Primary mediastinal lymphoma: diagnosis and treatment options.

Primary mediastinal large B-cell lymphoma (PMBCL) is a unique B-cell lymphoma variant that arises from a putative thymic medulla B cell. It constitutes 2-4% of non-Hodgkin lymphomas and occurs most frequently in young females. PMBCL is characterized by a diffuse proliferation of medium-to-large B cells associated with sclerosis. Molecular analysis shows that PMBCL is a distinct entity compared to other types of diffuse large B-cell lymphomas. PMBCL is characterized by a locally invasive anterior mediastinal bulky mass. The combination of rituximab with CHOP/CHOP-like regimens followed by mediastinal radiation therapy (RT) is associated with a 5-year progression-free survival of 75-85%. However, the role of consolidation RT still remains uncertain. More intensive regimens, such as DA-EPOCH-R without mediastinal RT, have shown very promising results. The conclusive role of PET-CT scan requires prospective studies and there is hope that this may allow to de-escalate RT and accordingly yield reliable prognostic information

Is now the time for molecular driven therapy for diffuse large B-cell lymphoma?

INTRODUCTION: Recent genetic and molecular discoveries regarding alterations in diffuse large B-cell lymphoma (DLBCL) deeply changed the approach to this lymphoproliferative disorder. Novel additional predictors of outcomes and new therapeutic strategies are being introduced to improve outcomes. Areas covered: This review aims to analyse the recent molecular discoveries in DLBCL, the rationale of novel molecular driven treatments and their impact on DLBCL prognosis, especially in ABC-DLBCL and High Grade B Cell Lymphoma. Pre-clinical and clinical evidences are reviewed to critically evaluate the novel DLBCL management strategies. Expert commentary: New insights in DLBCL molecular characteristics should guide the therapeutic approach; the results of the current studies which are investigating safety and efficacy of novel 'X-RCHOP' will probably lead, in future, to a cell of origin (COO) based upfront therapy. Moreover, it is necessary to identify early patients with DLBCL who carried MYC, BCL2 and/or BCL6 rearrangements double hit lymphomas (DHL) because they should not receive standard R-CHOP but high intensity treatment as reported in many retrospective studies. New prospective trials are needed to investigate the more appropriate treatment of DHL

Urban Vibrancy: An Emerging Factor that Spatially Influences the Real Estate Market

Urban vibrancy is defined and measured differently in the literature. Originally, it was described as the number of people in and around streets or neighborhoods. Now, it is commonly associated with activity intensity, the diversity of land-use configurations, and the accessibility of a place. The aim of this paper is to study urban vibrancy, its relationship with neighborhood services, and the real estate market. Firstly, it is used a set of neighborhood service variables, and a Principal Component Analysis is performed in order to create a Neighborhood Services Index (NeSI) that is able to identify the most and least vibrant urban areas of a city. Secondly, the influence of urban vibrancy on the listing prices of existing housing is analyzed by performing spatial analyses. To achieve this, the presence of spatial autocorrelation is investigated and spatial clusters are identified. Therefore, spatial autoregressive models are applied to manage spatial effects and to identify the variables that significantly influence the process of housing price determination. The results confirm that housing prices are spatially autocorrelated and highlight that housing prices and NeSI are statistically associated with each other. The identification of the urban areas characterized by different levels of vibrancy and housing prices can effectively support the revision of the urban development plan and its regulatory act, as well as strategic urban policies and actions. Such data analyses support a deep knowledge of the current status quo, which is necessary to drive important changes to develop more effcient, sustainable, and competitive cities

