La musa bambina. 1911-2011: un secolo di letteratura mitologica per ragazzi in Italia tra storia, educazione e narrazione

Questa ricerca mostra l’evoluzione della letteratura mitologica per ragazzi in Italia. Il primo libro italiano di mitologia per bambini è stato pubblicato nel 1911 (lo stesso anno di un’importante e violenta guerra coloniale tra l’Italia e la Libia): la scrittrice italiana Laura Orvieto pubblicò allora “Storie della storia del mondo”, in cui riunì antichi racconti greci per giovani lettori. Queste storie erano ispirate al libro mitologico per bambini “Il libro delle meraviglie” di Hawthorne (titolo originale “A Wonder Book for Girls and Boys”). In seguito molti scrittori italiani scrissero libri mitologici per giovani lettori: serie importanti di libri di mitologia per bambini furono pubblicate durante il regime mussoliniano – talvolta per diffondere l’ideologia fascista della superiorità romana. Durante questo periodo, i libri mitologici spesso mostravano uno stile letterario solenne. Dopo la seconda guerra mondiale, la letteratura mitologica per bambini cambiò lentamente prospettiva: gli scrittori italiani cominciarono ad usare il mito per parlare di problemi sociali (p.e. Gianni Rodari descriveva re Mida come un capitalista) e per spiegare le diverse condizioni umane (p.e. Beatrice Masini fa riferimento alle dee e alle eroine greche per descrivere la condizione femminile). La ricerca analizza anche la relazione tra mito e scuola in Italia: i racconti mitologici hanno sempre fatto parte dei programmi scolastici italiani per bambini dagli 8 agli 11 anni. Le riforme scolastiche – deliberate negli anni ’20 e ’40 – fissarono pratiche didattiche sui miti ancora oggi in uso. I racconti mitologici erano soprattutto un supporto per gli studi storici e letterari. Tuttavia, negli ultimi decenni, i miti sono divenuti un importante aiuto per gli insegnamenti scientifici e artistici.

Systematic studies of protein immobilization by surface plasmon field-enhanced fluorescence spectroscopy

The research interest of this study is to investigate surface immobilization strategies for proteins and other biomolecules by the surface plasmon field-enhanced fluorescence spectroscopy (SPFS) technique. The recrystallization features of the S-layer proteins and the possibility of combining the S-layer lattice arrays with other functional molecules make this protein a prime candidate for supramolecular architectures. The recrystallization behavior on gold or on the secondary cell wall polymer (SCWP) was recorded by SPR. The optical thicknesses and surface densities for different protein layers were calculated. In DNA hybridization tests performed in order to discriminate different mismatches, recombinant S-layer-streptavidin fusion protein matrices showed their potential for new microarrays. Moreover, SCWPs coated gold chips, covered with a controlled and oriented assembly of S-layer fusion proteins, represent an even more sensitive fluorescence testing platform. Additionally, S-layer fusion proteins as the matrix for LHCII immobilization strongly demonstrate superiority over routine approaches, proving the possibility of utilizing them as a new strategy for biomolecular coupling. In the study of the SPFS hCG immunoassay, the biophysical and immunological characteristics of this glycoprotein hormone were presented first. After the investigation of the effect of the biotin thiol dilution on the coupling efficiently, the interfacial binding model including the appropriate binary SAM structure and the versatile streptavidin-biotin interaction was chosen as the basic supramolecular architecture for the fabrication of a SPFS-based immunoassay. Next, the affinity characteristics between different antibodies and hCG were measured via an equilibrium binding analysis, which is the first example for the titration of such a high affinity interaction by SPFS. The results agree very well with the constants derived from the literature. Finally, a sandwich assay and a competitive assay were selected as templates for SPFS-based hCG detection, and an excellent LOD of 0.15 mIU/ml was attained via the “one step” sandwich method. Such high sensitivity not only fulfills clinical requirements, but is also better than most other biosensors. Fully understanding how LHCII complexes transfer the sunlight energy directionally and efficiently to the reaction center is potentially useful for constructing biomimetic devices as solar cells. After the introduction of the structural and the spectroscopic features of LHCII, different surface immobilization strategies of LHCII were summarized next. Among them the strategy based on the His-tag and the immobilized metal (ion) affinity chromatography (IMAC) technique were of great interest and resulted in different kinds of home-fabricated His-tag chelating chips. Their substantial protein coupling capacity, maintenance of high biological activity and a remarkably repeatable binding ability on the same chip after regeneration was demonstrated. Moreover, different parameters related to the stability of surface coupled reconstituted complexes, including sucrose, detergent, lipid, oligomerization, temperature and circulation rate, were evaluated in order to standardize the most effective immobilization conditions. In addition, partial lipid bilayers obtained from LHCII contained proteo-liposomes fusion on the surface were observed by the QCM technique. Finally, the inter-complex energy transfer between neighboring LHCIIs on a gold protected silver surface by excitation with a blue laser (λ = 473nm) was recorded for the first time, and the factors influencing the energy transfer efficiency were evaluated.

