Il Nilotinib nella terapia di prima linea della leucemia mieloide cronica

Background: Nilotinib is a potent and selective BCR-ABL inhibitor. The phase 3 ENESTnd trial demonstrated superior efficacy nilotinib vs imatinib, with higher and faster molecular responses. After 24 months, the rates of progression to accelerated-blastic phase (ABP) were 0.7% and 1.1% with nilotinib 300mg and 400mg BID, respectively, significantly lower compared to imatinib (4.2%). Nilotinib has been approved for the frontline treatment of Ph+ CML. With imatinib 400mg (IRIS trial), the rate of any event and of progression to ABP were higher during the first 3 years. Consequently, a confirmation of the durability of responses to nilotinib beyond 3 years is extremely important. Aims: To evaluate the response and the outcome of patients treated for 3 years with nilotinib 400mg BID as frontline therapy. Methods: A multicentre phase 2 trial was conducted by the GIMEMA CML WP (ClinicalTrials.gov.NCT00481052). Minimum 36-month follow-up data for all patients will be presented. Definitions: Major Molecular Response (MMR): BCR-ABL/ABL ratio <0,1%IS; Complete Molecular Response (CMR): undetectable transcript levels with ≥10,000 ABL transcripts; failures: according to the revised ELN recommendations; events: failures and treatment discontinuation for any reason. All the analysis has been made according to the intention-to-treat principle. Results: 73 patients enrolled: median age 51 years; 45% low, 41% intermediate and 14% high Sokal risk. The cumulative incidence of CCgR at 12 months was 100%. CCgR at each milestone: 78%, 96%, 96%, 95%, 92% at 3, 6, 12, 18 and 24 months, respectively. The overall estimated probability of MMR was 97%, while the rates of MMR at 3, 6, 12, 18 and 24 months were 52%, 66%, 85%, 81% and 82%, respectively. The overall estimated probability of CMR was 79%, while the rates of CMR at 12 and 24 months were 12% and 27%, respectively. No patient achieving a MMR progressed to AP. Only one patient progressed at 6 months to ABP and subsequently died (high Sokal risk, T315I mutation). Adverse events were mostly grade 1 or 2 and manageable with appropriate dose adaptations. During the first 12 months, the mean daily dose was 600-800mg in 74% of patients. The nilotinib last daily dose was as follows: 800mg in 46 (63%) patients, 600mg in 3 (4%) patients and 400mg in 18 (25%), 6 permanent discontinuations. Detail of discontinuation: 1 patient progressed to ABP; 3 patients had recurrent episodes of amylase and/or lipase increase (no pancreatitis); 1 patient had atrial fibrillation (unrelated to study drug) and 1 patient died after 32 months of mental deterioration and starvation (unrelated to study drug). Two patients are currently on imatinib second-line and 2 on dasatinib third-line. With a median follow-up of 39 months, the estimated probability of overall survival, progression-free survival and failure-free survival was 97%, the estimated probability of event-free survival was 91%. Conclusions: The rate of failures was very low during the first 3 years. Responses remain stable. The high rates of responses achieved during the first 12 months are being translated into optimal outcome for most of patients.

