Science.gov

Sample records for gruppo abeliano senza

  1. Pharmacosurveillance in hospitalized patients in Italy. Study design of the 'Gruppo Italiano di Farmacovigilanza nell'Anziano' (GIFA).

    PubMed

    Carosella, L; Pahor, M; Pedone, C; Zuccalà, G; Manto, A; Carbonin, P

    1999-09-01

    The Italian Group of Pharmacoepidemiology in the Elderly (Gruppo Italiano di Farmacovigilanza nell'Anziano, GIFA) is a collaborative pharmacosurveillance study in hospitalized patients, sponsored by the Italian National Research Council (CNR) and the Italian Society of Gerontology and Geriatrics. It was founded in 1987 with the aim to constitute a multicentre research group to study quality of care and problems related to pharmacological therapy in the elderly. Until now the GIFA study has completed seven periodical surveys and enrolled a total of 28,411 hospitalized patients in 83 clinical centres. The database of the study contains approximately 174,000 in-hospital drug prescriptions, approximately 88,000 discharge diagnoses and a great deal of data on topical geriatric items such as cognitive performance, disability, comorbidity, adverse drug reactions and incontinence. This paper describes the general organization and the methods of the GIFA study and shows in detail the type of data collected. PMID:10479475

  2. Real-life use of erythropoiesis-stimulating agents in myelodysplastic syndromes: a "Gruppo Romano Mielodisplasie (GROM)" multicenter study.

    PubMed

    Buccisano, Francesco; Piccioni, Anna Lina; Nobile, Carolina; Criscuolo, Marianna; Niscola, Pasquale; Tatarelli, Caterina; Fianchi, Luana; Villivà, Nicoletta; Neri, Benedetta; Carmosino, Ida; Gumenyuk, Svitlana; Mancini, Stefano; Voso, Maria Teresa; Maurillo, Luca; Breccia, Massimo; Zini, Gina; Venditti, Adriano; Fenu, Susanna; Spiriti, Maria Antonietta Aloe; Latagliata, Roberto

    2016-06-01

    The Gruppo Romano Mielodisplasie (GROM) conducted a retrospective study in 543 patients with myelodysplastic syndromes (MDS) to evaluate the safety and efficacy of erythropoiesis-stimulating agents (ESAs) in "real-life" clinical practice. The 40.000-UI/week erythropoietin (EPO)-alpha and 30.000-UI/week EPO-beta starting dose were defined "standard," and 80,000 UI/week EPO-alpha and 60.000 UI/week EPO-beta were defined "high." Response was defined according to International Working Group (IWG) 2006 criteria. At ESA's start, median age was 74.2 years (interquartile range (IR) 67.8-79.5) and median hemoglobin was 8.9 g/dl (IR 8.2-9.6). Median time from diagnosis to ESAs start was 3.8 months (IR 0.8-13.2). ESA starting dose was "standard" in 361 patients (66.5 %) and "high" in 182 patients (33.5 %). Erythroid response was observed in 82/185 (44.3 %) transfusion dependent (TD) patients as compared with 226/329 (68.6 %) transfusion independent (TI) ones (p < 0.001). At multivariate analysis, in TD patients, only endogenous EPO levels <50 mU/l were significant (p = 0.046), whereas in TI patients, high-dose ESAs (p < 0.001), abnormal creatinine levels (0.009), and endogenous EPO levels <50 mU/l (p = 0.014) were predictors of response. Responders showed a higher 5-year overall survival (OS) (57.8 vs. 32.2 %, p < 0.001) and leukemia-free survival (76.0 vs. 49.8 %, p < 0.001). At multivariable analysis for OS, response to ESA, low International Prognostic Scoring System (IPSS), no transfusion need, and female sex showed an independent favorable prognostic role. Our results confirm that treatment with ESAs is effective in a real-life MDS setting, particularly at high dose and in TI patients. Prospective studies are needed to define the optimal starting dose. PMID:27091349

  3. Heterogeneity in the therapeutic approach to relapsed elderly patients with acute myeloid leukaemia: a survey from the Gruppo Italiano Malattie Ematologiche dell' Adulto (GIMEMA) Acute Leukaemia Working Party.

    PubMed

    Ferrara, Felicetto; Fazi, Paola; Venditti, Adriano; Pagano, Livio; Amadori, Sergio; Mandelli, Franco

    2008-06-01

    The percentage of long-term survivors in acute myeloid leukaemia (AML) in the elderly does not exceed 10-15% of patients enrolled into clinical trials because of lower complete remission (CR) rates and higher incidence of relapse. However, few data are available as the treatment of elderly patients with relapsed disease is concerned. The aim of this study was of collecting data on criteria adopted for the treatment of these patients. A questionnaire was e-mailed to 32 haematologic institutions involved in the Gruppo Italiano per le Malattie Ematologiche dell'Adulto (GIMEMA) group. Questions to be addressed regarded: (1) per cent of relapsed elderly patients treated with aggressive salvage chemotherapy; (2) the selection criteria adopted for inclusion into intensive reinduction; (3) the specific treatment adopted; (4) the treatment given to patients not eligible for intensive salvage. Per cent of patients enrolled into aggressive salvage regimens varied from 10 to 80% (median 50%). The most frequent factor influencing the therapeutic choice was performance status (97%). Additional factors were age >70 years (44%) and duration of first CR (53%). Fludarabine including regimens were most frequently used as aggressive salvage therapy (59%), while gemtuzumab ozogamicin was adopted in various combinations at 11 out of 32 institutions (34%). For patients not eligible to aggressive therapy, the most frequent approach included hydroxyurea (59%). Low dose ARA-C (LDARA-C) was adopted at five centres: as single agent (n = 1), with 6-thioguanine (n = 1), with vitamin D3 and all-trans retinoic acid (ATRA) (n = 2), or with ATRA alone (n = 1). The FLT3 inhibitor CEP-701 was used at one centre. We conclude that the treatment of AML in elderly relapsed patients is extremely heterogeneous. A marked selection is operated as to inclusion into aggressive salvage regimens and only a small minority of patients are offered experimental approaches. PMID:18271064

  4. Incidence and outcome of invasive fungal diseases after allogeneic stem cell transplantation: a prospective study of the Gruppo Italiano Trapianto Midollo Osseo (GITMO).

    PubMed

    Girmenia, Corrado; Raiola, Anna Maria; Piciocchi, Alfonso; Algarotti, Alessandra; Stanzani, Marta; Cudillo, Laura; Pecoraro, Clara; Guidi, Stefano; Iori, Anna Paola; Montante, Barbara; Chiusolo, Patrizia; Lanino, Edoardo; Carella, Angelo Michele; Zucchetti, Elisa; Bruno, Benedetto; Irrera, Giuseppe; Patriarca, Francesca; Baronciani, Donatella; Musso, Maurizio; Prete, Arcangelo; Risitano, Antonio Maria; Russo, Domenico; Mordini, Nicola; Pastore, Domenico; Vacca, Adriana; Onida, Francesco; Falcioni, Sadia; Pisapia, Giovanni; Milone, Giuseppe; Vallisa, Daniele; Olivieri, Attilio; Bonini, Alessandro; Castagnola, Elio; Sica, Simona; Majolino, Ignazio; Bosi, Alberto; Busca, Alessandro; Arcese, William; Bandini, Giuseppe; Bacigalupo, Andrea; Rambaldi, Alessandro; Locasciulli, Anna

    2014-06-01

    Epidemiologic investigation of invasive fungal diseases (IFDs) in allogeneic hematopoietic stem cell transplantation (allo-HSCT) may be useful to identify subpopulations who might benefit from targeted treatment strategies. The Gruppo Italiano Trapianto Midollo Osseo (GITMO) prospectively registered data on 1858 consecutive patients undergoing allo-HSCT between 2008 and 2010. Logistic regression analysis was performed to identify risk factors for proven/probable IFD (PP-IFD) during the early (days 0 to 40), late (days 41 to 100), and very late (days 101 to 365) phases after allo-HSCT and to evaluate the impact of PP-IFDs on 1-year overall survival. The cumulative incidence of PP-IFDs was 5.1% at 40 days, 6.7% at 100 days, and 8.8% at 12 months post-transplantation. Multivariate analysis identified the following variables as associated with PP-IFDs: transplant from an unrelated volunteer donor or cord blood, active acute leukemia at the time of transplantation, and an IFD before transplantation in the early phase; transplant from an unrelated volunteer donor or cord blood and grade II-IV acute graft-versus-host disease (GVHD) in the late phase; and grade II-IV acute GVHD and extensive chronic GVHD in the very late phase. The risk for PP-IFD was significantly higher when acute GVHD was followed by chronic GVHD and when acute GVHD occurred in patients undergoing transplantation with grafts from other than matched related donors. The presence of PP-IFD was an independent factor in long-term survival (hazard ratio, 2.90; 95% confidence interval, 2.32 to 3.62; P < .0001). Our findings indicate that tailored prevention strategies may be useful in subpopulations at differing levels of risk for PP-IFDs. PMID:24631738

  5. A multicenter phase III prospective randomized trial of high-dose epirubicin in combination with cyclophosphamide (EC) versus docetaxel followed by EC in node-positive breast cancer. GOIM (Gruppo Oncologico Italia Meridionale) 9902 study

    PubMed Central

    Vici, P.; Brandi, M.; Giotta, F.; Foggi, P.; Schittulli, F.; Di Lauro, L.; Gebbia, N.; Massidda, B.; Filippelli, G.; Giannarelli, D.; Di Benedetto, A.; Mottolese, M.; Colucci, G.; Lopez, M.

    2012-01-01

    Background: The Gruppo Oncologico Italia Meridionale 9902 trial compared four cycles of high-dose epirubicin plus cyclophosphamide (EC) with four cycles of docetaxel (Taxotere, D) followed by four cycles of EC as adjuvant treatment of node-positive breast cancer. Patients and methods: Patients were randomly assigned to EC (E 120 mg/m2, C 600 mg/m2, arm A) for four cycles or four cycles of D (100 mg/m2) followed by four cycles of EC (arm B), both regimens every 21 days. Hormone receptor-positive patients were given hormonal therapy for 5 years. Primary end point was 5-year disease-free survival (DFS). Secondary objectives were overall survival (OS) and safety. Results: There were 750 patients enrolled. With a median follow-up of 64 months, 5-year DFS was 73.4% in both arms, and 5-year OS was 89.5% versus 90.7% in arm A and B [hazard ratio was 0.99 (95% confidence interval for DFS 0.75–1.31; P = 0.95)], respectively. Grade 3–4 toxicity was more common in arm B. Conclusions: This study did not show advantages from the addition of docetaxel to high-dose EC as adjuvant chemotherapy in node-positive breast cancer. The small sample size and low number of DFS events may have limited the ability to observe statistically significant difference between the two arms. PMID:21965475

  6. La relatività debole. La fisica dello spazio e del tempo senza paradossi

    NASA Astrophysics Data System (ADS)

    Selleri, Franco

    2011-06-01

    Secondo Einstein e Poincaré la simultaneità di eventi che hanno luogo in punti diversi dello spazio può essere definita solo per convenzione. Dal punto di vista matematico si dimostra, quindi, che due diverse definizioni di simultaneità corrispondono a due diversi valori del coefficiente e1 della variabile spaziale x presente nelle trasformazioni di Lorentz. A partire da premesse normalmente accettate otterremo diverse dimostrazioni della necessità di reintrodurre il concetto di simultaneità assoluta. Le conseguenze cosmologiche della nuova struttura dello spazio e del tempo andranno contro la cosmologia del Big Bang. Inoltre, dopo questi risultati, il relativismo sopravviverà in una forma meno aspra ("relatività debole") perché risulter privo di quel campionario di paradossi portato dalla teoria della Relatività Speciale.