L'univers féminin du picaresque

Les considérations sur le statut de la femme dans la littérature picaresque sont principalement limitées à la production littéraire espagnole. Nous ne pouvons que constater l’absence d’une étude comparatiste s’attachant aux personnages féminins qui peuplent le monde picaresque des pays où ce genre littéraire s’est majoritairement affirmé : l’Espagne, la France et l’Angleterre. Le but de cette analyse est de proposer une comparaison exhaustive entre les personnages féminins des romans picaresques européens de l’époque classique. Ceux-ci sont présentés selon les âges de la vie féminine : l’enfance, la jeunesse, l’âge d’épouse et de mère et la vieillesse. L’exploration de ces catégories d’âges dans lesquelles les rôles féminins se construisent met en évidence la place déterminante qu’ils occupent dans la narration. Leurs tâches, leurs comportements, leurs modes relationnels sont analysés dans les différents espaces et à l’intérieur d’un cadre temporel qui leur sont propres. Les représentations de la femme qui sont diffusées par les écrivains sont bien souvent marquées par une conduite désordonnée. Que les femmes soient victimes d’une société sexiste ou bien qu’elles fassent sciemment de mauvais choix, elles sont dans la majorité des cas, inexorablement condamnées à accepter la condition d’infériorité qui leur est imposée. Il est pourtant une catégorie d’entre elles qui ne s’en tient pas au rôle qui lui est dévolu à l’époque par la société et ses institutions et qui met en place toute une série de stratagèmes lui permettant de se frayer un chemin dans un monde dominé par la supériorité masculine

