Radiation therapy for Graves' ophthalmopathy: a systematic review and meta-analysis of randomized controlled trials

PURPOSE: To evaluate the efficacy of radiotherapy (RT) with total dose of 20 Gy (RT 20 Gy) in the treatment of Graves' ophthalmopathy. METHODS: A systematic review and meta-analysis of randomized controlled trials was performed comparing RT 20 Gy with or without glucocorticoid to clinical treatments for Graves' ophthalmopathy. The MEDLINE, EMBASE, Cochrane Library databases and recent relevant journals were searched. Relevant reports were reviewed by two reviewers. Response to radiotherapy was defined as clinical success according to each trial. We also evaluated the quality of life and whether RT to produce fewer side effects than other treatments. RESULTS: A total of 8 randomized controlled trials (439 patients) were identified. In the subgroup analysis, the overall response to treatment rates was better for: RT 20 Gy plus glucocorticoid vs glucocorticoids alone, OR=17.5 (CI95% 1.85-250, p=0.04), RT 20 Gy vs sham RT, OR= 3.15 (CI95%1.59-6.23, p=0.003) and RT 20Gy plus intravenous glucocorticoid vs RT 20Gy plus oral glucocorticoid, OR=4.15(CI95% 1.34-12.87, p=0.01). There were no differences between RT 20 Gy versus other fractionations and RT 20 Gy versus glucocorticoid alone. RT 20 Gy with or without glucocorticoids showed an improvement in diplopia grade, visual acuity, optic neuropathy, lid width, proptosis and ocular motility. No difference was seen for costs, intraocular pressure and quality of life. CONCLUSION: Our data have shown that RT 20 Gy should be offered as a valid therapeutic option to patients with moderate to severe ophthalmopathy. The effectiveness of orbital radiotherapy can be increased by the synergistic interaction with glucocorticoids. Moreover, RT 20 Gy is useful to improve a lot of ocular symptoms, excluding intraocular pressure, without any difference in quality of life and costs.

Taxonomical study on a sample of pulmonates from Santa Maria da Vitória, Bahia, Brazil, with description of a new genus and four new species (Mollusca: Orthalicidae and Megalobulimidae)

A sample of Pulmonata collected in Santa Maria da Vitória, interior of Bahia, Brazil, in Caatinga semi-arid environment, is studied taxonomically. From the five species, four are revealed as new, including a new genus. The new taxa are the Bulimulidae (1) Kora corallina gen. et sp. n. characterized by the elongated shell with aperture somewhat dislocated from the shell axis, and an oblique tooth in middle level of inner lip; (2) Spixia coltrorum, mainly characterized by an uneven spire, delicate sculpture and peristome with 4 equidistant teeth; (3) Anostoma tessa, mainly characterized by a broad spire and well-developed anal canal; and the Megalobulimidae (4) Megalobulimus amandus, mainly characterized by pointed protoconch sculptured by dense quantity of axial cords. Rhinus suturalis is the only previously known species, but its geographic distribution is expanded southwards to Bahia state. A discussion with respect to necessity for improving the study on the malacofauna from the interior region of the Brazilian Northeast and the importance for preservation of the Caatinga biome is also provided.

Spatio-temporal and functional structure of the amphipod communities off Santos, Southwestern Atlantic

The amphipod fauna was employed to investigate a bottom environmental gradient in the continental shelf adjacent to Santos Bay. The constant flow of less saline water from the estuarine complex of the Santos and São Vicente rivers besides the seasonal intrusion of the cold saline South Atlantic Central Water (SACW) bring a highly dynamic water regime to the area. Density, distribution, diversity and functional structure of the communities were studied on a depth gradient from 10 to 100 m on two cruises in contrasting seasons, winter 2005 and summer 2006. Twenty-one sediment samples were taken with a 0.09m² box corer. Temperature and salinity were measured at each station and an additional surface sediment sample was obtained with the box corer for granulometric and chemical analyses. Sixty species were collected on each survey and higher density values were found in summer. A priori one-way Analysis of Similarities (ANOSIM) indicated the existence of three different groups of amphipods related to the depth gradient: the Coastal group, the Mixed Zone group and the Deep Zone group. The Coastal Zone in both cruises was inhabited by a community presenting low diversity and density, besides high dominance of the infaunal tube-dweller Ampelisca paria; the area around 30 m presented the highest values of all the ecological indicators and the species showed several life styles; the outer area, situated between 50 and 100 m depth in the SACW domain, presented a community characterized by lower diversity and high biomass and density values. A season-depth ANOSIM showed the influence of depth and season for the Coastal and Mixed Zone groups whereas no seasonal difference was obtained for the Deep Zone group. The synergistic effect of the SACW and depth in the first place, followed by physical changes in substrate, seem to be the main factors controlling the fauna's distribution. In addition, the estuarine waters from Santos Bay apparently had no effect on the establishment of the environmental gradient observed on the adjacent shelf. Diversity, distribution, functional groups and trophic conditions of superficial sediments are discussed in the light of the main oceanographic processes present on the southern Brazilian shelf.