  7. Low-dose aspirin in polycythaemia vera: a pilot study. Gruppo Italiano Studio Policitemia (GISP).

    PubMed

    1997-05-01

    In this pilot study, aimed at exploring the feasibility of a large-scale trial of low-dose aspirin in polycythaemia vera (PV), 112 PV patients (42 females, 70 males. aged 17-80 years) were selected for not having a clear indication for, or contraindication to, aspirin treatment and randomized to receive oral aspirin (40 mg/d) or placebo. Follow-up duration was 16 +/- 6 months. Measurements of thromboxane A2 production during whole blood clotting demonstrated complete inhibition of platelet cyclooxygenase activity in patients receiving aspirin. Aspirin administration was not associated with any bleeding complication. Within the limitations of the small sample size, this study indicates that a biochemically effective regimen of antiplatelet therapy is well tolerated in patients with polycythaemia vera and that a large-scale placebo-controlled trial is feasible. PMID:9163613

  8. Is the control of disease progression within our grasp? Review of the GRISAR study. (Gruppo Reumatologi Italiani Studio Artrite Reumatoide).

    PubMed

    Ferraccioli, G F; Della Casa-Alberighi, O; Marubini, E; Priolo, F; Mathieu, A; Fantini, F; Cutolo, M; Pasero, G

    1996-09-01

    A prospective, open, multicentre, randomized study with a blinded radiological end-point was started in 1991. The aim of the study was to assess whether cyclosporin A (CyA) controls ongoing anatomical damage in active early rheumatoid arthritis (RA) better than conventional disease-modifying anti-rheumatic drugs (DMARDs) as used in everyday clinical practice. A total of 340 consenting patients with early RA (mean duration 1.4 yr) were recruited; 167 were randomized to CyA 3mg/kg per day and 173 to DMARDs. Hand, wrist and foot X-rays were blindly scored by a central committee of three radiologists using the Larsen-Dale method. Any side-effects were carefully recorded. The control of clinical symptoms was similar in both groups. Radiological evaluation of 284 patients (141 on CyA; 143 on DMARDs) after 12 months showed a significant decrease in the mean progression in the eroded joint count (1.3 +/- 3.1 vs 2.4 +/- 3.0, P < 0.001). There was also better maintenance on treatment with CyA than in the group treated with DMARDs (89.2 vs 77.5%, respectively; P = 0.002). CyA seems to offer greater control of ongoing anatomical joint damage in early RA than conventional DMARDs after 12 months. PMID:8810684

  9. Deferasirox chelation therapy in patients with transfusion-dependent MDS: a 'real-world' report from two regional Italian registries: Gruppo Romano Mielodisplasie and Registro Basilicata.

    PubMed

    Maurillo, Luca; Breccia, Massimo; Buccisano, Francesco; Voso, Maria Teresa; Niscola, Pasquale; Trapè, Giulio; Tatarelli, Caterina; D'Addosio, Ada; Latagliata, Roberto; Fenu, Susanna; Piccioni, Anna Lina; Fragasso, Alberto; Aloe Spiriti, Maria A; Refrigeri, Marco; Criscuolo, Marianna; Musto, Pellegrino; Venditti, Adriano

    2015-07-01

    Deferasirox (DFX) is an orally administered iron chelator approved for use in patients with transfusion-dependent iron overload due to myelodysplastic syndromes (MDS). The safety and efficacy of DFX has been explored in clinical trial settings, but there is little data on unselected patients with MDS. The aim of this study was to retrospectively evaluate the safety, compliance, efficacy and effect on haematopoiesis of DFX in a large 'real-world' MDS population. One hundred and eighteen patients with transfusion-dependent MDS were treated with DFX across 11 centres in Italy. Serum ferritin levels, haematological response, dosing, adverse events and transfusion dependence were recorded at baseline, 3, 6, 12 and 24 months following initiation of treatment. DFX reduced mean serum ferritin levels from 1790 to 1140 ng/mL (P < 0.001), with 7.1% of patients achieving transfusion independence. Significant haematological improvement was seen in erythroid (17.6%), platelet (5.9%) and neutrophil counts (7.1%). Adverse events were reported in 47.5% of patients, including gastrointestinal and renal toxicity. Regression analysis showed that higher starting doses of DFX are associated with transfusion independence at 24 months. DFX is a safe, effective treatment for transfusion-dependent MDS that can lead to transfusion independence and haematological improvement in a subset of patients. PMID:25764148

  10. Antithymocyte globulin for graft-versus-host disease prophylaxis in transplants from unrelated donors: 2 randomized studies from Gruppo Italiano Trapianti Midollo Osseo (GITMO).

    PubMed

    Bacigalupo, A; Lamparelli, T; Bruzzi, P; Guidi, S; Alessandrino, P E; di Bartolomeo, P; Oneto, R; Bruno, B; Barbanti, M; Sacchi, N; Van Lint, M T; Bosi, A

    2001-11-15

    One hundred nine patients with hematologic malignancies, undergoing bone marrow transplants (BMT) from unrelated donors, were randomized in 2 consecutive trials to receive or not to receive antithymocyte globulin (ATG) in the conditioning regimen, as follows: (A) 54 patients (median age, 28 years; 39% with advanced disease) were randomized to no ATG (n = 25) versus 7.5 mg/kg rabbit ATG (Thymoglobulin; Sangstat, Lyon, France) (n = 29); (B) 55 patients (median age, 31 years, 71% with advanced disease) were randomized to no ATG (n = 28) versus 15 mg/kg rabbit ATG (n = 27). Grade III-IV graft-versus-host disease (GVHD) was diagnosed in 36% versus 41% (P =.8) in the first and in 50% versus 11% (P =.001) in the second trial. Transplant-related mortality (TRM), relapse, and actuarial 3-year survival rates were comparable in both trials. In fact, despite the reduction of GVHD in the second trial, a higher risk for lethal infections (30% vs 7%; P =.02) was seen in the arm given 15 mg/kg ATG. Extensive chronic GVHD developed overall more frequently in patients given no ATG (62% vs 39%; P =.04), as confirmed by multivariate analysis (P =.03). Time to 50 x 10(9)/L platelets was comparable in the first trial (21 vs 24 days; P =.3) and delayed in the ATG arm in the second trial (23 vs 38 days; P =.02). These trials suggest that (1) 15 mg/kg ATG before BMT significantly reduces the risk for grade III-IV acute GVHD, (2) this does not translate to a reduction in TRM because of the increased risk for infections, and (3) though survival is unchanged, extensive chronic GVHD is significantly reduced in patients receiving ATG. PMID:11698275

  11. Serum cholesterol and acute myocardial infarction: a case-control study from the GISSI-2 trial. Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto-Epidemiologia dei Fattori di Rischio dell'Infarto Miocardico Investigators.

    PubMed Central

    Nobili, A.; D'Avanzo, B.; Santoro, L.; Ventura, G.; Todesco, P.; La Vecchia, C.

    1994-01-01

    OBJECTIVE--To examine the role of serum cholesterol in acute myocardial infarction in a population of patients with no history of coronary heart disease and to establish the nature of this association, the degree of risk, and the possible interaction between serum cholesterol and other major risk factors for acute myocardial infarction. DESIGN--Case-control study. SETTING--90 hospitals in northern, central, and southern Italy. PATIENTS--916 consecutive cases of newly diagnosed acute myocardial infarction and 1106 hospital controls admitted to hospital with acute conditions not related to known or suspected risk factors for coronary heart disease. DATA COLLECTION--Data were collected with a structured questionnaire and blood samples were taken by venepuncture as soon as possible after admission to hospital from cases and controls. Blood cholesterol concentrations were available for 614 cases and 792 controls. RESULTS--After adjustment by logistic regression for sex, age, education, geographical area, smoking status, body mass index, history of diabetes and hypertension, and family history of coronary heart disease the estimated relative risks of acute myocardial infarction for quintiles of serum cholesterol (from lowest to highest) were 2.3 (95% confidence interval (CI) 1.6 to 3.4), 3.1 (95% CI 2.1 to 4.6), 4.1 (95% CI 2.8 to 6.0), and 5.2 (95% CI 3.5 to 7.7). The estimated relative risk across selected covariates increased from the lowest to the highest quintile of serum cholesterol particularly for men, patients under 55 years of age, and smokers. When the possible interaction of known risk factors with serum cholesterol was examined, smoking habits, diabetes, and hypertension had approximately multiplicative effects on relative risk. CONCLUSIONS--This study indicates that serum cholesterol was an independent risk factor for acute myocardial infarction. This association was linear, with no threshold level. Moreover, there was a multiplicative effect between cholesterol and other major risk factors on the relative risk of acute myocardial infarction. PMID:8011413

  12. Cryotherapy in the prevention of oral mucositis in patients receiving low-dose methotrexate following myeloablative allogeneic stem cell transplantation: a prospective randomized study of the Gruppo Italiano Trapianto di Midollo Osseo nurses group.

    PubMed

    Gori, E; Arpinati, M; Bonifazi, F; Errico, A; Mega, A; Alberani, F; Sabbi, V; Costazza, G; Leanza, S; Borrelli, C; Berni, M; Feraut, C; Polato, E; Altieri, M C; Pirola, E; Loddo, M C; Banfi, M; Barzetti, L; Calza, S; Brignoli, C; Bandini, G; De Vivo, A; Bosi, A; Baccarani, M

    2007-03-01

    Severe oral mucositis is a major cause of morbidity following allogeneic hematopoietic stem cell transplantation (AHSCT). Cryotherapy, that is, the application of ice chips on the mucosa of the oral cavity during the administration of antineoplastic agents, may reduce the incidence and severity of chemotherapy-related oral mucositis. In this multicenter randomized study, we addressed whether cryotherapy during MTX administration is effective in the prevention of severe oral mucositis in patients undergoing myeloablative AHSCT. One hundred and thirty patients undergoing myeloablative AHSCT and MTX-containing GVHD prophylaxis were enrolled and randomized to receive or not receive cryotherapy during MTX administration. The incidence of severe (grade 3-4) oral mucositis, the primary end point of the study, was comparable in patients receiving or not cryotherapy. Moreover, no difference was observed in the incidence of oral mucositis grade 2-4 and the duration of oral mucositis grade 3-4 or 2-4, or in the kinetics of mucositis over time. In univariate and multivariate analysis, severe oral mucositis correlated with TBI in the conditioning regimen and lack of folinic acid rescue following MTX administration. Thus, cryotherapy during MTX administration does not reduce severe oral mucositis in patients undergoing myeloablative allogeneic HSCT. Future studies will assess cryotherapy before allogeneic HSCT. PMID:17277790

  13. Long term outcome of localized aggressive non-Hodgkin lymphoma treated with a short weekly chemotherapy regimen (doxorubicin, cyclophosphamide, bleomycin, vincristine, and prednisone) and involved field radiotherapy: result of a Gruppo Italiano Multiregionale per lo Studio dei Linfomi e Leucenie (GIMURELL) study.

    PubMed

    Cabras, Maria Giuseppina; Mamusa, Angela Maria; Vitolo, Umberto; Freilone R, Roberto; Dessalvi, Paolo; Orsucci, Lorella; Tonso, Anna; Levis, Alessandro; Liberati, Marina; Lay, Giancarlo; Angelucci, Emanuele

    2009-09-01

    Recently, management of limited stage diffuse large cell lymphoma (DLCL) is trending toward a low intensity chemotherapy approach. Since 1993 we have used a brief weekly (6 weeks) chemotherapy scheme (Doxorubicin, Cyclophosphamide, Bleomycin, Vincristine, and Prednisone = ACOP-B) followed by involved field radiotherapy in 207 consecutive patients with well defined localized DLCL without age limit (median 57 years, range 18-85). Treatment was completed as designed in 183 of 207 patients (88%). One hundred and ninety-nine patients (96%) achieved complete remission. At a median follow-up of 66 months 170 patients are alive (82%), 168 of them free of disease. Twenty-nine patients experienced relapse after achieving a complete remission. Kaplan-Meier, risk of relapse was 24% after 13 years. Thirty (14.5%) patients have died, 14 (6.8%) due to lymphoma progression, one due to regimen toxicity and 15 (7.2%) from other causes while remaining in complete remission. The probability of overall survival and event free survival at 13 years was 78% (95% CI 70-87%) and 63% (95% CI 50-75), respectively. Crude rate of secondary malignancy was 5.26 /1000 person-years. The ACOP-B regimen plus involved field radiotherapy is well tolerated both short and long term and is an effective chemotherapy scheme for very well defined limited stage aggressive non-Hodgkin lymphomas in all age categories. PMID:19579074

  14. Antilymphocyte globulin, cyclosporine, prednisolone, and granulocyte colony-stimulating factor for severe aplastic anemia: an update of the GITMO/EBMT study on 100 patients. European Group for Blood and Marrow Transplantation (EBMT) Working Party on Severe Aplastic Anemia and the Gruppo Italiano Trapianti di Midolio Osseo (GITMO).