Muster und Prozesse in einer Microcebus-Hybridzone in Südostmadagaskar

Im Rahmen dieser Doktorarbeit wurde in zwei Schwerpunktanalysen mit eine Teil- und Gesamtdatensatz die Untersuchung der Hybridisierung zwischen den beiden Microcebus-Arten M. murinus und M. griseorufus im Ökoton Südostmadagaskars umfangreich und vertieft untersucht. Für die genetischen Analysen wurden die maternal vererbte mitochondriale Hypervariable Region I (HVR 1) und neun nukleäre biparental vererbte Mikrosatellitenmarker eingesetzt. Als weiterer Datensatz wurden morphometrische Daten verwendet. Für die erste Schwerpunktanalyse wurde ein bereits vorhandener Teildatensatz (Hapke 2005 & Gligor 2006) mit Daten von insgesamt 162 Individuen aus neun Populationen der Dornbuschzone, der Übergangswaldzone und des Küstenwaldgebietes eingesetzt. In der zweiten Schwerpunktanalyse wurde eine umfangreiche Untersuchung der Microcebus griseoruus-M. murinus- Hybridzone vorgenommen. Für diese detaillierte Charakterisierung der Hybridzone wurde eine ausgedehnte und fein auflösende Probennahme in einem als Kernzone definierten Bereich, der die gesamte Übergangswaldzone und die dazu benachbarten Dornbuschgebiete umfasste, durchgeführt. Die morphometrischen und genetischen Daten der neu beprobten Individuen dieser Kernzone wurden mit den Daten des Teildatensatzes und weiteren Daten aus Küstenwaldpopulationen (Hapke 2005) zu einem Gesamtdatensatz zusammengefasst. Die Integration des Teildatensatzes in den Gesamtdatensatz erforderte umfassende und zeitintensive Labor- und Analysearbeiten, die im Rahmen dieser Doktorarbeit durchgeführt wurden. Der Gesamtdatensatz umfasste insgesamt 569 Individuen der Gattung Microcebus aus 29 Untersuchungsstandorten. Die mit beiden Datensätzen durchgeführte Analyse morphometrischer Daten zeigte deutlich, dass die Mehrzahl der Individuen aus der Übergangswaldzone einen intermediären Morphotyp aufweist. Durch die mit den Daten des Teildatensatzes durchgeführten Bayes’schen Clusteranalysen und Assignment-Tests, das vornehmlich in den Populationen der Übergangszone beobachtete signifikante Kopplungsungleichgewicht und Heterozygotendefizit, die festgestellte Verteilung der mitochondrialen Haplotypen und das kontrastierende Muster zwischen nukleären Mikrosatellitengenotypen und mitochondrialen Haplotypen in den Übergangswaldpopulationen konnte erstmals das Vorkommen einer Hybridzone zwischen Microcebus-Arten wissenschaftlich fundiert festgestellt werden. Die Ergebnisse dieser Schwerpunktanalyse wurden in der Fachzeitschrift Molecular Ecology publiziert (Gligor et al. 2009). Die in der ersten Schwerpunktanalyse festgestellte Hybridzone konnte durch die zweite Schwerpunktanalyse mit den genetischen und morphometrischen Daten des Gesamtdatensatzes nicht nur bestätigt werden, sondern auch auf die gesamte Übergangswaldzone erweitert werden. Ferner wurden starke Hinweise auf eine Hybridisierung beider Microcebus-Arten an einigen Dornbuschstandorten der Kernzone gefunden. Durch die große Datenmenge des Gesamtdatensatzes, vor allem aus der Kernzone des Untersuchungsgebietes, war es möglich eine fundierte Charakterisierung der Microcebus griseoruus-M. murinus- Hybridzone durchzuführen. Die Übereinstimmung der Hybridzone mit dem beobachteten Vegetationsmosaik zusammen mit den Ergebnissen der PCA, der PCoA und der Bayes’schen Clusteranalyse sprechen für das Modell der „Mosaik Hybridzone“, während die Einzelbetrachtung der mosaikartig verteilten intermediären Übergangswälder eine hohe Abundanz der Hybride aufzeigte und somit eher das „Bounded Hybrid Superiority model“ unterstützt. Der gewählte geographische Beprobungsmaßstab könnte somit einen Einfluss auf die beobachtete Struktur einer Hybridzone haben. Eines der markantesten Muster in der Hybridzone ist das stark kontrastierende cyto-nukleäre Muster. Der seit ca. 3000 Jahren fortschreitende Klimawandel in Südmadagaskar und die damit verbundene Expansion des Verbreitungsgebietes der Art Microcebus griseorufus nach Osten, das in dieser Arbeit festgestellte „male-biased dispersal“ bei M. griseorufus und der Einfluss exogener Selektion sprechen stark für eine massive asymmetrische nukleäre Genintrogression von M. griseorufus-Allelen in M. murinus-Populationen, verbunden mit einer potentiellen Verdrängung der Art M. murinus aus der Übergangswaldzone. In den jeweiligen Kerngebieten Dornbusch und Küstenwald bleibt jedoch die Diskretheit beider Arten gewahrt.

Synthese und präklinische Evaluation von neuen antioxidativen Substanzen zur Neuroprotektion

