Ticagrelor Versus Clopidogrel in Patients With Acute Coronary Syndromes and a History of Stroke or Transient Ischemic Attack

Background-Patients with acute coronary syndromes and history of stroke or transient ischemic attack (TIA) have an increased rate of recurrent cardiac events and intracranial hemorrhages. Methods and Results-We evaluated treatment effects of ticagrelor versus clopidogrel in patients with acute coronary syndrome with and without a history of prior stroke or TIA in the PLATelet inhibition and patient Outcomes (PLATO) trial. Of the 18 624 randomized patients, 1152 (6.2%) had a history of stroke or TIA. Such patients had higher rates of myocardial infarction (11.5% versus 6.0%), death (10.5% versus 4.9%), stroke (3.4% versus 1.2%), and intracranial bleeding (0.8% versus 0.2%) than patients without prior stroke or TIA. Among patients with a history of stroke or TIA, the reduction of the primary composite outcome and total mortality at 1 year with ticagrelor versus clopidogrel was consistent with the overall trial results: 19.0% versus 20.8% (hazard ratio, 0.87; 95% confidence interval, 0.66-1.13; interaction P=0.84) and 7.9% versus 13.0% (hazard ratio, 0.62; 95% confidence interval, 0.42-0.91). The overall PLATO-defined bleeding rates were similar: 14.6% versus 14.9% (hazard ratio, 0.99; 95% confidence interval, 0.71-1.37), and intracranial bleeding occurred infrequently (4 versus 4 cases, respectively). Conclusions-Patients with acute coronary syndrome with a prior history of ischemic stroke or TIA had higher rates of clinical outcomes than patients without prior stroke or TIA. However, the efficacy and bleeding results of ticagrelor in these high-risk patients were consistent with the overall trial population, with a favorable clinical net benefit and associated impact on mortality.

Rivaroxaban compared with warfarin in patients with atrial fibrillation and previous stroke or transient ischaemic attack: a subgroup analysis of ROCKET AF

Background In ROCKET AF, rivaroxaban was non-inferior to adjusted-dose warfarin in preventing stroke or systemic embolism among patients with atrial fibrillation (AF). We aimed to investigate whether the efficacy and safety of rivaroxaban compared with warfarin is consistent among the subgroups of patients with and without previous stroke or transient ischaemic attack (TIA). Methods In ROCKET AF, patients with AF who were at increased risk of stroke were randomly assigned (1:1) in a double-blind manner to rivaroxaban 20 mg daily or adjusted dose warfarin (international normalised ratio 2-0-3.0). Patients and investigators were masked to treatment allocation. Between Dec 18,2006, and June 17,2009,14 264 patients from 1178 centres in 45 countries were randomly assigned. The primary endpoint was the composite of stroke or non-CNS systemic embolism. In this substudy we assessed the interaction of the treatment effects of rivaroxaban and warfarin among patients with and without previous stroke or TIA. Efficacy analyses were by intention to treat and safety analyses were done in the on-treatment population. ROCKET AF is registered with ClinicalTrials.gov, number NCT00403767. Findings 7468 (52%) patients had a previous stroke (n=4907) or TIA (n=2561) and 6796 (48%) had no previous stroke or TIA. The number of events per 100 person-years for the primary endpoint in patients treated with rivaroxaban compared with warfarin was consistent among patients with previous stroke or TIA (2.79% rivaroxaban vs 2.96% warfarin; hazard ratio [HR] 0-94,95% CI 0.77-1.16) and those without (1.44% vs 1.88%; 0.77, 0.58-1-01; interaction p=0.23). The number of major and non-major clinically relevant bleeding events per 100 person-years in patients treated with rivaroxaban compared with warfarin was consistent among patients with previous stroke or TIA (13.31% rivaroxaban vs 13.87% warfarin; HR 0.96,95% CI 0.87-1-07) and those without (16.69% vs 15.19%; 1.10, 0.99-1.21; interaction p=0.08). Interpretation There was no evidence that the relative efficacy and safety of rivaroxaban compared with warfarin was different between patients who had a previous stroke or TIA and those who had no previous stroke or TIA. These results support the use of rivaroxaban as an alternative to warfarin for prevention of recurrent as well as initial stroke in patients with AF.

Functional characterization and oligomerization of a recombinant xyloglucan-specific endo-beta-1,4-glucanase (GH12) from Aspergillus niveus

Xyloglucan is a major structural polysaccharide of the primary (growing) cell wall of higher plants. It consists of a cellulosic backbone (beta-1,4-linked glucosyl residues) that is frequently substituted with side chains. This report describes Aspergillus nidulans strain A773 recombinant secretion of a dimeric xyloglucan-specific endo-beta-1,4-glucanohydrolase (XegA) cloned from Aspergillus niveus. The ORF of the A. niveus xegA gene is comprised of 714 nucleotides, and encodes a 238 amino acid protein with a calculated molecular weight of 23.5 kDa and isoelectric point of 4.38. The optimal pH and temperature were 6.0 and 60 degrees C, respectively. XegA generated a xyloglucan-oligosaccharides (XGOs) pattern similar to that observed for cellulases from family GH12, i.e., demonstrating that its mode of action includes hydrolysis of the glycosidic linkages between glucosyl residues that are not branched with xylose. In contrast to commercial lichenase, mixed linkage beta-glucan (lichenan) was not digested by XegA, indicating that the enzyme did not cleave glucan beta-1,3 or beta-1,6 bonds. The far-UV CD spectrum of the purified enzyme indicated a protein rich in beta-sheet structures as expected for GH12 xyloglucanases. Thermal unfolding studies displayed two transitions with mid-point temperatures of 51.3 degrees C and 81.3 degrees C respectively, and dynamic light scattering studies indicated that the first transition involves a change in oligomeric state from a dimeric to a monomeric form. Since the enzyme is a predominantly a monomer at 60 degrees C. the enzymatic assays demonstrated that XegA is more active in its monomeric state. (c) 2012 Elsevier B.V. All rights reserved.