Progetto e realizzazione del sistema di gestione autonoma del volo e controllo in remoto per un velivolo UAV ad ala rotante

This PhD thesis presents the results, achieved at the Aerospace Engineering Department Laboratories of the University of Bologna, concerning the development of a small scale Rotary wing UAVs (RUAVs). In the first part of the work, a mission simulation environment for rotary wing UAVs was developed, as main outcome of the University of Bologna partnership in the CAPECON program (an EU funded research program aimed at studying the UAVs civil applications and economic effectiveness of the potential configuration solutions). The results achieved in cooperation with DLR (German Aerospace Centre) and with an helicopter industrial partners will be described. In the second part of the work, the set-up of a real small scale rotary wing platform was performed. The work was carried out following a series of subsequent logical steps from hardware selection and set-up to final autonomous flight tests. This thesis will focus mainly on the RUAV avionics package set-up, on the onboard software development and final experimental tests. The setup of the electronic package allowed recording of helicopter responses to pilot commands and provided deep insight into the small scale rotorcraft dynamics, facilitating the development of helicopter models and control systems in a Hardware In the Loop (HIL) simulator. A neested PI velocity controller1 was implemented on the onboard computer and autonomous flight tests were performed. Comparison between HIL simulation and experimental results showed good agreement.

Messung der Zerfallsasymmetrien der radiativen Hyperonzerfälle Xi 0 Lambda gamma und Xi 0 Sigma 0 gamma mit dem NA48/1-Experiment

Der radiative Zerfall eines Hyperons in ein leichteres Hyperon und ein Photon erlaubt eine Untersuchung der Struktur der elektroschwachen Wechselwirkung von Hadronen. Dazu wird die Zerfallsasymmetrie $alpha$ betrachtet. Sie beschreibt die Verteilung des Tochterhyperons bezüglich der Polarisation $vec{P}$ des Mutterhyperons mit $dN / d cos(Theta) propto 1 + alpha |vec{P}| cos(Theta)$, wobei $Theta$ der Winkel zwischen $vec{P}$ und dem Impuls des Tochterhyperons ist. Von besonderem Interesse ist der radiative Zerfall $Xi^0 to Lambda gamma$, für den alle Rechnungen auf Quarkniveau eine positive Asymmetrie vorhersagen, wohingegen bisher eine negative Asymmetrie von $alpha_{Lambda gamma} = -0,73 +- 0,17$ gemessen wurde. Ziel dieser Arbeit war es, die bisherigen Messungen zu überprüfen und die Asymmetrie mit einer deutlich höheren Präzision zu bestimmen. Ferner wurden die Zerfallsasymmetrie des radiativen Zerfalls $Xi^0 to Sigma^0 gamma$ ermittelt und zum Test der angewandten Analysemethode der gut bekannte Zerfall $Xi^0 to Lambda pi^0$ herangezogen. Während der Datennahme im Jahr 2002 zeichnete das NA48/1-Experiment am CERN gezielt seltene $K_S$- und Hyperonzerfälle auf. Damit konnte der weltweit größte Datensatz an $Xi^0$-Zerfällen gewonnen werden, aus dem etwa 52.000 $Xi^0 to Lambda gamma$-Zerfälle, 15.000 $Xi^0 to Sigma^0 gamma$-Zerfälle und 4 Mill. $Xi^0 to Lambda pi^0$-Zerfälle mit nur geringem Untergrund extrahiert wurden. Ebenso wurden die entsprechenden $antiXi$-Zerfälle mit etwa einem Zehntel der obigen Ereigniszahlen registriert. Die Bestimmung der Zerfallsasymmetrien erfolgte durch den Vergleich der gemessene Daten mit einer detaillierten Detektorsimulation und führte zu den folgenden Resultaten dieser Arbeit: $alpha_{Lambda gamma} = -0,701 +- 0,019_{stat} +- 0,064_{sys}$, $alpha_{Sigma^0 gamma} = -0,683 +- 0,032_{stat} +- 0,077_{sys}$, $alpha_{Lambda pi^0} = -0,439 +- 0,002_{stat} +- 0,056_{sys}$, $alpha_{antiLambda gamma} = 0,772 +- 0,064_{stat} +- 0,066_{sys}$, $alpha_{antiSigma^0 gamma} = 0,811 +- 0,103_{stat} +- 0,135_{sys}$, $alpha_{antiLambda pi^0} = 0,451 +- 0,005_{stat} +- 0,057_{sys}$. Somit konnte die Unsicherheit der $Xi^0 to Lambda gamma$-Zerfallsasymmetrie auf etwa ein Drittel reduziert werden. Ihr negatives Vorzeichen und damit der Widerspruch zu den Vorhersagen der Quarkmodellrechnungen ist so zweifelsfrei bestätigt. Mit den zum ersten Mal gemessenen $antiXi$-Asymmetrien konnten zusätzlich Grenzen auf eine mögliche CP-Verletzung in den $Xi^0$-Zerfällen, die $alpha_{Xi^0} neq -alpha_{antiXi}$ zur Folge hätte, bestimmt werden.