Oxidativer Stress ist seit über 25 Jahren als ein Charakteristikum vieler pathologischer Prozesse bekannt. Helmut Sies beschrieb bereits in den 1980er Jahren oxidativen Stress als Störung in der prooxidativ – antioxidativen Balance zugunsten der prooxidativen Seite, wodurch es potentiell zu Schäden in verschiedenen Geweben kommt. Oxidativer Stress tritt sowohl bei neurodegenerativen Erkrankungen wie Morbus Alzheimer, Morbus Parkinson und zerebraler Ischämie, bei peripheren Erkrankungen wie Arteriosklerose, als auch beim Alterungsprozess per se auf und wird als Ursache oder zumindest als ein krankheitsfördernder Faktor diskutiert. Die in in vitro-Experimenten als vielversprechend antioxidativ getesteten Substanzen (meist phenolhaltig) ergaben in mehreren klinischen Studien keinen signifikanten Vorteil. Um die Ursachen dieser Ergebnisse näher zu analysieren, wurde in der vorliegenden Arbeit auf Basis des cytoprotektiven Phenothiazins, einem aromatischen trizyklischen Amin, der Einfluss von verschiedenen Substituenten im Hinblick auf Lipophilie, Radikalstabilisierung und Löslichkeit des Moleküls chemisch vorhergesagt. Anhand dieser in silicio Struktur-Wirkungs-Beziehung wurden anschließend neue Modellsubstanzen synthetisiert, welche sich systematisch in den drei zuvor genannten Parametern unterschieden. Dies wurde durch Substitution von unterschiedlich langen Fettsäureketten, von löslichkeitsbeeinflussenden funktionellen Gruppen, oder durch Anellierung zusätzlicher aromatischer Ringe erreicht. In den folgenden Versuchen zu antioxidativer Kapazität, zellulärem Überleben, Lipidperoxidation und Proteinoxidation zeigte sich, dass mit gesteigerter Stabilität der korrespondierenden Radikale und mit wachsender Lipophilie die antioxidativ cytoprotektive Aktivität der neuen Derivate bis zu einer gewissen Grenze (logP ≈ 7) signifikant zunahm; über diesen Wert hinaus sank die Effektivität wieder ab. Benzanellierte Phenothiazine entwickelten mit EC50-Werten von ungefähr 8-10 nM die höchste mittlere effektive Wirkkonzentration in oxidativ geschädigten, klonalen hippocampalen Neuronen (HT-22 Zellen). Dies entspricht einer etwa 20-fachen Verbesserung gegenüber α-Tocopherol, welches bisher als bestes natürliches lipophiles Antioxidans angesehen wurde. Im Vergleich zu Phenothiazin erreichen die neuen Antioxidantien immerhin eine höhere Effektivität um den Faktor 4. Folglich sind es sowohl Aspekte der Löslichkeit und der Distribution, welche die Potenz der gegenwärtigen Antioxidantien limitieren als auch Aspekte der Radikalstabilisierung, die Einfluss auf die primäre Wirksamkeit nehmen. Dieses Wissen sollte beim zukünftigen Design neuer, antioxidativ potenter Moleküle im Hinblick auf ihren langfristigen Einsatz bei neurodegenerativen Erkrankungen von Nutzen sein.

Pharmacogenetics in palliative care

Response to analgesics, anticancer pharmacotherapy and pharmacotherapy of other cancer related symptoms vary broadly between individuals. Age, disease, comorbidities, concomitant medication, organ function and patients' compliance may partly explain the differences. However, the focus of ongoing research has shifted towards genomic variants of phase I and II drug metabolizing enzymes with one important goal being an individual dose adjustment according to a patient's genotype. Polymorphisms of the cytochrome P 450 2D6 influence the metabolism of many drugs including the analgesics codeine, tramadol, hydrocodone and oxycodone, as well as the metabolism of tricyclic antidepressants and the anticancer drug tamoxifen. Other candidate genes such as (opioid)-receptors, transporters and other molecules important for pharmacotherapy in pain management are discussed. Although pharmacogenetics as a diagnostic tool has the potential to improve patient therapy, study results are often equivocal and limited by small sample sizes and often by their retrospective design. Well designed studies are needed to demonstrate superiority of pharmoacogenetics to conventional dosing regimes.

Personalized therapy in pain management: where do we stand?

Genomic variations influencing response to pharmacotherapy of pain are currently under investigation. Drug-metabolizing enzymes represent a major target of ongoing research in order to identify associations between an individual's drug response and genetic profile. Polymorphisms of the cytochrome P450 enzymes (CYP2D6) influence metabolism of codeine, tramadol, hydrocodone, oxycodone and tricyclic antidepressants. Blood concentrations of some NSAIDs depend on CYP2C9 and/or CYP2C8 activity. Genomic variants of these genes associate well with NSAIDs' side effect profile. Other candidate genes, such as those encoding (opioid) receptors, transporters and other molecules important for pharmacotherapy in pain management, are discussed; however, study results are often equivocal. Besides genetic variants, further variables, for example, age, disease, comorbidity, concomitant medication, organ function as well as patients' compliance, may have an impact on pharmacotherapy and need to be addressed when pain therapists prescribe medication. Although pharmacogenetics as a diagnostic tool has the potential to improve patient therapy, well-designed studies are needed to demonstrate superiority to conventional dosing regimes.

