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.

Transient transfection of serum-free suspension HEK 293 cell culture for efficient production of human rFVIII

Abstract Background Hemophilia A is a bleeding disorder caused by deficiency in coagulation factor VIII. Recombinant factor VIII (rFVIII) is an alternative to plasma-derived FVIII for the treatment of hemophilia A. However, commercial manufacturing of rFVIII products is inefficient and costly and is associated to high prices and product shortage, even in economically privileged countries. This situation may be solved by adopting more efficient production methods. Here, we evaluated the potential of transient transfection in producing rFVIII in serum-free suspension HEK 293 cell cultures and investigated the effects of different DNA concentration (0.4, 0.6 and 0.8 μg/106 cells) and repeated transfections done at 34° and 37°C. Results We observed a decrease in cell growth when high DNA concentrations were used, but no significant differences in transfection efficiency and in the biological activity of the rFVIII were noticed. The best condition for rFVIII production was obtained with repeated transfections at 34°C using 0.4 μg DNA/106 cells through which almost 50 IU of active rFVIII was produced six days post-transfection. Conclusion Serum-free suspension transient transfection is thus a viable option for high-yield-rFVIII production. Work is in progress to further optimize the process and validate its scalability.

Development and characterization of a distributed measurement system for the evaluation of voltage quality in electric power networks

The research activity carried out during the PhD course in Electrical Engineering belongs to the branch of electric and electronic measurements. The main subject of the present thesis is a distributed measurement system to be installed in Medium Voltage power networks, as well as the method developed to analyze data acquired by the measurement system itself and to monitor power quality. In chapter 2 the increasing interest towards power quality in electrical systems is illustrated, by reporting the international research activity inherent to the problem and the relevant standards and guidelines emitted. The aspect of the quality of voltage provided by utilities and influenced by customers in the various points of a network came out only in recent years, in particular as a consequence of the energy market liberalization. Usually, the concept of quality of the delivered energy has been associated mostly to its continuity. Hence the reliability was the main characteristic to be ensured for power systems. Nowadays, the number and duration of interruptions are the “quality indicators” commonly perceived by most customers; for this reason, a short section is dedicated also to network reliability and its regulation. In this contest it should be noted that although the measurement system developed during the research activity belongs to the field of power quality evaluation systems, the information registered in real time by its remote stations can be used to improve the system reliability too. Given the vast scenario of power quality degrading phenomena that usually can occur in distribution networks, the study has been focused on electromagnetic transients affecting line voltages. The outcome of such a study has been the design and realization of a distributed measurement system which continuously monitor the phase signals in different points of a network, detect the occurrence of transients superposed to the fundamental steady state component and register the time of occurrence of such events. The data set is finally used to locate the source of the transient disturbance propagating along the network lines. Most of the oscillatory transients affecting line voltages are due to faults occurring in any point of the distribution system and have to be seen before protection equipment intervention. An important conclusion is that the method can improve the monitored network reliability, since the knowledge of the location of a fault allows the energy manager to reduce as much as possible both the area of the network to be disconnected for protection purposes and the time spent by technical staff to recover the abnormal condition and/or the damage. The part of the thesis presenting the results of such a study and activity is structured as follows: chapter 3 deals with the propagation of electromagnetic transients in power systems by defining characteristics and causes of the phenomena and briefly reporting the theory and approaches used to study transients propagation. Then the state of the art concerning methods to detect and locate faults in distribution networks is presented. Finally the attention is paid on the particular technique adopted for the same purpose during the thesis, and the methods developed on the basis of such approach. Chapter 4 reports the configuration of the distribution networks on which the fault location method has been applied by means of simulations as well as the results obtained case by case. In this way the performance featured by the location procedure firstly in ideal then in realistic operating conditions are tested. In chapter 5 the measurement system designed to implement the transients detection and fault location method is presented. The hardware belonging to the measurement chain of every acquisition channel in remote stations is described. Then, the global measurement system is characterized by considering the non ideal aspects of each device that can concur to the final combined uncertainty on the estimated position of the fault in the network under test. Finally, such parameter is computed according to the Guide to the Expression of Uncertainty in Measurements, by means of a numeric procedure. In the last chapter a device is described that has been designed and realized during the PhD activity aiming at substituting the commercial capacitive voltage divider belonging to the conditioning block of the measurement chain. Such a study has been carried out aiming at providing an alternative to the used transducer that could feature equivalent performance and lower cost. In this way, the economical impact of the investment associated to the whole measurement system would be significantly reduced, making the method application much more feasible.

