Multiple Sclerosis Center of Atlanta

Distal radioulnar joint (DRUJ) instability is a complex pathology that typically occurs due to injury of the triangular fibrocartilage complex. In the acute setting, repair is often successful. However, in the chronic setting or after a prior failed repair, reconstructive methods aim to improve stability using an extrinsic radioulnar soft tissue link. Traditional surgical techniques are technically demanding and require a broad exposure, compromising extrinsic stabilizers. Modifications to these methods using arthroscopy facilitate preservation of ulnocarpal and DRUJ secondary stabilizers, while providing excellent visualization for anatomic passage of the graft and placement of the foveal bone tunnel. We describe a simple and effective arthroscopic reconstruction method for restoring and reinforcing the native anatomy of the critical stabilizers of the DRUJ.

Background: Cancer therapy–related cardiac dysfunction (CTRCD) is a well-recognized adverse effect of HER2-targeted therapies, particularly trastuzumab. While current guidelines recommend serial left ventricular ejection fraction (LVEF) monitoring every 3 months during treatment, such uniform surveillance may lead to overutilization in low-risk patients. Objective: This study aimed to externally validate a nomogram from Memorial Sloan Kettering to predict CTRCD in a contemporary cohort of patients with HER2-positive breast cancer. Methods: This retrospective study included women with HER2-positive breast cancer treated with trastuzumab between 2013&2022 at a large cancer center. The primary endpoint was 1-year CTRCD-free survival, with CTRCD defined as an LVEF decline ≥10% to <53% or a ≥16% reduction from baseline. Patients were stratified into risk groups based on total nomogram points. Model performance was evaluated in the validation cohort using Kaplan-Meier estimates, calibration plots, concordance index (C-index), and area under the ROC curve (AUC). Results: The derivation and validation cohorts demonstrated notable differences in baseline characteristics. Patients in the validation cohort (n=356) had a higher mean BMI (39.6% vs. 22.9%) and greater prevalence of cardiovascular comorbidities, including hypertension (34.8% vs. 23.5%), diabetes (11.5% vs. 7.2%), and hyperlipidemia (24.7% vs. 17.1%) but with substantially lower anthracycline exposure (31.5% vs. 77.8%) compared to the derivation cohort. 9.6% of patients developed CTRCD within 395 days of trastuzumab initiation, which was defined as the 1-year CTRCD event. The 1-year CTRCD event rates across increasing quartiles of the nomogram score were 6.0%, 4.4%, 9.6%, and 19.5%, respectively, indicating effective risk stratification. Kaplan-Meier–estimated 1-year CTRCD-free survival was 90.1%, closely aligned with the nomogram-predicted probability of 87.8%. The model demonstrated excellent discriminative performance, with a C-index of 0.68 (95% CI, 0.49–0.86) and an AUC of 0.69 (95% CI, 0.58–0.78) (Figure A, B). Conclusion: The novel CTRCD nomogram demonstrated excellent discriminatory power and generalizable to an independent, real-world patient population. These findings support its utility for personalized CTRCD risk stratification and suggest its potential to guide less frequent LVEF monitoring in low-risk patients receiving HER2-targeted therapy.

ABSTRACTBackgroundWe aimed to provide updated evidence from the current literature regarding pediatric environmental factors associated with the risk of developing multiple sclerosis (MS).MethodsArticles were searched in PubMed, SciVerse ScienceDirect, and Web of Science. We included all clinical studies assessing the occurrence of MS at any age in association with the exposure to any environmental risk factor during childhood or adolescence. The main outcome was the occurrence of MS. The quality assessment was performed with the critical appraisal checklist for case–control studies. Pooled unadjusted effect sizes (OR) were calculated and reported with a 95% CI from random‐effects meta‐analysis.ResultsThe review included 87 studies conducted across 20 countries. The studies analyzed diverse environmental risk factors, including infections, vaccinations, tobacco exposure, body mass index, and other pediatric exposures. EBV infection showed a significant positive association with MS risk (ES = 2.38, 95% CI = 1.80–3.15). Breastfeeding showed limited protective associations, and various adverse social experiences like bullying and sexual abuse were linked to increased MS risk. Active smoking during childhood/adolescence and obesity during these periods were associated with higher MS risk, while normal body mass index was protective. Antibiotic and chemical exposures, as well as vitamin D deficiency, were linked to higher MS risk. The review highlighted substantial heterogeneity and identified publication bias in studies on infections and vaccinations.ConclusionsEnvironmental risk factors for MS are important during childhood and adolescence. The first 20 years are a key window for prevention and should be seen as an opportunity.