Double-blinded, randomized controlled trial comparing real versus placebo acupuncture to improve tolerance of diagnostic esophagogastroduodenoscopy without sedation: a study protocol

Background Sedation prior to performance of diagnostic esophagogastroduodenoscopy (EGDE) is widespread and increases patient comfort. But 98% of all serious adverse events during EGDEs are ascribed to sedation. The S3 guideline for sedation procedures in gastrointestinal endoscopy published in 2008 in Germany increases patient safety by standardization. These new regulations increase costs because of the need for more personnel and a prolonged discharge procedure after examinations with sedation. Many patients have difficulties to meet the discharge criteria regulated by the S3 guideline, e.g. the call for a second person to escort them home, to resign from driving and working for the rest of the day, resulting in a refusal of sedation. Therefore, we would like to examine if an acupuncture during elective, diagnostic EGDEs could increase the comfort of patients refusing systemic sedation. Methods/Design A single-center, double blinded, placebo controlled superiority trial to compare the success rates of elective, diagnostic EGDEs with real and placebo acupuncture. All patients aged 18 years or older scheduled for elective, diagnostic EGDE who refuse a systemic sedation are eligible. 354 patients will be randomized. The primary endpoint is the rate of successful EGDEs with the randomized technique. Intervention: Real or placebo acupuncture before and during EGDE. Duration of study: Approximately 24 months. Discussion Organisation/Responsibility The ACUPEND - Trial will be conducted in accordance with the protocol and in compliance with the moral, ethical, and scientific principles governing clinical research as set out in the Declaration of Helsinki (1989) and Good Clinical Practice (GCP). The Interdisciplinary Endoscopy Center (IEZ) of the University Hospital Heidelberg is responsible for design and conduct of the trial, including randomization and documentation of patients' data. Data management and statistical analysis will be performed by the independent Institute for Medical Biometry and Informatics (IMBI) and the Center of Clinical Trials (KSC) at the Department of General, Visceral and Transplantation Surgery, University of Heidelberg.

Aging and experience in the recognition of musical transpositions

The authors examined the effects of age, musical experience, and characteristics of musical stimuli on a melodic short-term memory task in which participants had to recognize whether a tune was an exact transposition of another tune recently presented. Participants were musicians and nonmusicians between ages 18 and 30 or 60 and 80. In 4 experiments, the authors found that age and experience affected different aspects of the task, with experience becoming more influential when interference was provided during the task. Age and experience interacted only weakly, and neither age nor experience influenced the superiority of tonal over atonal materials. Recognition memory for the sequences did not reflect the same pattern of results as the transposition task. The implications of these results for theories of aging, experience, and music cognition are discussed.

Long-term clinical outcomes of biodegradable polymer biolimus-eluting stents versus durable polymer sirolimus-eluting stents in patients with coronary artery disease (LEADERS): 4 year follow-up of a randomised non-inferiority trial

