Mercato diritti e consumi: la tutela del consumatore nella disciplina antitrust

Lo studio “Mercato, diritti e consumi: la tutela del consumatore nella disciplina antitrust”, ricostruisce e analizza i rapporti intercorrenti tra pubbliche amministrazioni e consumatore, singolo e associato, concentrando l’attenzione sulla protezione del consumatore quale soggetto che opera nel mercato, titolare di un diritto economico, in relazione all’attività regolativa svolta dall’amministrazione nella cura dell’interesse pubblico alla tutela della concorrenza. Il lavoro è strutturato in quattro parti. Una prima parte, di carattere generale, è dedicata alla nozione di consumatore e ai diritti in capo allo stesso contemplati, nonché alle associazioni dei consumatori ed al ruolo istituzionale ad esse affidato. Nella seconda parte si concentra l’attenzione, da un lato, sulla posizione assunta dalle Regioni per quel che concerne la competenza legislativa ad esse riconosciuta nell’ambito della tutela dei consumatori e degli utenti e, dall’altro lato, sul versante degli strumenti più propriamente di diritto amministrativo, sull’attività amministrativa di controllo, vigilanza e disciplina delle attività economiche private rilevanti per i consumatori, attuata dalle autorità indipendenti e, per ciò che attiene alle loro funzioni, dalle Camere di commercio. La terza parte riferisce in ordine al quadro normativo in cui si colloca l’attività di regolazione del mercato soprattutto avendo riguardo alle recenti modifiche legislative che hanno profondamente modificato il Codice del consumo relativamente ai suddetti temi ed al ruolo svolto dall’Autorità Garante della Concorrenza e del Mercato, per poi dar conto dell’evoluzione giurisprudenziale cui si è assistito recentemente circa la rilevanza dell’interesse del consumatore nella disciplina Antitrust. Nell’ultima parte, anche alla luce delle osservazioni svolte, si affronta il fondamento giuridico – costituzionale dell’interesse del consumatore anche alla luce del nuovo assetto dei rapporti con l’Autorità Garante della Concorrenza e del Mercato e si tenta, attraverso una reinterpretazione del concetto di iniziativa economica, di ricondurlo al primo comma dell’articolo 41 della Costituzione.

Mechanism of resistance to tyrosine kinase inhibitors in philadelphia-positive acute lymphblastic leukaemia (all): from genetic alterations to impaired RNA editing

The Ph chromosome is the most frequent cytogenetic aberration associated with adult ALL and it represents the single most significant adverse prognostic marker. Despite imatinib has led to significant improvements in the treatment of patients with Ph+ ALL, in the majority of cases resistance developed quickly and disease progressed. Some mechanisms of resistance have been widely described but the full knowledge of contributing factors, driving both the disease and resistance, remains to be defined. The observation of rapid development of lymphoblastic leukemia in mice expressing altered Ikaros (Ik) isoforms represented the background of this study. Ikaros is a zinc finger transcription factor required for normal hemopoietic differentiation and proliferation, particularly in the lymphoid lineages. By means of alternative splicing, Ikaros encodes several proteins that differ in their abilities to bind to a consensus DNA-binding site. Shorter, DNA nonbinding isoforms exert a dominant negative effect, inhibiting the ability of longer heterodimer partners to bind DNA. The differential expression pattern of Ik isoforms in Ph+ ALL patients was analyzed in order to determine if molecular abnormalities involving the Ik gene could associate with resistance to imatinib and dasatinib. Bone marrow and peripheral blood samples from 46 adult patients (median age 55 yrs, 18-76) with Ph+ ALL at diagnosis and during treatment with imatinib (16 pts) or dasatinib (30 pts) were collected. We set up a fast, high-throughput method based on capillary electrophoresis technology to detect and quantify splice variants. 41% Ph+ ALL patients expressed high levels of the non DNA-binding dominant negative Ik6 isoform lacking critical N-terminal zinc-fingers which display abnormal subcellular compartmentalization pattern. Nuclear extracts from patients expressed Ik6 failed to bind DNA in mobility shift assay using a DNA probe containing an Ikaros-specific DNA binding sequence. In 59% Ph+ ALL patients there was the coexistence in the same PCR sample and at the same time of many splice variants corresponded to Ik1, Ik2, Ik4, Ik4A, Ik5A, Ik6, Ik6 and Ik8 isoforms. In these patients aberrant full-length Ikaros isoforms in Ph+ ALL characterized by a 60-bp insertion immediately downstream of exon 3 and a recurring 30-bp in-frame deletion at the end of exon 7 involving most frequently the Ik2, Ik4 isoforms were also identified. Both the insertion and deletion were due to the selection of alternative splice donor and acceptor sites. The molecular monitoring of minimal residual disease showed for the first time in vivo that the Ik6 expression strongly correlated with the BCR-ABL transcript levels suggesting that this alteration could depend on the Bcr-Abl activity. Patient-derived leukaemia cells expressed dominant-negative Ik6 at diagnosis and at the time of relapse, but never during remission. In order to mechanistically demonstrated whether in vitro the overexpression of Ik6 impairs the response to tyrosine kinase inhibitors (TKIs) and contributes to resistance, an imatinib-sensitive Ik6-negative Ph+ ALL cell line (SUP-B15) was transfected with the complete Ik6 DNA coding sequence. The expression of Ik6 strongly increased proliferation and inhibited apoptosis in TKI sensitive cells establishing a previously unknown link between specific molecular defects that involve the Ikaros gene and the resistance to TKIs in Ph+ ALL patients. Amplification and genomic sequence analysis of the exon splice junction regions showed the presence of 2 single nucleotide polymorphisms (SNPs): rs10251980 [A/G] in the exon2/3 splice junction and of rs10262731 [A/G] in the exon 7/8 splice junction in 50% and 36% of patients, respectively. A variant of the rs11329346 [-/C], in 16% of patients was also found. Other two different single nucleotide substitutions not recognized as SNP were observed. Some mutations were predicted by computational analyses (RESCUE approach) to alter cis-splicing elements. In conclusion, these findings demonstrated that the post-transcriptional regulation of alternative splicing of Ikaros gene is defective in the majority of Ph+ ALL patients treated with TKIs. The overexpression of Ik6 blocking B-cell differentiation could contribute to resistance opening a time frame, during which leukaemia cells acquire secondary transforming events that confer definitive resistance to imatinib and dasatinib.