Analisi critica di modelli previsionali per le frane in Emilia Romagna

Questa tesi di dottorato è inserita nell’ambito della convenzione tra ARPA_SIMC (che è l’Ente finanziatore), l’Agenzia Regionale di Protezione Civile ed il Dipartimento di Scienze della Terra e Geologico - Ambientali dell’Ateneo di Bologna. L’obiettivo principale è la determinazione di possibili soglie pluviometriche di innesco per i fenomeni franosi in Emilia Romagna che possano essere utilizzate come strumento di supporto previsionale in sala operativa di Protezione Civile. In un contesto geologico così complesso, un approccio empirico tradizionale non è sufficiente per discriminare in modo univoco tra eventi meteo innescanti e non, ed in generale la distribuzione dei dati appare troppo dispersa per poter tracciare una soglia statisticamente significativa. È stato quindi deciso di applicare il rigoroso approccio statistico Bayesiano, innovativo poiché calcola la probabilità di frana dato un certo evento di pioggia (P(A|B)) , considerando non solo le precipitazioni innescanti frane (quindi la probabilità condizionata di avere un certo evento di precipitazione data l’occorrenza di frana, P(B|A)), ma anche le precipitazioni non innescanti (quindi la probabilità a priori di un evento di pioggia, P(A)). L’approccio Bayesiano è stato applicato all’intervallo temporale compreso tra il 1939 ed il 2009. Le isolinee di probabilità ottenute minimizzano i falsi allarmi e sono facilmente implementabili in un sistema di allertamento regionale, ma possono presentare limiti previsionali per fenomeni non rappresentati nel dataset storico o che avvengono in condizioni anomale. Ne sono esempio le frane superficiali con evoluzione in debris flows, estremamente rare negli ultimi 70 anni, ma con frequenza recentemente in aumento. Si è cercato di affrontare questo problema testando la variabilità previsionale di alcuni modelli fisicamente basati appositamente sviluppati a questo scopo, tra cui X – SLIP (Montrasio et al., 1998), SHALSTAB (SHALlow STABility model, Montgomery & Dietrich, 1994), Iverson (2000), TRIGRS 1.0 (Baum et al., 2002), TRIGRS 2.0 (Baum et al., 2008).

Studi su Cimone. Saggio di storia greca, ca. 478-461 a.C.

La monografia propone un’analisi del periodo ca. 478-461 a.C. della storia ateniese e delle vicende di Cimone figlio di Milziade entro il contesto contemporaneo. Lo studio dell’Atene, e più in generale di varie realtà elleniche affacciate sull’Egeo, negli immediati anni ‘post-persiani’ si articola in due parti: la prima ripercorre in senso cronologico le notizie, essenzialmente letterarie, disponibili in merito alle attività politiche e militari di Atene, quale guida dell’alleanza greca; la seconda trae conclusioni di respiro più ampio, fondate sull’analisi precedente, e cerca una sintesi del periodo e del personaggio nel superamento di stereotipi e condizionamenti letterari. In tale ottica si esprime una riflessione, a partire dalla scarna trattazione tucididea, sui meccanismi attraverso i quali la tradizione ha deformato e sedimentato le informazioni disponibili generando un progressivo arricchimento che ha portato alla definizione, di fatto, di una ‘era cimoniana’ che è possibile mettere in discussione in alcuni tratti essenziali. Si mira dunque a proporre una valutazione del periodo priva di alcuni elementi, in ultimo evidenti soprattutto nell’approccio plutarcheo alla materia, che appaiono alieni al contesto di riferimento per la prima parte del V secolo: i temi principali ai quali si dedica la riflessione sono quelli dell’imperialismo ateniese, del filolaconismo, della bipolarità tra democrazia e oligarchia, della propaganda politico-mitologica. Il rapporto di Atene con Sparta, con gli Ioni e con le altre realtà del mondo egeo viene letto alla luce degli indizi disponibili sul clima di incertezza e di delicati equilibri creatosi all’indomani della ritirata delle forze persiane. Il ritratto di Cimone che si propone è quello di una figura indubbiamente significativa nella politica contemporanea ma, al contempo, fortemente condizionata e talora adombrata da dinamiche in qualche modo condivise all’interno dello scenario politico ateniese, improntato alla soddisfazione di necessità e volontà che la tradizione renderà archetipiche del paradigma democratico.

Toward a Magnitude Scale for Low Frequency Seismicity The LP energy for Campi Flegrei caldera

The energy released during a seismic crisis in volcanic areas is strictly related to the physical processes in the volcanic structure. In particular Long Period seismicity, that seems to be related to the oscillation of a fluid-filled crack (Chouet , 1996, Chouet, 2003, McNutt, 2005), can precedes or accompanies an eruption. The present doctoral thesis is focused on the study of the LP seismicity recorded in the Campi Flegrei volcano (Campania, Italy) during the October 2006 crisis. Campi Flegrei Caldera is an active caldera; the combination of an active magmatic system and a dense populated area make the Campi Flegrei a critical volcano. The source dynamic of LP seismicity is thought to be very different from the other kind of seismicity ( Tectonic or Volcano Tectonic): it’s characterized by a time sustained source and a low content in frequency. This features implies that the duration–magnitude, that is commonly used for VT events and sometimes for LPs as well, is unadapted for LP magnitude evaluation. The main goal of this doctoral work was to develop a method for the determination of the magnitude for the LP seismicity; it’s based on the comparison of the energy of VT event and LP event, linking the energy to the VT moment magnitude. So the magnitude of the LP event would be the moment magnitude of a VT event with the same energy of the LP. We applied this method to the LP data-set recorded at Campi Flegrei caldera in 2006, to an LP data-set of Colima volcano recorded in 2005 – 2006 and for an event recorded at Etna volcano. Experimenting this method to lots of waveforms recorded at different volcanoes we tested its easy applicability and consequently its usefulness in the routinely and in the quasi-real time work of a volcanological observatory.

