Hausdorff dimension for non-hyperbolic repellers II: Da diffeomorphisms

We study non-hyperbolic repellers of diffeomorphisms derived from transitive Anosov diffeomorphisms with unstable dimension 2 through a Hopf bifurcation. Using some recent abstract results about non-uniformly expanding maps with holes, by ourselves and by Dysman, we show that the Hausdorff dimension and the limit capacity (box dimension) of the repeller are strictly less than the dimension of the ambient manifold.

Treatment times of Class II malocclusion: four premolar and non-extraction protocols

The purpose of this study was to retrospectively compare the treatment times of Class II division 1 malocclusion subjects treated with four first premolar extractions or a non- extraction protocol and fixed edgewise appliances. Eighty- four patients were selected and divided into two groups. Group 1, treated with four first premolar extractions, consisted of 48 patients (27 males and 21 females) with a mean age of 13.03 years and group 2, treated without extractions, consisted of 36 patients (18 males and 18 females) with a mean age of 13.13 years. Group 2 was subdivided into two subgroups, 2A consisting of 16 patients treated in one phase and 2B consisting of 20 patients treated in two phases. The initial and final Treatment Priority Index (TPI), initial ages, initial mandibular crowding, and treatment times of groups 1 and 2 were compared with t- tests. These variables were also compared between group 1 and the subgroups with analysis of variance followed by Tukey's tests. The treatment times for groups 1 and 2 and subgroups 2A and 2B were 2.36, 2.47, 2.25, and 2.64 years, respectively, which were not significantly different. Treatment times with non-extraction and four premolar extraction protocols are similar.

Amenagement du territoire autour des sites Seveso: comparaison entre les approches en Italie et en region Wallonne

Il continuo verificarsi di gravi incidenti nei grandi impianti industriali ha spinto gli Stati membri dell’Unione Europea a dotarsi di una politica comune in materia di prevenzione dei grandi rischi industriali. Anche a seguito della pressione esercitata dall’opinione pubblica sono state implementate, nel corso degli ultimi quarant’anni, misure legislative sempre più efficaci per la prevenzione e la mitigazione dei rischi legati ad attività industriali particolarmente pericolose. A partire dagli ultimi anni dello scorso secolo, l’Unione Europea ha emanato una serie di direttive che obbligano gli Stati membri ad essere garanti della sicurezza per l’uomo e per l’ambiente nelle zone circostanti a stabilimenti a rischio di incidente rilevante. In quest’ottica è stata pubblicata nel 1982 la Direttiva Seveso I [82/501/EEC], che è stata ampliata nel 1996 dalla Direttiva Seveso II [96/82/CE] ed infine emendata nel dicembre 2003 dalla Direttiva Seveso III [2003/105/CE]. Le Direttive Seveso prevedono la realizzazione negli Stati membri di una valutazione dei rischi per gli stabilimenti industriali che sono suscettibili a incendi, esplosioni o rilasci di gas tossici (quali, ad esempio, le industrie chimiche, le raffinerie, i depositi di sostanze pericolose). La Direttiva Seveso II è stata trasposta in legge belga attraverso “l’Accord de Coopération” del 21 giugno 1999. Una legge federale nel giugno del 2001 [M.B. 16/06/2001] mette in vigore “l’Accord de Coopération”, che è stato in seguito emendato e pubblicato il 26 aprile del 2007 [M.B. 26/04/2007]. A livello della Regione Vallona (in Belgio), la tematica del rischio di incidente rilevante è stata inclusa nelle disposizioni decretali del Codice Vallone della Pianificazione Territoriale, dell’Urbanismo e del Patrimonio [CWATUP]. In questo quadro la Regione Vallona ha elaborato in collaborazione con la FPMs (Faculté Polytechnique de Mons) una dettagliata metodologia di analisi del rischio per gli stabilimenti a rischio di incidente rilevante. In Italia la Direttiva Seveso II è stata recepita dal Decreto Legislativo n°334 emanato nell’agosto del 1999 [D. Lgs. 334/99], che ha introdotto per la prima volta nel quadro normativo italiano i concetti fondamentali di “controllo dell’urbanizzazione” e “requisiti minimi di sicurezza per la pianificazione territoriale”. Il Decreto Legislativo 334/99 è attualmente in vigore, modificato ed integrato dal Decreto Legislativo n°238 del 21 settembre 2005 [D. Lgs. 238/05], recepimento italiano della Direttiva Seveso III. Tra i decreti attuativi del Decreto Legislativo 334/99 occorre citare il Decreto Ministeriale n°151 del 2001 [D. M. 151/01] relativo alla pianificazione territoriale nell’intorno degli stabilimenti a rischio di incidente rilevante. L’obiettivo di questo lavoro di tesi, che è stato sviluppato presso la Faculté Polytechnique di Mons, è quello di analizzare la metodologia di quantificazione del rischio adottata nella Regione Vallona, con riferimento alla pianificazione territoriale intorno agli stabilimenti a rischio di incidente rilevante, e di confrontarla con quella applicata in Italia. La metodologia applicata in Vallonia è di tipo “probabilistico” ovvero basata sul rischio quale funzione delle frequenze di accadimento e delle conseguenze degli scenari incidentali. Il metodo utilizzato in Italia è “ibrido”, ovvero considera sia le frequenze che le conseguenze degli scenari incidentali, ma non la loro ricomposizione all’interno di un indice di rischio. In seguito al confronto teorico delle due metodologie, se ne è effettuato anche una comparazione pratica tramite la loro applicazione ad un deposito di GPL. Il confronto ha messo in luce come manchino, nella legislazione italiana relativa agli stabilimenti a rischio di incidente rilevante, indicazioni di dettaglio per la quantificazione del rischio, a differenza di quanto accade nella legislazione belga. Ciò lascia all’analista di rischio italiano una notevole arbitrarietà nell’effettuare ipotesi ed assunzioni che rendono poi difficile la comparazione del rischio di stabilimenti differenti. L’auspicio è che tale lacuna possa essere rapidamente superata.

