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Traditional outcome measures for patients with multiple sclerosis (MS), whether in clinical trials or clinical practice, are currently in question. The combination of relapses, physical disability progression and magnetic resonance imaging (MRI) disease activity reflect only part of the impact that MS has on a patient's daily life. Quality of life (QoL) is considered by many to be the ideal outcome measure. Since it captures the patient's own perspective of well-being, QoL should be the primary focus when evaluating a patient and the main objective of MS management. Nevertheless, whilst numerous instruments to measure QoL in MS patients are available or proposed, there is no current consensus regarding which is the best tool to use and under what circumstances. QoL in patients with MS is determined by several factors beyond the more obvious; these include coping with the MS diagnosis, understanding the disease and the disease process, dealing with so-called 'hidden' symptoms such as fatigue, cognitive impairment and sexual disturbances, and managing the many associated personal challenges such as social isolation, family issues and working difficulties. Evidence is emerging that psychological interventions may be beneficial in MS patients although more research is required to confirm their utility. This article examines some factors that influence QoL in MS patients which may be overlooked in the general busyness of routine clinical practice.

Item does not contain fulltext The objective of this work was to develop and validate a set of clinical criteria for the classification of patients affected by periodic fevers. Patients with inherited periodic fevers (familial Mediterranean fever (FMF); mevalonate kinase deficiency (MKD); tumour necrosis factor receptor-associated periodic fever syndrome (TRAPS); cryopyrin-associated periodic syndromes (CAPS)) enrolled in the Eurofever Registry up until March 2013 were evaluated. Patients with periodic fever, aphthosis, pharyngitis and adenitis (PFAPA) syndrome were used as negative controls. For each genetic disease, patients were considered to be 'gold standard' on the basis of the presence of a confirmatory genetic analysis. Clinical criteria were formulated on the basis of univariate and multivariate analysis in an initial group of patients (training set) and validated in an independent set of patients (validation set). A total of 1215 consecutive patients with periodic fevers were identified, and 518 gold standard patients (291 FMF, 74 MKD, 86 TRAPS, 67 CAPS) and 199 patients with PFAPA as disease controls were evaluated. The univariate and multivariate analyses identified a number of clinical variables that correlated independently with each disease, and four provisional classification scores were created. Cut-off values of the classification scores were chosen using receiver operating characteristic curve analysis as those giving the highest sensitivity and specificity. The classification scores were then tested in an independent set of patients (validation set) with an area under the curve of 0.98 for FMF, 0.95 for TRAPS, 0.96 for MKD, and 0.99 for CAPS. In conclusion, evidence-based provisional clinical criteria with high sensitivity and specificity for the clinical classification of patients with inherited periodic fevers have been developed.

New claims of periodic variability from gamma-ray blazars have been reported, possibly pointing at milli-pc SMBH binary systems. A modulation of ~2 year on 3.5 cycles was recently discovered with Fermi/LAT on the blazar PG1553+113 -- for the first time in gamma-rays with high significance -- and confirmed by optical lightcurves. Other possible gamma-ray periodic variations have been claimed on PKS 2155-304 and PKS 0537 by Sandrinelli et al. (2015, 2016). The interpretation of such periodicity, when confirmed with continuous observations in following years, is not straightforward. Emission from blazars is dominated by non-thermal emission from the jet; different processes in the jet or at its base, may lead to quasi-periodic emission. We used multi-wavelength (MWL) observations on PG1553+113 to investigate if the observed modulation can be explained with geometrical variations in the jet, possibly pointing to jet precession or to an helical pattern. The ongoing MWL monitoring campaign from radio to very-high energy gamma-ray bands, led by the MAGIC collaboration, will follow the maximum expected at the beginning of 2017, and will allow to set tighter constrains on underlying periodic processes.

We study the large-scale dynamics of the interstellar medium in barred galaxies. The interest in doing this is two-fold. On the one hand, the hydrodynamic flow is the source of many interesting physical phenomena, such as shocks and spiral arms. On the other hand, it is a powerful tool to constrain the characteristics of individual galaxies. Approximately half of this thesis is devoted to understanding the general characteristics of the gas dynamics. There are two key ingredients. The first is ballistic closed orbits. We investigate the connection between closed orbits and the full hydrodynamic flow. We show how they also form the basis to explain bar-driven spiral arms. The second key ingredient is shocks. These can arise at the transition between different families of closed orbits, or when the spiral arms become too strong. Under certain conditions, shocks become hydrodynamically unstable and produce density fluctuations that may have an observational counterpart in the form of asymmetries in the Milky Way molecular gas distribution. We also explore systematically how the gas flow is affected by a change in the parameters that characterise the bar, such as its length, strength and pattern speed. Through the study of the gas dynamics, inferences can be made about the structure of galaxies. We have compared our models with observations of the Milky Way. First, we revisit and refine the Binney et al (1991) model, one of the most successful models for the gas flow in the Galaxy. Then, we present new models that while preserving the good properties of the previous model can also correct its main shortcomings. These models can qualitatively account for most of the observational signatures of the Galactic bar and allow us to constrain its characteristics, such as its pattern speed, length and strength. However, we show that is difficult to find a model that accounts for all the important observational features simultaneously due to the high dimensionality of parameter space involved. We argue that automatic fitting method are necessary. To this end, we develop a new quantitative method to fit Milky Way longitude-velocity diagrams that is based on feature matching.

