet adhesive activity (r=0.412, P=NS vs. r=0.537, P=0.026), fibrinogen concentration (r=0.198, P=NS vs. r=0.566, P=0.018), erythrocyte aggregative activity (r=0.049, P=NS vs. r=0.627, P=0.007) and blood viscosity (r=−0.256, P=NS vs. r=0.552, P=0.022). Conclusions In spite of the priority meaning of percentage index of flow-mediated vasodilatation for assessment of endothelial function in the current guideline, our study showed that for the assessment of endothelial function most valuable is to use absolute index of diameter changes, instead of percentage index of it.

Amyloid-β, Tau Protein, and Oxidative Changes as a Physiological Compensatory Mechanism to Maintain CNS Plasticity under Alzheimer's Disease and Other Neurodegenerative Conditions

In this review, we propose that the neurodegenerative changes in the neurochemistry of amyloid-beta (Abeta) aggregation, tau phosphorylation, cytoskeleton rearrangement, oxidative stress, and lipid peroxidation in Alzheimer's disease (AD), and a number of other neurodegenerative diseases, are secondary pathological features. In fact, we believe that these phenomena represent natural compensatory mechanisms for impaired primary neurodegeneration, membrane dynamic deterioration, and/or associated failures of neurotransmission, synaptic function, and neuroplasticity. Physiologically, Abeta, lipid peroxidation, and tau protein may function to sense changes in activity-dependent membrane properties and therefore biochemically modulate membrane lipid homeostasis for more efficient synaptic action. As such, the previously proposed therapeutic tackling of amyloid, tau, oxidative stress, and other brain disease markers may have no ability to cure AD or other devastating central nervous system pathologies and peripheral nervous system diseases. This unfortunate realization provides a wake-up call to the neuroscience community, demanding open-minded approach.

0482: The Clinic Value of High Frequency Ultrasound in Diagnosis of Peripheral Nerve Diseases

0482: The Clinic Value of High Frequency Ultrasound in Diagnosis of Peripheral Nerve Diseases

Syndrome de jambe douloureuse et orteils instables associé à une radiculopathie lombaire

Introduction Painful legs and moving toes (PLMT) is a rare syndrome characterized by spontaneous neuropathic pain in the lower limbs associated with peculiar involuntary movements of the toes. It has been associated with a variety of peripheral and central nervous system diseases. Pathophysiology is unclear and treatment approaches remain largely empirical. Clinical case We report a case of a 42-year-old women with typical presentation of PLMT syndrome, associated with lumbar (L 5) disc prolapse. Oxcarbazepine gave a partial improvement. Conclusion Clinical presentations and etiological aspects of the PLMT syndrome are described and pathophysiological mechanisms and therapeutic possibilities discussed.

Suppression of Sproutys Has a Therapeutic Effect for a Mouse Model of Ischemia by Enhancing Angiogenesis

Sprouty proteins (Sproutys) inhibit receptor tyrosine kinase signaling and control various aspects of branching morphogenesis. In this study, we examined the physiological function of Sproutys in angiogenesis, using gene targeting and short-hairpin RNA (shRNA) knockdown strategies. Sprouty2 and Sprouty4 double knockout (KO) (DKO) mice were embryonic-lethal around E12.5 due to cardiovascular defects. The number of peripheral blood vessels, but not that of lymphatic vessels, was increased in Sprouty4 KO mice compared with wild-type (WT) mice. Sprouty4 KO mice were more resistant to hind limb ischemia and soft tissue ischemia than WT mice were, because Sprouty4 deficiency causes accelerated neovascularization. Moreover, suppression of Sprouty2 and Sprouty4 expression in vivo by shRNA targeting accelerated angiogenesis and has a therapeutic effect in a mouse model of hind limb ischemia. These data suggest that Sproutys are physiologically important negative regulators of angiogenesis in vivo and novel therapeutic targets for treating peripheral ischemic diseases.

Visual Outcome and Corneal Topography After Eccentric “Shaped” Corneal Grafts

To study the clinical and visual outcome and corneal topography in eyes that underwent full-thickness or lamellar eccentric-"shaped" (biconvex/crescentic) corneal grafts. Tertiary care center in south India. In this retrospective, interventional, noncomparative case series, eccentric-shaped corneal grafts were performed in 10 eyes (10 patients). Biconvex grafts were performed in 7 eyes, and crescentic grafts were done in 3 eyes. The indications for biconvex grafts were peripheral infected corneal ulcer (3 eyes), limbal dermoid (1 eye), squamous cell carcinoma at limbus (1 eye), rheumatoid arthritis-associated peripheral corneal melt (1 eye), and peripheral corneal perforation of unknown etiology (1 eye). Crescentic graft was performed for perforated Mooren ulcer in 3 eyes. All grafts were tectonically effective. Three grafts developed stromal haze with fine vascularization. Visual acuity was equal to or better than that before surgery in all eyes but one. This eye had deterioration in visual acuity because of progression of cataract. Corneal topography was performed in 5 eyes, which revealed corneal asymmetry but regular central corneal surface. Shaped corneal grafts for peripheral corneal diseases are tectonically viable and result in good visual outcomes.

The validity of hospital administrative data for outcome measurement after hip replacement

Background: Because of the increasing availability of clinical information on the basis of electronically processed data obtained through the hospital discharge records in the HIS, large databases are being set up to develop risk adjustment models for outcome assessment. This study is aimed at assessing the validity of hospital discharge data from the Hospital Information System (HIS) of patients with hip arthroplasty. Methods: 677 records were extracted from the database of the pilot project “Lazio Region Hip Arthroplasty Register (Ripa-L)” and were compared to the corresponding HIS discharge records. The Ripa-L dataset was used as a reference to evaluate the completeness and accuracy of the socio-demographic and clinical HIS data. Results: Data such as the patients’ age and sex, principal diagnosis, and surgical procedures, showed a very high level of agreement. By contrast, clinical information about comorbidities on admission and in-hospital complications mostly showed unacceptable variances in the datasets. The sensitivity of hospital data reporting was generally very low for almost all conditions, with the highest value being observed for diabetes (58%) and the lowest for endocrine and peripheral venous diseases (4%). Conclusions: Gaps in clinical information may compromise the ability to carry out high quality appraisals. In particular, the underreporting of comorbidities in hospital administrative data may lead to misestimation of the providers’ skill and quality of care, as a consequence of imperfect risk-adjustment. Stakeholders should highlight the potentialities related to the use of high quality administrative datasets also in clinical evaluations by stimulating health professionals to further improve the quality of the collected data.