Differentiating societal costs of disability worsening in multiple sclerosis

Journal of Neurology - In multiple sclerosis (MS), confirmed disability progression (CDP) can be either the result of progression independent of relapse activity (PIRA) or relapse-associated...     

Correction to: Differentiating societal costs of disability worsening in multiple sclerosis

Journal of Neurology - The original version of this article unfortunately contained a mistake. The captions of Fig. 2 and Fig. 3 are mismatched.     

Neither Incretin or Amino Acid Responses,nor Casein Content,Account for the Equal Insulin Response Following Iso-Lactose Loads of Natural Human and Cow Milk in Healthy Young Adults

Human milk contains <50% less protein (casein) than cow milk, but is equally effective in insulin secretion despite lower postingestion hyperaminoacidemia. Such potency of human milk might be modulated either by incretins (glucagon-like polypeptide-1,GLP-1); glucose-inhibitory-polypeptide, GIP), and/or by milk casein content. Healthy volunteers of both sexes were fed iso-lactose loads of two low-protein milks, i.e., human [Hum] (n = 8) and casein-deprived cow milk (Cow [↓Cas]) (n = 10), as well as loads of two high-protein milks, i.e., cow (n = 7), and casein-added human-milk (Hum [↑Cas]) (n = 7). Plasma glucose, insulin, C-peptide, incretins and amino acid concentrations were measured for 240′. All milks induced the same transient hyperglycemia. The early [20′–30′] insulin and C-peptide responses were comparable among all milk types apart from the low-protein (Cow [↓Cas]) milk, where they were reduced by <50% (p < 0.05 vs. others). When comparing the two high-protein milks, GLP-1 and GIP [5’–20’] responses with the (Hum [↑Cas]) milk were lower (by ≈2–3 fold, p < 0.007 and p < 0.03 respectively) than those with cow milk, whereas incretin secretion was substantially similar. Plasma amino acid increments largely reflected the milk protein content. Thus, neither casein milk content, nor incretin or amino acid concentrations, can account for the specific potency of human milk on insulin secretion, which remains as yet unresolved.     

Circadian variation in the incidence of sudden cardiac death in the Framingham Heart Study population

To determine if sudden cardiac death shows circadian variation, the time of day of sudden cardiac deaths in the Framingham Heart Study was analyzed. Analysis was based on mortality data collected in a standardized manner for the past 38 years for each death among the 5,209 persons in the original cohort. The necessary assumptions about the cause and timing of unwitnessed deaths were made in a manner likely to diminish the possibility of detecting an increased incidence of sudden cardiac death during the morning. In the Framingham study, analyses using these assumptions reveal a significant circadian variation (p less than 0.01) in occurrence of sudden cardiac death (n = 429), with a peak incidence from 7 to 9 AM and a decreased incidence from 9 AM to 1 PM. Risk of sudden cardiac death was at least 70% higher during the peak period than was the average risk during other times of the day. Further studies are needed to confirm this finding in other populations, to collect data regarding medications and to determine activity immediately before sudden cardiac death. Investigation of physiologic changes occurring during the period of increased incidence of sudden cardiac death may provide increased insight into its causes and suggest possible means of prevention.     

Endoscopic sphincterotomy in the treatment of biliary lithiasis. Our experience

Endoscopic Sphincterotomy (E.S.) is a simple and efficacious method for the management of bile duct stones and papillary stenosis. In this series, the E.S. was attempted in 25 patients and performed in 23 (92%). Nine patients had common bile duct stones. Eleven patients (48%) had common bile duct and gallbladder stones. Two patients (8.7%) had intrahepatic lithiasis and one patient (4.3%) had papillary stenosis without gallstones. After E.S. all patients underwent instrument removal of bile duct stones, using "Dormia" basket and "Fogarty" balloon catheter. Transnasal bile duct drainage was performed in 20 patients (86.9%). Early complications were observed in three patients (13%); one sphincterotomy side bleeding and two acute pancreatitis, which were treated successfully conservatively. Mean follow-up was 10.7 months (range 3-27 months). Late complications did not occur for the method and/or for gallbladder stones. Four patients over 80 years of age, died for unrelated causes during follow-up.     

Urinary continence recovery after radical prostatectomy – anatomical/reconstructive and nerve‐sparing techniques to improve outcomes

In an editorial board‐moderated debate format, two experts in prostate cancer surgery are challenged with presenting the key strategies in radical prostatectomy that improve urinary functional outcomes. Dr Bernardo Rocco was tasked with arguing the facts that support the anatomical preservation and reconstruction steps that improve urinary continence. Drs Christian Pavlovich and Sasha Druskin were tasked with arguing the facts supporting neurovascular bundle and high anterior release surgical planes that improve urinary continence. Associate Editor John Davis moderates the debate, and outlines the current status of validated patient questionnaires that can be used to evaluate urinary continence, and recent work that allows measuring what constitutes a ‘clinically significant’ difference that either or both of these surgical techniques could influence. A review of raw data from a publication from Dr Pavlovich's team demonstrates how clinically relevant differences in patient‐reported outcomes can be correlated to technique. A visual atlas is presented from both presenting teams, and Dr Davis demonstrates further reproducibility of technique. A linked video on this concept is available as a supplementary file.