Mikrosomale Biotransformation von Benzo[ghi]perylen, einem mutagenen polyaromatischen Kohlenwasserstoff ohne das Strukturelement der Bay-Region des kanzerogenen Benzo[a]pyrens

Kanzerogene polyaromatische Kohlenwasserstoffe (PAKs), wie Benzo[a]pyren, besitzen eine Bay-Region mit ortho-kondensiertem Benzoring. Dadurch ist die enzymatische Bildung von Bay-Region-Dihydrodiolepoxiden (Oxiranylring in der sterisch abgeschirmten Molekülbucht) möglich, die als ultimal kanzerogene Metaboliten der PAKs gelten. Diese lösen durch DNA-Modifikation Primärläsionen aus, die, sofern sie nicht enzymatisch repariert werden, bei der DNA-Replikation Fehler verursachen (Mu-tationen). Der Mehrstufenprozeß der Kanzerogenese (Promotion und Progression) führt schließlich zur neoplastischen Entartung der Zelle. Benzo[ghi]perylen (BghiP) repräsentiert eine Gruppe von PAKs, die keine „klassische“ Bay-Region besitzen und daher keine vicinalen Dihydrodiolepoxiden bilden können. Trotzdem ist BghiP mutagen, z. B. in den Stämmen TA98 und TA100 von Salmonella typhimurium (1,3- bzw. 4,3 his+-Revertanten/nmol) nach metabolischer Aktivierung mit der postmitochondrialen Fraktion von Ratten nach Behandlung mit 3-Methylcholanthren. Hemmung der mikrosomalen Epoxidhydrolase (mEH) mit 1,1,1-Trichlor-2-propenoxid (TCPO) steigert die bakterielle Mutagenität von BghiP im Stamm TA98 um das 4-fache, was Arenoxide als ultimale Mutagene wahrscheinlich macht. Dieses Ergebnis wird au-ßerdem durch Untersuchung der DNA-Bindung mit dem Verfahren des 32P-Postlabelings bestätigt (Dr. Fickler, Institut für Toxikologie, Universität Mainz). Danach bildete mikrosomal aktiviertes BghiP drei Addukte (ein Hauptaddukt, zwei Nebenaddukte), die durch Hemmung der mEH mit TCPO verstärkt wurden (das Hauptaddukt um 29%). Um den für die bakterielle Mutagenität von BghiP verantwortlichen Metaboliten zu identifizieren, wurde die mikrosomale Biotransformaton von BghiP aufgeklärt. Umsetzung von BghiP mit Lebermikrosomen von Ratten nach Behandlung mit Aroclor 1254 lieferte 17 mit Ethylacetat extrahierbare Metaboliten. Zwölf dieser Metaboliten konnten durch eine Kombination von chromatographischen, spektroskopi-schen und biochemischen Methoden identifiziert werden. Daraus ergeben sich zwei Biotransformati-onswege: Weg I beginnt mit einem Angriff von Cytochrom P450-abhängigen Monooxygenasen an Position 7 und der Bildung des 7-Phenols. Dieses wird dann in das 7,8- bzw. 7,10-Diphenol überführt, die schließlich zu den mehrkernigen Chinonen an der 7,8- bzw. 7,10-Position oxidiert werden. Im Bio-transformationsweg II werden die K-Regionen von BghiP durch Cytochrom P450 funktionalisiert. Zu-nächst entstehen das auf indirektem Weg identifizierte 3,4-Oxid und das 3,4,11,12-Bisoxid, die in mikrosomalen Umsetzungen von BghiP nur nach Hemmung der mEH gebildet werden. Enzymatische Hydrolyse des 3,4-Oxides ergibt das trans-3,4-Dihydrodiol, das zum 3,4-Chinon oxidiert wird. Ebenso entsteht aus dem 3,4,11,12-Bisoxid das trans-3,4-trans-11,12-Bisdihydrodiol, aus dem durch Oxidati-on das trans-3,4-Dihydrodiol-11,12-Chinon hervorgeht. Untersuchung der stereoselektiven