RAS mutations and cetuximab in locally advanced rectal cancer: results of the EXPERT-C trial.

Background: RAS mutations predict resistance to anti-epidermal growthfactor receptor (EGFR) monoclonal antibodies in metastatic colorectal cancer. We analysed RAS mutations in 30 non-metastatic rectal cancer patients treated with or without cetuximab within the 31 EXPERT-C trial.

Methods: Ninety of 149 patients with tumours available for analysis were KRAS/BRAF wild-type, and randomly assigned to capecitabine plus oxaliplatin (CAPOX) followed by chemoradiotherapy, surgery and adjuvant CAPOX or the same regimen plus cetuximab (CAPOX-C). Of these, four had a mutation of NRAS exon 3, and 84 were retrospectively analysed for additional KRAS (exon 4) and NRAS (exons 2/4) mutations by using bi-directional Sanger sequencing. The effect of cetuximab on study end-points in the RAS wild-type population was analysed.

Results: Eleven (13%) of 84 patients initially classified as KRAS/BRAF wild-type were found to have a mutation in KRAS exon 4 (11%) or NRAS exons 2/4 (2%). Overall, 78/149 (52%) assessable patients were RAS wild-type (CAPOX, n = 40; CAPOX-C, n = 38). In this population, after a median follow-up of 63.8 months, in line with the initial analysis, the addition of cetuximab was associated with numerically higher, but not statistically significant, rates of complete response (15.8% versus 7.5%, p = 0.31), 5-year progression-free survival (75.5% versus 67.5%, hazard ratio (HR) 0.61, p = 0.25) and 5-year overall survival (83.8% versus 70%, HR 0.54, p = 0.20).

Conclusions: RAS mutations beyond KRAS exon 2 and 3 were identified in 17% of locally advanced rectal cancer patients. Given the small sample size, no definitive conclusions on the effect of additional RAS mutations on cetuximab treatment in this setting can be drawn and further investigation of RAS in larger studies is warranted.

Enhancing composite Digital Documents Using XML-based Standoff Markup

Document representations can rapidly become unwieldy if they try to encapsulate all possible document properties, ranging from abstract structure to detailed rendering and layout. We present a composite document approach wherein an XMLbased document representation is linked via a shadow tree of bi-directional pointers to a PDF representation of the same document. Using a two-window viewer any material selected in the PDF can be related back to the corresponding material in the XML, and vice versa. In this way the treatment of specialist material such as mathematics, music or chemistry (e.g. via read aloud or play aloud ) can be activated via standard tools working within the XML representation, rather than requiring that application-specific structures be embedded in the PDF itself. The problems of textual recognition and tree pattern matching between the two representations are discussed in detail. Comparisons are drawn between our use of a shadow tree of pointers to map between document representations and the use of a code-replacement shadow tree in technologies such as XBL.

From the human rights-based approach to an ecological approach on how to achieve successful inclusion in international disability education

