Dusseldorf, Germany, September 8, 2009
Giancarlo Comi, Hans-Peter Hartung and Fred Lublin, who are also the Scientific Organizers of the meeting, delivered, as usual, outstanding lectures respectively on MS pathogenesis, clinical course and prognosis, and new and future therapies. Their excellent presentations stimulated discussion throughout the whole meeting. It is very difficult to report all the interesting points covered during the meeting, but credit should be given particularly to the stimulating the lectures delivered by Sandra Vikusic and Mar Tintoré who replaced the two top-level experts Christian Confavreux and Xavier Montalban.
Sandra Vukusic from France gave a detailed review of the epidemiological data, environmental factors and micro-organisms related to MS. Mar Tintoré from Spain presented a comprehensive overview of criteria to diagnose and follow-up MS patients in practice.
Frederik Barkhof (The Netherlands) and Mark Freedman (Canada) covered, respectively, traditional and innovative MRI diagnostic tools, and main clinical trials outcomes.
Two comments can depict adequately the scientific level of the 2009 Edition of the MS Academia meeting. Professor Comi, who has been Scientific Organizer of all the editions of the MS Academia, told delegates at the end of the meeting that this year the level has been the higher ever. An MS Academia participant, who visited the SSIF booth the day after, told us that probably she learned more attending MS Academia that all the ECTRIMS sessions.
Tommaso Sacco
Dusseldorf, Germany, September 8, 2009
The lectures addressed the most important topics in the field and offered an overview of current research and the ways that it might enhance the management of MS in the coming years.
The workshop sessions were planned to help the audience to understand both the physician and the nurse perspective on all the clinical aspects reviewed in the conference.
The first session – Practical issues and solutions in DMDs – started with a lecture by Ralf Gold from Germany on the immunomodulatory treatments currently under development which, after the recent progress in understanding pathogenesis of MS, could provide a better control of long-term disease and related neurodegeneration.
Mohammed Sharif, and the nurse Sharalyn Anderson – both from UK – provided the physician and nurse perspective on adherence to DMDs, and stressed the point that DMD treatment can be challenging but to foster treatment adherence all healthcare professionals need to continuously promote education and realistic expectations to patients.
The three remaining talks of the first session reviewed the essential role of nurses between patients and physicians. The three speakers, Mark Freedman from Canada, Carlo Pozzilli from Italy and Mrs. Amy Perrin Ross, president of the world MS nurse organization, presented a wide and exhaustive list of activities and services to be provided to patients within home assistance programs in order to reduce the problems that MS patients need to face every day.
The second session focused on cognitive and emotional issues to be faced in MS. Giancarlo Comi from Italy, scientific organizer of the event, gave an overview of the main affective disorders linked to Multiple Sclerosis, particularly depression, suicide, and emotional lability. Nervous damage and immunological factors as well as adverse effects to steroid treatments could play a role in mood changes. Mrs Langdon, a nurse from the UK, provided some clinical guidelines on supporting and managing emotional distress in such patients. Maria Pia Amato and Monica Falautano, providing the physician and nurse perspective in Italy, went through cognitive problems and related rehabilitation in MS. In fact MS is a demyelinating disease of the CNS that commonly leads first to inflammatory and atrophic brain and than to cognitive impairment (40-65% in these patients). Several specific rehabilitative tools were presented to the audience.
In the third session – Motor problems and rehabilitation in MS – Franco Molteni, a neurologist from Italy, presented all the exciting applications ready to be implemented in daily clinical practice: from new technologies (telemedicine, robotics, virtual medicine, etc) to the practical management of movement and motor disturbances in MS patients. Urs Gamper, a physical therapist from Switzerland, drew attention to his personal experience in important procedures to improve motor ability: physical therapy is in fact a crucial tool in MS management.
Session four was specifically dedicated to the genito-urinary problems affecting many MS patients. Oscar Fernandez from Spain warned the audience about the silent urologic dysfunctions so common in people with MS. He also presented some techniques aimed at preventing further urinary complications in these subjects. The nurse point of view was given by Roberta Motta from Italy who showed in detail the catheterization procedures to be implemented in subjects affected by MS.
The fifth and final session, involving Xavier Montalban and Gemma Rodriguez both from Spain was dedicated to informing participants about the procedures that need to be fulfilled in order to comply with regulations in experimental therapy and clinical trials; this was particularly appreciated by nurses who are frequently involved in clinical trial implementation.