Introduction. The study was driven by the prevalence of secondary progressive multiple sclerosis (SPMS) in Russia and the lack of data on siponimod in the real clinical practice (RCP).Aim. To collect and analyze data on the administration of siponimod in SPMS patients within Russia’s RCP as part of the EMBOSSES study (rEtrospective Multicenter oBservatiOnal Study Siponimod rEal-world Spms).Materials and methods. The study encompassed data of 606 SPMS patients from 11 centers who received siponimod for at least 6 months. The analysed data included demographic and clinical characteristics of patients, changes in the Expanded Disability Status Scale (EDSS) scores over time, percentage of patients with 6-month confirmed disability progression (6mCDP), annualized relapse rate (ARR) for MS, radiological signs of the disease activity and adverse events (AEs).Results. Among the study patients, women predominated (64.9%), while men accounted for 35.1%. The median age of patients was 49.5 (±8.9) years. 143 (23.6%) patients reported relapses during 2 years, whereas relapse-free SPMS was observed in 463 (76.4%) patients. The average EDSS scores remained stable, demonstrating minimal changes from 5.44 (±0.998) to 5.58 (±1.028) scores during the 2-year therapy. The percentage of patients free from 6mCDP was 85.5%. The KaplanMeier analysis revealed that 25% of patients achieved 6mCDP by Month 27 of therapy. The average ARR decreased from 0.14 to 0.032 at 12 months and remained low (0.062) after 2 years of treatment. The MRI showed a decrease in the percentage of patients with Gd+ T1 lesions to their complete absence over 2 years of therapy. Main AEs: lymphopenia, bradycardia, and elevated liver enzymes; serious AEs were observed in 3.3% of all cases.Conclusions. Siponimod demonstrated efficacy in controlling disability progression and inflammatory activity, as well as a favourable safety profile in patients with SPMS in the RCP setting. The results confirm the feasibility of using siponimod in patients with SPMS.

ObjectivesTo examine volumetric magnetic resonance imaging (vMRI) in myelin oligodendrocyte glycoprotein antibody‐associated disease (MOGAD), compared to multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and healthy controls (HC).MethodsStandardized vMRI in MOGAD were compared to age, sex, and disease duration matched MS (5:1), and non‐matched NMOSD and HC, in mixed linear models with time and group interactions. Disability assessments included; patient determined disease steps (PDDS), manual dexterity (MDT), walking speed (WST), processing speed (PST), and contrast sensitivity tests (CST). Correlations between vMRI and disability in MOGAD were examined.ResultsA total of 293 patients were included; 32 MOGAD, 160 MS, 49 NMOSD, and 52 HC. MOGAD had a faster rate of volume loss in all brain regions compared to HC (p < 0.05). At baseline, MOGAD had preserved thalamic (0.000507, p = 0.005), caudate (0.000287, p = 0.004), and putamen (0.000341, p = 0.007) fractions than MS. Longitudinally, MOGAD had increased lateral ventricle fraction (LVF) (−0.000645, p = 0.032), but less hippocampal (0.000031, p = 0.044) and upper cervical cord area (UCCA) loss (1.482887, p = 0.005), compared to NMOSD. MOGAD had increased LVF (0.00529, p < 0.001), but less UCCA loss (0.538656, p = 0.042) longitudinally compared to MS. Among MOGAD, UCCA was associated with PDDS (−0.72, p = 0.004) and CST (0.60, p = 0.014). Whole brain fraction (WBF) was associated with PDDS (−0.66, p = 0.01) and PST (0.52, p = 0.019). LVF was associated with PDDS (0.78, p < 0.001).InterpretationMOGAD showed longitudinal brain volume loss compared to HC. Deep gray matter was relatively preserved compared to MS, while MS and NMOSD had greater UCCA loss, indicating regional differences in atrophy. Despite less overall atrophy, volume loss in MOGAD was associated with disability. ANN NEUROL 2025;98:1044–1056

