Efficacia, sicurezza e valutazione farmaco-economica dei farmaci biotecnologici per il trattamento dell´artrite reumatoide: revisione della letteratura e contributo casistico

Background. Rheumatoid Arthritis (RA) is a highly invalidating, chronic, progressive disease; it represents the 2% of all rheumatic diseases and it is related to very high costs for both civil society and health systems. Since many efficacious therapeutic options are now available (in particular the so-called biologic drugs) and because of the high costs related to these therapies, pharmaco-economic studies are becoming a useful tool for the optimization of health system-related budgets. Methods. Review of the literature for pharmaco-economic studies in RA. Efficacy, safety and pharmaco-economic retrospective analysis in a large monocentric cohort of patients treated with a TNF-inhibitor (first biologic line with infliximab - IFX), etanercept – ETN, or adalimumab - ADA); the database covers a follow-up of 10 years. Results. The review of the literature reported that annual direct costs for managing a patient with RA in Italy range from € 1.643 (1st stage of disease) to € 5.697 (4th stage of disease), while indirect costs range from € 2.705 to € 17.249. ADA monotherapy at the standard 40 mg every other week dose costed € 13.451/year while costs raised up to € 26.369 when the drug was administred at the dose 40 mg/week. The cost of ETN was € 13.582. In the case of combination therapy with methotrexate (MTX) the costs were € 13.637 for ADA and € 13.855 for ETN. The 3 TNF-inhibitors were highly efficacious in significantly reducing disease activity and were well tolerated (with no significant difference for the 3 molecules). Conclusion. In our experience, TNF-alfa inhibitors demonstrated to be an efficacious and safe therapeutic option, in particular in patients with moderate-to-severe disease activity. In the future, prospectic studies implementing extensive quality of life assessment (e.g. calculation of QALY) must be warranted, in order to produced detailed real-life pharmaco-economic evaluations

Investigation of refractive index sensing based on Fano resonance in fiber Bragg grating ring resonators.

In this paper we theoretically investigate a ring resonant cavity obtained by closing on itself a pi-shifted fiber Bragg grating, to be used for refractive index sensing applications. Differently from a conventional pi-shifted fiber Bragg grating, the spectral structure of this cavity is characterized by an asymmetric splitting doublet composed by a right side resonance having an asymmetric Fano profile and a left side resonance having a symmetric Lorentzian profile. The right side resonance shows a narrower and sharper peak than all the other kinds of resonance achievable with both conventional ring resonators and pi-shifted fiber Bragg gratings. A reduction of the resonant linewidth with respect to a conventional pi-shifted Fiber Bragg grating and a fiber ring resonator, having the same physical parameters, is theoretically proved, achieving up to five orders of magnitude improvement with respect to the usual ring resonator. Due to these resonance features, the pi-shifted Bragg grating ring resonator results suitable for RI sensing applications requiring extremely narrow resonances for high resolution measurements. In particular, by assuming a refractive index sensing to detect the presence of sugar in water, the sensor can show a theoretical resolution better than 10(-9) RIU. (C)2015 Optical Society of Americ

A Unique Case of Bilateral Thalamic High-Grade Glioma in a Pediatric Patient with LI-Fraumeni Syndrome: Case Presentation and Review of the Literature

Li-Fraumeni syndrome (LFS) is a rare high-penetrance and autosomal-dominant pathological condition caused by the germline mutation of the TP53 gene, predisposing to the development of tumors from pediatric age. We conducted a qualitative systematic review following the ENTREQ (Enhancing Transparency in Reporting the Synthesis of Qualitative Research) framework. A search was made in MEDLINE/Pubmed and MeSH Database using the terms “Li-Fraumeni” AND “pediatric high-grade glioma (HGG)”, identifying six cases of HGGs in pediatric patients with LFS. We added a further case with peculiar features such as no familiar history of LFS, association of embryonal rhabdomyosarcoma and bithalamic HGG, whose immunohistochemical profile was accurately defined by Next Generation Sequencing. Knowledge synthesis and case analysis grounded the discussion about challenges in the management of this pathology in pediatric age

Design and Optimization of Polarization Splitting and Rotating Devices in Silicon-on-Insulator Technology

We review polarization splitting and rotating photonic devices based on silicon-on-insulator technology platform, focusing on their performance and design criteria. In addition, we present a theoretical investigation and optimization of some rotator and splitter architectures to be employed for polarization diversity circuits. In this context, fabrication tolerances and their influences on device performance are theoretically estimated by rigorous simulations too

Investigation of SOI Raman Lasers for Mid-Infrared Gas Sensing

In this paper, the investigation and detailed modeling of a cascaded Raman laser, operating in the midwave infrared region, is described. The device is based on silicon-on-insulator optical waveguides and a coupled resonant microcavity. Theoretical results are compared with recent experiments, demonstrating a very good agreement. Design criteria are derived for cascaded Raman lasers working as continuous wave light sources to simultaneously sense two types of gases, namely C2H6 and CO2, at a moderate power level of 130 mW