    PubMed

    Bacigalupo, A; Bruno, B; Saracco, P; Di Bona, E; Locasciulli, A; Locatelli, F; Gabbas, A; Dufour, C; Arcese, W; Testi, G; Broccia, G; Carotenuto, M; Coser, P; Barbui, T; Leoni, P; Ferster, A

    2000-03-15

    One hundred consecutive patients with severe aplastic anemia (SAA) received horse antilymphocyte globulin (ALG), cyclosporin A (CyA), 6-methylprednisolone (6Mpred), and granulocyte colony-stimulating factor (G-CSF) as first-line therapy. The median age was 16 years (range, 1-72 years) and median neutrophil count was 0.2 x 10(9)/L (range, 0-0.5 x 10(9)/L). Trilineage hematologic recovery (at a median interval of 96 days from treatment) was seen in 77 patients (48 complete, 29 partial) after 1 (n = 50) or more courses of ALG (n = 27). Of the 23 nonresponders, 11 patients died at a median interval of 83 days (range, 16-1132 days), 6 were considered treatment failures and underwent transplantation, and 6 were pancytopenic. Cytogenetic abnormalities were seen in 11% of patients, clonal hematologic disease in 8%, and relapse of marrow aplasia in 9%. The actuarial survival at 5 years was 87% (median follow-up 1424 days): 76% versus 98% for patients with neutrophil counts less than versus greater than 0.2 x 10(9)/L (P =.001) and 88% versus 87% for patients aged less than versus more than 16 years (P =.8). The actuarial probability of discontinuing CyA was 38%. Patients who did not achieve a white blood cell (WBC) count of 5 x 10(9)/L during G-CSF treatment have a low probability of responding (37%) and a high mortality rate (42%). This update confirms a high probability for SAA patients of becoming transfusion independent and of surviving after treatment with ALG, CyA, 6Mpred, and G-CSF, with a significant effect of neutrophil counts on outcome. Problems still remain, such as absent or incomplete responses, clonal evolution, relapse of the original disease, and cyclosporine dependence. Early transplantation, also from alternative donors, may be warranted in patients with poor WBC response to G-CSF. (Blood. 2000;95:1931-1934) PMID:10706857

  15. Explodet Project:. Methods of Automatic Data Processing and Analysis for the Detection of Hidden Explosive

    NASA Astrophysics Data System (ADS)

    Lecca, Paola

    2003-12-01

    The research of the INFN Gruppo Collegato di Trento in the ambit of EXPLODET project for the humanitarian demining, is devoted to the development of a software procedure for the automatization of data analysis and decision taking about the presence of hidden explosive. Innovative algorithms of likely background calculation, a system based on neural networks for energy calibration and simple statistical methods for the qualitative consistency check of the signals are the main parts of the software performing the automatic data elaboration.

  16. Left atrium remodeling after acute myocardial infarction (results of the GISSI-3 Echo Substudy).

    PubMed

    Popescu, Bogdan A; Macor, Franco; Antonini-Canterin, Francesco; Giannuzzi, Pantaleo; Temporelli, Pier L; Bosimini, Enzo; Gentile, Francesco; Maggioni, Aldo P; Tavazzi, Luigi; Piazza, Rita; Ascione, Luigi; Stoian, Ioana; Cervesato, Eugenio; Nicolosi, Gian L

    2004-05-01

    To evaluate the existence, timing, and determinants of post-infarction left atrial remodeling, we studied a subgroup of 514 patients from the Third Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico Echo Substudy who underwent 4 serial 2-dimensional echocardiograms up to 6 months after acute myocardial infarction. This study is the first to demonstrate, in a large series of patients, the existence of early and late left atrial remodeling after low-risk acute myocardial infarction and the relation of left atrial remodeling to left ventricular remodeling. PMID:15110211

  17. Improving earthquake hazard assessments in Italy: An alternative to “Texas sharpshooting”

    NASA Astrophysics Data System (ADS)

    Peresan, Antonella; Panza, Giuliano F.

    2012-12-01

    The 20 May 2012 M = 6.1 earthquake that struck the Emilia region of northern Italy illustrates a common problem afflicting earthquake hazard assessment. It occurred in an area classified as "low seismic hazard" based on the current national seismic hazard map (Gruppo di Lavoro, Redazione della mappa di pericolosità sismica, rapporto conclusivo, 2004, http://zonesismiche.mi.ingv.it/mappa_ps_apr04/italia.html) adopted in 2006. That revision of the seismic code was motivated by the 2002 M = 5.7 earthquake that struck S. Giuliano di Puglia in central Italy, also a previously classified low-hazard area, resulting in damage and casualties. Previous code was updated in 1981-1984 after earlier maps missed the 1980 M = 6.5 Irpinia earthquake.

  18. An Italian Education: IEEE Pulse talks with Riccardo Pietrabissa, president of Italy's National Bioengineering Group, about Italian progress and challenges in biomedical engineering education.

    PubMed

    Pietrabissa, Riccardo; Reynolds, Pamela

    2015-01-01

    From Leonardo da Vinci's designs for ball bearings to the incredible engineering wizardry behind the Ferrari, the inventive, inquisitive, and ingenious spirit of the engineer has always lived--and thrived--in Italy. From education to research to product development, Italy has always been regarded as an engineering leader. But does this apply to biomedical engineering (BME)? Despite many successes, questions loom, as they do at engineering schools worldwide. Concerns such as whether BME programs are providing students with enough focused, practical, hands-on training remain at the forefront, as does the question of whether graduates will be able to find jobs in industry after university studies are over. Here, IEEE Pulse explores these topics with Riccardo Pietrabissa, president of the Gruppo Nazionale di Bioingegneria (National Bioengineering Group) and a full professor in the Department of Chemistry, Materials, and Chemical Engineering at Politecnico di Milano. PMID:26186055

  19. Italian consensus conference for colonic diverticulosis and diverticular disease

    PubMed Central

    Barbara, Giovanni; Pace, Fabio; Annese, Vito; Bassotti, Gabrio; Binda, Gian Andrea; Casetti, Tino; Colecchia, Antonio; Festi, Davide; Fiocca, Roberto; Laghi, Andrea; Maconi, Giovanni; Nascimbeni, Riccardo; Scarpignato, Carmelo; Villanacci, Vincenzo; Annibale, Bruno

    2014-01-01

    The statements produced by the Consensus Conference on Diverticular Disease promoted by GRIMAD (Gruppo Italiano Malattia Diverticolare, Italian Group on Diverticular Diseases) are reported. Topics such as epidemiology, risk factors, diagnosis, medical and surgical treatment of diverticular disease (DD) in patients with uncomplicated and complicated DD were reviewed by a scientific board of experts who proposed 55 statements graded according to level of evidence and strength of recommendation, and approved by an independent jury. Each topic was explored focusing on the more relevant clinical questions. Comparison and discussion of expert opinions, pertinent statements and replies to specific questions, were presented and approved based on a systematic literature search of the available evidence. Comments were added explaining the basis for grading the evidence, particularly for controversial areas. PMID:25360320

  20. European Collaboration on Low-dose Aspirin in Polycythemia Vera (ECLAP): a randomized trial.

    PubMed

    Landolfi, R; Marchioli, R

    1997-01-01

    Thrombotic complications characterize the clinical course of polycythemia vera (PV) and represent the main cause of morbidity and mortality. However, uncertainty still exists as to the benefit/risk ratio of aspirin prophylaxis in this setting. In vivo platelet biosynthesis of thromboxane A2 is enhanced and can be suppressed by low-dose aspirin in PV, thus providing a rationale for assessing the efficacy and safety of a low-dose aspirin regimen in these patients. The Gruppo Italiano Studio Policitemia Vera has recently performed a pilot study on 112 patients randomized to receive aspirin, 40 mg daily, or placebo and followed for 16 +/- 6 months (mean +/- SD). This study showed that low-dose aspirin is well tolerated in PV patients, and that a large-scale efficacy trial is feasible in this setting. In this article we report the protocol of the European Collaboration on Low-dose Aspirin in Polycythemia Vera (ECLAP) study, which is a randomized trial designed to assess the risk/benefit ratio of low-dose aspirin in PV. To estimate the size and the follow-up duration required for the ECLAP trial, a retrospective analysis of the clinical epidemiology of a large PV population has recently been completed by the Gruppo Italiano Studio Policitemia Vera. On this basis, approximately 3500 patients will be enrolled in the ECLAP study with a follow-up of 3 to 4 years. The uncertainty principle will be used as the main eligibility criterion: Polycythemic patients of any age, having no clear indication for or contraindication to aspirin treatment, will be randomized in a double-blind fashion to receive oral aspirin (100 mg daily) or placebo. According to current therapeutic recommendations, the basic treatment of randomized patients should be aimed at maintaining the hematocrit value < or = 45% in subjects aged < or = 50, and hematocrit < 45% as well as platelet count < 400 x 10(9)/L in patients aged > 50. Randomization will be stratified by participating center. The study is

  1. [Teoria della Mente e funzionamento sociale nella schizofrenia: correlazione con anomalie del linguaggio figurato, sintomatologia clinica e intelligenza generale].

    PubMed

    Piovan, Cristiano; Gava, Laura; Campeol, Mara

    2016-01-01

    RIASSUNTO. Scopo. Negli ultimi decenni gli studi hanno mostrato come la Teoria della Mente (ToM) non sia un processo unitario, ma un sistema che include aspetti cognitivi e affettivi. Nell'ambito dei domini che definiscono la social cognition, la ToM rappresenta il miglior predittore dello scarso funzionamento sociale nella schizofrenia. Lo scopo del presente lavoro è stato di esaminare la competenza di un gruppo di pazienti ambulatoriali affetti da schizofrenia in compiti di ToM, di riconoscimento di aspetti metaforici e idiomatici del linguaggio, in una prova di rispetto di regole conversazionali e di indagarne la relazione con il funzionamento sociale. Metodi. Sono stati reclutati 30 pazienti ambulatoriali con diagnosi di schizofrenia e 24 controlli sani. Sono stati somministrati il TIB per il calcolo del QI premorboso, la PANSS, il Theory of Mind Picture Sequencing Task, un test di comprensione di metafore e idiomi e un test conversazionale. Il funzionamento sociale è stato valutato con la PSP. Risultati. Non vi era differenza significativa tra i valori medi del QI premorboso del gruppo dei pazienti e dei controlli. Ai test di ToM e di competenza pragmatica, la differenza tra i gruppi è risultata altamente significativa, con i pazienti che hanno eseguito le prove in modo peggiore. È emersa una correlazione tra la comprensione di metafore e idiomi e le false credenze di secondo ordine. La PSP è risultata correlata con la PANSS e con la quota di ToM cognitiva, ma non con la ToM affettiva. Conclusioni. I risultati hanno mostrato che i soggetti affetti da schizofrenia, in condizione clinica di stabilizzazione, hanno evidenti difficoltà nelle prove di ToM e di comprensione del linguaggio figurato. Nel nostro modello teorico, la correlazione evidenziata tra la ToM cognitiva, i deficit pragmatici, lo stato clinico e il livello di funzionamento sociale suggerisce l'utilità di interventi riabilitativi di recupero delle funzioni metacognitive e delle abilit

  2. Foundry waste recycling in moulding operations and in the ceramic industry.

    PubMed

    Zanetti, Maria Chiara; Fiore, Silvia

    2003-06-01

    An industrial treatment was performed by the Sasil plant of Brusnengo (Biella, Northern Italy), which is part of the Gruppo Minerali S.p.A. (Novara, Northern Italy), to consider the reclamation of bentonite bonded moulding sands obtained from the Teksid Italia S.p.A. cast iron foundry plant in Crescentino (Vercelli, Northern Italy). An evaluation of the fine particles produced by the wet-mechanical regeneration treatment was made with the purpose of proposing their recycling as binding agents in moulding operations in the cast iron foundry and for the production of tiles in the ceramic industry. The pre-mixed product sold by bentonite suppliers (35% coal dust and 65% bentonite, 0.15 Euro/kg) could be made from the recovered fine fraction below 0.025 mm with the addition of active clay and coal dust, thus obtaining a product that will have physico-chemical properties similar to those of calcic bentonite. The improvements due to the addition of the fine particles to the usually employed clay for tile production were also underlined from the results of several baking tests. The recovery and recycling of sands and fine particles obtained from the reclamation of bentonite moulding sands will lead to a saving of raw materials and landfill space, with economic and environmental advantages. PMID:12870643

  3. Urine albumin excretion, within normal range, reflects increasing prevalence of metabolic syndrome in patients with essential hypertension.

