Combination of transient lymphodepletion with busulfan and fludarabine and peptide vaccination in a phase I clinical trial for patients with advanced melanoma.

Taking advantage of homeostatic mechanisms to boost tumor-specific cellular immunity is raising increasing interest in the development of therapeutic strategies in the treatment of melanoma. Here, we have explored the potential of combining homeostatic proliferation, after transient immunosuppression, and antigenic stimulation of Melan-A/Mart-1 specific CD8 T-cells. In an effort to develop protocols that could be readily applicable to the clinic, we have designed a phase I clinical trial, involving lymphodepleting chemotherapy with Busulfan and Fludarabine, reinfusion of Melan-A specific CD8 T-cell containing peripheral blood mononuclear cells (exempt of growth factors), and Melan-A peptide vaccination. Six patients with advanced melanoma were enrolled in this outpatient regimen that demonstrated good feasibility combined with low toxicity. Consistent depletion of lymphocytes with persistent increased CD4/CD8 ratios was induced, although the proportion of circulating CD4 regulatory T-cells remained mostly unchanged. The study of the immune reconstitution period showed a steady recovery of whole T-cell numbers overtime. However, expansion of Melan-A specific CD8 T-cells, as measured in peripheral blood, was mostly inconsistent, accompanied with marginal phenotypic changes, despite vaccination with Melan-A/Mart-1 peptide. On the clinical level, 1 patient presented a partial but objective antitumor response following the beginning of the protocol, even though a direct effect of Busulfan/Fludarabine cannot be completely ruled out. Overall, these data provide further ground for the development of immunotherapeutic approaches to be both effective against melanoma and applicable in clinic.

β-Lactam Monotherapy vs β-Lactam-Macrolide Combination Treatment in Moderately Severe Community-Acquired Pneumonia: A Randomized Noninferiority Trial.

IMPORTANCE: The clinical benefit of adding a macrolide to a β-lactam for empirical treatment of moderately severe community-acquired pneumonia remains controversial. OBJECTIVE: To test noninferiority of a β-lactam alone compared with a β-lactam and macrolide combination in moderately severe community-acquired pneumonia. DESIGN, SETTING, AND PARTICIPANTS: Open-label, multicenter, noninferiority, randomized trial conducted from January 13, 2009, through January 31, 2013, in 580 immunocompetent adult patients hospitalized in 6 acute care hospitals in Switzerland for moderately severe community-acquired pneumonia. Follow-up extended to 90 days. Outcome assessors were masked to treatment allocation. INTERVENTIONS: Patients were treated with a β-lactam and a macrolide (combination arm) or with a β-lactam alone (monotherapy arm). Legionella pneumophila infection was systematically searched and treated by addition of a macrolide to the monotherapy arm. MAIN OUTCOMES AND MEASURES: Proportion of patients not reaching clinical stability (heart rate <100/min, systolic blood pressure >90 mm Hg, temperature <38.0°C, respiratory rate <24/min, and oxygen saturation >90% on room air) at day 7. RESULTS: After 7 days of treatment, 120 of 291 patients (41.2%) in the monotherapy arm vs 97 of 289 (33.6%) in the combination arm had not reached clinical stability (7.6% difference, P = .07). The upper limit of the 1-sided 90% CI was 13.0%, exceeding the predefined noninferiority boundary of 8%. Patients infected with atypical pathogens (hazard ratio [HR], 0.33; 95% CI, 0.13-0.85) or with Pneumonia Severity Index (PSI) category IV pneumonia (HR, 0.81; 95% CI, 0.59-1.10) were less likely to reach clinical stability with monotherapy, whereas patients not infected with atypical pathogens (HR, 0.99; 95% CI, 0.80-1.22) or with PSI category I to III pneumonia (HR, 1.06; 95% CI, 0.82-1.36) had equivalent outcomes in the 2 arms. There were more 30-day readmissions in the monotherapy arm (7.9% vs 3.1%, P = .01). Mortality, intensive care unit admission, complications, length of stay, and recurrence of pneumonia within 90 days did not differ between the 2 arms. CONCLUSIONS AND RELEVANCE: We did not find noninferiority of β-lactam monotherapy in patients hospitalized for moderately severe community-acquired pneumonia. Patients infected with atypical pathogens or with PSI category IV pneumonia had delayed clinical stability with monotherapy. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00818610.

