Pre-clinical and clinical development of leukemia stem cell inhibitors in acute leukemias

In Leukemias, recent developments have demonstrated that the Hedgehog pathway plays a key-role in the peculiar ability of self renewal of leukemia stem cells. The aim of this research activity was to investigate, through a first in man, Phase I, open label, clinical trial, the role and the impact, mainly in terms of safety profile, adverse events and pharmacokinetics, of a Sonic Hedgehog inhibitor compound on a population of heavely pretreated patients affected by AML, CML, MF, or MDS, resistant or refractory to standard chemotherapy. Thirty-five patients have been enrolled. The drug was administered orally, in 28 days cycles, without rest periods. The compound showed a good safety profile. The half life was of 17-35 hours, justifying the daily administration. Significant signs of activity, in terms of reduction of bone marrow blast cell amount were seen in most of the patients enrolled. Interestingly, correlative biological studies demonstrated that, comparing the gene expression profyiling signature of separated CD34+ cells before and after one cycle of treatment, the most variably expressed genes were involved in the Hh pathway. Moreover, we observed that many genes involved in MDR (multidrug resistance)were significantly down regulated after treatment. These data might lead to future clinical trials based on combinatory approaches, including, for instance, Hh inhibitors and conventional chemotherapy.

Development and evaluation of a 44 Ti, 44 Sc radionuclide generator and labeling of biomolecules with 44 Sc and 68 Ga for PET imaging

Non-invasive molecular-imaging technologies are playing a key role in drug discovery, development and delivery. Positron Emission Tomography (PET) is such a molecular imaging technology and a powerful tool for the observation of various deceases in vivo. However, it is limited by the availability of vectors with high selectivity to the target and radionuclides with a physical half-life which matches the biological half-life of the observed process. The 68Ge/68Ga radionuclide generator makes the PET-nuclide anywhere available without an on-site cyclotron. Besides the perfect availability 68Ga shows well suited nuclide properties for PET, but it has to be co-ordinated by a chelator to introduce it in a radiopharmaceuticals.rnHowever, the physical half-life of 68Ga (67.7 min) might limit the spectrum of clinical applications of 68Ga-labelled radiodiagnostics. Furthermore, 68Ga-labelled analogues of endoradiotherapeuticals of longer biological half-live such as 90Y- or 177Lu-labeled peptides and proteins cannot be used to determine individual radiation dosimetry directly. rnThus, radionuclide generator systems providing positron emitting daughters of extended physical half-life are of renewed interest. In this context, generator-derived positron emitters with longer physical half-life are needed, such as 72As (T½ = 26 h) from the 72Se/72As generator, or 44Sc (T½ = 3.97 h) from the 44Ti/44Sc generator.rnIn this thesis the implementation of radioactive gallium-68 and scandium-44 for molecular imaging and nuclear medical diagnosis, beginning with chemical separation and purification of 44Ti as a radionuclide mother, investigation of pilot generators with different elution mode, building a prototype generator, development and investigation of post-processing of the generator eluate, its concentration and further purification, the labeling chemistry under different conditions, in vitro and in vivo studies of labeled compounds and, finally, in vivo imaging experiments are described.

Efficient certification of feasibility and objective value of linear programs and its applications

The use of linear programming in various areas has increased with the significant improvement of specialized solvers. Linear programs are used as such to model practical problems, or as subroutines in algorithms such as formal proofs or branch-and-cut frameworks. In many situations a certified answer is needed, for example the guarantee that the linear program is feasible or infeasible, or a provably safe bound on its objective value. Most of the available solvers work with floating-point arithmetic and are thus subject to its shortcomings such as rounding errors or underflow, therefore they can deliver incorrect answers. While adequate for some applications, this is unacceptable for critical applications like flight controlling or nuclear plant management due to the potential catastrophic consequences. We propose a method that gives a certified answer whether a linear program is feasible or infeasible, or returns unknown'. The advantage of our method is that it is reasonably fast and rarely answers unknown'. It works by computing a safe solution that is in some way the best possible in the relative interior of the feasible set. To certify the relative interior, we employ exact arithmetic, whose use is nevertheless limited in general to critical places, allowing us to rnremain computationally efficient. Moreover, when certain conditions are fulfilled, our method is able to deliver a provable bound on the objective value of the linear program. We test our algorithm on typical benchmark sets and obtain higher rates of success compared to previous approaches for this problem, while keeping the running times acceptably small. The computed objective value bounds are in most of the cases very close to the known exact objective values. We prove the usability of the method we developed by additionally employing a variant of it in a different scenario, namely to improve the results of a Satisfiability Modulo Theories solver. Our method is used as a black box in the nodes of a branch-and-bound tree to implement conflict learning based on the certificate of infeasibility for linear programs consisting of subsets of linear constraints. The generated conflict clauses are in general small and give good rnprospects for reducing the search space. Compared to other methods we obtain significant improvements in the running time, especially on the large instances.