    PubMed

    Vyssoulis, Gregory; Karpanou, Eva; Spanos, Pangiotis; Kyvelou, Stella-Maria; Adamopoulos, Dionysios; Stefanadis, Christodoulos

    2010-08-01

    Microalbuminuria is a prognostic marker of cardiovascular disease and is related to metabolic syndrome (MetS). For this purpose, the authors examined the relationship of low grade albuminuria to MetS, using 4 current definitions and a MetS score. They studied 6650 consecutive, nondiabetic, hypertensive patients with normal microalbumin excretion. MetS was defined by Adult Treatment Panel III, American Heart Association, World Heart Organization, International Diabetes Federation criteria, and MetS Gruppo Italiano per lo Studio della Streptochinasi nell'Infarcto Miocardico (GISSI) score. Urine microalbumin concentration was measured after a 24-hour urine collection by immunonephelometry. By all definitions, hypertensive patients with MetS had higher microalbumin levels. Significantly higher microalbumin levels were observed as the number of metabolic components rose. After adjustment for systolic blood pressure, the strength of this association was reduced to a nonsignificant level. Microalbumin levels, within normal range, are increased in patients with MetS, irrespective of the definition criteria. PMID:20695936

  4. [Valutazione delle guardie di sicurezza privata attraverso la Suicide Probability Scale e la Brief Symptom Inventory].

    PubMed

    Dogan, Bulent; Canturk, Gurol; Canturk, Nergis; Guney, Sevgi; Özcan, Ebru

    2016-01-01

    RIASSUNTO. Scopo. Lo scopo di questo studio è stato quello di investigare l'influenza della probabilità di suicidio, con le sue caratteristiche sociodemografiche, e di procurare i dati per la prevenzione del suicidio tra le guardie di sicurezza privata che lavorano in condizioni di stress, essendo a contatto ininterrottamente con eventi negativi e traumatici di vita durante il loro lavoro. Metodi. Hanno partecipato allo studio 200 guardie di sicurezza privata e 200 persone dell'Università di Ankara. Per raccogliere i dati sono stati utilizzati un questionario riguardante le condizioni sociodemografiche dei partecipanti, la Suicide Probability Scale (SPS) e la Brief Symptom Inventory (BSI). Risultati. Genere, stato civile, stipendio, credenze religiose, vivere una situazione di pericolo di vita, passato di tentativi di suicidio, fumare e non avere una malattia cronica hanno causato statisticamente una differenza significativa sui punteggi di SPS tra il gruppo di guardie di sicurezza privata e quello di controllo. In aggiunta, c'è stata una correlazione positiva statisticamente significativa tra i punteggi totali delle sottoscale di SPS e quelli di BSI. Conclusioni. Allo stesso modo degli agenti di polizia e dei gendarmi, le guardie di sicurezza privata sono ad alto rischio di commettere e tentare il suicidio trovandosi in condizioni stressanti di lavoro e anche soffrendo del trauma secondario. È necessario che essi siano consapevoli della propria tendenza al suicidio e avere controlli psichiatrici regolari. PMID:27183512

  5. Multicentre study of allergic contact cheilitis from toothpastes.

    PubMed

    Francalanci, S; Sertoli, A; Giorgini, S; Pigatto, P; Santucci, B; Valsecchi, R

    2000-10-01

    The present work reports the results of a multicentre study of toothpaste allergic contact cheilitis (TACC) conducted by GIRDCA (Gruppo Italiano Ricerca Dermatiti da Contatto e Ambientali). The study examined 54 patients with eczematous lesions on the lips, the possible cause of which was suspected to be the use of toothpastes. Patch tests were conducted with a standard series, a specially-targeted series (toothpaste cheilitis series, TCS), and with suspected toothpaste(s). A stop-restart test (SRT) was carried out with these, together with a use test to identify possible alternative products. The TCS produced 17 positive reactions in 13 patients, the most frequent being to spearmint oil. Of the 54 patients, 5 displayed positive reactions only to the TCS. The patch tests with toothpaste produced positive reactions in 11/32 patients, the SRT a positive response in 10/12 cases. The diagnosis of TACC was confirmed in 15/54 patients. Alternative products were identified for 5 patients. In conclusion, the allergens most frequently responsible for TACC were the flavourings, and the additional series proved to be useful in many cases (together with patch tests with toothpastes and the SRT) for correct diagnosis and to initiate effective prevention. PMID:11011921

  6. Risk factors and prevention of vascular complications in polycythemia vera.

    PubMed

    Barbui, T; Finazzi, G

    1997-01-01

    Risk factors for vascular complications in polycythemia vera (PV) include laboratory and clinical findings. Among laboratory values, the hematocrit has been clearly associated with thrombosis, particularly in the cerebral circulation. Platelet count is a possible but not yet clearly established predictor of vascular complications. Platelet function tests are of little help in prognostic evaluation because most attempts to correlate these abnormalities with clinical events have been disappointing. Clinical predictors of thrombosis include increasing age and a previous history of vascular events. Identifying risk factors for thrombosis is important to initiate therapy. Phlebotomy is associated with an increased incidence of thrombosis in the first 3 to 5 years, whereas chemotherapy may induce a higher risk of secondary malignancies after 7 to 10 years of follow-up. New cytoreductive drugs virtually devoid of mutagenic risk include interferon-alpha and anagrelide, but their role in reducing thrombotic complications remains to be demonstrated. Antithrombotic drugs, such as aspirin, are frequently used in PV, despite doubts regarding safety and efficacy. Two recent studies from the Gruppo Italiano Studio Policitemia Vera (GISP) assessed the rate of major thrombosis as well as the tolerability of low-dose aspirin in PV patients. These investigations created a favorable scenario for launching a European collaborative clinical trial (ECLAP study) aimed at testing the efficacy of low-dose aspirin in preventing thrombosis and prolonging survival in patients with PV. PMID:9387204

  7. Vitamin E supplementation in the prevention of coronary heart disease.

    PubMed

    Pruthi, S; Allison, T G; Hensrud, D D

    2001-11-01

    Vitamin E consists of a number of compounds, tocopherols and tocotrienols, that function as lipid-soluble antioxidants. A hypothesis is that vitamin E may slow the progression of atherosclerosis by blocking the oxidative modification of low-density lipoprotein cholesterol and thus decrease its uptake into the arterial lumen. Basic science and animal studies have generally supported this hypothesis. Observational studies have primarily assessed patients with no established coronary heart disease (CHD), and results have generally supported a protective role of vitamin E in CHD. Early primary and secondary prevention clinical trials (Alpha-Tocopherol, Beta-Carotene Cancer Protection study and Cambridge Heart Antioxidant Study) showed mixed results. Despite years of encouraging evidence from basic science and observational studies, 3 large randomized clinical trials (Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto miocardico, Heart Outcomes Prevention Evaluation, and Primary Prevention Project) with a combined total of more than 25,000 patients failed to show a significant benefit with vitamin E taken as a dietary supplement for the prevention of CHD. Four large randomized primary prevention trials currently under way should add to our knowledge. The American Heart Association has recommended consumption of a balanced diet with emphasis on antioxidant-rich fruits and vegetables but has made no recommendations regarding vitamin E supplementation for the general population. Although vitamin E supplementation seems to be safe for most people, recommendations from health care professionals should reflect the uncertainty of established benefit as demonstrated in clinical trials. PMID:11702901

  8. Drug data coding and analysis in epidemiologic studies.

    PubMed

    Pahor, M; Chrischilles, E A; Guralnik, J M; Brown, S L; Wallace, R B; Carbonin, P

    1994-08-01

    In epidemiologic studies that collect comprehensive information on medication use, the complexity of dealing with a large number of trade and generic names may limit the utilization of these data bases. This paper shows the specific advantage of using two coding systems, one to maximize efficiency of data entry, and the other to facilitate analysis by organizing the drug ingredients into hierarchical categories. The approach used by two large surveys, one in the USA and one in Italy, is described: the Established Populations for Epidemiologic Studies of the Elderly (EPESE) and the 'Gruppo Italiano di Farmacovigilanza nell' Anziano' (GIFA). To enter the medications into a computerized database, codes matching the drug product names are needed. In the EPESE the prescription and over the counter drug products are coded with the Drug Products Information Coding System (DPICS) and the Iowa Nonprescription Drug Products Information Coding System (INDPICS), respectively. The GIFA study uses the coding system of the Italian Ministry of Health (MINSAN), with a unique numeric code for each drug product available in Italy. To simplify the analytical process the drug entry codes are converted into hierarchical coding systems with unique codes for specific drug ingredients, chemical and therapeutic categories. The EPESE and GIFA drug data are coded with the Iowa Drug Information System (IDIS) ingredient codes, and the Anatomical Therapeutic and chemical (ATC) codes, respectively. Examples are provided that show coding of diuretics in these two studies and demonstrate the analytic advantages of these systems. PMID:7843344

  9. Risks and benefits of low-dosage cyclosporin in rheumatoid arthritis.

    PubMed

    Pasero, G; Ferraccioli, G F; Portioli, I

    1997-05-01

    The effects of cyclosporin on the activity of rheumatoid arthritis have mainly been investigated in patients with active, refractory, long-standing disease. The data obtained in these trials suggest that cyclosporin is not only a symptomatic treatment for rheumatoid arthritis but can also be considered a disease-modifying antirheumatic drug (DMARD), since it seems to be capable of slowing the progression of cartilage and bone damage due to rheumatoid arthritis. The trials conducted so far have led to a better understanding of cyclosporin toxicity and, therefore, to better monitoring of patients in order to avoid it. The reasons for studying the role of cyclosporin in patients with early, active and potentially severe rheumatoid arthritis are the poor prognosis of the disease despite the use of the presently available DMARDs, and the hypothesis that the drug is more efficacious and better tolerated in early rheumatoid arthritis. A new classification of antirheumatic drugs proposes that disease-controlling antirheumatic therapies decrease inflammatory synovitis and prevent structural joint damage or significantly reduce its rate of progression. However, few existing drugs meet these criteria. The 12-month results of a disease-controlling antirheumatic therapy clinical trial with a blinded radiological end-point, named GRISAR (Gruppo Reumatologi Italiani Studio Artrite Reumatoide) comparing cyclosporin with conventional DMARDs in patients with early rheumatoid arthritis provide strong evidence that cyclosporin offers better control of ongoing joint damage than do conventional DMARDs. PMID:18031101

  10. Aggressive rheumatoid arthritis registry in Italy. Characteristics of the early rheumatoid arthritis subtype among patients classified according to the ACR criteria.