Santi africani venuti dal mare nell'agiografia campana altomedievale: la Passio s. Prisci e la Vita s. Castrensis tra storia e tradizione letteraria

Utilizzando fonti della più diversa tipologia (liturgiche, agiografiche, storiche, letterarie, archeologiche ed epigrafiche), lo studio condotto sulla Passio s. Prisci e sulla Vita s. Castrensis, entrambe con ogni probabilità composte da monaci benedettini a Capua tra X e XI secolo, si concentra innanzitutto sulle vicende che in quell'arco di tempo resero possibile la permanenza delle comunità di Montecassino e di S. Vincenzo al Volturno nel centro campano e sul riflesso che la loro presenza ebbe sulla vita politica e culturale della città. La Passio s. Prisci acquista una valenza non solo religiosa ma anche politica se messa in relazione con la quasi contemporanea istituzione della metropolia capuana; la Vita s. Castrensis, per la netta prevalenza dell'elemento fantastico e soprannaturale che la caratterizza, appare meno legata alle contingenze storico-politiche e più vicina ai topoi della tradizione agiografica e popolare. I capitoli centrali della tesi sono dedicati alla figura di Quodvultdeus, vescovo cartaginese esiliato dai Vandali nel V secolo, la cui vicenda, narrata da Vittore di Vita nell'Historia persecutionis africanae provinciae ha funto da modello per le agigrafie campane. La ricerca prende dunque in considerazione le fonti letterarie, i ritrovamenti archeologici e le testimonianze epigrafiche che confermerebbero la testimonianza di Vittore, riflettendo inoltre sui rapporti di natura commerciale che nel V secolo intercorsero tra Africa e Campania e sul forte legame esistente, già a partire dal secolo precedente, tra le Chiese delle due regioni, fattori che potrebbero aver facilitato l'arrivo degli esuli cartaginesi a Napoli. L'ultima parte del lavoro è volta a rintracciare le ragioni storiche e letterarie che possono aver spinto gli autori dei testi a trasformare due santi di sicura origine campana in vescovi africani venuti dal mare, favorendo la diffusione del topos nell'agiografia campana medievale.

Preliminary experimental evaluation of the immediate angiographic occlusion time with use of the AMPLATZER vascular plug II for carotid artery occlusion

Delayed occlusion time in parent artery occlusion of brain-supplying vessels might carry risk for thromboembolic complications. Vascular plug devices are successfully used in cardiopulmonary and peripheral interventions to occlude high-flow lesions and have been adapted for use in neurointerventions. The purpose of the present study was to experimentally evaluate the immediate occlusion time of the AMPLATZER vascular plug (AVP) II-a second-generation cylindrical, self-expandable, resheathable nitinol wire mesh consisting of three lobes-in the carotid artery.

Work-related behavior and experience patterns and predictors of mental health in German physicians in medical practice

Background and Objectives: Work-related stress and burnout among physicians are of increasing relevance. The aim of this study was to investigate work-related behavior and experience patterns and predictors of mental health of physicians working in medical practice in Germany. Methods: We surveyed a stratified, random sample of 900 physicians from different specialties. The questionnaire included the standardized instruments Work-related Behavior and Experience Pattern (AVEM) and the Short Form-12 Health Survey (SF-12). Results: Only one third of physicians reported high or very high general satisfaction with their job, but 64% would choose to study medicine again. Only 18% of physicians presented a healthy behavior and experience pattern. Almost 40% presented a pattern of reduced motivation to work, 21% were at risk of overexertion, and 22% at risk for burnout. Willingness to study medicine again, fulfilled job expectations, professional years, marital status, and behavior patterns were significant predictors of mental health and accounted for 35.6% of the variance in mental health scores. Job-related perceptions also had a significant effect on burnout. Conclusions: The strong influence of work-related perceptions suggests a need for realistic expectation management in medical education, as well as support in stress management and coping strategies during medical training.