Clinical characteristics and management of cancer-associated acute venous thromboembolism: findings from the MASTER Registry.

Background: Clinical characteristics and management of acute deep vein thrombosis and pulmonary embolism (PE) have been reported to be different in patients with and without cancer. The aim of this paper was to provide information on clinical characteristics and management of acute venous thromboembolism in patients with cancer by means of a large prospective registry. Design and Methods: MASTER is a multicenter registry of consecutively recruited patients with symptomatic, objectively confirmed, acute venous thromboembolism. Information about clinical characteristics and management was collected by an electronic data network at the time of the index event. Results: A total of 2119 patients were enrolled, of whom 424 (20%) had cancer. The incidence of bilateral lower limb deep vein thrombosis was significantly higher in patients with cancer than in patients without cancer (8.5% versus 4.6%; p<0.01), as were the rates of iliocaval thombosis (22.6% versus 14%; p<0.001), and upper limb deep vein thrombosis (9.9% versus 4.8%; p<0.001). Major bleeding (3.3% versus 1.1%; p=0.001), in-hospital treatment (73.3% versus 66.6%; p=0.02) and inferior vena cava filter implantation (7.3% versus 4.1%; p=0.005) were significantly more frequent in patients with cancer, in whom oral anticoagulants were less often used (64.2% versus 82%; p<0.0001). Conclusions: The clinical presentation of acute venous thromboembolism is different and often more extensive in cancer patients than in patients free from malignancy. Moreover, the management of the acute phase of venous thromboembolism is more problematic in cancer patients, especially because of a higher rate of major bleeding and the need for implantation of inferior vena cava filters

The impact of combined nutraceutical supplementation on work-related stress, mood and eating disorders during the menopausal transition: A pilot study

Objectives: Menopause represents a "window of vulnerability" in women's life. This transition comprehends many changes: Physical, metabolical and psychological. It could, also, cause difficulties at work and the most problematic symptoms are poor concentration and memory, tiredness, feeling depressed and lowered confidence. Moreover food becomes, often, a practical, easy and fast solution to manage negative emotions. The aims of this pilot study were: To analyze the existence of a possible link between menopausal transition, mood, eating behavior and well-being perception on the workplace and to verify the possible influence of nutraceutical supplementation on the above mentioned factors. Method: 40 women, with mean age 52 years old and mean BMI 33.27 were enrolled and divided into two groups: Diet + behavioral advices (D), or diet + behavioral advices and a nutraceutical compound (D+N) (Assist Forte Retard\uae 1 cp in the evening) for four months. The following psychological questionnaires were administrated at the beginning and after four months: Zung depression scale, (ZDS); Binge Eating Scale (BES); Job Content Questionnaire ( JCQ) used to measure the investigate job related stress. After the test, each woman had an individual psychological interview aimed to investigate her personal experiences, related to what come out from the results. Results: After four months: women (D+N) achieved a statistically significant improvement in both tests (ZDS p <0.0001 Bes p <0.0083). The women (D) had no statistically significant changes in BES, even if there was better management of feeding behavior, and ZDS did not show an improvement in mood. JCQ analysis showed: women (D+N) had a moderate increase of decision-making capacity (DL 64 to 66) compared with an unchanged workload ( JD 33 to 33.5); social-support perception (SS ) showed a slight improvement even if it remained below the median line of the reference sample. In the (D) group we observed a slight increase of the workload , accompanied by a reduction of the decision-making capacity (DL 74 to 69) and by a tiny lowering of the perception of the social support (SS). Conclusions: The combination of a diet program, behavioural advice and nutraceuticals, compared to the sole diet, made it possible to relieve the emotional and eating disturbs related to the menopause and to improve the perception of a satisfactory work

Integrative genomic analysis of trisomy 12 abnormality in B-cell chronic lymphocytic leukemia

Background: Flow cytometry allows specific assessment of the expression of ZAP-70, a promising new prognostic factor in B-cell chronic lymphocytic leukemia (B-CLL), but suffers from a lack of multicenter standardization. Design and Methods: An optimized method for direct detection of ZAP-70 in flow cytometry was tested in a multicenter fashion. Adapted for frozen cells, this method includes a normalization step by addition of B cells from a pool of peripheral blood mononuclear cells collected from normal donors. ZAP-70 expression levels were assessed for 153 patients with typical B-cell chronic lymphocytic leukemia chronic lymphocytic leukemia. Results were expressed as the ratio of ZAP-70 mean fluorescence intensity between B-CLL cells and normal B cells. Results: The statistically optimized cut-off of ZAP-70 positivity was a ratio of 1.4. Concordance between ZAP-70 and CD38 expression was 67%. Concordance between the mutational status of IgVH genes and ZAP-70 or CD38 expression was 87% and 65%, respectively. ZAP-70 was significantly expressed in 28%, 54% and 61% of patients with Binet stages A, B and C B-cell chronic lymphocytic leukemia, respectively (p=0.008). The absence of ZAP-70 expression was associated with isolated del(13q14), a cytogenetic abnormality with a good prognosis, while most patients with the del(17p13) poor prognosis cytogenetic marker expressed ZAP-70 (p&lt;10-5). ZAP-70 expression was not related to the other poor prognosis cytogenetic abnormality del(11q22.3) nor to trisomy 12. Conclusions: This new technique provides highly reliable results well correlated with the mutational status of IgVH genes, CD38 expression, Binet stage and cytogenetic abnormalities. This robust discriminative technique appears of particular interest for routine diagnosis and assessment of ZAP-70 expression in large, prospective, multicenter therapeutic trials