Mechanical non-surgical treatment of peri-implantitis: a single-blinded randomized longitudinal clinical study. II. Microbiological results

BACKGROUND: Peri-implantitis is common in patients with dental implants. We performed a single-blinded longitudinal randomized study to assess the effects of mechanical debridement on the peri-implant microbiota in peri-implantitis lesions. MATERIALS AND METHODS: An expanded checkerboard DNA-DNA hybridization assay encompassing 79 different microorganisms was used to study bacterial counts before and during 6 months following mechanical treatment of peri-implantitis in 17 cases treated with curettes and 14 cases treated with an ultrasonic device. Statistics included non-parametric tests and GLM multivariate analysis with p<0001 indicating significance and 80% power. RESULTS: At selected implant test sites, the most prevalent bacteria were: Fusobacterium nucleatum sp., Staphylococci sp., Aggregatibacter actinomycetemcomitans, Helicobacter pylori, and Tannerella forsythia. 30 min. after treatment with curettes, A. actinomycetemcomitans (serotype a), Lactobacillus acidophilus, Streptococcus anginosus, and Veillonella parvula were found at lower counts (p<0.001). No such differences were found for implants treated with the ultrasonic device. Inconsistent changes occurred following the first week. No microbiological differences between baseline and 6-month samples were found for any species or between treatment study methods in peri-implantitis. CONCLUSIONS: Both methods failed to eliminate or reduce bacterial counts in peri-implantitis. No group differences were found in the ability to reduce the microbiota in peri-implantitis.

Outcome, quality of life and cognitive function of patients with brain metastases from non-small cell lung cancer treated with whole brain radiotherapy combined with gefitinib or temozolomide. A randomised phase II trial of the Swiss Group for Clinical Cancer Research (SAKK 70/03)

Patients with brain metastases (BM) rarely survive longer than 6months and are commonly excluded from clinical trials. We explored two combined modality regimens with novel agents with single agent activity and radiosensitizing properties.

Bevacizumab and erlotinib (BE) first-line therapy in advanced non-squamous non-small-cell lung cancer (NSCLC) (stage IIIB/IV) followed by platinum-based chemotherapy (CT) at disease progression: A multicenter phase II trial (SAKK 19/05)

This phase II trial aimed to evaluate feasibility and efficacy of a first-line combination of targeted therapies for advanced non-squamous NSCLC: bevacizumab (B) and erlotinib (E), followed by platinum-based CT at disease progression (PD).

Prognostic factors affecting long-term outcomes in patients with resected stage IIIA pN2 non-small-cell lung cancer: 5-year follow-up of a phase II study

The aim was to investigate the efficacy of neoadjuvant docetaxel-cisplatin and identify prognostic factors for outcome in locally advanced stage IIIA (pN2 by mediastinoscopy) non-small-cell lung cancer (NSCLC) patients. In all, 75 patients (from 90 enrolled) underwent tumour resection after three 3-week cycles of docetaxel 85 mg m-2 (day 1) plus cisplatin 40 or 50 mg m-2 (days 1 and 2). Therapy was well tolerated (overall grade 3 toxicity occurred in 48% patients; no grade 4 nonhaematological toxicity was reported), with no observed late toxicities. Median overall survival (OS) and event-free survival (EFS) times were 35 and 15 months, respectively, in the 75 patients who underwent surgery; corresponding figures for all 90 patients enrolled were 28 and 12 months. At 3 years after initiating trial therapy, 27 out of 75 patients (36%) were alive and tumour free. At 5-year follow-up, 60 and 65% of patients had local relapse and distant metastases, respectively. The most common sites of distant metastases were the lung (24%) and brain (17%). Factors associated with OS, EFS and risk of local relapse and distant metastases were complete tumour resection and chemotherapy activity (clinical response, pathologic response, mediastinal downstaging). Neoadjuvant docetaxel-cisplatin was effective and tolerable in stage IIIA pN2 NSCLC, with chemotherapy contributing significantly to outcomes.