Assessing Social and Territorial Vulnerability on Real Estate Submarkets

The concept of social vulnerability is widely studied in literature in order to identify particularly socially fragile sectors of the population. For this purpose, several studies have adopted indexes to measure the economic and social conditions of the population. The aim of this paper is to investigate the link between social and territorial vulnerability and the real estate market, by means of an exploratory analysis related to the possibility that spatial analyses can help to identify spatial latent components and variables in the process of price determination. A three phase approach is proposed, using the geographical segmentation of Turin and its related submarkets as a case study. After the identification and analysis of a set of three social and territorial vulnerability indicators, a traditional hedonic approach was applied to measure their influence on property listing prices. Subsequently, spatial analyses were investigated to focus on the spatial components of the indicators and property prices; their spatial autocorrelation was measured and the presence of spatial dependence was taken into account by applying a spatial regression. Results demonstrated that two indicators were spatially correlated with property prices and had a significant and negative influence on them. The proposed approach may help not only to identify the most vulnerable urban areas characterized by the lowest property prices, but also to support the future modification to the actual geographical segmentation of Turin

Location and real estate values: a study for the segmentation of the Microzones of Turin

The city of Turin is segmented in 40 cadastral Microzones, approved by the City Council in June 1999, which are set up as independent segments of the real estate market. Eighteen years have passed since the approval of the division of the city into homogeneous spatial segments, a period of time in which the pattern of the city has changed, both on the level of urban planning and due to the important changes in the real estate market, most notably the economic-financial crisis which has led to a steady decrease of prices from 2010 to date. Over the past few years, prior to upgrading the Microzones, the Turin Real Estate Market Observatory (TREMO) conducted a series of studies including the segmentation of the Microzones in Historical Territorial Units (HTU), identified on the basis of a historical-urban analysis of the area without questioning the boundaries of the Microzones. The purpose of this article is to illustrate the HTUs and to examine the contribution that a territorial unit smaller than the Microzone can give to the explanation of property prices, taking into account that when decreasing the territorial extension, one has to manage even less representative data samples. In order to study the explanatory capacity of the positional variable, together with a series of variables related to the features of the apartments and buildings in the price determination process, a hedonic model was applied by using a sample of housing units offered on the market during the four-year period 2013-2016. In particular, starting from the territorial segmentation of the Microzones in the HTUs, a traditional hedonic model was applied: in the first application, the Microzone positional variable was assumed, whereas in the second, the HTUs were adopted. Both applications generated significant results, with a high coefficient of determination (Adjusted R2) and an excellent explanatory capacity of the variables considered. The importance of the “location”, taken into consideration through the Microzones or through the HTUs, is historically recognized even at an international level and continues to be one of the most important features in the listing price determination process, even during the crisis period of the real estate market

An innovative methodological and operational approach to developing Management Plans for UNESCO World Heritage Sites: a Geographic Information System for “Ivrea, industrial city of the 20th century”

The model for developing Management Plans for UNESCO World Heritage Sites drawn up by the Italian Ministry of Cultural Heritage and Activities in 2005 is no longer wholly adequate in terms of promoting heritage resources and their local contexts. The article considers the innovation developed in the IT/ICT field and provides theoretical and methodological considerations, based on which a new methodology for devising Management Plans could be developed. A Geographic Information System (GIS) for the knowledge and management of the site “Ivrea, industrial city of the 20th century”, is proposed as an innovative, dynamic, interoperable model that can both support urban-scale projects to capture the economic value of cultural heritage and promote forms of indirect enjoyment of the site

Repeated successful use of eltrombopag in chronic primary immune thrombocytopenia: description of an intriguing case.

Thrombopoietin receptor agonists (TPO-RAs) are used as effective alternative treatments in ITP patients unresponsive to first-/second-line therapies. TPO- RAs can also be used to normalize platelet count to safely perform invasive pro- cedures and chemotherapy, in case of malignancies. In few responsive patients, TPO-RAs can be suspended maintaining a sustained respons

Economic and cultural value, urban and built heritage, architecture education: the active role of stakeholders