Not in the Legends

In writing “Not in the Legends”, one of the images and concepts which constantly returned was that of pilgrimage. I began to write these poems while studying abroad in London, after having passed the previous semester in France and travelling around Europe. There was something in the repetition of sightseeing— walking six miles in Luxembourg to see the grave of General Patton, taking photographs of the apartment where Sylvia Plath ended her life, bowing before the bones of saints, searching through Père Lachaise for the grave of Théodore Gericault— which struck me as numinous and morbid. At the same time, I came to love living abroad and I grew discontent with both remaining and returning. I wanted the opportunity to live everywhere all the time and not have to choose between home and away. Returning from abroad, I turned my attention to the landscape of my native country. I found in the New England pilgrims a narrative of people who had left their home in search of growth and freedom. In these journeys I began to appreciate the significance of place and tried to understand what it meant to move from one place to another, how one chose a home, and why people searched for meaning in specific locations. The processes of moving from student to worker and from childhood to adulthood have weighed on me. I began to see these transitions towards maturity as travels to a different land. Memory and nostalgia are their own types of pilgrimage in their attempts to return to lost places, as is the reading of literature. These pilgrimages, real and metaphorical, form the thematic core of the collection. I read the work of many poets who came before me, returning to the places where the Canon was forged. Those poets have a large presence in the work I produced. I wondered how I, as a young poet, could earn my own place in the tradition and sought models in much the same way a painter studies the brushstrokes of a master. In the process, I have tried to uncover what it means to be a poet. Is it something like being a saint? Is it something like being a colonist? Or is to be the one who goes in search of saints and colonists? In trying to measure my own life and work based on the precedent, I have questioned what role era and generation have on the formation of identity. I focused my reading heavily on the early years of English poetry, trying to find the essence of the time when the language first achieved the transcendence of verse. In following the development of English poetry through Coleridge, John Berryman, and Allison Titus, I have explored the progression of those basic virtues in changing contexts. Those bearings, applied to my modern context, helped to shape the poetry I produced. Many of the poems in “Not in the Legends” are based on my own personal experience. In my recollections I have tried to interrogate nostalgia rather than falling into mere reminiscence. Rather than allowing myself poems of love and longing, I have tried to find the meaning of those emotions. A dominant conflict exists between adventure and comfort which mirrors the central engagement with the nature of being “here” or “there”. It is found in scenes of domesticity and wilderness as I attempt to understand my own simultaneous desire for both. For example, in “Canned Mangoes…” the intrusion of nature, even in a context as innocuous as a poem by Sir Walter Raleigh, unravels ordinary comforts of the domestic sphere. The character of “The Boy” from Samuel Beckett’s Waiting for Godot proved such an interesting subject for me because he is one who can transcend the normal boundaries of time and place. The title suggests connections to both place and time. “Legends” features the dual meaning of both myths and the keys to maps. To propose something “Not in the Legends” is to find something which has no precedent in our histories and our geographies, something beyond our field of knowledge and wholly new. One possible interpretation I devised was that each new generation lives a novel existence, the future being the true locus of that which is beyond our understanding. The title comes from Keats’ “Hyperion, a Fragment”, and details the aftermath of the Titanomachy. The Titans, having fallen to the Olympians, are a representation of the passing of one generation for the next. Their dejection is expressed by Saturn, who laments: Not in my own sad breast, Which is its own great judge and searcher out, Can I find reason why ye should be thus: Not in the legends of the first of days… (129-132) The emotions of the conquered Titans are unique and without antecedent. They are experiencing feelings which surpass all others in history. In this, they are the equivalent of the poet who feels that his or her own sufferings are special. In contrast are Whitman’s lines from “Song of Myself” which serve as an epigraph to this collection. He contends for a sense of continuity across time, a realization that youth, age, pleasure, and suffering have always existed and will always exist. Whitman finds consolation in this unity, accepting that kinship with past generations is more important that his own individuality. These opposing views offer two methods of presenting the self in history. The instinct of poetry suggests election. The poet writes because he feels his experiences are special, or because he believes he can serve as a synecdoche for everyone. I have fought this instinct by trying to contextualize myself in history. These poems serve as an attempt at prosopography with my own narrative a piece of the whole. Because the earth abides forever, our new stories get printed over the locations of the old and every place becomes a palimpsest of lives and acts. In this collection I have tried to untangle some of those layers, especially my own, to better understand the sprawling legend of history.