Speziation von Plutonium bei der Sorption und Diffusion in Opalinuston

Die vorliegende Arbeit wurde im Rahmen des BMWi-Verbundprojektes Wechselwirkung und Transport von Aktiniden im natürlichen Tongestein unter Berücksichtigung von Huminstoffen und Tonorganika – Wechselwirkung von Neptunium und Plutonium mit natürlichem Tongestein“ durchgeführt. Um die langfristige Sicherheit der nuklearen Endlager beurteilen zu können, muss eine mögliche Migration der radiotoxischen Abfälle in die Umwelt betrachtet werden. Wegen seiner langen Halbwertszeit (24000 a) leistet Pu-239 einen wesentlichen Beitrag zur Radiotoxizität abgebrannter Kernbrennstoffe in einem Endlager. Das redox-sensitive Pu tritt in Lösung unter umweltrelevanten Bedingungen in den Oxidationsstufen +III bis +VI auf und kann nebeneinander in bis zu vier Oxidationsstufen vorliegen. Tonsteinformationen werden als mögliches Wirtsgestein für Endlager hoch-radioaktiver Abfälle betrachtet. Deshalb sind ausführliche Informationen zur Mobilisierung und Immobilisierung des Pu durch/in das Grundwasser aus einem Endlager von besonderer Bedeutung. In dieser Arbeit wurden neue Erkenntnisse über die Wechselwirkung zwischen Pu und dem natürlichen Tongestein Opalinuston (OPA, Mont Terri, Schweiz) mit Hinblick auf die Endlagerung wärmeentwickelnder radioaktiver Abfälle in einem geologischen Tiefenlager gewonnen.rnDer Fokus der Arbeit lag dabei auf der Bestimmung der Speziation von Pu an der Mineraloberfläche nach Sorptions- und Diffusionsprozessen mittels verschiedener synchrotronbasierter Methoden (µ-XRF, µ-XANES/EXAFS, µ-XRD, XANES/EXAFS). rnDie Wechselwirkung zwischen Pu und OPA wurde zunächst in Batch- und Diffusionsexperimenten in Abhängigkeit verschiedener experimenteller Parameter (u.a. pH, Pu-Oxidationsstufe) untersucht. In Sorptionsexperimenten konnte gezeigt werden, dass einige Parameter (z.B. Temperatur, Huminsäure) einen deutlichen Einfluss auf die Sorption von Pu haben.rnDie Speziationsuntersuchungen wurden zum einen an Pulverproben aus Batchexperimenten und zum anderen an OPA-Dünnschliffen bzw. Diffusionsproben in Abhängigkeit verschiedener experimenteller Parameter durchgeführt. Die EXAFS-Messungen an der Pu LIII-Kante der Pulverproben ergaben, dass eine innersphäriche Sorption von Pu(IV) an Tongestein unabhängig von dem Ausgangsoxidationszustand des Plutoniums in Lösung stattgefunden hat. Durch die Kombination der ortsaufgelösten Methoden wurde erstmalig mittels μ-XRF die Verteilung von Pu und anderen in OPA enthaltenen Elementen bestimmt. µ-XANES-Spektren an Pu-Anreicherungen auf OPA-Dünnschliffen und in Diffusionsproben bestätigen, dass das weniger mobile Pu(IV) die dominierende Spezies nach den Sorptions- und Diffusionsprozessen ist. Darüber hinaus wurde zum ersten Mal ein Diffusionsprofil von Pu in OPA mittels µ-XRF gemessen. Die Speziationsuntersuchungen mittels μ-XANES zeigten, dass das eingesetzte Pu(V) entlang seines Diffusionspfades zunehmend zu Pu(IV) reduziert wird. Mit µ-XRD wurde Illit als dominierende Umgebung, in der Pu angereichert wurde, identifiziert und Siderit als eine redoxaktive Phase auftreten kann. Die Ergebnisse dieser Arbeit zeigen, dass die Sicherheit von OPA als Wirtsgestein eines Endlagers hoch-radioaktiver Abfälle positiv zu bewerten ist. rn

Value of the SYNTAX score for risk assessment in the all-comers population of the randomized multicenter LEADERS (Limus Eluted from A Durable versus ERodable Stent coating) trial

