Julkaisuarkisto

Background

B-cell–depleting anti-CD20 therapies are among the most effective disease-modifying treatments for relapsing–remitting multiple sclerosis (RRMS). Rituximab (RTX) is widely used off-label, while ocrelizumab (OCR) is approved for RRMS; yet comparative real-world evidence between the two remains limited.

Methods

We conducted a retrospective registry-based cohort study using the Finnish MS Registry, including adult RRMS patients treated with RTX or OCR between 2018 and 2024 at two university hospitals. Propensity score matching (1:1) was applied to balance baseline characteristics. Primary outcomes were annualized relapse rate (ARR) during follow-up and relapse-free survival. Secondary outcomes included MRI activity, disability progression, adverse events, and longitudinal plasma immunoglobulin G (IgG) levels.

Results

Of 636 screened patients, 191 met inclusion criteria and 112 patients (56 RTX, 56 OCR) were included after matching. Median follow-up was 3.1 years for RTX and 2.6 years for OCR. ARR was low and similar in both groups (mean 0.03), and relapse-free survival did not differ (log-rank p = 0.95; HR 0.95, 95% CI 0.21–4.33). MRI activity remained largely stable, with no significant differences in T2 lesion changes. Adverse events were infrequent and mild. IgG declined modestly in both groups (mean−13%), with values below the reference range in 4.5% of patients and no association with infections. No disease reactivation was observed among patients switching from OCR to RTX.

Conclusions

In this population-based Finnish real-world study, RTX and OCR demonstrated comparable effectiveness and safety in RRMS, supporting RTX as a rational alternative to OCR in routine clinical practice.

Objectives: Rescue stenting (RS) has emerged as a bailout strategy after failed reperfusion during endovascular treatment (EVT). Optimal blood pressure (BP) management after RS remains unclear. Our aim is to evaluate the association of BP levels and blood pressure variability (BPV) during the first 24 h after RS with short-term and long-term patient outcomes.

Methods: We performed a retrospective analysis of an international registry where data from adult patients who underwent either RS or rescue angioplasty after failed EVT were collected. Patients who received RS with large vessel occlusion and at least 4 BP measurements in the first 24 h were included.

Results: RS was performed in 437 patients (40.5% female, mean age 67.1 ± 13 years). Admission median National Institutes of Health Stroke Scale score was 12 (IQR 7-18) and history of hypertension was present in 74.2% of patients. Μean Systolic BP (SBP) in the first 24 h was 137.4 ± 14.6 mmHg. Higher values of BPV (coefficient of variation, standard deviation, average real variability and successive variation) were associated with lower odds for Modified Rankin Scale score 0-2 at 90 days (adjusted odds ratio ranging 0.55 [0.38, 0.79] to 0.99 [0.98, 0.99] per 10 units increase). No associations were found between any SBP measure and death, sICH as well as neurological deterioration at 24 h.

Conclusion: In our study, higher BPV was associated with worse clinical outcomes in stroke patients treated with RS as bailout therapy after failed reperfusion. No association was shown between mean, maximum, minimum and delta SBP and clinical outcomes.

Background: Early treatment of malocclusion in primary and early mixed dentition is often carried out by dentists under the supervision of orthodontists. In these treatments, simple appliances are preferred.

Objectives: To analyse which occlusal traits can be corrected with prefabricated eruption guidance appliances (EGAs) in mixed dentitions.

Search methods: Articles written in English and published between January 1990 and March 2023 were searched from Cochrane Library, Clinicaltrials.gov, EMBASE, International Clinical Trials Registry Platform, LILAC, PubMed, and Scopus.

Selection criteria: The inclusion criteria were formed according to the Patient, Intervention, Comparison, Outcomes, and Study design schema (PICOS).

Data collection and analysis: Selection of the articles followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Risk of bias was evaluated using RoB 2 and ROBINS-I tools. The pooled estimates for the change in clinical and cephalometric measurements were calculated. The overall quality of the outcome was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool.

Results: Seven articles with 277 patients and 219 controls were included. One was a randomized controlled trial, one was a retrospective study, and three were prospective treatment studies. Two follow-up studies analysed cephalometric data of already included studies. Four prefabricated appliances were used: Education Fonctionnelle, LM-Activator™, Nite-Guide®, and Occlus-o-Guide®. Treatment protocols varied from passive night-time use to combinations of active daytime and passive night-time use. Treatment periods varied from 10 months to 3.3 years. The main findings were reductions in overjet (range 1.1-2.3 mm) and overbite (range 0.6-2.0 mm). Other findings included improvement in crowding and molar relationship and better tooth-to-tooth contacts. Even though most of the changes were dental, significant increases in the length of the mandible were reported in two studies. Four studies were included in the meta-analyses. In these analyses, the changes in overjet, overbite, SNB, and ANB were found statistically significant.

Conclusions: EGAs comprise a group of functional appliances suitable for reduction of excessive overjet and overbite in mixed dentition. However, more studies are needed to elucidate their effects on skeletal structures.

Registration: The protocol for this review was registered at PROSPERO under the ID CRD42023441197.

Just over 125 years has passed since the ‘filterable’ agents of tobacco mosaic disease and foot-and-mouth disease were first described as infectious, replicating entities smaller than bacteria. Today, viruses are formally classified into more than 16,000 species ranked into genera, families and higher taxa. The development of an official virus taxonomy has been overseen by an International Committee, first constituted in 1966 and renamed as the International Committee on Taxonomy of Viruses (ICTV) in 1975. Despite the engagement of the ICTV in virus taxonomy over the last 60 years, many aspects of virus classification and nomenclature may seem odd or sometimes incomprehensible to virologists more familiar with the taxonomy of cellular organisms. Who runs the ICTV? What are virus species demarcation criteria? Why have all virus species names become binomial? How can a sequence in a metagenomic dataset be assigned to a virus species? This article attempts to answer several such questions and outlines how a large, inclusive and global community of virologists has developed new and responsive policies for virus taxonomy in a decade when the pace of virus discovery has dramatically accelerated.