The barriers that people with disabilities face around the world are not only inherent to the limitations resulting from the disability itself, but, more importantly, these barriers rest with the societal technologies of exclusion. Using a mixed methodology approach, I conduct a quest to revealing several societal factors that limit full participation of people with disabilities in their communities, which will contribute to understanding and developing a more comprehensive framework for full inclusion of people with disabilities into the society. First, I conduct a multiple regression analysis to seek whether there is a statistical relationship between the national level of development, the level of democratization, and the level of education within a country’s population on one hand, and expressed concern for and preparedness to improve the quality of life for people of disabilities on another hand. The results from the quantitative methodology reveal that people without disabilities are more prepared to take care of people with disabilities when the level of development of the country is higher, when the people have more freedom of expression and hold the government accountable for its actions, and when the level of corruption is under control. However, a greater concern for the well-being of people with disabilities is correlated with a high level of country development, a decreased value of political stability and absence of violence, a decreased level of government effectiveness, and a greater level of law enforcement. None of the dependent variables are significantly correlated with the level of education from a given country. Then, I delve into an interpretive analysis to understand multiple factors that contribute to the construction of attitudes and practices towards people with disabilities. In doing this, I build upon the four main principles outlined by the United Nations as strongly recommended to be embedded in all international programmes: (1) identification of claims of human rights and the corresponding obligations of governments, hence, I assess and analyze disability rights in education, looking at United Nation, United States, and European Union Perspectives Educational Rights Provisions for People with Disabilities (Ch. 3); (2) estimated capacity of individuals to claim their rights and of governments to fulfill their obligations, hence, I look at the people with disabilities as rights-holders and duty-bearers and discuss the importance of investing in special capital in the context of global development (Ch. 4); (3) programmes monitor and evaluate the outcomes and the processes under the auspices of human rights standards, hence, I look at the importance of evaluating the UN World Programme of Action Concerning People with Disabilities from multiple perspectives, as an example of why and how to monitor and evaluate educational human rights outcomes and processes (Ch. 5); and (4) programming should reflect the recommendations of international human rights bodies and mechanisms, hence, I focus on programming that fosters development of the capacity of people with disabilities, that is, planning for an ecology of disabilities and ecoducation for people with disabilities (Ch. 6). Results from both methodologies converge to a certain point, and they further complement each other. One common result for the two methodologies employed is that disability is an evolving concept when viewed in a broader context, which integrates the four spaces that the ecological framework incorporates. Another common result is that factors such as economic, social, legal, political, and natural resources and contexts contribute to the health, education and employment opportunities, and to the overall well-being of people with disabilities. The ecological framework sees all these factors from a meta-systemic perspective, where bi-directional interactions are expected and desired, and also from a human rights point of view, where the inherent value of people is upheld at its highest standard.

Theoretical investigation of intra- and inter-cellular spatiotemporal calcium patterns in microcirculation

Microcirculatory vessels are lined by endothelial cells (ECs) which are surrounded by a single or multiple layer of smooth muscle cells (SMCs). Spontaneous and agonist induced spatiotemporal calcium (Ca2+) events are generated in ECs and SMCs, and regulated by complex bi-directional signaling between the two layers which ultimately determines the vessel tone. The contractile state of microcirculatory vessels is an important factor in the determination of vascular resistance, blood flow and blood pressure. This dissertation presents theoretical insights into some of the important and currently unresolved phenomena in microvascular tone regulation. Compartmental and continuum models of isolated EC and SMC, coupled EC-SMC and a multi-cellular vessel segment with deterministic and stochastic descriptions of the cellular components were developed, and the intra- and inter-cellular spatiotemporal Ca2+ mobilization was examined.^ Coupled EC-SMC model simulations captured the experimentally observed localized subcellular EC Ca2+ events arising from the opening of EC transient receptor vanilloid 4 (TRPV4) channels and inositol triphosphate receptors (IP3Rs). These localized EC Ca2+ events result in endothelium-derived hyperpolarization (EDH) and Nitric Oxide (NO) production which transmit to the adjacent SMCs to ultimately result in vasodilation. The model examined the effect of heterogeneous distribution of cellular components and channel gating kinetics in determination of the amplitude and spread of the Ca2+ events. The simulations suggested the necessity of co-localization of certain cellular components for modulation of EDH and NO responses. Isolated EC and SMC models captured intracellular Ca2+ wave like activity and predicted the necessity of non-uniform distribution of cellular components for the generation of Ca2+ waves. The simulations also suggested the role of membrane potential dynamics in regulating Ca2+ wave velocity. The multi-cellular vessel segment model examined the underlying mechanisms for the intercellular synchronization of spontaneous oscillatory Ca2+ waves in individual SMC. ^ From local subcellular events to integrated macro-scale behavior at the vessel level, the developed multi-scale models captured basic features of vascular Ca2+ signaling and provide insights for their physiological relevance. The models provide a theoretical framework for assisting investigations on the regulation of vascular tone in health and disease.^

School belongingness and mental health functioning across the primary-secondary transition in a mainstream sample: Multi-group cross-lagged analyses