    PubMed

    2003-01-01

    The Italian Society of Rheumatology in the year 2000 decided to sponsor the creation of a data base (Registry) of consecutive patients who fulfilled the diagnosis of rheumatoid arthritis (RA) according to the American College of Rheumatology (ACR) criteria. The registry is designed to collect data on the "aggressive" type of RA all over the country in order to determine the percentage of patients who satisfy the established criteria among incident cases of RA and to define the therapeutic approach according to the characteristics of the enrolled patients. Predefined criteria set up by eight recognized opinion leaders on the disease were used by all the centers to create the database. The GIARA registry (Gruppo Italiano Artrite Reumatoide Aggressiva) has now enrolled 706 patients who will be followed up for 24 months. They have been divided into two major subsets--patients with early (< 4 months' disease duration) and late (> 4 months) RA--with the aim of establishing whether differences in clinical, serological, radiographic and therapeutic (DMARDs: disease modifying antirheumatic drugs) parameters may distinguish the two subsets. The major conclusion of this preliminary analysis is that an overall tendency to undertreatment is discernable. PMID:14969064

  11. Veno-occlusive disease nurse management: development of a dynamic monitoring tool by the GITMO nursing group.

    PubMed

    Botti, Stefano; Orlando, Laura; Gargiulo, Gianpaolo; Cecco, Valentina De; Banfi, Marina; Duranti, Lorenzo; Samarani, Emanuela; Netti, Maria Giovanna; Deiana, Marco; Galuppini, Vera; Pignatelli, Adriana Concetta; Ceresoli, Rosanna; Vedovetto, Alessio; Rostagno, Elena; Bambaci, Marilena; Dellaversana, Cristina; Luminari, Stefano; Bonifazi, Francesca

    2016-01-01

    Veno-occlusive disease (VOD) is a complication arising from the toxicity of conditioning regimens that have a significant impact on the survival of patients who undergo stem cell transplantation. There are several known risk factors for developing VOD and their assessment before the start of conditioning regimens could improve the quality of care. Equally important are early identification of signs and symptoms ascribable to VOD, rapid diagnosis, and timely adjustment of support therapy and treatment. Nurses have a fundamental role at the stages of assessment and monitoring for signs and symptoms; therefore, they should have documented skills and training. The literature defines nurses' areas of competence in managing VOD, but in the actual clinical practice, this is not so clear. Moreover, there is an intrinsic difficulty in managing VOD due to its rapid and often dramatic evolution, together with a lack of care tools to guide nurses. Through a complex evidence-based process, the Gruppo Italiano per il Trapianto di Midollo Osseo (GITMO), cellule staminali emopoietiche e terapia cellulare nursing board has developed an operational flowchart and a dynamic monitoring tool applicable to haematopoietic stem cell transplantation patients, whether they develop this complication or not. PMID:27594906

  12. Veno-occlusive disease nurse management: development of a dynamic monitoring tool by the GITMO nursing group

    PubMed Central

    Botti, Stefano; Orlando, Laura; Gargiulo, Gianpaolo; Cecco, Valentina De; Banfi, Marina; Duranti, Lorenzo; Samarani, Emanuela; Netti, Maria Giovanna; Deiana, Marco; Galuppini, Vera; Pignatelli, Adriana Concetta; Ceresoli, Rosanna; Vedovetto, Alessio; Rostagno, Elena; Bambaci, Marilena; Dellaversana, Cristina; Luminari, Stefano; Bonifazi, Francesca

    2016-01-01

    Veno-occlusive disease (VOD) is a complication arising from the toxicity of conditioning regimens that have a significant impact on the survival of patients who undergo stem cell transplantation. There are several known risk factors for developing VOD and their assessment before the start of conditioning regimens could improve the quality of care. Equally important are early identification of signs and symptoms ascribable to VOD, rapid diagnosis, and timely adjustment of support therapy and treatment. Nurses have a fundamental role at the stages of assessment and monitoring for signs and symptoms; therefore, they should have documented skills and training. The literature defines nurses’ areas of competence in managing VOD, but in the actual clinical practice, this is not so clear. Moreover, there is an intrinsic difficulty in managing VOD due to its rapid and often dramatic evolution, together with a lack of care tools to guide nurses. Through a complex evidence-based process, the Gruppo Italiano per il Trapianto di Midollo Osseo (GITMO), cellule staminali emopoietiche e terapia cellulare nursing board has developed an operational flowchart and a dynamic monitoring tool applicable to haematopoietic stem cell transplantation patients, whether they develop this complication or not. PMID:27594906

  13. [Parte III. Ethical and juridical aspects in end-stage chronic organ failures. A position paper on a shared care planning].

    PubMed

    Barbisan, Camillo; Casonato, Carlo; Palermo Fabris, Elisabetta; Piccinni, Mariassunta; Zatti, Paolo

    2014-01-01

    The specific target of an experts panel was to assess in terms of law and ethics the compliance of a new specific decision making algorithm described in the position paper proposed by the Gruppo di Lavoro Insufficienze Croniche d'Organo, with the main goal of the position paper consisting in the shared care planning process. The following specific aspects were assessed by the experts: a) the impact on case law and statute law of a new clinical pathway shared by scientific societies in light of good clinical practice and scientific evidence; b) the relevance of all tools useful to identify the appropriateness of care pathways, recognizing responsibilities and decision-making skills related to the end of life choices made by all stakeholders involved (healthcare professionals, patients and their beloved ones); c) the consistency of the healthcare professionals duties proposed in the position paper with the Italian legal order; d) the opportunity to take into account the role of all healthcare providers involved in care relationship; e) the consistency of the definition of patient rights at the end of life as proposed in the position paper with the Italian legal order and the relevance in this context of simultaneous palliative care; f) the relevance of shared care planning and its consistency with the proposed operative tools; g) the relevance of the conscientious objection issue and the compliance of management tools proposed in the position paper with the results of ethical and legal considerations; h) considerations about available resources allocation. PMID:24553594

  14. A History of Streptokinase Use in Acute Myocardial Infarction

    PubMed Central

    Sikri, Nikhil; Bardia, Amit

    2007-01-01

    A serendipitous discovery by William Smith Tillett in 1933, followed by many years of work with his student Sol Sherry, laid a sound foundation for the use of streptokinase as a thrombolytic agent in the treatment of acute myocardial infarction. The drug found initial clinical application in combating fibrinous pleural exudates, hemothorax, and tuberculous meningitis. In 1958, Sherry and others started using streptokinase in patients with acute myocardial infarction and changed the focus of treatment from palliation to “cure.” Initial trials that used streptokinase infusion produced conflicting results. An innovative approach of intracoronary streptokinase infusion was initiated by Rentrop and colleagues in 1979. Subsequently, larger trials of intracoronary infusion achieved reperfusion rates ranging from 70% to 90%. The need for a meticulously planned and systematically executed randomized multicenter trial was fulfilled by the Gruppo Italiano per la Sperimentazione della Streptochinasi nell'Infarto Miocardico (GISSI) trial in 1986, which not only validated streptokinase as an effective therapeutic method but also established a fixed protocol for its use in acute myocardial infarction. Currently, despite the wide use of tissue plasminogen activator in developed nations, streptokinase remains essential to the management of acute myocardial infarction in developing nations. PMID:17948083

  15. A challenging diagnosis for potential fatal diseases: recommendations for diagnosing acute porphyrias.

    PubMed

    Ventura, Paolo; Cappellini, Maria Domenica; Biolcati, Gianfranco; Guida, Claudio Carmine; Rocchi, Emilio

    2014-07-01

    Acute porphyrias are a heterogeneous group of metabolic disorders resulting from a variable catalytic defect of four enzymes out of the eight involved in the haem biosynthesis pathway; they are rare and mostly inherited diseases, but in some circumstances, the metabolic disturbance may be acquired. Many different environmental factors or pathological conditions (such as drugs, calorie restriction, hormones, infections, or alcohol abuse) often play a key role in triggering the clinical exacerbation (acute porphyric attack) of these diseases that may often mimic many other more common acute medical and neuropsychiatric conditions and whose delayed diagnosis and treatment may be fatal. In order to obtain an accurate diagnosis of acute porphyria, the knowledge and the use of appropriate diagnostic tools are mandatory, even in order to provide as soon as possible the more effective treatment and to prevent the use of potentially unsafe drugs, which can severely precipitate these diseases, especially in the presence of life-threatening symptoms. In this paper, we provide some recommendations for the diagnostic steps of acute porphyrias by reviewing literature and referring to clinical experience of the board members of the Gruppo Italiano Porfiria (GrIP). PMID:24809927

  16. The PAX5 gene is frequently rearranged in BCR-ABL1-positive acute lymphoblastic leukemia but is not associated with outcome. A report on behalf of the GIMEMA Acute Leukemia Working Party

    PubMed Central

    Iacobucci, Ilaria; Lonetti, Annalisa; Paoloni, Francesca; Papayannidis, Cristina; Ferrari, Anna; Storlazzi, Clelia Tiziana; Vignetti, Marco; Cilloni, Daniela; Messa, Francesca; Guadagnuolo, Viviana; Paolini, Stefania; Elia, Loredana; Messina, Monica; Vitale, Antonella; Meloni, Giovanna; Soverini, Simona; Pane, Fabrizio; Baccarani, Michele; Foà, Robin; Martinelli, Giovanni

    2010-01-01

    Background Recently, in genome-wide analyses of DNA copy number abnormalities using single nucleotide polymorphism microarrays, genetic alterations targeting PAX5 were identified in over 30% of pediatric patients with acute lymphoblastic leukemia. So far the occurrence of PAX5 alterations and their clinical correlation have not been investigated in adults with BCR-ABL1-positive acute lymphoblastic leukemia. Design and Methods The aim of this study was to characterize the rearrangements on 9p involving PAX5 and their clinical significance in adults with BCR-ABL1-positive acute lymphoblastic leukemia. Eighty-nine adults with de novo BCR-ABL1-positive acute lymphoblastic leukemia were enrolled into institutional (n=15) or GIMEMA (Gruppo Italiano Malattie EMatologiche dell’Adulto) (n=74) clinical trials and, after obtaining informed consent, their genome was analyzed by single nucleotide polymorphism arrays (Affymetrix 250K NspI and SNP 6.0), genomic polymerase chain reaction analysis and re-sequencing. Results PAX5 genomic deletions were identified in 29 patients (33%) with the extent of deletions ranging from a complete loss of chromosome 9 to the loss of a subset of exons. In contrast to BCR-ABL1-negative acute lymphoblastic leukemia, no point mutations were found, suggesting that deletions are the main mechanism of inactivation of PAX5 in BCR-ABL1-positive acute lymphoblastic leukemia. The deletions were predicted to result in PAX5 haploinsufficiency or expression of PAX5 isoforms with impaired DNA-binding. Deletions of PAX5 were not significantly correlated with overall survival, disease-free survival or cumulative incidence of relapse, suggesting that PAX5 deletions are not associated with outcome. Conclusions PAX5 deletions are frequent in adult BCR-ABL1-positive acute lymphoblastic leukemia and are not associated with a poor outcome. PMID:20534699

  17. Right ventricular functional recovery after acute myocardial infarction: relation with left ventricular function and interventricular septum motion. GISSI-3 echo substudy

    PubMed Central

    Popescu, B A; Antonini-Canterin, F; Temporelli, P L; Giannuzzi, P; Bosimini, E; Gentile, F; Maggioni, A P; Tavazzi, L; Piazza, R; Ascione, L; Stoian, I; Cervesato, E; Popescu, A C; Nicolosi, G L