Nonlinear/electromagnetic co-simulation of microwaves and millimeter-waves links

The Ph.D. thesis describes the simulations of different microwave links from the transmitter to the receiver intermediate-frequency ports, by means of a rigorous circuit-level nonlinear analysis approach coupled with the electromagnetic characterization of the transmitter and receiver front ends. This includes a full electromagnetic computation of the radiated far field which is used to establish the connection between transmitter and receiver. Digitally modulated radio-frequency drive is treated by a modulation-oriented harmonic-balance method based on Krylov-subspace model-order reduction to allow the handling of large-size front ends. Different examples of links have been presented: an End-to-End link simulated by making use of an artificial neural network model; the latter allows a fast computation of the link itself when driven by long sequences of the order of millions of samples. In this way a meaningful evaluation of such link performance aspects as the bit error rate becomes possible at the circuit level. Subsequently, a work focused on the co-simulation an entire link including a realistic simulation of the radio channel has been presented. The channel has been characterized by means of a deterministic approach, such as Ray Tracing technique. Then, a 2x2 multiple-input multiple-output antenna link has been simulated; in this work near-field and far-field coupling between radiating elements, as well as the environment factors, has been rigorously taken into account. Finally, within the scope to simulate an entire ultra-wideband link, the transmitting side of an ultrawideband link has been designed, and an interesting Front-End co-design technique application has been setup.

Nonlinear / electromagnetic co-simulation and co-design of microwave links in highly polluted and / or strongly inhomogeneous environments

The objective of the Ph.D. thesis is to put the basis of an all-embracing link analysis procedure that may form a general reference scheme for the future state-of-the-art of RF/microwave link design: it is basically meant as a circuit-level simulation of an entire radio link, with – generally multiple – transmitting and receiving antennas examined by EM analysis. In this way the influence of mutual couplings on the frequency-dependent near-field and far-field performance of each element is fully accounted for. The set of transmitters is treated as a unique nonlinear system loaded by the multiport antenna, and is analyzed by nonlinear circuit techniques. In order to establish the connection between transmitters and receivers, the far-fields incident onto the receivers are evaluated by EM analysis and are combined by extending an available Ray Tracing technique to the link study. EM theory is used to describe the receiving array as a linear active multiport network. Link performances in terms of bit error rate (BER) are eventually verified a posteriori by a fast system-level algorithm. In order to validate the proposed approach, four heterogeneous application contexts are provided. A complete MIMO link design in a realistic propagation scenario is meant to constitute the reference case study. The second one regards the design, optimization and testing of various typologies of rectennas for power generation by common RF sources. Finally, the project and implementation of two typologies of radio identification tags, at X-band and V-band respectively. In all the cases the importance of an exhaustive nonlinear/electromagnetic co-simulation and co-design is demonstrated to be essential for any accurate system performance prediction.

Study of electromagnetic reactions on light nuclei with the Lorentz Integral Transform method

In dieser Arbeit aus dem Bereich der Wenig-Nukleonen-Physik wird die neu entwickelte Methode der Lorentz Integral Transformation (LIT) auf die Untersuchung von Kernphotoabsorption und Elektronenstreuung an leichten Kernen angewendet. Die LIT-Methode ermoeglicht exakte Rechnungen durchzufuehren, ohne explizite Bestimmung der Endzustaende im Kontinuum. Das Problem wird auf die Loesung einer bindungzustandsaehnlichen Gleichung reduziert, bei der die Endzustandswechselwirkung vollstaendig beruecksichtigt wird. Die Loesung der LIT-Gleichung wird mit Hilfe einer Entwicklung nach hypersphaerischen harmonischen Funktionen durchgefuehrt, deren Konvergenz durch Anwendung einer effektiven Wechselwirkung im Rahmem des hypersphaerischen Formalismus (EIHH) beschleunigt wird. In dieser Arbeit wird die erste mikroskopische Berechnung des totalen Wirkungsquerschnittes fuer Photoabsorption unterhalb der Pionproduktionsschwelle an 6Li, 6He und 7Li vorgestellt. Die Rechnungen werden mit zentralen semirealistischen NN-Wechselwirkungen durchgefuehrt, die die Tensor Kraft teilweise simulieren, da die Bindungsenergien von Deuteron und von Drei-Teilchen-Kernen richtig reproduziert werden. Der Wirkungsquerschnitt fur Photoabsorption an 6Li zeigt nur eine Dipol-Riesenresonanz, waehrend 6He zwei unterschiedliche Piks aufweist, die dem Aufbruch vom Halo und vom Alpha-Core entsprechen. Der Vergleich mit experimentellen Daten zeigt, dass die Addition einer P-Wellen-Wechselwirkung die Uebereinstimmung wesentlich verbessert. Bei 7Li wird nur eine Dipol-Riesenresonanz gefunden, die gut mit den verfuegbaren experimentellen Daten uebereinstimmt. Bezueglich der Elektronenstreuung wird die Berechnung der longitudinalen und transversalen Antwortfunktionen von 4He im quasi-elastischen Bereich fuer mittlere Werte des Impulsuebertrages dargestellt. Fuer die Ladungs- und Stromoperatoren wird ein nichtrelativistisches Modell verwendet. Die Rechnungen sind mit semirealistischen Wechselwirkungen durchgefuert und ein eichinvarianter Strom wird durch die Einfuehrung eines Mesonaustauschstroms gewonnen. Die Wirkung des Zweiteilchenstroms auf die transversalen Antwortfunktionen wird untersucht. Vorlaeufige Ergebnisse werden gezeigt und mit den verfuegbaren experimentellen Daten verglichen.