enzymati-schen Bildung der K-Region-trans-Di¬hydrodiole ergaben eine präferentielle Entstehung der 3R,4R- bzw. 3R,4R,11R,12R-Enantiomere. Untersuchungen der bakteriellen Mutagenität der Hauptmetaboliten 3,4-Dihydrodiol und dem 7-Phenol machte deutlich, dass beide Biotransformationswege I und II von BghiP zur bakteriellen Mutagenität beitragen. Das 7-Phenol aus Weg I ist ein proximales Mutagen, was auch von Phenolen anderer PAKs bekannt ist. Das 3,4-Dihydrodiol aus Weg II wird so schwach zu Mutagenen aktiviert, dass dem vermutlich gebildete 3,4-Dihydrodiol-11,12-oxid keine große Bedeutung als ultimales Mutagen von BghiP zukommt. Die Bestimmung der direkten mutagenen Aktivität (ohne metabolische Aktivierung) der mutmaßlich ultimal mutagenen Arenoxide von BghiP ergab, dass die des 3,4,11,12-Bisarenoxides sehr gering war (1,3 his+-Revertanten/nmol im Stamm TA98). Das 3,4-Oxid hingegen bewirkte einen deutlichen gentoxischen Effekt in den Stämmen TA98 und TA100 (5,5 bzw. 10 his+-Revertanten/nmol). Dies wurde durch die Bestimmung der DNA-Bindung mit dem 32P-Postlabeling, in dem das 3,4-Oxid für das Hauptaddukt von BghiP verantwortlich gemacht werden konnte, bestätigt. Daher kommt dem 3,4-Oxid als ultimales Mutagen die größte Bedeutung für die Gentoxizität von BghiP zu. Die Ergebnisse dieser Arbeit lassen bei PAKs ohne Bay-Region auf Arenoxide schließen, die eine notwendige Voraussetzung für DNA-Bindung und Mutagenität sind.

The influence of saliva on the dissolution of calcium fluoride after application of different fluoride gels in vitro

OBJECTIVE: To determine the formation and dissolution of calcium fluoride on the enamel surface after application of two fluoride gel-saliva mixtures. METHOD AND MATERIALS: From each of 80 bovine incisors, two enamel specimens were prepared and subjected to two different treatment procedures. In group 1, 80 specimens were treated with a mixture of an amine fluoride gel (1.25% F-; pH 5.2; 5 minutes) and human saliva. In group 2, 80 enamel blocks were subjected to a mixture of sodium fluoride gel (1.25% F; pH 5.5; 5 minutes) and human saliva. Subsequent to fluoride treatment, 40 specimens from each group were stored in human saliva and sterile water, respectively. Ten specimens were removed after each of 1 hour, 24 hours, 2 days, and 5 days and analyzed according to potassium hydroxide-soluble fluoride. RESULTS: Application of amine fluoride gel resulted in a higher amount of potassium hydroxide-soluble fluoride than did sodium fluoride gel 1 hour after application. Saliva exerted an inhibitory effect according to the dissolution rate of calcium fluoride. However, after 5 days, more than 90% of the precipitated calcium fluoride was dissolved in the amine fluoride group, and almost all potassium hydroxide-soluble fluoride was lost in the sodium fluoride group. Calcium fluoride apparently dissolves rapidly, even at almost neutral pH. CONCLUSION: Considering the limitations of an in vitro study, it is concluded that highly concentrated fluoride gels should be applied at an adequate frequency to reestablish a calcium fluoride-like layer.