The brilliant final panel discussions and participants’ warm involvement showed that, once again, the MS Nurse workshop was a very successful meeting.
Luca Megas
Prague, Czech Republic, October 2-3 2009
Prof. Bruno Lunenfeld (Israel) provided an overview of developments in the past fifty years evolution in IVF treatments. Current ovarian stimulation protocols were discussed by Klaus Bühler (Germany), who also provided a detailed review of the tools currently available in daily clinical practice.
A lecture describing the clinical profile of low responders and illustrating potential treatment strategies was given by Antonio La Marca, from Italy; this talk was particularly appreciated, coming from a young and brilliant scientist.
Matts Wikland from Sweden gave an exhaustive talk on how to create models to help clinicians to individualize the starting dose of rFSH in ART cycles. Such models might be enclosed to clinical protocols making COS more safe and efficient.
Adherence to treatment was the subject analyzed by Lone Schmidt from Denmark. With her experience at the Danish Institute of Public Health she explained to the audience the importance of strategies to reduce distress and anxiety in patients, give access to reimbursements, develop user-friendly treatment procedures and so on.
The audience was encouraged to participate actively in this meeting through a round-table session moderated by Veljco Vlaisavljevic from Slovenjia. The session featured an innovative remote-voting system that allowed the audience to bring its personal experiences to the discussion. The debate centred on how to optimize ovarian stimulation, and the four round-table discussants were Bühler from Germany, Calderon from Israel, Kovacs from Hungary and Harbulak from Slovak Republic, and topics discussed included treatment of high and low responders, LH activity and gonadotrophin treatment individualization. Contribution from Peter Kovacs was highly appreciated.
Polish scientist Ana Dablowska-Huc opened the second session discussing about the importance of anti-Mullerian hormone (AMH) as promising marker to determine ovarian response; in fact a better knowledge of the biological role of AMH can improve the diagnosis and subsequent treatment of infertility connected with lack of ovulation and decreased ovarian reserve. Semra Kahraman from Turkey gave a talk on a provocative topic: is PGS the correct answer to the right question? Results from clinical practice say that nowadays pre-implantation genetic screening (PGS) for aneuploidy is became so popular that of all the PGD procedures approximately 75% in USA and 65% in Europe are carried out to identify chromosomal abnormalities.
Murat Sonmezer (Turkey) presented a lecture on how and when to perform cryopreservation (of gametes, embryos and gonadal tissues) in patients who suffered of reproductive failure as side effect after high dose radiotherapy and chemotherapy.
To emphasize the concept of individualizing treatments, Dr Buhler challenged all the participants to focus in the future less on randomized clinical trials, where patients are perfectly sized, and more on considering every patient as unique.
The final session closed with two other eastern European scientists, Tonko Mardesic from Czech Republic and Miodrag Stojkovic from Serbia, looked towards the future of IVF in Europe, considering both the implications of EU directives, and the promise of current stem cell research.
Luca Mega
Stockholm, Sweden, September 11-12, 2009
The importance of individualised treatments was emphasised by Jean Noel Hugues (France) who explained that infertility treatment must overcome the traditional paradigm of ‘one size fits all’. The well-known epidemiologist Allan Templeton (UK) confirmed this view point and underlined the risk, particularly high in Europe, of the increasing number of women who delay childbearing, and who are more likely to experience primary or secondary infertility.
Manuela Simoni (Italy) discussed the main genetic markers influencing the reproductive function (genotypes and polymorphisms associated with male infertility and abnormal ovarian response in female subjects) as well as proposing a clear genetic screening timetable. The importance of screening tests was confirmed by Nick Macklon (Australia) and Evangelos Papanikolau (Greece) who illustrated the basis of the screening in endocrine reproductive function, from the patient’s history to the importance of lifestyle factors.
The question of profiling patients with infertility issues was addressed by Frank Broekman (Holland) who pointed out the importance of prediction of the outcome response in terms of number of oocytes during ovarian stimulation. Carlos Simon (Spain) presented investigational data about the factors influencing endometrial function in IVF as well as the state of the art of human endometrial receptivity markers.
Fertility in cancer survivors was discussed by Erik Ernst (Denmark) who presented some preliminary data on several therapeutic procedures able to reduce infertility rate in this important group of subjects.