β-Lactam Monotherapy vs β-Lactam-Macrolide Combination Treatment in Moderately Severe Community-Acquired Pneumonia: A Randomized Noninferiority Trial.

IMPORTANCE: The clinical benefit of adding a macrolide to a β-lactam for empirical treatment of moderately severe community-acquired pneumonia remains controversial. OBJECTIVE: To test noninferiority of a β-lactam alone compared with a β-lactam and macrolide combination in moderately severe community-acquired pneumonia. DESIGN, SETTING, AND PARTICIPANTS: Open-label, multicenter, noninferiority, randomized trial conducted from January 13, 2009, through January 31, 2013, in 580 immunocompetent adult patients hospitalized in 6 acute care hospitals in Switzerland for moderately severe community-acquired pneumonia. Follow-up extended to 90 days. Outcome assessors were masked to treatment allocation. INTERVENTIONS: Patients were treated with a β-lactam and a macrolide (combination arm) or with a β-lactam alone (monotherapy arm). Legionella pneumophila infection was systematically searched and treated by addition of a macrolide to the monotherapy arm. MAIN OUTCOMES AND MEASURES: Proportion of patients not reaching clinical stability (heart rate <100/min, systolic blood pressure >90 mm Hg, temperature <38.0°C, respiratory rate <24/min, and oxygen saturation >90% on room air) at day 7. RESULTS: After 7 days of treatment, 120 of 291 patients (41.2%) in the monotherapy arm vs 97 of 289 (33.6%) in the combination arm had not reached clinical stability (7.6% difference, P = .07). The upper limit of the 1-sided 90% CI was 13.0%, exceeding the predefined noninferiority boundary of 8%. Patients infected with atypical pathogens (hazard ratio [HR], 0.33; 95% CI, 0.13-0.85) or with Pneumonia Severity Index (PSI) category IV pneumonia (HR, 0.81; 95% CI, 0.59-1.10) were less likely to reach clinical stability with monotherapy, whereas patients not infected with atypical pathogens (HR, 0.99; 95% CI, 0.80-1.22) or with PSI category I to III pneumonia (HR, 1.06; 95% CI, 0.82-1.36) had equivalent outcomes in the 2 arms. There were more 30-day readmissions in the monotherapy arm (7.9% vs 3.1%, P = .01). Mortality, intensive care unit admission, complications, length of stay, and recurrence of pneumonia within 90 days did not differ between the 2 arms. CONCLUSIONS AND RELEVANCE: We did not find noninferiority of β-lactam monotherapy in patients hospitalized for moderately severe community-acquired pneumonia. Patients infected with atypical pathogens or with PSI category IV pneumonia had delayed clinical stability with monotherapy. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00818610.

The role of teriparatide in sequential and combination therapy of osteoporosis.

Osteoporosis is complicated by the occurrence of fragility fractures. Over past years, various treatment options have become available, mostly potent antiresorptive agents such as bisphosphonates and denosumab. However, antiresorptive therapy cannot fully and rapidly restore bone mass and structure that has been lost because of increased remodelling. Alternatively recombinant human parathyroid hormone (rhPTH) analogues do increase the formation of new bone material. The bone formation stimulated by intermittent PTH analogues not only increases bone mineral density (BMD) and bone mass but also improves the microarchitecture of the skeleton, thereby reducing incidence of vertebral and nonvertebral fractures. Teriparatide, a recombinant human PTH fragment available in Switzerland, is reimbursed as second-line treatment in postmenopausal women and men with increased fracture risk, specifically in patients with incident fractures under antiresorptive therapy or patients with glucocorticoid-induced osteoporosis and intolerance to antiresorptives. This position paper focuses on practical aspects in the management of patients on teriparatide treatment. Potential first-line indications for osteoanabolic treatment as well as the benefits and limitations of sequential and combination therapy with antiresorptive drugs are discussed.

Fluoroscopic-Guided Radial Endobronchial Ultrasound Without Guide Sheath For Peripheral Pulmonary Lesions: A Safe And Efficient Combination.