Introduction Chronic non-specific low back pain is a common problem with high costs. Many factors can contribute to motor dysfunction after an initial episode of pain and many people are not aware that they are moving differently. The loss of proprioceptive acuity is an element that can contribute to motor dysfunction. Recent literature suggests that two point discrimination (TPD) threshold at the back is greater in patients with back pain than in healthy controls, and greater TPD threshold at the back relates to decreased voluntary lumbopelvic control. These findings raise the possibility that decreased tactile acuity may contribute to poor motor control, which has implications for back pain rehabilitation in particular and for movement retraining in general. Purpose/Aim to study TPD threshold in a sample of CLBP patients, to verify if a 6 week sensory discrimination training improved TDP threshold, low back pain, function, movement patterns Materials and Methods A blinded randomized clinical study involving a sample of 77 patients with chronic non-specific low back pain. Subjects aged between 18 and 65 years, with low back pain more than 12 months, for at least 90 days within the past year were enrolled in the study. While patients with red flags or yellow flags, structural pathologies, spine surgery, pain below the knee were excluded. Patients underwent an interview and physical assessment with a physiotherapist and completed a body chart, the Baecke scale, the SF 36 questionnaire, the Oswestry disability index, the Roland–Morris Disability questionnaire and two 100-mm VAS to describe both back pain at the moment of evaluation and average back pain. The TPD was assessed bilaterally in the back. FIGURE 1 TPD assessment grid on the subject’s back, a plastic caliper was used to test the TPD threshold in the different areas. The movement impairment evaluation was based on Sahrmann examination.The sample was divided into two groups (experimental and control group) by randomization: 40 patients were submitted to the sensory discrimination training, while 37 patients took part in the control group. The treatment group underwent 3 session per week lasting 6 weeks (grand total of 18 sessions). All the enrolled subjects were evaluated at baseline (t0), at 6 weeks (t1) and after another 6 weeks follow up (t2). FIGURE 2 TPD treatment grid example on subject’s back (subject with unilateral pain). The subjects, while looking at a picture of their back with the points represented, were asked to recognize which point the therapist was touching and which kind of pointer was used (thin or thick). Results Treated patients and controls were homogeneous showing no differences in sex, age, weight, height, body mass index, pain, Baecke scale , SF 36 questionnaire, Oswestry disability index and Roland–Morris Disability questionnaire and TDP threshold. Also the movement impairment evaluation was similar between patients and controls. Movement impairment evaluation at t1 demonstrated an improvement in treated subjects on rotation signs, extension signs and total symptoms. Patients had a significant improvement of pain intensity (VAS mean t0= 4,8mm and VAS mean t1=2,9mm, p=0,015). Also the Oswestry disability index and the Roland–Morris Disability questionnaire disability scales showed a significant decrease after the period of training. Improvement at t1 were kept at t2. Figure 3 TPD changes (cm) over time, levels are reported on the horizontal axis with 10 representing the most caudal level (Fig.1). Red circles represent significant changes (p

Although the value of magnetic resonance imaging (MRI) for diagnosis/differential diagnosis of patients with clinically isolated syndromes suggestive of multiple sclerosis (MS) is widely accepted, adoption of MRI into clinical practice to monitor disease evolution remains a work in progress. However, an accumulating body of evidence points to a central role for MRI in managing patients with relapsing-remitting MS along the disease continuum. Routine MRI surveillance provides insight into disease activity that is not evident clinically and this information, in turn, can be used to inform prognosis and guide treatment decisions. In Europe, practical guidelines have been developed to reduce the heterogeneity of imaging (both intracentre and intercentre) and improve the quality of MRI assessment and interpretation. Aimed at the general neurologist, this review explores some of the issues associated with MRI and examines evidence supporting its use for routine monitoring of MS patients in everyday practice.

Background and purpose The Rio score (RS) and the modified Rio score (MRS) are two scoring systems that can identify the early predictive factors of disability progression in relapsing−remitting multiple sclerosis (RRMS) patients treated with interferon-β (IFN-β). The objective of the study was to validate the usefulness of the RS and MRS in a large cohort of multiple sclerosis patients treated with IFN-β in daily clinical practice. Methods The analysis included a cohort of RRMS patients treated with different formulations of IFN-β for at least 1 year. The RS and MRS were used to classify the patients after 1 year of treatment. Multivariate analysis was performed to identify predictive variables of suboptimal response at 5 years, defined as Expanded Disability Status Scale confirmed progression or switching to a second-line therapy. Results Sixty-nine of 416 included patients were considered as suboptimal responders at 5-year evaluation. The possible score range was 0–3. A higher risk of suboptimal response was found for RS and MRS in the presence of ≥2 scores (hazard ratio 3.0, P = 0.002, and hazard ratio 5.0, P