    2005-01-01

    Objective: To evaluate the pattern of right ventricular (RV) functional recovery and its relation with left ventricular (LV) function and interventricular septal (IVS) motion in low risk patients after acute myocardial infarction (AMI). Design and setting: Multicentre clinical trial carried out in 47 Italian coronary care units. Patients: 500 patients from the GISSI (Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico) -3 echo substudy, who underwent serial echocardiograms 24–48 hours after symptom onset and at discharge, six weeks, and six months after AMI. Results: Tricuspid annular plane systolic excursion (TAPSE) increased significantly during follow up (mean (SD) 1.79 (0.46) cm at 24–48 hours to 1.92 (0.46) cm at six months, p < 0.001) and the increase was already significant at discharge (1.88 (0.47) cm, p < 0.001). LV ejection fraction (LVEF) was the best correlate of TAPSE at 24–48 hours (r  =  0.15, p  =  0.001). TAPSE increased significantly in patients both with reduced (< 45%) and with preserved (⩾ 45%) LVEF, but the magnitude of increase was higher in patients with lower initial LVEF (p  =  0.001). Improvement in IVS wall motion score index (IVS-WMSI) was the only independent predictor of TAPSE changes during follow up (r  =  −0.12, p  =  0.007). Conclusions: In low risk patients after AMI, RV function recovered throughout six months of follow up and was already significant at discharge. TAPSE was significantly related to LVEF at 24–48 hours. The magnitude of RV functional recovery was higher in patients with lower initial LVEF. RV functional recovery is best related to IVS-WMSI improvement, suggesting that IVS motion has an important role in RV functional improvement in this setting. PMID:15772207

  18. Aspirin in polycythemia vera and essential thrombocythemia: current facts and perspectives.

    PubMed

    Landolfi, R; Patrono, C

    1996-09-01

    The role of aspirin in the antithrombotic strategy of patients with polycythemia vera (PV) and essential thrombocythemia (ET) is highly controversial. Long considered unsafe on the basis of a single clinical trial testing very high doses in PV patients, aspirin is being increasingly used at lower dosage. The rationale for the use of aspirin in patients with PV and ET is provided by the efficacy of this agent in the treatment of microcirculatory disturbances of thrombocythemic states associated with myeloproliferative disorders and by recent evidence that asymptomatic PV and ET patients have persistently increased thromboxane (TX) A2-biosynthesis. This increase, which most likely reflects enhanced platelet activation in vivo, is independent of the platelet mass and blood viscosity and largely supressed by a short term low-dose aspirin regimen (50 mg/day for 7 days). Since enhanced TXA2 biosynthesis may play a role in transducing the increased thrombotic risk associated with PV and ET, long-term low-dose aspirin administration has been proposed as a possible antithombotic strategy in these subjects. The safety of this treatment in PV patients has been recently reassessed by the Gruppo Italiano per lo Studio della Policitemia Vera (GISP) which has followed for over one year 112 patients randomized to receive 40 mg/day aspirin or placebo. In the same study, serum TXB2 measurements provided evidence that the low-dose aspirin regimen tested was fully effective in inhibiting platelet cyclooxygenase activity. On this basis, a large scale trial aimed at assessing the antithrombotic efficacy of this approach is currently being organized. In patients with ET both the minimal aspirin dose required for complete inhibition of platelet cyclooxygenase and the safety of long-term aspirin administration need to be established prior to extensive clinical evaluation of this strategy. PMID:8951777

  19. First-line treatment with FOLFOXIRI for advanced pancreatic cancer in clinical practice: Patients' outcome and analysis of prognostic factors.

    PubMed

    Vivaldi, Caterina; Caparello, Chiara; Musettini, Gianna; Pasquini, Giulia; Catanese, Silvia; Fornaro, Lorenzo; Lencioni, Monica; Falcone, Alfredo; Vasile, Enrico

    2016-08-15

    FOLFIRINOX is a standard first-line treatment for advanced pancreatic cancer (aPC). The Gruppo Oncologico Nord Ovest (GONO) FOLFOXIRI regimen demonstrated efficacy in metastatic colorectal cancer. We aimed to evaluate activity and tolerability of FOLFOXIRI regimen in patients with aPC and to explore putative prognostic factors. One hundred thirty-seven consecutive aPC patients were treated with FOLFOXIRI in our institution between 2008 and 2014. Clinical, laboratory and pathological data were collected and their association with activity, progression free survival (PFS) and overall survival (OS) was investigated. After a median follow up of 30 months, median PFS and OS were 8.0 months (95% CI 6.19-9.81) and 12 months (95% CI 9.75-14.25), respectively. Response rate was 38.6%, while disease-control rate 72.2%. At multivariate analysis liver metastases (p = 0.019; Hazard Ratio, HR, 0.59, 95% Confidence Interval, CI, 0.380.96), Eastern Cooperative Oncology Group (ECOG) performance status (PS) 1 (p = 0.001; HR 2.26, 95%CI 1.42-3.59) and neutrophil-lymphocyte ratio (NLR)> 4 (p= 0.002; HR: 2.42; 95% CI 1.38-4.25) were associated with poorer OS. We categorized 119 pts with complete available data as good-risk (0 factors, 38 pts), intermediate-risk (1 factor, 49 pts) and poor-risk (≥2 factors, 32 pts). Median OS for these three groups were 17.6, 11.1 and 7.4 months, respectively (p < 0.001). FOLFOXIRI is active and feasible in aPC. Prognosis of aPC pts treated with FOLFOXIRI is influenced by easily available factors: our analysis revealed ECOG PS, liver metastases and NLR as the most important predictors of survival. These factors could be helpful for treatment decision and clinical trial design. PMID:27038273

  20. NOTCH1, SF3B1, BIRC3 and TP53 mutations in patients with chronic lymphocytic leukemia undergoing first-line treatment: correlation with biological parameters and response to treatment.

    PubMed

    Chiaretti, Sabina; Marinelli, Marilisa; Del Giudice, Ilaria; Bonina, Silvia; Piciocchi, Alfonso; Messina, Monica; Vignetti, Marco; Rossi, Davide; Di Maio, Valeria; Mauro, Francesca Romana; Guarini, Anna; Gaidano, Gianluca; Foà, Robin

    2014-12-01

    In chronic lymphocytic leukemia, NOTCH1, SF3B1, BIRC3 and TP53 disruptions are recurrent and affect survival. To define their incidence and clinical impact in patients undergoing first-line treatment, we evaluated 163 cases enrolled in the GIMEMA (Gruppo Italiano Malattie EMatologiche dell'Adulto) LLC0405 protocol (fludarabine plus alemtuzumab or fludarabine plus cyclophosphamide), for young patients, or in the ML21445 protocol (chlorambucil plus rituximab), for elderly patients. NOTCH1, SF3B1, BIRC3 and TP53 disruptions were detected in 15.9%, 12.2%, 8.6% and 10.4% of cases. NOTCH1 mutations correlated with a shorter treatment-free interval (p = 0.058), an unmutated immunoglobulin heavy variable gene (IGHV) status (p < 0.0001), CD38 and ZAP-70 expression (p = 0.0025 and 0.026, respectively) and trisomy 12 (p = 0.0028), SF3B1 mutations with an unmutated IGHV status (p = 0.02), and BIRC3 disruptions with an unmutated IGHV configuration (p = 0.01) and 11q deletion (p < 0.0001). NOTCH1 and SF3B1 did not appear to impact on overall response, while an inferior response was observed for BIRC3- and TP53-disrupted cases in the LLC0405 and ML21445 protocols, respectively. Progression-free survival, evaluable in the LLC0405 protocol - not affected by NOTCH1, SF3B1 and TP53 - appeared inferior for BIRC3 disruption. NOTCH1 and SF3B1 mutations may be overcome by aggressive regimens, while BIRC3 might impact on outcome also in intensive regimens. PMID:24597984

  1. Current activities of Cardiovascular Rehabilitation in the ambulatory setting of the Lombardy Region.

    PubMed

    Ambrosetti, Marco; Pedretti, Roberto F E; Facchini, Mario; Malfatto, Gabriella; Riccobono, Salvatore Pio; Febo, Oreste; Diaco, Tommaso

    2016-01-01

    , le condizioni di accesso alle MAC più utilizzate sono stati gli esiti di sindrome coronarica (con o senza rivascolarizzazione) e vi è stata una robusta rappresentazione (oltre 60%) di situazioni cliniche a medio/alto rischio clinico, complessità e disabilità. L'outcome dell'intervento in regime di MAC (in termini di recupero funzionale, titolazione della terapia di cardioprotezione e raggiungimento dei target terapeutici) è stato globalmente soddisfacente, seppure minore (non superiore al 70%) nel MAC 8 meno "intensivo". PMID:27374037

  2. Recombinant human erythropoietin in very elderly patients with myelodysplastic syndromes: results from a retrospective study.

    PubMed

    Tatarelli, Caterina; Piccioni, Anna Lina; Maurillo, Luca; Naso, Virginia; Battistini, Roberta; D'Andrea, Mariella; Criscuolo, Marianna; Nobile, Carolina; Villivà, Nicoletta; Mancini, Stefano; Neri, Benedetta; Breccia, Massimo; Fenu, Susanna; Buccisano, Francesco; Voso, Maria Teresa; Latagliata, Roberto; Aloe Spiriti, Maria Antonietta

    2014-08-01

    Myelodysplastic syndromes (MDS) are common in elderly patients. Recombinant human erythro-poietin (rHuEPO) has been widely used to treat anemia in lower risk MDS patients, but few data are known about rHuEPO treatment in the very elderly patient group. In order to investigate the role of rHuEPO treatment in terms of response, overall survival (OS), and toxicity in a very elderly MDS patient group, 93 MDS patients treated with rHuEPO when aged ≥80 years were selected among MDS cases enrolled in a retrospective multicenter study by the cooperative group Gruppo Romano Mielodisplasie (GROM) from Jan 2002 to Dec 2010. At baseline, median age was 82.7 (range 80-99.1) with a median hemoglobin (Hb) level of 9 g/dl (range 6-10.8). The initial dose of rHuEPO was standard (epoetin alpha 40,000 IU/week or epoetin beta 30,000 IU/week) in 59 (63.4 %) patients or high in 34 (36.6 %) (epoetin alpha 80,000 IU/week) patients. We observed an erythroid response (ER) in 59 (63.4 %) patients. No thrombotic event was reported. Independent predictive factors for ER were low transfusion requirement before treatment (p = 0.004), ferritin <200 ng/ml (p = 0.017), Hb >8 g/dl (p = 0.034), and a high-dose rHuEPO treatment (p = 0.032). Median OS from rHuEPO start was 49.3 months (95 % CI 27.5-68.4) in responders versus 30.6 months (95 % CI 7.3-53.8) in resistant patients (p = 0.185). In conclusion, rHuEPO treatment is safe and effective also in the very elderly MDS patients. However, further larger studies are warranted to evaluate if EPO treatment could be worthwhile in terms of quality of life and cost-efficacy in very old patients. PMID:24647684

  3. [Psicopatologia, fattori psicosociali e obesità].