Background The effectiveness of durable polymer drug-eluting stents comes at the expense of delayed arterial healing and subsequent late adverse events such as stent thrombosis (ST). We report the 4 year follow-up of an assessment of biodegradable polymer-based drug-eluting stents, which aim to improve safety by avoiding the persistent inflammatory stimulus of durable polymers. Methods We did a multicentre, assessor-masked, non-inferiority trial. Between Nov 27, 2006, and May 18, 2007, patients aged 18 years or older with coronary artery disease were randomly allocated with a computer-generated sequence to receive either biodegradable polymer biolimus-eluting stents (BES) or durable polymer sirolimus-eluting stents (SES; 1:1 ratio). The primary endpoint was a composite of cardiac death, myocardial infarction, or clinically-indicated target vessel revascularisation (TVR); patients were followed-up for 4 years. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00389220. Findings 1707 patients with 2472 lesions were randomly allocated to receive either biodegradable polymer BES (857 patients, 1257 lesions) or durable polymer SES (850 patients, 1215 lesions). At 4 years, biodegradable polymer BES were non-inferior to durable polymer SES for the primary endpoint: 160 (18·7%) patients versus 192 (22·6%) patients (rate ratios [RR] 0·81, 95% CI 0·66–1·00, p for non-inferiority <0·0001, p for superiority=0·050). The RR of definite ST was 0·62 (0·35–1·08, p=0·09), which was largely attributable to a lower risk of very late definite ST between years 1 and 4 in the BES group than in the SES group (RR 0·20, 95% CI 0·06–0·67, p=0·004). Conversely, the RR of definite ST during the first year was 0·99 (0·51–1·95; p=0·98) and the test for interaction between RR of definite ST and time was positive (pinteraction=0·017). We recorded an interaction with time for events associated with ST but not for other events. For primary endpoint events associated with ST, the RR was 0·86 (0·41–1·80) during the first year and 0·17 (0·04–0·78) during subsequent years (pinteraction=0·049). Interpretation Biodegradable polymer BES are non-inferior to durable polymer SES and, by reducing the risk of cardiac events associated with very late ST, might improve long-term clinical outcomes for up to 4 years compared with durable polymer SES. Funding Biosensors Europe SA, Switzerland.

Comparison of titanium-nitride-oxide-coated stents with zotarolimus-eluting stents for coronary revascularization a randomized controlled trial

Objectives This study sought to compare the efficacy of passive stent coating with titanium-nitride-oxide (TiNO) with drug-eluting stents releasing zotarolimus (ZES) (Endeavor, Medtronic, Minneapolis, Minnesota). Background Stent coating with TiNO has been shown to reduce restenosis compared with bare-metal stents in experimental and clinical studies. Methods In an assessor-blind noninferiority study, 302 patients undergoing percutaneous coronary intervention were randomized to treatment with TiNO or ZES. The primary endpoint was in-stent late loss at 6 to 8 months, and analysis was by intention to treat. Results Both groups were well balanced with respect to baseline clinical and angiographic characteristics. The TiNO group failed to reach the pre-specified noninferiority margin for the primary endpoint (in-stent late loss: 0.64 ± 0.61 mm vs. 0.47 ± 0.48 mm, difference: 0.16, upper 1-sided 95% confidence interval [CI]: 0.26; pnoninferiority = 0.54), and subsequent superiority testing was in favor of ZES (psuperiority = 0.02). In-segment binary restenosis was lower with ZES (11.1%) than with TiNO (20.5%; psuperiority = 0.04). A stratified analysis of the primary endpoint found particularly pronounced differences between stents among diabetic versus nondiabetic patients (0.90 ± 0.69 mm vs. 0.39 ± 0.38 mm; pinteraction = 0.04). Clinical outcomes showed a similar rate of death (0.7% vs. 0.7%; p = 1.00), myocardial infarction (5.3% vs. 6.7%; p = 0.60), and major adverse cardiac events (21.1% vs. 18.0%, hazard ratio: 1.19, 95% CI: 0.71 to 2.00; p = 0.50) at 1 year. There were no differences in rates of definite or probable stent thrombosis (0.7% vs. 0%; p = 0.51) at 1 year. Conclusions Compared with TiNO, ZES was superior with regard to late loss and binary restenosis. The concept of passive stent coating with TiNO remains inferior to drug-eluting stent technology in reducing restenosis. ([TIDE] Randomized Trial Comparing Titan Stent With Zotarolimus-Eluting Stent: NCT00492908)

Treatment of adolescents with early-onset schizophrenia spectrum disorders: in search of a rational, evidence-informed approach