Life Events and Interdependent Lives: Implications for Research and Intervention

The central thesis of this article is that a single life event has the capacity to affect and change not one but several lives. This thesis is related to theory on attachment, roles, and convoys. The concept of life-event webs is introduced to capture the complex relations between individuals within networks such as families. Research challenges presented by the life-event web perspective include defining networks, assessing the impact of events on each member, and treating the web, not the individual, as the unit of analysis. The web perspective implies that intervention programs should be focused not on the individual but on the web.

Herpes-simplex virus encephalitis is characterized by an early MMP-9 increase and collagen type IV degradation

Cerebrovascular complications including cerebral edema, raised intracranial pressure and hemorrhage contribute to the high mortality and morbidity of herpes-simplex virus encephalitis (HSE). We examined changes of collagen type IV, the major constituent of the neurovascular matrix, together with expression and localization of matrix-degrading enzymes during the development of acute HSE. In an experimental model of focal HSE, we found that early, symptomatic HSE (3 days after infection) and acute, fully developed HSE (7 days after infection) are associated with significantly raised levels of matrix-metalloproteinase-9 (MMP-9) (both P<0.05). In situ zymography of brain sections revealed that the increase of MMP-9 was restricted to the cerebral vasculature in early HSE and further expanded towards the perivascular space and adjacent tissue in acute HSE. Around the cerebral vasculature, we observed that MMP-9 activity was insufficiently counterbalanced by its endogenous tissue inhibitor of MMP (TIMP) TIMP-1, resulting in loss of collagen type IV. Our findings suggest that MMP-9 is involved in the evolution of HSE by causing damage to the cerebral vasculature. The degradation of the neurovascular matrix in HSE facilitates the development of cerebrovascular complications and may represent a target for novel adjuvant treatment strategies.

Myocardial infarction and post-traumatic stress disorder: frequency, outcome, and atherosclerotic mechanisms

BACKGROUND: Post-traumatic stress disorder (PTSD) may develop in the aftermath of an acute myocardial infarction (MI). Whether PTSD is a risk factor for cardiovascular disease (CVD) is elusive. The biological mechanisms linking PTSD with atherosclerosis are unclear. DESIGN: A critical review of 31 studies in the English language pursuing three aims: (i) to estimate the prevalence of PTSD in post-MI patients; (ii) to investigate the association of PTSD with cardiovascular endpoints; and (iii) to search for low-grade systemic inflammatory changes in PTSD pertinent to atherosclerosis. METHODS: We located studies by PubMed electronic library search and through checking the bibliographies of these sources. RESULTS: The weighted prevalence of PTSD after MI was 14.7% (range 0-25%; a total of 13 studies and 827 post-MI patients). Two studies reported a prospective association between PTSD and an increased risk of cardiovascular readmission in post-MI patients and of cardiovascular mortality in combat veterans, respectively. In a total of 11 studies, patients with PTSD had increased rates of physician-rated and self-reported cardiovascular diseases. Various cytokines and C-reactive protein were investigated in a total of seven studies suggesting that PTSD confers a pro-inflammatory state. CONCLUSIONS: Increasing evidence suggests that PTSD specifically related to MI develops considerably frequently in post-MI patients. More research is needed in larger cohorts applying a population design to substantiate findings suggesting PTSD is an atherogenic risk factor and to understand better the suspected behavioural and biological mechanisms involved.