Innovation in architecture education is increasingly oriented towards the analysis of real problems considered in their multi-dimensionality and the active involvement of the stakeholders. In learning processes, it is useful to face real case studies so that students acquire disciplinary tools and technical knowledge for the definition of sustainable projects, closely linked to the territorial reality, the socio-economic context and the needs expressed by the different stakeholders involved. With an approach of students’ inclusion and involvement in the process of knowledge and definition of the problem under study, they are responsible for their project, collaborate with each other and with external stakeholders and become active in the community of reference. For the students this implies competences in engaging with stakeholders establishing consistent vocabularies, and facilitating participatory research and decision making in collaboration with experts from academia, industry, government, and civil society. Assuming these premises, the aim of this paper is to highlight how the active role of the stakeholders can improve the economic and cultural value of enhancement projects developed in Architecture and Planning Schools, focusing on the potentialities of the Problem-Based Learning (PBL) approach in addressing sustainable and effective design processes. For this purpose, a three steps methodology based on PBL approach is presented in order to facilitate the active involvement of the stakeholders in improving the economic and cultural value of complex building heritages at the architectural and urban scale, starting from real problems and developing sustainable and feasible projects. Each step of the proposed methodology was applied during the atelier “Heritage Preservation and Enhancement”, carried out at the Politecnico di Torino and implemented as a module within the Erasmus + EU project “Citylab. Engaging students with sustainable cities in Latin-America”, co-funded by the European Commission. Specific results were achieved for each step through the interaction among stakeholders, teachers and students and the application of evaluation tools. In particular, the steps and the related findings mainly regarded the context and the main problem definition, the knowledge acquisition and management and the development of feasible and sustainable projects. This experience highlighted the learner’s role in defining problems and alternative design solutions, focusing not so much on the intended result (project) as on the path to get there and so start the transformation from a project-based approach to a PBL one

Relapsed/Refractory Diffuse Large B-Cell Lymphoma (R/R DLBCL) Patients: A Retrospective Analysis of Eligibility Criteria for CAR-T Cell Therapy

Patients (pts) with diffuse large B-cell lymphoma (DLBCL) refractory to second-line therapy or relapsed after an autologous stem cell transplant (ASCT) have a very poor clinical outcome with a median overall survival (OS) of 5 and 8-10 months, respectively. Autologous anti-CD19 chimeric antigen receptor (CD19 CAR) T cells have been associated with sustained complete remissions and long-term survivals in a large proportion of pts with R/R DLBCL by the two pivotal clinical trials Zuma1 and Juliet. This has led to the rapid approval by FDA and then by EMA of CAR-T cells for the third-line treatment of R/R DLBCL. Despite being a potentially revolutionary treatment for pts with advanced disease, the costs are much greater than any previously approved cancer therapy and this may become a substantial economic challenge for the health care system. The definition of inclusion and exclusion criteria capable of identifying more precisely pts who can successfully undergo CAR-T cell therapy, minimizing the severity of the toxicity, still remains a matter of discussion. Moreover, some eligible pts run the risk of becoming ineligible because of poor disease control. Indeed, one of the major obstacles to the successful use of CAR-T cells is the 4-5 week period so far required for the manufacturing and transfer of CAR-T cells. To address this issue, we have examined data of R/R DLBCL pts managed between 2010 and 2018 at our Center in order to: 1) better identify the characteristics and outcome of a cohort of R/R DLBCL pts potentially eligible, according to the approval criteria, for CAR-T cell therapy; 2) define factors influencing CAR-T cell eligibility; 3) make a realistic estimate of pts eligible for CAR-T cells. In this retrospective real-life cohort of R/R DLBCLs, 82/480 pts (17%) were R/R tosecond-line treatment including ASCT. Considering Juliet's inclusion/exclusion criteria for CAR-T cell therapy, only 50 pts (10.4%) would be eligible for CAR-T cells. Our analysis suggests that elevated LDH plus ECOG ≥2 have to be considered the two most significant features of very rapid disease progression. These variables should be taken in account in order to better select DLBCL pts potentially eligible to CAR-T therapy

Corrigendum to a new neurocognitive interpretation of shoulder position sense during reaching:unexpected competence in the measurement of extracorporeal space

[This corrects the article DOI: 10.1155/2016/9065495.