Effect of organic treatments on soil carbon and nitrogen dynamics in vineyard

The work aims to investigate the effects of different soil management strategies on carbon sequestration and total nitrogen in areas of vineyards suffering from loss of soil functionality. Treatments, selected for inter-row management, to re-install soil functionality were based on compost or other organic amendments (COMP), green manure (GM), and dry mulching (DM) strategies using winter legumes and cereals. Cover crops were seeded in fall and mown in late spring, leaved in the ground for mulching in DM or incorporated into the uppermost soil layers in GM. Such approaches were investigated in six vineyards in Italy, six in France, and two vineyards in Slovenia and Turkey. The results showed that COMP significantly increased total organic carbon (TOC) and total nitrogen (Ntot) in the topsoil after one year of application. Also DM tends to increase significantly TOC in the topsoil, but only after two years. Modelling 20-year carbon stock dynamics in Italy vineyards, the average increase resulted 0.49, 0.34, 0.21 and 0.03 Mg C ha-1 yr-1 for COMP, DM, GM and control, respectively

sp2 carbon allotropes in elastomer matrix: from master curves for the mechanical reinforcement to lightweight materials

This work presents high surface area sp2 carbon allotropes as important tools to design and prepare lightweight materials. Composites were prepared based on either carbon black (CB) or carbon nanotubes (CNT) or hybrid CB/CNT filler systems, with either poly(1,4-cis-isoprene) or poly(styrene-co-butadiene) as the polymer matrix. A correlation was established between the specific interfacial area (i.a.), i.e. the surface made available by the filler per unit volume of composite, and the initial modulus of the composite (G′γmin), determined through dynamic mechanical shear tests. Experimental points could be fitted with a common line, a sort of master curve, up to about 30.2 and 9.8 mass% as CB and CNT content, respectively. The equation of such master curve allowed to correlate modulus and density of the composite. Thanks to the mastercurve, composites with the same modulus and lower density could be designed by substituting part of CB with lower amount of the carbon allotrope with larger surface area, CNT. This work establishes a quantitative correlation as a tool to design lightweight materials and paves the way for large scale application in polymer matrices of innovative sp2 carbon allotropes

Edoxaban: an update on the new oral direct factor Xa inhibitor.

Edoxaban is a once-daily oral anticoagulant that rapidly and selectively inhibits factor Xa in a concentration-dependent manner. This review describes the extensive clinical development program of edoxaban, including phase III studies in patients with non-valvular atrial fibrillation (NVAF) and symptomatic venous thromboembolism (VTE). The ENGAGE AF-TIMI 48 study (N = 21,105; mean CHADS2 score 2.8) compared edoxaban 60 mg once daily (high-dose regimen) and edoxaban 30 mg once daily (low-dose regimen) with dose-adjusted warfarin [international normalized ratio (INR) 2.0-3.0] and found that both regimens were non-inferior to warfarin in the prevention of stroke and systemic embolism in patients with NVAF. Both edoxaban regimens also provided significant reductions in the risk of hemorrhagic stroke, cardiovascular mortality, major bleeding and intracranial bleeding. The Hokusai-VTE study (N = 8,292) in patients with symptomatic VTE had a flexible treatment duration of 3-12 months and found that following initial heparin, edoxaban 60 mg once daily was non-inferior to dose-adjusted warfarin (INR 2.0-3.0) for the prevention of recurrent VTE, and also had a significantly lower risk of bleeding events. Both studies randomized patients at moderate-to-high risk of thromboembolic events and were further designed to simulate routine clinical practice as much as possible, with edoxaban dose reduction (halving dose) at randomisation or during the study if required, a frequently monitored and well-controlled warfarin group, a well-monitored transition period at study end and a flexible treatment duration in Hokusai-VTE. Given the phase III results obtained, once-daily edoxaban may soon be a key addition to the range of antithrombotic treatment options

Soil functionality assessment in degraded plots of vineyards

Land transformation to adapt fields to mechanization in perennial crop farming is a common practice which includes land levelling, deep ploughing, stone-breakage and clearing, application of fertilizers and amendments. Manipulation of the natural soil profile along its entire depth can severely disturb the naturally existing chemical physical,biological and hydrological equilibrium (Costantini and Barbetti, 2008; Costantini et al., 2013). The most common effects of the land transformation are mixing of soil horizons and soil truncation, which result in reduction of soil depth and available water, organic matter depletion, enrichment of calcium carbonate content in the topsoil,imbalance of some element ratio, and decline in the activity and diversity of soil biological communities involved in nutrient cycles. A decline in the capacity of soil to accommodate the soil-dwelling organisms causes a strong impact on several ecosystem services, in particular, the growth of the vine, the quality and quantity of the grapes,the production costs and the risk of erosion. These negative effects of a pre-planting mismanagement can occur simultaneously and interact to decrease soil fertility and grapevine performance (Lanyon et al., 2004; Tagliavini and Rombolà, 2001; Martínez-Casasnovas and Ramos, 2009).Since soil spatial variability is usually high, soil manipulations frequently result into reduced soil functionality and decline of soil ecosystem services in defined plots of the vineyards. Sometimes soil degradation in these areas is very high and compromises not only vine performance and crop yield, but also disease resistance of plants to diseases and their survival. The impact of improper soil manipulations in vineyards may be of particular concern, because vineyards are frequently located on marginal hillsides, which are sensitive to soil erosion and characterized by shallow soil depth (Ramos, 2006). This paper wants to show the assessment of soil functionality in degraded areas within two farms in Tuscany. This work reports the results of the first activities in Italian sites of the ReSolVe Core-organic+ project, aimed at restoring optimal Soil functionality in degraded areas within organic European vineyards