BACKGROUND: Several guidelines recommend computed tomography scans for populations with high-risk for lung cancer. The number of individuals evaluated for peripheral pulmonary lesions (PPL) will probably increase, and with it non-surgical biopsies. Associating a guidance method with a target confirmation technique has been shown to achieve the highest diagnostic yield, but the utility of bronchoscopy with radial probe endobronchial ultrasound using fluoroscopy as guidance without a guide sheath has not been reported. METHODS: We conducted a retrospective analysis of bronchoscopy with radial probe endobronchial ultrasound using fluoroscopy procedures for the investigation of PPL performed by experienced bronchoscopists with no specific previous training in this particular technique. Operator learning curves and radiological predictors were assessed for all consecutive patients examined during the first year of application of the technique. RESULTS: Fifty-one PPL were investigated. Diagnostic yield and visualization yield were 72.5 and 82.3% respectively. The diagnostic yield was 64.0% for PPL ≤20mm, and 80.8% for PPL>20mm. No false-positive results were recorded. The learning curve of all diagnostic tools showed a DY of 72.7% for the first sub-group of patients, 81.8% for the second, 72.7% for the third, and 81.8% for the last. CONCLUSION: Bronchoscopy with radial probe endobronchial ultrasound using fluoroscopy as guidance is safe and simple to perform, even without specific prior training, and diagnostic yield is high for PPL>and ≤20mm. Based on these findings, this method could be introduced as a first-line procedure for the investigation of PPL, particularly in centers with limited resources.

A Novel Accelerator Combination for the Low Temperature Curing of Silica-Filled NBR Compounds

Zinc salts of ethyl, isopropyl, and butyl xanthates were prepared in the laboratory. The effect of these xanthates in combination with zinc diethyldithiocarbamate (ZDC) on the vulcanization of silica-filled NBR compounds has been studied at different temperatures. The cure times of these compounds were compared with that of NBR compounds containing tetramethylthiuram disulphide/dibenzthiazyl disulphide. The rubber compounds with the xanthates and ZDC were cured at various temperatures from 60 to 150°C. The sheets were molded and properties such as tensile strength, tear strength, crosslink density, elongation at break, compression set, abrasion resistance, flex resistance, heat buildup, etc. were evaluated. The properties showed that zinc salt of xanthate/ZDC combination has a positive synergistic effect on the cure rate and mechanical properties of NBR compounds.

Studies on Xanthate/Dithiocarbamate Accelerator Combination in NR/BR Blends

Zinc butyl xanthate [Zn(bxt)2] was prepared in the laboratory . The effect of this xanthate with zinc diethyl dithiocarbamate (ZDC) on the vulcanization of natural rubber ( NR), polybutadiene rubber (BR), and NR/BR blend has been studied at different temperatures. The amounts of Zn (bxt)2 and ZDC in the compounds were optimized by varying the amount of ZDC from 0 . 75 to 1.5 phr and Zn (bxt)2 from 0 . 75 to 1 .5 phr. The cure characteristics were also studied . HAF filled NR, BR, and NR / BR blend compounds were cured at different temperatures from 60 to 150 C. The sheets were molded and properties such as tensile strength, tear strength, crosslink density and elongation at break, compression set, abrasion resistance, etc. were evaluated. The results show that the mechanical properties of 80NR/20BR blends are closer to that of NR vulcanizates, properties of 60NR/40BR blends are closer to BR vulcanizates, while the 70NR/30BR blends show an intermediate property.

Investigations on the Dynamics of Combination Maps and the Analysis of Bifurcation in a Discontinuous Logistic Map

This thesis is a study of discrete nonlinear systems represented by one dimensional mappings.As one dimensional interative maps represent Poincarre sections of higher dimensional flows,they offer a convenient means to understand the dynamical evolution of many physical systems.It highlighting the basic ideas of deterministic chaos.Qualitative and quantitative measures for the detection and characterization of chaos in nonlinear systems are discussed.Some simple mathematical models exhibiting chaos are presented.The bifurcation scenario and the possible routes to chaos are explained.It present the results of the numerical computational of the Lyapunov exponents (λ) of one dimensional maps.This thesis focuses on the results obtained by our investigations on combinations maps,scaling behaviour of the Lyapunov characteristic exponents of one dimensional maps and the nature of bifurcations in a discontinous logistic map.It gives a review of the major routes to chaos in dissipative systems,namely, Period-doubling ,Intermittency and Crises.This study gives a theoretical understanding of the route to chaos in discontinous systems.A detailed analysis of the dynamics of a discontinous logistic map is carried out, both analytically and numerically ,to understand the route it follows to chaos.The present analysis deals only with the case of the discontinuity parameter applied to the right half of the interval of mapping.A detailed analysis for the n –furcations of various periodicities can be made and a more general theory for the map with discontinuities applied at different positions can be on a similar footing