The relationship between school belongingness and mental health functioning before and after the primary-secondary school transition has not been previously investigated in students with and without disabilities. This study used a prospective longitudinal design to test the bi-directional relationships between these constructs, by surveying 266 students with and without disabilities and their parents, 6-months before and after the transition to secondary school. Cross-lagged multi-group analyses found student perception of belongingness in the final year of primary school to contribute to change in their mental health functioning a year later. The beneficial longitudinal effects of school belongingness on subsequent mental health functioning were evident in all student subgroups; even after accounting for prior mental health scores and the cross-time stability in mental health functioning and school belongingness scores. Findings of the current study substantiate the role of school contextual influences on early adolescent mental health functioning. They highlight the importance for primary and secondary schools to assess students' school belongingness and mental health functioning and transfer these records as part of the transition process, so that appropriate scaffolds are in place to support those in need. Longer term longitudinal studies are needed to increase the understanding of the temporal sequencing between school belongingness and mental health functioning of all mainstream students.

Molecular and functional characterization of the interplay between malignant and stromal cells in acute myeloid leukemia and myelodysplastic syndrome

In this thesis, we studied the cross-talk between malignant cells and stromal cells, with the aim to elucidate the respective contribution to myeloid neoplasm onset and progression. First, we characterized and compared mesenchymal stromal cells (MSCs) isolated from myelodysplastic syndrome (MDS-MSCs) and acute myeloid leukemia (AML-MSCs) patients. We demonstrated that, despite some unaltered functions, patient-derived MSCs show also intrinsic, distinct functional abnormalities, which could all potentially favor a leukemia-protective bone marrow (BM) niche in vivo. Second, we investigated the ability of AML cells to modulate the AML-MSC functions. In a GEP-screening, we found that 40% of BM-derived AML samples show a higher IFN-γ expression, compared to the mean IFN-γ expression in healthy BM-derived cells. We demonstrated that in co-culture experiments, IFN-γ+ AML cells modify AML-MSC gene expression and function, inducing the up-regulation of IDO1, and consequently the generation of T regulatory cells. Finally, we wondered if the transcriptome of stromal cells could be influenced by the hematopoietic-specific alterations, i.e. Dnmt3a and Asxl1 mutations, which occur early in MDS/AML patients. We found that Dnmt3a- and Asxl1-null BM cells, when transplanted in wild-type mice, induce profound and deletion-specific modifications in the transcriptome of wild-type BM stromal cells, suggesting the ability of Dnmt3a- and Asxl1-null BM cells to shape the niche. Furthermore, we compared the transcriptome of wild-type BM stromal cells, obtained from transplantation experiments, with that of MSCs isolated from low-risk MDS patients with DNMT3A and ASXL1 mutations, and we highlighted some common modifications, which could be potentially relevant for human disease and specific for DNMT3A/ASXL1 mutations. In conclusion, this thesis pointed out that there is a bi-directional cross-talk, in which stromal cells can influence malignant cells, and in turn malignant/pre-malignant cells can alter stromal cell gene expression and function. Both mechanisms could potentially contribute to the pathogenesis of myeloid malignancies.

Analysis and improvements of four-wire power converters for electric vehicle chargers

A robust and well-distributed backbone charging network is the priority to ensure widespread electrification of road transport, providing a driving experience similar to that of internal combustion engine vehicles. International standards set multiple technical targets for on-board and off-board electric vehicle chargers; output voltage levels, harmonic emissions, and isolation requirements strongly influence the design of power converters. Additionally, smart-grid services such as vehicle-to-grid and vehicle-to-vehicle require the implementation of bi-directional stages that inevitably increase system complexity and component count. To face these design challenges, the present thesis provides a rigorous analysis of four-leg and split-capacitor three-phase four-wire active front-end topologies focusing on the harmonic description under different modulation techniques and conditions. The resulting analytical formulation paves the way for converter performance improvements while maintaining regulatory constraints and technical requirements under control. Specifically, split-capacitor inverter current ripple was characterized as providing closed-form formulations valid for every sub-case ranging from synchronous to interleaved PWM. Outcomes are the base for a novel variable switching PWM technique capable of mediating harmonic content limitation and switching loss reduction. A similar analysis is proposed for four-leg inverters with a broad range of continuous and discontinuous PWM modulations. The general superiority of discontinuous PWM modulation in reducing switching losses and limiting harmonic emission was demonstrated. Developments are realized through a parametric description of the neutral wire inductor. Finally, a novel class of integrated isolated converter topologies is proposed aiming at the neutral wire delivery without employing extra switching components rather than the one already available in typical three-phase inverter and dual-active-bridge back-to-back configurations. The fourth leg was integrated inside the dual-active-bridge input bridge providing relevant component count savings. A novel modified single-phase-shift modulation technique was developed to ensure a seamless transition between working conditions like voltage level and power factor. Several simulations and experiments validate the outcomes.