    PubMed

    Pinna, Federica; Sardu, Claudia; Orrù, Walter; Velluzzi, Fernanda; Loviselli, Andrea; Contu, Paolo; Carpiniello, Bernardo

    2016-01-01

    RIASSUNTO. Scopi. Gli obiettivi di questo studio sono stati la valutazione dell'associazione tra obesità, variabili socio-demografiche e psicopatologiche in un campione clinico di pazienti afferenti a un centro per la diagnosi e il trattamento dell'obesità, confrontati con un campione omogeneo di controllo costituito da soggetti di peso normale. Metodi. Nel contesto di un progetto di ricerca riguardante obesità e psicopatologia, è stata applicata una regressione logistica multivariata per esaminare l'associazione tra obesità e variabili demografiche e cliniche relative a un campione consecutivo di 293 pazienti obesi (48 maschi, 245 femmine, età media: 45,41±13,55, indice di massa corporea [BMI] 35,6±6,2), confrontato con un gruppo di controllo omogeneo appaiato di 293 soggetti non obesi (48 maschi, 245 femmine, età media 45,66±13,86, BMI medio 21,8±2,06). Tutti i soggetti sono stati valutati mediante un'intervista clinica strutturata, la Structured Clinical Interview per la diagnosi di asse I del DSM-IV (SCID-I) e per l'asse II DSM-IV (SCID-II). Risultati. L'analisi statistica multivariata ha dimostrato che lo status di casalinga e la presenza "lifetime" di disturbi di asse I e II e in generale della presenza di una qualsiasi diagnosi psichiatrica, e, in particolare, delle diagnosi di disturbo depressivo, d'ansia, del comportamento alimentare e di alcuni disturbi di personalità, sono associate in modo significativo a una maggiore probabilità di essere in sovrappeso oppure obesi. Le probabilità di essere sovrappeso/obesi si modificano in rapporto alle diverse combinazioni di fattori di rischio, aumentando da un valore di 32,3% per un individuo non esposto ad alcun fattore di rischio, a un valore di 86,7% per i soggetti esposti a tutti i fattori di rischio considerati. Conclusioni. La presenza di una diagnosi di asse I e/o II e lo stato di casalinga è indipendentemente associata a un maggiore rischio di sovrappeso/obesità. L'interazione di questi

  4. Prognostic impact of pre-transplantation transfusion history and secondary iron overload in patients with myelodysplastic syndrome undergoing allogeneic stem cell transplantation: a GITMO study

    PubMed Central

    Alessandrino, Emilio Paolo; Porta, Matteo Giovanni Della; Bacigalupo, Andrea; Malcovati, Luca; Angelucci, Emanuele; Van Lint, Maria Teresa; Falda, Michele; Onida, Francesco; Bernardi, Massimo; Guidi, Stefano; Lucarelli, Barbarella; Rambaldi, Alessandro; Cerretti, Raffaella; Marenco, Paola; Pioltelli, Pietro; Pascutto, Cristiana; Oneto, Rosi; Pirolini, Laura; Fanin, Renato; Bosi, Alberto

    2010-01-01

    Background Transfusion-dependency affects the natural history of myelodysplastic syndromes. Secondary iron overload may concur to this effect. The relative impact of these factors on the outcome of patients with myelodysplastic syndrome receiving allogeneic stem-cell transplantation remains to be clarified. Design and Methods We retrospectively evaluated the prognostic effect of transfusion history and iron overload on the post-transplantation outcome of 357 patients with myelodysplastic syndrome reported to the Gruppo Italiano Trapianto di Midollo Osseo (GITMO) registry between 1997 and 2007. Results Transfusion-dependency was independently associated with reduced overall survival (hazard ratio=1.48, P=0.017) and increased non-relapse mortality (hazard ratio=1.68, P=0.024). The impact of transfusion-dependency was noted only in patients receiving myeloablative conditioning (overall survival: hazard ratio=1.76, P=0.003; non-relapse mortality: hazard ratio=1.70, P=0.02). There was an inverse relationship between transfusion burden and overall survival after transplantation (P=0.022); the outcome was significantly worse in subjects receiving more than 20 red cell units. In multivariate analysis, transfusion-dependency was found to be a risk factor for acute graft-versus-host disease (P=0.04). Among transfusion-dependent patients undergoing myeloablative allogeneic stem cell transplantation, pre-transplantation serum ferritin level had a significant effect on overall survival (P=0.01) and non-relapse mortality (P=0.03). This effect was maintained after adjusting for transfusion burden and duration, suggesting that the negative effect of transfusion history on outcome might be determined at least in part by iron overload. Conclusions Pre-transplantation transfusion history and serum ferritin have significant prognostic value in patients with myelodysplastic syndrome undergoing myeloablative allogeneic stem cell transplantation, inducing a significant increase of non

  5. Simulation of strong ground motion for moderate earthquakes: comparison between two high frequency approaches

    NASA Astrophysics Data System (ADS)

    Emolo, A.; Pacor, F.; Cultrera, G.; Franceschina, G.; Zollo, A.; Cocco, M.

    2003-04-01

    We used two different strong ground motion simulation techniques to generate shaking scenarios for the 1997 Colfiorito earthquake (Mw=6.0). This earthquake has been studied in the framework of a Italian research project (supported by Gruppo Nazionale per la Difesa dai Terremoti - INGV, 2002-2003). The project concerns the design of ground shaking scenarios based on the identification of the position, geometry and rupture mechanism of seismogenetic faults and on the characterization of the crustal structure. Both techniques use the high frequency solution (ray theory) to compute the Green functions in a flat-layered velocity model. While one method (ASymptotic Method, ASM) solves numerically the representation integral, the other one (Deterministic-Stochastic Method, DSM) generalizes the point-source stochastic method using a deterministic acceleration envelope for an extended fault. Only the direct S wave field is computed because, in the near source range, it can be considered dominant in amplitude with respect to the P wave field and secondary phases. We computed synthetic time histories at 64 nodes of a grid area (60km x 60km) up to fmax=5 Hz. First of all, we compared the methods for two source models obtained, for the Colfioririto earthquake, by the inversion of geodetic and accelerometric data. Both techniques give similar distribution of PGA and integral ground motion parameters. In particular, peak values are not symmetrically distributed around the fault, but show the largest amplitude values north to the Colfiorito fault, in the directive direction. The reliability of the proposed rupture scenario has been checked for 6 accelerometric stations located at epicentral distances ranging from 5 to 30 Km that recorded the mainshock. We then generated shaking scenarios varying several parameters, such as the nucleation position, the slip distribution and the rupture velocity. Fault geometry, source mechanism and propagation medium are fixed. The results of the

  6. Combination of International Scoring System 3, High Lactate Dehydrogenase, and t(4;14) and/or del(17p) Identifies Patients With Multiple Myeloma (MM) Treated With Front-Line Autologous Stem-Cell Transplantation at High Risk of Early MM Progression–Related Death

    PubMed Central

    Moreau, Philippe; Cavo, Michele; Sonneveld, Pieter; Rosinol, Laura; Attal, Michel; Pezzi, Annalisa; Goldschmidt, Hartmut; Lahuerta, Juan Jose; Marit, Gerald; Palumbo, Antonio; van der Holt, Bronno; Bladé, Joan; Petrucci, Maria Teresa; Neben, Kai; san Miguel, Jesus; Patriarca, Francesca; Lokhorst, Henk; Zamagni, Elena; Hulin, Cyrille; Gutierrez, Norma; Facon, Thierry; Caillot, Denis; Benboubker, Lotfi; Harousseau, Jean-Luc; Leleu, Xavier; Avet-Loiseau, Hervé; Mary, Jean-Yves

    2014-01-01

    Purpose To construct and validate among patients with multiple myeloma (MM) who were treated with intensive therapy a prognostic index of early MM progression–related death. Patients and Methods Patient-level data from the Intergroupe Francophone du Myélome (IFM) 2005-01 trial (N = 482) were used to construct the prognostic index. The event was MM progression–related death within 2 years from treatment initiation. The index was validated using data from three other trials: the Gruppo Italiano Malattie Ematologiche dell' Adulto (GIMEMA) 26866138-MMY-3006 trial (N = 480), the Programa para el Estudio de la Terapéutica en Hemopatía Maligna (PETHEMA)–GEMMENOS65 trial (N = 390), and the Hemato-Oncologie voor Volwassenen Nederland (HOVON) –65/German-Speaking Myeloma Multicenter Group (GMMG) –HD4 trial (N = 827). Results The risk of early MM progression–related death was related to three independent prognostic variables: lactate dehydrogenase (LDH) higher than than normal, International Staging System 3 (ISS3), and adverse cytogenetics [t(4;14) and/or del(17p)]. These three variables enabled the definition of an ordinal prognostic classification composed of four scores (0 to 3). Patients with a score of 3, defined by the presence of t(4;14) and/or del(17p) in addition to ISS3 and/or high LDH, comprised 5% (20 of 387 patients) to 8% (94 of 1,139 patients) of the patients in the learning and validation samples, respectively, and they had a very poor prognosis. When applied to the population of 855 patients who had received bortezomib-based induction therapy in the four trials, the prognostic classification was also able to segregate patients into four categories, with a very poor prognosis attributed to patients with a score of 3. Conclusion Our model allows the simple definition of a subgroup of MM patients at high risk of early MM progression–related death despite the use of the most modern and effective strategies. PMID:24888806

  7. Prognostic evaluation by clinical exercise test scores in patients treated with primary percutaneous coronary intervention or fibrinolysis for acute myocardial infarction (a Danish Trial in Acute Myocardial Infarction-2 Sub-Study).

    PubMed

    Valeur, Nana; Clemmensen, Peter; Grande, Peer; Saunamäki, Kari

    2007-10-01

    The prognostic accuracy of exercise testing after myocardial infarction is low, and different models have been proposed to enhance the predictive value for subsequent mortality. This study tested a simple score against 3 established scores. Patients with ST-elevation myocardial infarctions were randomized in the Danish Trial in Acute Myocardial Infarction-2 (DANAMI-2) to either primary percutaneous coronary intervention or fibrinolysis with predischarge exercise testing. Clinical and exercise test data were collected prospectively and were available for 1,115 patients. A simple score was derived, awarding 1 point for history or new signs of heart failure, 1 point for a left ventricular ejection fraction <40%, 1 point for age >65 years in men and age >70 years in women, and 1 point for exercise capacity <5 METs in men and exercise capacity <4 METs in women. This DANAMI score was compared with the Veterans Affairs Medical Center score, the Duke treadmill score, and the Gruppo Italiano per lo Studio Della Sopravvivenza nell'Infarto Miocardico-2 (GISSI-2) score in multivariate Cox models and receiver-operating characteristic plots. All scoring systems were predictive of adverse outcomes. The DANAMI score performed better, with greater chi-square values (142 vs 53 to 88 for the prediction of death). Areas under the receiver-operating characteristic curves were compared and were larger for the DANAMI score (C-statistic 0.79 vs 0.71 to 0.74 for the other tests regarding mortality). The DANAMI score stratified patients into a small high-risk group (8% of the population with 43% mortality in 6 years), an intermediate-risk group (13% with 16% mortality in 6 years), and a low-risk group (79% with 4% mortality in 6 years). In conclusion, a simple exercise test score composed of age, METs, heart failure, and a left ventricular ejection fraction <40% seems to outperform the Duke treadmill score, Veterans Affairs Medical Center score, and GISSI-2 score in risk stratifying

  8. Introduzione Nuove tecnologie in urologia.

    PubMed

    Bianchi, Giampaolo

    2011-03-30

    Negli ultimi anni sono state introdotte in urologia nuove tecniche chirurgiche alcune già applicabili nella pratica clinica, altre ancora in corso di sperimentazione. Quella che ha trovato attualmente applicazione è la LESS (Laparo Endoscopic Single-site Surgery); essa riguarda tutte le metodiche che utilizzano una sola porta (multiaccesso) per eseguire interventi laparoscopici. I vantaggi apparenti di questa metodica rispetto alla laparoscopia tradizionale sono soltanto un dimostrato miglior risultato estetico. Mancano studi prospettici randomizzati. NOTES (Natural Orifices Transluminal Endoscopic Surgery) È una metodica ancor più nuova che sfrutta gli orifizi naturali (bocca, retto, vagina, vescica per accedere alla cavità addominale. Rispetto alla LESS questa tecnica utilizza prevalentemente i gastroscopi e lo strumentario dei gastoenterologi per eseguire interventi demolitivi. In urologia l'impiego di questa metodica è puramente sperimentale, comunque piccoli passi sono stati fatti nel migliorare lo strumentario. I chirurghi stanno consolidando questa metodica sull'uomo riguardo alla colecistectomia, ma i risultati sono scarsi, discordanti sulla via d'accesso e limitati a case reports. Oggi i risultati più incoraggianti li ha descritti Estevao Lima, un ingegnoso portoghese che utilizzando una tecnica NOTES di terza generazione (accesso combinato trans-vescicale e trans-gastrico) è riuscito ad eseguire una serie di nefrectomie sul maiale. Tanto si sa e si è speculato riguardo al robot da Vinci®, che oggi la prostatectomia senza di lui non è più competitiva. Moltissimi sono i centri che lo hanno, molti quelli che lo usano, tanti quelli che hanno risultati migliori rispetto alla tecnica laparoscopica classica. Ancora ad oggi però non esistono studi prospettici randomizzati che dimostrino la sua superiorità; inoltre una spina nel fianco sono i costi. Un ulteriore sviluppo futuro di da Vinci® forse potrebbe vedersi nell'assistere le nuove tecniche