Content Based Video Retrieval using SURF Descriptor

This paper presents a Robust Content Based Video Retrieval (CBVR) system. This system retrieves similar videos based on a local feature descriptor called SURF (Speeded Up Robust Feature). The higher dimensionality of SURF like feature descriptors causes huge storage consumption during indexing of video information. To achieve a dimensionality reduction on the SURF feature descriptor, this system employs a stochastic dimensionality reduction method and thus provides a model data for the videos. On retrieval, the model data of the test clip is classified to its similar videos using a minimum distance classifier. The performance of this system is evaluated using two different minimum distance classifiers during the retrieval stage. The experimental analyses performed on the system shows that the system has a retrieval performance of 78%. This system also analyses the performance efficiency of the low dimensional SURF descriptor.

Performance Study of an Improved Legendre Moment Descriptor as Region-Based Shape Descriptor

This paper reports a novel region-based shape descriptor based on orthogonal Legendre moments. The preprocessing steps for invariance improvement of the proposed Improved Legendre Moment Descriptor (ILMD) are discussed. The performance of the ILMD is compared to the MPEG-7 approved region shape descriptor, angular radial transformation descriptor (ARTD), and the widely used Zernike moment descriptor (ZMD). Set B of the MPEG-7 CE-1 contour database and all the datasets of the MPEG-7 CE-2 region database were used for experimental validation. The average normalized modified retrieval rate (ANMRR) and precision- recall pair were employed for benchmarking the performance of the candidate descriptors. The ILMD has lower ANMRR values than ARTD for most of the datasets, and ARTD has a lower value compared to ZMD. This indicates that overall performance of the ILMD is better than that of ARTD and ZMD. This result is confirmed by the precision-recall test where ILMD was found to have better precision rates for most of the datasets tested. Besides retrieval accuracy, ILMD is more compact than ARTD and ZMD. The descriptor proposed is useful as a generic shape descriptor for content-based image retrieval (CBIR) applications

Nitrogen in combination with Desmodium intortum effectively suppress Striga asiatica in a sorghum‒Desmodium intercropping system

It is well known that the parasitic weed Striga asiatica (L.) Kuntze can be suppressed by Striga-tolerant sorghum (Sorghum bicolor L. Moench) cultivars, Desmodium intortum (Mill.) Urb. (greanleaf desmodium), and by fertilization with nitrogen. The study objective was the assessment of Striga control provided by integration of Desmodium density, timing of sorghum-Desmodium intercrop establishment, and nitrogen fertilization. Growth responses and yield of three sorghum cultivars were measured in three pot experiments. A soil naturally infested with Striga was used, and that part of the soil which served as uninfested control was chemically sterilised. Striga numbers and growth were affected significantly by sorghum cultivars, sorghum-Desmodium intercrop ratios, timing of the sorghum-Desmodium association, as well as by their interactions. Desmodium caused 100% suppression of Striga emergence when Desmodium was established in the 1:3 sorghum-Desmodium ratio at seeding of sorghum. Total control of Striga was also achieved with the 1:1 sorghum-Desmodium ratio when Desmodium was transplanted 30 days before sorghum seeding. However, these two treatments also caused significant reductions in sorghum yield. In contrast, 100% Striga control and a dramatic increase in sorghum yield were achieved with 100 kg N ha^{-1} in the 1:1 sorghum-Desmodium intercrop. Compatibility of sorghum and Desmodium was evident at the 1:1 sorghum-Desmodium intercrop established at sorghum seeding. Overall, the Ethiopian cultivars Meko and Abshir showed better agronomic performance and higher tolerance to Striga than the South African cultivar PAN 8564. It is recommended that the N × Desmodium × sorghum interaction be investigated under field conditions.

Slow and Smooth: A Bayesian Theory for the Combination of Local Motion Signals in Human Vision

In order to estimate the motion of an object, the visual system needs to combine multiple local measurements, each of which carries some degree of ambiguity. We present a model of motion perception whereby measurements from different image regions are combined according to a Bayesian estimator --- the estimated motion maximizes the posterior probability assuming a prior favoring slow and smooth velocities. In reviewing a large number of previously published phenomena we find that the Bayesian estimator predicts a wide range of psychophysical results. This suggests that the seemingly complex set of illusions arise from a single computational strategy that is optimal under reasonable assumptions.