Beurteilung der Eignung der NPEMFE-Methode (Natural Pulsed Electromagnetic Field of Earth) mit dem "Cereskop" in Rutschungen und in Locker- und Festgesteinen mit Spannungsänderungen im Mittel- und Hochgebirge

Spannungsumlagerungen in Mineralen und Gesteinen induzieren in geologisch aktiven Bereichen mikromechanische und seismische Prozesse, wodurch eine schwache natürliche elektromagnetische Strahlung im Niederfrequenzbereich emittiert wird. Die elektromagnetischen Emissionen von nichtleitenden Mineralen sind auf dielektrische Polarisation durch mehrere physikalische Effekte zurückzuführen. Eine gerichtete mechanische Spannung führt zu einer ebenso gerichteten elektromagnetischen Emission. Die Quellen der elektromagnetischen Emissionen sind bekannt, jedoch können sie noch nicht eindeutig den verschiedenen Prozessen in der Natur zugeordnet werden, weshalb im Folgenden von einem seismo-elektromagnetischen Phänomen (SEM) gesprochen wird. Mit der neuentwickelten NPEMFE-Methode (Natural Pulsed Electromagnetic Field of Earth) können die elektromagnetischen Impulse ohne Bodenkontakt registriert werden. Bereiche der Erdkruste mit Spannungsumlagerungen (z.B. tektonisch aktive Störungen, potenzielle Hangrutschungen, Erdfälle, Bergsenkungen, Firstschläge) können als Anomalie erkannt und abgegrenzt werden. Basierend auf dem heutigen Kenntnisstand dieser Prozesse wurden Hangrutschungen und Locker- und Festgesteine, in denen Spannungsumlagerungen stattfinden, mit einem neuentwickelten Messgerät, dem "Cereskop", im Mittelgebirgsraum (Rheinland-Pfalz, Deutschland) und im alpinen Raum (Vorarlberg, Österreich, und Fürstentum Liechtenstein) erkundet und die gewonnenen Messergebnisse mit klassischen Verfahren aus Ingenieurgeologie, Geotechnik und Geophysik in Bezug gesetzt. Unter Feldbedingungen zeigte sich großenteils eine gute Übereinstimmung zwischen den mit dem "Cereskop" erkundeten Anomalien und den mit den konventionellen Verfahren erkundeten Spannungszonen. Auf Grundlage der bisherigen Kenntnis und unter Einbeziehung von Mehrdeutigkeiten werden die Messergebnisse analysiert und kritisch beurteilt.

Sampling methods for low-frequency electromagnetic imaging

For the detection of hidden objects by low-frequency electromagnetic imaging the Linear Sampling Method works remarkably well despite the fact that the rigorous mathematical justification is still incomplete. In this work, we give an explanation for this good performance by showing that in the low-frequency limit the measurement operator fulfills the assumptions for the fully justified variant of the Linear Sampling Method, the so-called Factorization Method. We also show how the method has to be modified in the physically relevant case of electromagnetic imaging with divergence-free currents. We present numerical results to illustrate our findings, and to show that similar performance can be expected for the case of conducting objects and layered backgrounds.

A sampling method for detecting buried objects using electromagnetic scattering

We consider a simple (but fully three-dimensional) mathematical model for the electromagnetic exploration of buried, perfect electrically conducting objects within the soil underground. Moving an electric device parallel to the ground at constant height in order to generate a magnetic field, we measure the induced magnetic field within the device, and factor the underlying mathematics into a product of three operations which correspond to the primary excitation, some kind of reflection on the surface of the buried object(s) and the corresponding secondary excitation, respectively. Using this factorization we are able to give a justification of the so-called sampling method from inverse scattering theory for this particular set-up.

Power Transient Analysis of Experimental Devices for Jules Horowitz Material Testing Reactor (JHR)

The objective of this thesis is the power transient analysis concerning experimental devices placed within the reflector of Jules Horowitz Reactor (JHR). Since JHR material testing facility is designed to achieve 100 MW core thermal power, a large reflector hosts fissile material samples that are irradiated up to total relevant power of 3 MW. MADISON devices are expected to attain 130 kW, conversely ADELINE nominal power is of some 60 kW. In addition, MOLFI test samples are envisaged to reach 360 kW for what concerns LEU configuration and up to 650 kW according to HEU frame. Safety issues concern shutdown transients and need particular verifications about thermal power decreasing of these fissile samples with respect to core kinetics, as far as single device reactivity determination is concerned. Calculation model is conceived and applied in order to properly account for different nuclear heating processes and relative time-dependent features of device transients. An innovative methodology is carried out since flux shape modification during control rod insertions is investigated regarding the impact on device power through core-reflector coupling coefficients. In fact, previous methods considering only nominal core-reflector parameters are then improved. Moreover, delayed emissions effect is evaluated about spatial impact on devices of a diffuse in-core delayed neutron source. Delayed gammas transport related to fission products concentration is taken into account through evolution calculations of different fuel compositions in equilibrium cycle. Provided accurate device reactivity control, power transients are then computed for every sample according to envisaged shutdown procedures. Results obtained in this study are aimed at design feedback and reactor management optimization by JHR project team. Moreover, Safety Report is intended to utilize present analysis for improved device characterization.