  9. Short-term and long-term risk factors in gastric cancer.

    PubMed

    Verlato, Giuseppe; Marrelli, Daniele; Accordini, Simone; Bencivenga, Maria; Di Leo, Alberto; Marchet, Alberto; Petrioli, Roberto; Zoppini, Giacomo; Muggeo, Michele; Roviello, Franco; de Manzoni, Giovanni

    2015-06-01

    While in chronic diseases, such as diabetes, mortality rates slowly increases with age, in oncological series mortality usually changes dramatically during the follow-up, often in an unpredictable pattern. For instance, in gastric cancer mortality peaks in the first two years of follow-up and declines thereafter. Also several risk factors, such as TNM stage, largely affect mortality in the first years after surgery, while afterward their effect tends to fade. Temporal trends in mortality were compared between a gastric cancer series and a cohort of type 2 diabetic patients. For this purpose, 937 patients, undergoing curative gastrectomy with D1/D2/D3 lymphadenectomy for gastric cancer in three GIRCG (Gruppo Italiano Ricerca Cancro Gastrico = Italian Research Group for Gastric Cancer) centers, were compared with 7148 type 2 diabetic patients from the Verona Diabetes Study. In the early/advanced gastric cancer series, mortality from recurrence peaked to 200 deaths per 1000 person-years 1 year after gastrectomy and then declined, becoming lower than 40 deaths per 1000 person-years after 5 years and lower than 20 deaths after 8 years. Mortality peak occurred earlier in more advanced T and N tiers. At variance, in the Verona diabetic cohort overall mortality slowly increased during a 10-year follow-up, with ageing of the type 2 diabetic patients. Seasonal oscillations were also recorded, mortality being higher during winter than during summer. Also the most important prognostic factors presented a different temporal pattern in the two diseases: while the prognostic significance of T and N stage markedly decrease over time, differences in survival among patients treated with diet, oral hypoglycemic drugs or insulin were consistent throughout the follow-up. Time variations in prognostic significance of main risk factors, their impact on survival analysis and possible solutions were evaluated in another GIRCG series of 568 patients with advanced gastric cancer, undergoing

  10. New mapping of Radlandi basin and detailed analysis of its inner plains

    NASA Astrophysics Data System (ADS)

    Minelli, Francesco; Giorgetti, Carolina; Mondini, Alessandro; Pauselli, Cristina; Mancinelli, Paolo

    2013-04-01

    NEW MAPPING OF RADITLADI BASIN AND DETAILED ANALYSIS OF ITS INNER PLAINS. Francesco Minelli 1, Carolina Giorgetti 1, Alessandro C. Mondini 2, Cristina Pauselli 1, Paolo Mancinelli1. 1 Gruppo di Geologia Strutturale e Geofisica (GSG), Dipartimento di Scienze della Terra, Università degli Studi di Perugia, 06123, Perugia, Italy . Email: minelli91@yahoo.it. 2 CNR IRPI Perugia, 06123, Perugia. Introduction: The Raditladi basin is a large peak-ring impact crater discovered during the MESSENGER (MErcury Surface, Space ENvironment, GEochemistry, and Ranging) first flyby of Mercury in January 2008 [1]. The Raditladi basin is relatively young [2], and the study of the internal structures give an indication of the processes that acted recently in Mercury's geological history. Geological mapping: We first present the geological mapping of Raditladi crater. In the map we defined different sub-units on the base of previous studies [4][5] and surface morphology and reflectance. Through a GIS software we associated a polygonal layer to each sub-unit, this allowed to distinguish nine different layers. Due to the similarities with the Rachmaninoff basin, to define sub-units mapped on Raditladi, we adopted Rachmaninoff crater's units definitions made by Marchi et al. (2011) [4]. Structures analysis : We also mapped secondary structures consisting in concentric troughs arranged in a circular pattern. We defined two different kinds of troughs: (i) structures characterized by a distinct flat floor and interpretable as grabens, and (ii) structures with linear and curvilinear segments [5]. Inner plain deposit: The analysis of the topography made possible the estimation of the deposit's thickness. The measurement of the thickness is possible thanks to the presence of two small craters, crater A and crater, located in Raditladi's Inner plain. Observing the morphology of the two small craters' rim and hummocky central floor, we distinguished two different units: the shallower consists in

  11. Seismotectonics investigations in the internal Cottian Alps (Italian Western Alps)

    NASA Astrophysics Data System (ADS)

    Perrone, Gianluigi; Eva, Elena; Solarino, Stefano; Cadoppi, Paola; Balestro, Gianni; Fioraso, Gianfranco; Tallone, Sergio

    2010-05-01

    -Early Miocene) is related to transtensive/extensional movements along the LTZ and the development of minor sub-parallel N-S faults. This kinematic evolution fits in a model of dextral-transtension at regional scale. The more recent activity of the LTZ may have caused the development of Pleistocene lacustrine basin, several hundred metres thick, in the Lower Chisone and Pellice valleys, which did not hosted glacial tongues. Along the LTZ, however, Pleistocene deposits showing evidence of brittle deformation were also found. With the aim to better understand the relation between the current seismic activity and faults, an analysis was carried out by selecting the best located earthquakes (location error less than 3 km) recorded by the seismic network of the North Western Italy (RSNI). This selection is made necessary by the relatively small size of the structures under investigations in order to avoid fake attributions. In addition to get qualitative information about the seismogenic source, the focal mechanisms of four earthquakes occurring along the mapped faults were calculated sorting out the best locatable events among those occurred in the area. The good geometric and kinematic agreement between structural and seismological data indicates a possible dependence of the seismicity of the inner Cottian Alps with the current tectonic activity of the LTZ and its associated minor structures. Balestro G. et al. (2009) Ital. J. Geosci., 128(2), 331-339. Bertotti G., Mosca P. (2009) Tectonophysics, 475, 117-127. Eva C. et al. (1990) Atti del Convegno Gruppo Nazionale Difesa dai terremoti, Ed. Ambiente, Pisa, 1, 25-34. Perrone G. et al. (2009) Ital. J. Geosci., 128(2), 541-549.

  12. Problems, solutions, and perspectives in the evaluation of interval cancers in Italian mammography screening programmes: a position paper from the Italian group for mammography screening (GISMa).

    PubMed

    Bucchi, Lauro; Frigerio, Alfonso; Zorzi, Manuel; Fedato, Chiara; Angiolucci, Giovanni; Bernardi, Daniela; Campari, Cinzia; Crocetti, Emanuele; Ferretti, Stefano; Giorgi, Daniela; Marchisio, Francesca; Morrone, Doralba; Naldoni, Carlo; Petrella, Marco; Ponti, Antonio; Ravaioli, Alessandra; Saguatti, Gianni; Santini, Dolores; Sassoli de Bianchi, Priscilla; Serafini, Monica; Vergini, Viviana; Giordano, Livia

    2015-01-01

    In this position paper, a self-convened team of experts from the Italian Group for Mammography Screening (Gruppo italiano screening mammografico, GISMa) pointed out the problems that increasingly hamper the feasibility and validity of the estimate of the proportional incidence of interval breast cancer (IBC) in Italy, suggested potential solutions and an agenda for research, and proposed that the question of the sensitivity of mammography be viewed in a larger perspective, with a greater attention to radiological review activities and breast radiology quality assurance programmes. The main problems are as follows: the coverage of cancer registration is incomplete; the robustness of using the pre-screening incidence rates as underlying rates decreases with time since the start of screening; the intermediate mammograms performed for early detection purposes may cause an overrepresentation of IBCs; the classification of many borderline screening histories is prone to subjectivity; and, finally, the composition of cohorts of women with negative screening results is uncertain, because several mammography reports are neither clearly negative nor clearly positive, and because of the limitations and instability of the electronic mammography records. Several possibilities can be considered to cope with these issues: standard methods for using the hospital discharge records in the identification of IBCs should be established; for the calculation of regional estimates of the underlying incidence, a suitable mathematical model should be identified; the definition of IBC according to the 2008 GISMa guidelines needs to be updated, especially with respect to in situ cancers and to invasive cancers with borderline screening histories; a closer adherence to standard screening protocols, with a simplified patient management, would make it easier to objectively identify IBCs; alternative methods for estimating the sensitivity of mammography should be taken into consideration; and

  13. PREFACE: A tribute to Virginio Bortolani

    NASA Astrophysics Data System (ADS)

    Brivio, Gian Paolo

    2007-08-01

    I met Virginio Bortolani at a meeting in Salerno (Italy) in summer 1977, when I was a fresh post-doc, just back to Italy after two years at the University of Liverpool (UK). At that time since 1972, Bortolani was the first Chairman of the Surface Physics Section of GNSM (Gruppo Nazionale di Struttura della Materia) of the Italian science research council (CNR), position which he held for about a decade. So I approached him with the formal respect due to a senior scientist by a younger fellow, which was customary at Italian Universities. However, his manners looked very non-conventional for those times. While smoking his daily nth cigarette, first he said to me 'Diamoci del tu' The literal translation would be: let us switch from 'you' to 'thou', and in modern English it is equivalent to being on first-name terms, and then started getting information about my work in a way which was both friendly and fatherly. Since then we crossed each other at several meeting, often discussing physics, but we only began to collaborate at a summer school at ICTP (Trieste) in 1988. There Bortolani, one of the Directors, had the excellent idea of involving T B Grimley and myself in a project in order to investigate theoretically trapping/desorption phenomena of noble gases at metal surfaces owing to phonon interaction. Eventually we understood the limits of validity of Knudsen's law for phenomena out of equilibrium such as those in chopped beam experiments. During that school, which lasted for many weeks, I was most impressed by the relaxed atmosphere that Bortolani was able to create and maintain throughout the event. Everyone from the newcomer student from Asia, Africa or Latin America, to the top scientist felt at ease. This helped students from developing countries to interact with the lecturers beneficially, and allowed other people like me to start a few very fruitful collaborations. By the way the proceedings of that school, edited by V Bortolani, N H March and M P Tosi, and

  14. PREFACE: A tribute to Virginio Bortolani

    NASA Astrophysics Data System (ADS)

    Brivio, Gian Paolo

    2007-08-01

    I met Virginio Bortolani at a meeting in Salerno (Italy) in summer 1977, when I was a fresh post-doc, just back to Italy after two years at the University of Liverpool (UK). At that time since 1972, Bortolani was the first Chairman of the Surface Physics Section of GNSM (Gruppo Nazionale di Struttura della Materia) of the Italian science research council (CNR), position which he held for about a decade. So I approached him with the formal respect due to a senior scientist by a younger fellow, which was customary at Italian Universities. However, his manners looked very non-conventional for those times. While smoking his daily nth cigarette, first he said to me 'Diamoci del tu' The literal translation would be: let us switch from 'you' to 'thou', and in modern English it is equivalent to being on first-name terms, and then started getting information about my work in a way which was both friendly and fatherly. Since then we crossed each other at several meeting, often discussing physics, but we only began to collaborate at a summer school at ICTP (Trieste) in 1988. There Bortolani, one of the Directors, had the excellent idea of involving T B Grimley and myself in a project in order to investigate theoretically trapping/desorption phenomena of noble gases at metal surfaces owing to phonon interaction. Eventually we understood the limits of validity of Knudsen's law for phenomena out of equilibrium such as those in chopped beam experiments. During that school, which lasted for many weeks, I was most impressed by the relaxed atmosphere that Bortolani was able to create and maintain throughout the event. Everyone from the newcomer student from Asia, Africa or Latin America, to the top scientist felt at ease. This helped students from developing countries to interact with the lecturers beneficially, and allowed other people like me to start a few very fruitful collaborations. By the way the proceedings of that school, edited by V Bortolani, N H March and M P Tosi, and