Comparison of calibrated and uncalibrated arterial pressure-based cardiac output monitors during orthotopic liver transplantation

Arterial pressure-based cardiac output monitors (APCOs) are increasingly used as alternatives to thermodilution. Validation of these evolving technologies in high-risk surgery is still ongoing. In liver transplantation, FloTrac-Vigileo (Edwards Lifesciences) has limited correlation with thermodilution, whereas LiDCO Plus (LiDCO Ltd.) has not been tested intraoperatively. Our goal was to directly compare the 2 proprietary APCO algorithms as alternatives to pulmonary artery catheter thermodilution in orthotopic liver transplantation (OLT). The cardiac index (CI) was measured simultaneously in 20 OLT patients at prospectively defined surgical landmarks with the LiDCO Plus monitor (CI(L)) and the FloTrac-Vigileo monitor (CI(V)). LiDCO Plus was calibrated according to the manufacturer's instructions. FloTrac-Vigileo did not require calibration. The reference CI was derived from pulmonary artery catheter intermittent thermodilution (CI(TD)). CI(V)-CI(TD) bias ranged from -1.38 (95% confidence interval = -2.02 to -0.75 L/minute/m(2), P = 0.02) to -2.51 L/minute/m(2) (95% confidence interval = -3.36 to -1.65 L/minute/m(2), P < 0.001), and CI(L)-CI(TD) bias ranged from -0.65 (95% confidence interval = -1.29 to -0.01 L/minute/m(2), P = 0.047) to -1.48 L/minute/m(2) (95% confidence interval = -2.37 to -0.60 L/minute/m(2), P < 0.01). For both APCOs, bias to CI(TD) was correlated with the systemic vascular resistance index, with a stronger dependence for FloTrac-Vigileo. The capability of the APCOs for tracking changes in CI(TD) was assessed with a 4-quadrant plot for directional changes and with receiver operating characteristic curves for specificity and sensitivity. The performance of both APCOs was poor in detecting increases and fair in detecting decreases in CI(TD). In conclusion, the calibrated and uncalibrated APCOs perform differently during OLT. Although the calibrated APCO is less influenced by changes in the systemic vascular resistance, neither device can be used interchangeably with thermodilution to monitor cardiac output during liver transplantation.

Internal fixation of symphyseal disruption resulting from childbirth

To investigate the clinical and radiographic results after operative treatment of complete symphyseal disruption resulting from childbirth and to evaluate residual pain and implant failure in relation to the timing of surgery.

CX3CR1 defines functionally distinct intestinal mononuclear phagocyte subsets which maintain their respective functions during homeostatic and inflammatory conditions

Intestinal mononuclear phagocytes (iMNP) are critically involved in mucosal immunity and tissue homeostasis. Two major non-overlapping populations of iMNP have been identified in mice. CD103(+) iMNP represent a migratory population capable of inducing tolerogenic responses, whereas CX3CR1(+) iMNP are resident cells with disease-promoting potential. CX3CR1(+) iMNP can further be subdivided based on differential expression of CX3CR1. Using CX3CR1(GFP/+) ×RAG2(-/-) mice, we demonstrate that CX3CR1(hi) and CX3CR1(lo) iMNP clearly differ with respect to their morphological and functional properties. Compared with CX3CR1(hi) iMNP, CX3CR1(lo) iMNP are polarised towards pro-inflammatory responses already under homeostatic conditions. During a CD4(+) T-cell-induced colitis, CX3CR1(lo) cells accumulate in the inflamed mucosa and upregulate the expression of pro-inflammatory cytokines and triggering receptor expressed on myeloid cells-1 (TREM-1). In contrast, CX3CR1(hi) iMNP retain their non-inflammatory profile even during intestinal inflammation. These findings identify two functionally distinct iMNP subsets based on differential expression of CX3CR1 and indicate an unanticipated stability of iMNP.

Risk of falls and major bleeds in patients on oral anticoagulation therapy

The risk of falls is the most commonly cited reason for not providing oral anticoagulation, although the risk of bleeding associated with falls on oral anticoagulants is still debated. We aimed to evaluate whether patients on oral anticoagulation with high falls risk have an increased risk of major bleeding.

A Departmental Focus on High Impact Undergraduate Research Experiences

Undergraduate research experiences have become an integral part of the Hamilton College chemistry experience. The major premise of the chemistry department’s curriculum is that research is a powerful teaching tool. Curricular offerings have been developed and implemented to better prepare students for the independence required for successful undergraduate research experiences offered during the academic year and the summer. Administrative support has played a critical role in our ability to initiate and sustain scholarly research programs for all faculty members in the department. The research-rich curriculum is built directly upon or derived from the scholarly research agendas of our faculty members. The combined strengths and synergies of our curriculum and summer research program have allowed us to pursue several programmatic initiatives.