Lifestyle factors such as age, stress, life-habits, as well as body weight maintenance, smoking and alcohol consumption are confirmed by many studies as key factors influencing fertility. These factors are increasingly being recognised as important in predicting IVF success.
Lone Schmidt (Denmark) demonstrated the relationship between psychological distress and infertility rates and explained that psychological interventions can influence all lifestyle factors, and reduce infertility in such patients, confirming the need for different approaches in different patient subgroups.
Available procedures for personalization of treatments were reviewed by Antonio Pellicer (France) who showed how ovarian stimulation protocols and knowledge on ovarian and embryo physiology has changed over time according to research outcomes. Stimulation protocols have a significant impact on oocyte quality and Geraldine Hartshorne (UK) explained that single oocytes from natural cycles are of better quality when compared with those coming from stimulated cycles, but in terms of outcome this potential advantage is cancelled out for most patients by the availability of several adequate quality oocytes after stimulation. Another important message from Hartshorne was that the single most important factor affecting oocyte quality in IVF cycles is female age; as it increases, the possibility of potential chromosomal abnormalities in her oocytes increases too.
Matts Wikland (Sweden) discussed individualizing gonadotrophin dose, and examined the baseline characteristics to be assessed in women to predict ovarian response in their first ART cycle.
GnRH antagonist protocols for the prevention of a premature LH surge have been introduced and allow a final oocyte maturation to be triggered with a single bolus of a GnRH agonist. Peter Humaidan (Denmark) analyzed some innovative approaches in ovarian stimulation showing that GnRH agonist is as effective as hCG for the induction of ovulation and that an FSH surge is introduced as well as the LH surge.
A number of promising methods, currently under development, were presented by Claus Y. Andersen (Denmark). He described all the promising methods currently under development, focusing particularly on cryopreservation, in order to preserve fertility in patients receiving potential gonadotoxic treatments. These methods will be helpful in all those patients who currently suffer of malignant diseases and need to perform chemo or radio therapies.
Maria Louise Grøndhal (Denmark) presented data from clinical studies on the transcriptome of the human oocyte in relation to age, and concluded that there was a substantial difference between younger and older oocytes in transcriptional level of genes involved in central biological functions of the oocytes and provided information on processes that might be associated with the ageing phenomenon contributing to decreased fertility.
Future directions in ART techniques were the subject addressed by Paul Devroey (Belgium) who examined recent developments in embryo testing and selection procedures.
The programme, together with strong participation from delegates showed also that Scandinavian countries – and their scientists – are playing an important role in infertility treatment research.
Luca Megas
Neurology
Annual Meeting in MS: Optimizing MS therapy – current treatment models and future options (12-13 March 2010; Rome, Italy)
New therapeutic approaches for changing MS scenario (21-22 May 2010; Rio de Janeiro, Brazil)
MS Preceptorship 2010 (June 2010; Barcelona, Spain)
Satellite symposium at ENS (19-23 June 2010 (symposium date TBC), Berlin, Germany )
MS Academia (Pre-ECTRIMS) (12 October 2010; Gothenburg, Sweden)
MS Nurse (Pre-ECTRIMS) (12 October 2010; Gothenburg, Sweden)
Immunology
Autoimmunity and Immune Mediated Disorders (23-24 April 2010; Milan, Italy)
ENDOCRINOLOGY AND METABOLISM
2nd European Phenylketonuria Group (EPG) Symposium - Advances and Challenges in PKU (22-23 January, 2010; Munich, Germany)
Reproductive Medicine
Annual Meeting in Reproductive Medicine: ART: experimental bases for improving outcomes for the benefit of patients (19-20 February 2010; Istanbul, Turkey)
ART: Personalized approaches to improve outcomes (25-27 March 2010; Panama, Republic of Panama)
Pre-ASPIRE Congress: from ovarian stimulation to the laboratory: is there room for improvement? (9 April 2010; Bangkok, Thailand)
Regulation of follicle development and its clinical implications - 4th edition (28-29 May 2010; Beaune, France)
Pre-ESHRE: Advanced course in human reproduction (26 June 2010; Rome, Italy)
Gene, environment and lifestyle in infertility - 2nd edition (27-28 August 2010; Malmo, Sweden)
From science to practice (24-25 September 2010; Lyon, France)
IVF Preceptorship (IVI Centre) (November 2010; Madrid, Spain)