Analyzing Panel Count Data with Informative Observation Times

In this paper, we study panel count data with informative observation times. We assume nonparametric and semiparametric proportional rate models for the underlying recurrent event process, where the form of the baseline rate function is left unspecified and a subject-specific frailty variable inflates or deflates the rate function multiplicatively. The proposed models allow the recurrent event processes and observation times to be correlated through their connections with the unobserved frailty; moreover, the distributions of both the frailty variable and observation times are considered as nuisance parameters. The baseline rate function and the regression parameters are estimated by maximizing a conditional likelihood function of observed event counts and solving estimation equations. Large sample properties of the proposed estimators are studied. Numerical studies demonstrate that the proposed estimation procedures perform well for moderate sample sizes. An application to a bladder tumor study is presented to illustrate the use of the proposed methods.

Thrombosis and drug-eluting stents: an objective appraisal

Stent thrombosis (ST) after percutaneous coronary intervention has been the focus of intense interest because of its attendant morbidity and mortality. There is controversy about several facets of the problem. These include the frequency of ST with drug-eluting stents (DES) versus bare-metal stents (BMS), the timing of the event, clinical consequences, risk factors, adjunctive therapy, and new preventive approaches. Information has accrued rapidly from several sources, including randomized controlled clinical trials of DES versus BMS in carefully selected subsets of patients and registry experiences in larger patient groups, which provide a more universal real-world picture. The results from these different data sets are not completely concordant. However, several general conclusions can be made: 1) ST is an infrequent but very severe complication of both BMS and DES; 2) at the present time, during 4 years of follow-up from randomized controlled trials that compared DES and BMS, there is no apparent difference in overall ST frequency, although the time course for occurrence appears to differ, with a relative numeric excess of ST late after DES implant; 3) despite this relative imbalance, no differences in the end points of death or death and infarction between DES and BMS are observed; 4) longer-term follow-up of these patients as well as larger angiographic and clinical subsets of patients who receive this technology outside of randomized trials are required to fully study this issue; and 5) advances in stent platforms for drug elution as well as adjunctive pharmacologic therapy are being evaluated to enhance long-term safety.

Wind plant interaction with series-compensated power systems

Wind power based generation has been rapidly growing world-wide during the recent past. In order to transmit large amounts of wind power over long distances, system planners may often add series compensation to existing transmission lines owing to several benefits such as improved steady-state power transfer limit, improved transient stability, and efficient utilization of transmission infrastructure. Application of series capacitors has posed resonant interaction concerns such as through subsynchronous resonance (SSR) with conventional turbine-generators. Wind turbine-generators may also be susceptible to such resonant interactions. However, not much information is available in literature and even engineering standards are yet to address these issues. The motivation problem for this research is based on an actual system switching event that resulted in undamped oscillations in a 345-kV series-compensated, typical ring-bus power system configuration. Based on time-domain ATP (Alternative Transients Program) modeling, simulations and analysis of system event records, the occurrence of subsynchronous interactions within the existing 345-kV series-compensated power system has been investigated. Effects of various small-signal and large-signal power system disturbances with both identical and non-identical wind turbine parameters (such as with a statistical-spread) has been evaluated. Effect of parameter variations on subsynchronous oscillations has been quantified using 3D-DFT plots and the oscillations have been identified as due to electrical self-excitation effects, rather than torsional interaction. Further, the generator no-load reactance and the rotor-side converter inner-loop controller gains have been identified as bearing maximum sensitivity to either damping or exacerbating the self-excited oscillations. A higher-order spectral analysis method based on modified Prony estimation has been successfully applied to the field records identifying dominant 9.79 Hz subsynchronous oscillations. Recommendations have been made for exploring countermeasures.