The Ecosystems Framework research project aims to amplify the voices of individuals with multiple sclerosis (MS) and their care teams, identifying barriers to care and informing interventions to drive systemic change.

To determine the clinical characteristics of patients with multiple sclerosis (MS) who switch from B-cell depleting therapies (anti-CD20s) to natalizumab (NTZ; TYSABRI®); to estimate the annualized relapse rate (ARR), time to first relapse, and MS healthcare resource utilization (HRU) and healthcare costs (HCC).

Background and ObjectivesMultiple sclerosis (MS) is a demyelinating disease of the central nervous system. Its etiology may involve both genetic and environmental factors, including vitamin D levels, body mass index, infections, and smoking. This is the first comprehensive systematic review with meta-analysis that synthesizes and explore the role of many environmental risk factors in the etiology of MS.MethodsA systematic search of MEDLINE, SciVerse ScienceDirect and Web of Science were conducted for any original peer-reviewed article that included adult subjects diagnosed with and without MS that were exposed to any environmental risk factor. We did not set any time restrictions. Data were extracted and the quality assessment was performed with the Critical Appraisal Checklist for Case Control Studies. All the information was synthesized qualitatively and quantitatively (meta-analysis). We used the random-effects model based on the binomial distribution to calculate the pooled effects sizes (ES) regarding the risk of developing MS according to each potential risk factor.ResultsOne-hundred thirty-two publications met all the eligibility criteria and were included in the review. Overall, 109,626 people with MS and 16,724,390 controls from 38 countries were included in the review. A total of 42 environmental risk factors were investigated as potential risk factors for MS. Among the various statistically significant associations, the pooled ES revealed a direct association between serological evidence of contact with EBV (ES = 1.96, 95% CI = 1.53–2.51), herpes virus type 6 (HHV-6) (ES = 2.84, 95% CI = 2.08–3.89) and varicella-zoster virus (ES = 1.33, 95% CI = 1.08–1.63) and the occurrence of MS. Similarly, smoking was associated with a greater likelihood of having MS (ES = 1.43, 95% CI = 1.27–1.61). Vitamin D levels at any time were negatively associated with the proportion of cases of MS and had a moderate pooled ES (g = – 0.48, 95% CI = – 0.88–0.09). Adult BMI was not associated with MS.DiscussionThis review furnishes a broad and detailed overview of the potential environmental risk factors associated with MS. Our findings hold notable implications for public health policies, clinical practices, and the focus of future research.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00415-025-13248-0.

Micro-Hydropower (MHP) is generally defined as a decentralized small scale water power plant that generate electricity power up to 100kw and server nearby householders thoughts a local grid for power generation up to 100kw. This study analyzes the livelihood impacts of the micro-hydro electricity projects of the rural people on Taplejung district of Nepal. There are twelve micro hydroelectricity projects constructed as well as they generated and supply the electricity power of the local people without connected in national grid of the NEA. Primary data were used for the study for the information and descriptive statistics were used for data analysis. To measure livelihood impacts of the project, different indicators like housing and sanitation condition, electricity used, industrial situation, agro-product pricing and wage rate of the labour had been used. The completion of the different MHPs in the sample area shows the result that the MHPs had positive impacts upon the surrounding community people’s income and living standard, which shows the positive impacts on their livelihood in the Taplejung district. The result encourages the different stages of governance as well as other investors for the implementation of the micro-hydroelectricity project in the situation of the Nepalese context.

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