Optimal energy management of smart households with electric vehicles, energy storage and distributed generation

In this thesis, the optimal operation of a neighborhood of smart households in terms of minimizing the total energy cost is analyzed. Each household may comprise several assets such as electric vehicles, controllable appliances, energy storage and distributed generation. Bi-directional power flow is considered for each household . Apart from the distributed generation unit, technological options such as vehicle-to-home and vehicle-to-grid are available to provide energy to cover self-consumption needs and to export excessive energy to other households, respectively.

Design, fabrication and mechanical characterization of a structural node made using Wire and Arc Additive Manufacturing (WAAM) technology

Additive Manufacturing (AM), also known as “3D printing”, is a recent production technique that allows the creation of three-dimensional elements by depositing multiple layers of material. This technology is widely used in various industrial sectors, such as automotive, aerospace and aviation. With AM, it is possible to produce particularly complex elements for which traditional techniques cannot be used. These technologies are not yet widespread in the civil engineering sector, which is slowly changing thanks to the advantages of AM, such as the possibility of realizing elements without geometric restrictions, with less material usage and a higher efficiency, in particular employing Wire-and-Arc Additive Manufacturing (WAAM) technology. Buildings that benefit most from AM are all those structures designed using form-finding and free-form techniques. These include gridshells, where joints are the most critical and difficult elements to design, as the overall behaviour of the structure depends on them. It must also be considered that, during the design, the engineer must try to minimize the structure's own weight. Self-weight reductions can be achieved by Topological Optimization (TO) of the joint itself, which generates complex geometries that could not be made using traditional techniques. To sum up, weight reductions through TO combined with AM allow for several potential benefits, including economic ones. In this thesis, the roof of the British Museum is considered as a case study, analysing the gridshell structure of which a joint will be chosen to be designed and manufactured, using TO and WAAM techniques. Then, the designed joint will be studied in order to understand its structural behaviour in terms of stiffness and strength. Finally, a printing test will be performed to assess the production feasibility using WAAM technology. The computational design and fabrication stages were carried out at Technische Universität Braunschweig in Germany.

Polarisation mode coupling of excessively tilted fibre Bragg gratings with directional transverse loading

We report a distinctive polarisation mode coupling behaviour of tilted fibre Bragg gratings (TFBGs) with tilted angle exceeding 45°. The ex-45° TFBGs exhibit pronounced polarisation mode splitting resulted from grating structure asymmetry induced birefringence. We have studied and analysed the property of ex-45° TFBGs under transverse load applied to their equivalent fast- and slow-axis. The results show that the coupling between the orthogonally polarised modes takes place only when the load is applied to its fast-axis, giving a prominent directional loading response. This transverse load related polarisation property may be exploitable for implementation of optical fibre vector sensors capable of measuring the magnitude and orientation of the applied transverse load.

Polarisation mode coupling of excessively tilted fibre Bragg gratings with directional transverse loading

We report a distinctive polarisation mode coupling behaviour of tilted fibre Bragg gratings (TFBGs) with tilted angle exceeding 45°. The ex-45° TFBGs exhibit pronounced polarisation mode splitting resulted from grating structure asymmetry induced birefringence. We have studied and analysed the property of ex-45° TFBGs under transverse load applied to their equivalent fast- and slow-axis. The results show that the coupling between the orthogonally polarised modes takes place only when the load is applied to its fast-axis, giving a prominent directional loading response. This transverse load related polarisation property may be exploitable for implementation of optical fibre vector sensors capable of measuring the magnitude and orientation of the applied transverse load.