Lifestyle and stroke risk: a review

PURPOSE OF REVIEW: In recent years, many epidemiological studies have given new insights into old and new lifestyle factors that influence the risk of cerebrovascular events. In this review, we refer to the most important articles to highlight recent advances, especially those important for stroke prevention. RECENT FINDINGS: This review focuses on the most recent studies that show the association of environmental factors, nutrition, alcohol, tobacco, education, lifestyle and behavior with the risk of vascular disease, including ischemic stroke and cerebral hemorrhage. The link between air pollution and stroke risk has become evident. Low education levels and depression are established as risk factors. This is also true for heavy alcohol consumption, although moderate drinking may be protective. Active and passive smoking are independent risk factors, and a smoking ban in public places has already reduced cardiovascular events in the short term. Physical activity reduces stroke risk; overweight increases it. However, clinical trials to assess the effect of weight reduction on stroke risk are still lacking. Fruits, vegetables, fish, fibers, low-fat dairy products, potassium and low sodium consumption are known and recommended to reduce cardiovascular risk. Data on omega 3 fatty acid, folic acid and B vitamins are inconsistent, and antioxidants are not recommended. SUMMARY: Stroke can be substantially reduced by an active lifestyle, cessation of smoking and a healthy diet. Both public and professional education should promote the awareness that a healthy lifestyle and nutrition have the potential to reduce the burden of stroke.

Integriertes Informationsmanagement für Bildungseinrichtungen

Der CampusSource Workshop fand vom 10. bis 12. Oktober 2006 an der Westfälischen Wilhelms Universität (WWU) in Münster statt. Kernpunkte der Veranstaltung waren die Entwicklung einer Engine zur Verknüpfung von e-Learning Anwendungen mit Systemen der HIS GmbH und die Erstellung von Lehr- und Lerninhalten mit dem Ziel der Wiederverwendung. Im zweiten Kapitel sind Vorträge der Veranstaltung im Adobe Flash Format zusammengetragen. Zur Betrachtung der Vorträge ist der Adobe Flash Player, mindestens in der Version 6 erforderlich

Hemispheric lateralization patterns and psychotic experiences in healthy subjects

The hypothesis that psychotic experiences in healthy subjects are associated with a dysfunction of the right hemisphere is supported by some, but not all, available studies. Differences in gender composition of study samples may explain in part the divergent findings. The present study was carried out in 42 healthy, right-handed university students. Scores on the Schizophrenia and Paranoia scales of the Minnesota Multidimensional Personality Inventory-2 were used in correlation analyses and to define a High- and a Low-Psychotic group. Brain Electrical Microstates and Low Resolution Electromagnetic Tomography (LORETA) source analyses of the auditory P300 (P3a and P3b) components of the event-related potential, as well as a battery of neuropsychological tests, were used to assess hemispheric functioning. Scores on the Paranoia scale were positively associated with a leftward shift of the P3a topographic descriptors in females but not in males. When comparing High-Psychotic and Low-Psychotic females, a leftward shift of P3a descriptors and an increased cortical activation in left fronto-temporal areas were observed in the High-Psychotic group. Our results demonstrated gender-related differences in the pattern of hemispheric imbalance associated with psychotic experiences in healthy subjects.

Faces and emotions: brain electric field sources during covert emotional processing

Covert brain activity related to task-free, spontaneous (i.e. unrequested), emotional evaluation of human face images was analysed in 27-channel averaged event-related potential (ERP) map series recorded from 18 healthy subjects while observing random sequences of face images without further instructions. After recording, subjects self-rated each face image on a scale from “liked” to “disliked”. These ratings were used to dichotomize the face images into the affective evaluation categories of “liked” and “disliked” for each subject and the subjects into the affective attitudes of “philanthropists” and “misanthropists” (depending on their mean rating across images). Event-related map series were averaged for “liked” and “disliked” face images and for “philanthropists” and “misanthropists”. The spatial configuration (landscape) of the electric field maps was assessed numerically by the electric gravity center, a conservative estimate of the mean location of all intracerebral, active, electric sources. Differences in electric gravity center location indicate activity of different neuronal populations. The electric gravity center locations of all event-related maps were averaged over the entire stimulus-on time (450 ms). The mean electric gravity center for disliked faces was located (significant across subjects) more to the right and somewhat more posterior than for liked faces. Similar differences were found between the mean electric gravity centers of misanthropists (more right and posterior) and philanthropists. Our neurophysiological findings are in line with neuropsychological findings, revealing visual emotional processing to depend on affective evaluation category and affective attitude, and extending the conclusions to a paradigm without directed task.