OBJECTIVES: We aimed to assess the predictive value of the SYNTAX score (SXscore) for major adverse cardiac events in the all-comers population of the LEADERS (Limus Eluted from A Durable versus ERodable Stent coating) trial. BACKGROUND: The SXscore has been shown to be an effective predictor of clinical outcomes in patients with multivessel disease undergoing percutaneous coronary intervention. METHODS: The SXscore was prospectively collected in 1,397 of the 1,707 patients enrolled in the LEADERS trial (patients after surgical revascularization were excluded). Post hoc analysis was performed by stratifying clinical outcomes at 1-year follow-up, according to 1 of 3 SXscore tertiles. RESULTS: The 1,397 patients were divided into tertiles based on the SXscore in the following fashion: SXscore8 and 16 (SXhigh) (n=461). At 1-year follow-up, there was a significantly lower number of patients with major cardiac event-free survival in the highest tertile of SXscore (SXlow=92.2%, SXmid=91.1%, and SXhigh=84.6%; p<0.001). Death occurred in 1.5% of SXlow patients, 2.1% of SXmid patients, and 5.6% of SXhigh patients (hazard ratio [HR]: 1.97, 95% confidence interval [CI]: 1.29 to 3.01; p=0.002). The myocardial infarction rate tended to be higher in the SXhigh group. Target vessel revascularization was 11.3% in the SXhigh group compared with 6.3% and 7.8% in the SXlow and SXmid groups, respectively (HR: 1.38, 95% CI: 1.1 to 1.75; p=0.006). Composite of cardiac death, myocardial infarction, and clinically indicated target vessel revascularization was 7.8%, 8.9%, and 15.4% in the SXlow, SXmid, and SXhigh groups, respectively (HR: 1.47, 95% CI: 1.19 to 1.81; p<0.001). CONCLUSIONS: The SXscore, when applied to an all-comers patient population treated with drug-eluting stents, may allow prospective risk stratification of patients undergoing percutaneous coronary intervention. (LEADERS Trial Limus Eluted From A Durable Versus ERodable Stent Coating; NCT00389220).

Prognostic value of the Geneva prediction rule in patients in whom pulmonary embolism is ruled out

The prognosis of patients in whom pulmonary embolism (PE) is suspected but ruled out is poorly understood. We evaluated whether the initial assessment of clinical probability of PE could help to predict the prognosis for these patients.

Value of the radiolabelled GLP-1 receptor antagonist exendin(9-39) for targeting of GLP-1 receptor-expressing pancreatic tissues in mice and humans

Radiolabelled glucagon-like peptide 1 (GLP-1) receptor agonists have recently been shown to successfully image benign insulinomas in patients. Moreover, it was recently reported that antagonist tracers were superior to agonist tracers for somatostatin and gastrin-releasing peptide receptor targeting of tumours. The present preclinical study determines therefore the value of an established GLP-1 receptor antagonist for the in vitro visualization of GLP-1 receptor-expressing tissues in mice and humans.

Review of Women Elders' Life Stories of the Omaha Tribe: Macy, Nebraska, 2004-2005

The volume contains two analytical chapters, "Finding the Sacred" and "Language as Landscape"; a fair amount of autobiographical material describing Summers's research process; an Omaha Language Pronunciation Guide; selected historical material; and a mixture of photos, including of the author with other Omaha language students. There are a number of editorial malfunctions, including the analytical chapters' tendency to wander around various topics; moreover, the author's role as editor of the firsthand accounts is never made explicit.

Prognostic value of microvascular invasion in predicting the cancer specific survival and risk of metastatic disease in renal cell carcinoma: a multicenter investigation

While microvascular invasion is an accepted risk factor in various cancers, its prognostic role in renal cell carcinoma is still unclear. Therefore, a large multicenter study examining the experience of 5 international institutions was performed to evaluate the prognostic value of microvascular invasion in the occurrence of metastases and cancer specific survival.

The Value of Intuitive Concepts in Evaporation Research

The Evaporative Fraction (EF) and the Complementary Relationship (CR), both extensively explored by Wilfried Brutsaert during his productive career, have elucidated the conceptual understanding of evapotranspiration within hydrological science, despite a lack of rigorous proof of validity of either concept. We briefly review Brutsaert's role in the history of these concepts and discuss their appeal and interrelationship.

Strategies for evaluating the economic value of drugs in alcohol dependence treatment

To assess existing health economic strategies, which are used to evaluate the economic value of drugs to treat alcohol dependence (AD) such as acamprosate, naltrexone and any other pharmaceuticals.