Purpose of review: We aimed to review literature on the efficacy and tolerability of psychosocial and psychopharmacological interventions in youth with early-onset schizophrenia spectrum disorders (EOS). A rationale for pragmatic psychopharmacology in EOS, including dosing, switching and adverse effect monitoring and management, is provided. Recent findings: Three randomized controlled trials (RCTs) over the last 8 years demonstrated benefits of psychosocial interventions (i.e. psychoeducation, cognitive remediation, cognitive behavioural therapy) for EOS without clear advantages of one psychosocial treatment over another. Six large, placebo-controlled, short-term RCTs over the last 4 years demonstrated that aripiprazole, olanzapine, paliperidone, quetiapine and risperidone, but not ziprasidone, were superior to placebo. Except for clozapine's superiority in treatment-refractory EOS, efficacy appeared similar across studied first-generation and second-generation antipsychotics, but tolerability varied greatly across individual agents. Summary: Antipsychotics are efficacious in the treatment of EOS. Given the lack of efficacy differences between antipsychotics (except for clozapine for treatment-refractory EOS), we propose that tolerability considerations need to guide choice of antipsychotics. Further and longer-term efficacy and effectiveness studies are urgently needed that should also explore pharmacologic and nonpharmacologic augmentation strategies.

Treatment of acute ischaemic stroke with thrombolysis or thrombectomy in patients receiving anti-thrombotic treatment

Systemic thrombolysis with alteplase is the only approved medical treatment for patients with acute ischaemic stroke. Thrombectomy is also increasingly used to treat proximal occlusions of the cerebral arteries, but has not shown superiority over systemic thrombolysis with alteplase. Many patients with acute ischaemic stroke are pretreated with antiplatelet or anticoagulant drugs, which can increase the bleeding risk of thrombolysis or thrombectomy. Pretreatment with aspirin monotherapy increases the bleeding risk of alteplase in both observational and randomised trials with no effect on clinical outcome, and the risk of intracerebral haemorrhage is increased with the combination of aspirin and clopidogrel. Antiplatelet drugs should not be given in the first 24 h after alteplase treatment. Data from pooled randomised trials and a large observational study show that thrombolysis can probably be done safely in patients given vitamin-K antagonists if the international normalised ratio is less than 1·7, although bleeding risk is slightly raised. Almost no data are available for the safety of alteplase in patients with atrial fibrillation who have been given novel oral anticoagulants (NOAC) for stroke prevention. Some coagulation parameters could help to identify patients treated with NOAC who might be eligible for thrombolysis. Thrombectomy can be done in patients given antiplatelets and probably in those given anticoagulants; however, conclusions about anticoagulants are based on findings from observational studies with small patient numbers.

A randomised controlled trial of the efficacy of supported employment

Although numerous randomised controlled trials indicated the superiority of supported employment (SE), we still have too little evidence that SE is more effective than traditional vocational rehabilitation programmes (TVR) in Western European countries with highly developed social security and welfare systems, sophisticated rehabilitation programmes and high thresholds to the open labour market. The aim of this study is to prove the efficacy of SE in Switzerland.

Anthracyclines during induction therapy in acute myeloid leukaemia: a systematic review and meta-analysis

This systematic review and meta-analysis compared the efficacy of different anthracyclines and anthracycline dosing schedules for induction therapy in acute myeloid leukaemia in children and adults younger than 60 years of age. Twenty-nine randomized controlled trials were eligible for inclusion in the review. Idarubicin (IDA), in comparison to daunorubicin (DNR), reduced remission failure rates (risk ratio (RR) 0·81; 95% confidence interval (CI), 0·66-0·99; P = 0·04), but did not alter rates of early death or overall mortality. Superiority of IDA for remission induction was limited to studies with a DNR/IDA dose ratio <5 (ratio <5: RR 0·65; 95% CI, 0·51-0·81; P < 0·001; ratio ≥5: RR 1·03; 95% CI, 0·91-1·16; P = 0·63). Higher-dose DNR, compared to lower-dose DNR, was associated with reduced rates for remission failure (RR 0·75; 95% CI, 0·60-0·94; P = 0·003) and overall mortality (RR 0·83; 95% CI, 0·75-0·93; P < 0·001), but not for early death. Comparisons of several other anthracycline derivates did not reveal significant differences in outcomes. Survival estimates in adults suggest that both high-dose DNR (90 mg/m(2) daily × 3 or 50 mg/m(2) daily × 5) and IDA (12 mg/m(2) daily × 3) can achieve 5-year survival rates of between 40 and 50 percent.