Multicenter phase II trial of gefitinib first-line therapy followed by chemotherapy in advanced non-small-cell lung cancer (NSCLC): SAKK protocol 19/03

BACKGROUND: Gefitinib is active in patients with pretreated non-small-cell lung cancer (NSCLC). We evaluated the activity and toxicity of gefitinib first-line treatment in advanced NSCLC followed by chemotherapy at disease progression. PATIENTS AND METHODS: In all, 63 patients with chemotherapy-naive stage IIIB/IV NSCLC received gefitinib 250 mg/day. At disease progression, gefitinib was replaced by cisplatin 80 mg/m(2) on day 1 and gemcitabine 1250 mg/m(2) on days 1, 8 for up to six 3-week cycles. Primary end point was the disease stabilization rate (DSR) after 12 weeks of gefitinib. RESULTS: After 12 weeks of gefitinib, the DSR was 24% and the response rate (RR) was 8%. Median time to progression (TtP) was 2.5 months and median overall survival (OS) 11.5 months. Never smokers (n = 9) had a DSR of 56% and a median OS of 20.2 months; patients with epidermal growth factor receptor (EGFR) mutation (n = 4) had a DSR of 75% and the median OS was not reached after the follow-up of 21.6 months. In all, 41 patients received chemotherapy with an overall RR of 34%, DSR of 71% and median TtP of 6.7 months. CONCLUSIONS: First-line gefitinib monotherapy led to a DSR of 24% at 12 weeks in an unselected patients population. Never smokers and patients with EGFR mutations tend to have a better outcome; hence, further trials in selected patients are warranted.

Neoadjuvant chemotherapy and radiotherapy followed by surgery in selected patients with stage IIIB non-small-cell lung cancer: a multicentre phase II trial

BACKGROUND: Stage IIIB non-small-cell lung cancer (NSCLC) is usually thought to be unresectable, and is managed with chemotherapy with or without radiotherapy. However, selected patients might benefit from surgical resection after neoadjuvant chemotherapy and radiotherapy. The aim of this multicentre, phase II trial was to assess the efficacy and toxicity of a neoadjuvant chemotherapy and radiotherapy followed by surgery in patients with technically operable stage IIIB NSCLC. METHODS: Between September, 2001, and May, 2006, patients with pathologically proven and technically resectable stage IIIB NSCLC were sequentially treated with three cycles of neoadjuvant chemotherapy (cisplatin with docetaxel), immediately followed by accelerated concomitant boost radiotherapy (44 Gy in 22 fractions) and definitive surgery. The primary endpoint was event-free survival at 12 months. Efficacy analyses were done by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00030810. FINDINGS: 46 patients were enrolled, with a median age of 60 years (range 28-70). 13 (28%) patients had N3 disease, 36 (78%) had T4 disease. All patients received chemotherapy; 35 (76%) patients received radiotherapy. The main toxicities during chemotherapy were neutropenia (25 patients [54%] at grade 3 or 4) and febrile neutropenia (nine [20%]); the main toxicity after radiotherapy was oesophagitis (ten patients [29%]; nine grade 2, one grade 3). 35 patients (76%) underwent surgery, with pneumonectomy in 17 patients. A complete (R0) resection was achieved in 27 patients. Peri-operative complications occurred in 14 patients, including two deaths (30-day mortality 5.7%). Seven patients required a second surgical intervention. Pathological mediastinal downstaging was seen in 11 of the 28 patients who had lymph-node involvement at enrolment, a complete pathological response was seen in six patients. Event-free survival at 12 months was 54% (95% CI 39-67). After a median follow-up of 58 months, the median overall survival was 29 months (95% CI 16.1-NA), with survival at 1, 3, and 5 years of 67% (95% CI 52-79), 47% (32-61), and 40% (24-55). INTERPRETATION: A treatment strategy of neoadjuvant chemotherapy and radiotherapy followed by surgery is feasible in selected patients. Toxicity is considerable, but manageable. Survival compares favourably with historical results of combined treatment for less advanced stage IIIA disease. FUNDING: Swiss Group for Clinical Cancer Research (SAKK) and an unrestricted educational grant by Sanofi-Aventis (Switzerland).