On the solute coupling at the moving solid/liquid interface during equiaxed solidification

Integral mass conservation was widely accepted for the solute coupling to solve solute redistribution during equiaxed solidification so far. The present study revealed that the integral form was invalid for moving boundary problems as it could not represent the mass balance at the moving interface. Accordingly, differential mass conservation at the solid/liquid interface was used to solve solute diffusion for spherical geometry. The model was applied for hydrogen diffusion in solidification to validate that the hydrogen enrichment was significant and depended on the growth rate. (c) 2006 American Institute of Physics.

Interaction of directional, neuromuscular and egocentric constraints on the stability of preferred bimanual coordination patterns

We investigated how the relative direction of limb movements in external space (iso- and non-isodirectionality), muscular constraints (the relative timing of homologous muscle activation) and the egocentric frame of reference (moving simultaneously toward/away the longitudinal axis of the body) contribute to the stability of coordinated movements. In the first experiment, we attempted to determine the respective stability of isodirectional and non-isodirectional movements in between-persons coordination. In a second experiment, we determined the effect of the relative direction in external space, and of muscular constraints, on pattern stability during a within-person bimanual coordination task. In the third experiment we dissociated the effects on pattern stability of the muscular constraints, relative direction and egocentric frame of reference. The results showed that (1) simultaneous activation of homologous muscles resulted in more stable performance than simultaneous activation of non-homologous muscles during within-subject coordination, and that (2) isodirectional movements were more stable than non-isodirectional movements during between-persons coordination, confirming the role of the relative direction of the moving limbs in the stability of bimanual coordination. Moreover, the egocentric constraint was to some extent found distinguishable from the effect of the relative direction of the moving limbs in external space, and from the effect of the relative timing of muscle activation. In summary, the present study showed that relative direction of the moving limbs in external space and muscular constraints may interact either to stabilize or destabilize coordination patterns. (C) 2003 Published by Elsevier B.V.

Structure and magnetic properties of mono- and bi-dispersed ferrofluids as revealed by simulations

Using a Langevin molecular dynamics simulation, we show that the magnetic properties of a mono- and bi-dispersed ferrofluid system depend on the volume fraction and the dipolar coupling parameter. For the bi-dispersed system, most of the chains are formed by the large particles, but the aggregation behavior of the large particles is hindered by the presence of the small particles, which are predominantly attached to the end of the particle chain. To further elucidate the microscopic fluid structure, anisotropic structure factors are calculated.

New insights on surface-enhanced Raman scattering based on controlled aggregation and spectroscopic studies, DFT calculations and symmetry analysis for 3,6-bi-2-pyridyl-1,2,4,5-tetrazine adsorbed onto citrate-stabilized gold nanoparticles

Asystematic study on the surface-enhanced Raman scattering (SERS) for 3,6-bi-2-pyridyl-1,2,4,5-tetrazine (bptz) adsorbed onto citrate-modified gold nanoparticles (cit-AuNps) was carried out based on electronic and vibrational spectroscopy and density functional methods. The citrate/bptz exchange was carefully controlled by the stepwise addition of bptz to the cit-AuNps, inducing flocculation and leading to the rise of a characteristic plasmon coupling band in the visible region. Such stepwise procedure led to a uniform decrease of the citrate SERS signals and to the rise of characteristic peaks of bptz, consistent with surface binding via the N heterocyclic atoms. In contrast, single addition of a large amount of bptz promoted complete aggregation of the nanoparticles, leading to a strong enhancement of the SERS signals. In this case, from the distinct Raman profiles involved, the formation of a new SERS environment became apparent, conjugating the influence of the local hot spots and charge-transfer (CT) effects. The most strongly enhanced vibrations belong to a(1) and b(2) representations, and were interpreted in terms of the electromagnetic and the CT mechanisms: the latter involving significant contribution of vibronic coupling in the system. Copyright (C) 2010 John Wiley & Sons, Ltd.