"Luxio": l'innovazione nella pubblica illuminazione. Redazione del business plan per il lancio del nuovo prodotto.

Il Business Plan è un importante strumento ai fini della pianificazione strategica delle imprese, siano esse già avviate o in fase di start up. Le varie funzioni che esso svolge, sono di natura sia interna all’impresa, evidenziando all’alta direzione le conseguenze economiche e finanziarie di determinate decisioni, che esterna all’impresa, volta ad illustrare il progetto ai vari stake-holders. L���obiettivo del presente lavoro è di offrire un contributo a coloro cui compete il compito di redigere un Business Plan, in ordine ai contenuti, ai criteri e agli strumenti logici e tecnici per la sua redazione, avendo comunque ben presente che ogni progetto imprenditoriale si caratterizza con peculiarità proprie. Pertanto, nella prima parte del presente lavoro, dopo un illustrazione delle molteplici funzioni del Business Plan, verranno fornite precise e concrete indicazioni su come deve essere articolato un buon piano d’impresa, soffermandosi in particolare sui contenuti dei vari argomenti che occorre esaminare all’interno dello stesso. Nella seconda parte verrà descritta la nascita e la struttura della Rebernig Supervisioni S.r.l., azienda con la quale ho collaborato per la redazione del presente lavoro. Nella terza parte, verrà invece sviluppato un vero e proprio Business Plan, riferito ad un caso con concreto, quello dell’azienda Rebernig Supervisioni S.r.l., per il lancio di un nuovo prodotto sul mercato dell’illuminazione. Un sentito ringraziamento al management della Rebernig Supervisioni S.r.l. per la collaborazione prestata e per il tempo da loro dedicato, fornendo in tal modo un importante contributo ai fini della redazione del presente lavoro.

Applicazione dei principi di project management per il trasferimento e l'ottimizzazione di una linea produttiva: Il caso Caterpillar Prodotti Stradali

Il presente lavoro di tesi nasce dall’esperienza di tirocinio maturata presso l���azienda Caterpillar Prodotti Stradali Servizi Italia S.r.l. dello stabilimento di Minerbio (Bo). L���obiettivo del progetto riguarda il trasferimento di una linea produttiva dallo stabilimento di Minerbio, a quello di Cattolica. In particolare, verrà effettuato un primo spostamento della linea all’interno dello stabilimento, per poi trasferirla definitivamente a partire dalla fine del 2015. Per gestire tale progetto verranno utilizzati i principi del Project Management con l���ausilio del software Microsoft Project Management.

Ḥamiššā ḥūmšê Tôr��, megillôt we-hafṭār��t bi-l��ôn aškenaz : ṣe'ênā û-re'ênā benôt Ṣiyyôn bā-ʿaṭār��

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Ḥamiššā ḥūmšê Tôr�� bi-l��ôn aškenaz : ṣe'ênā û-re'ênā benôt Ṣiyyôn bā-ʿaṭār��

še-ʿiṭṭēr l��kem ... Yaʿaqôv Ben- ... Yiṣḥāq ... mim-mišpaḥat rabbēnû ... be-q"q Yānôw

Ḥamiššā ḥūmšê Tôr�� bi-l��ôn aškenaz : ṣe'ênā û-re'ênā benôt Ṣiyyôn bā-ʿaṭār��

še-ʿiṭṭēr l��kem ... Yaʿaqôv Ben- ... Yiṣḥāq ... mim-mišpaḥat rabbēnû ... be-q"q Yānôw

Ḥamiššā ḥūmšê Tôr�� bi-l��ôn aškenaz : ṣe'ênā û-re'ênā benôt Ṣiyyôn bā-ʿaṭār��

še-ʿiṭṭēr l��kem ... Yaʿaqôv Ben- ... Yiṣḥāq ... mim-mišpaḥat rabbēnû ... be-q"q Yānôw

Ḥamiššā ḥūmšê Tôr�� bi-l��ôn aškenaz : ṣe'ênā û-re'ênā benôt Ṣiyyôn bā-ʿaṭār��

še-ʿiṭṭēr l��kem ... Yaʿaqôv Ben- ... Yiṣḥāq ... mim-mišpaḥat rabbēnû ... be-q"q Yānôw

Ḥamiššā ḥūmšê Tôr��, megillôt we-hafṭār��t bi-l��ôn aškenaz : ṣe'ênā û-re'ênā benôt Ṣiyyôn bā-ʿaṭār��

še-ʿiṭṭēr l��kem ... Yaʿaqôv Ben- ... Yiṣḥāq ... mim-mišpaḥat rabbēnû ... be-q"q Yānôw

Ḥamiššā ḥūmšê Tôr�� bi-l��ôn aškenaz : ṣe'ênā û-re'ênā benôt Ṣiyyôn bā-ʿaṭār��

še-ʿiṭṭēr l��kem ... Yaʿaqôv Ben- ... Yiṣḥāq ... mi-... Yānôw

Sēfer Emûnat Šemû'ēl

Ahar��n Šemû'ēl B. ... Yiśr��'ēl Qaydānōwer

Ḥamiššā ḥūmšê Tôr�� ʿim megillôt we-hafṭār��t bi-l��ôn aškenaz : ṣe'ênā û-re'ênā benôt Ṣiyyôn bā-ʿaṭār��

še-ʿiṭṭēr l��kem ... Yaʿaqôv Ben- ... Yiṣḥāq ... mi-... Yānôw