Current treatment approaches in CML.

Take home messages Five tyrosine kinase inhibitors are available, the treatment strategy is still challenging. Baseline risk, comorbidities, and patient and physician expectations play a pivotal role. Treatment-free remission is a new opportunity

Coarse-grained deltas approaching shallow-water canyon heads: A case study from the Lower Pleistocene Messina Strait, Southern Italy

The tide-dominated Messina Strait (southern Italy) is a 3 km wide marine passageway, whose block-faulted borders form steep subaqueous zones incised by canyons and gullies. These erosional features retreat towards the shorelines and are often in direct connection with subaerial valley-bounded river deltas. High-energy density-flows generated by river floods periodically enter the canyon heads, attaining supercritical-flow regime and accreting large, upslope-migrating bedforms. Although these bedforms have been documented in recent studies, little attention has been paid to the definition of the type of delta entering canyon heads, the internal features of river-influenced deposits accumulated in the nearshore zone, and their interplay with tidal currents flowing axially to the strait. This study focuses on a Lower Pleistocene coarse-grained succession exposed along the north-eastern margin of the modern Messina Strait, investigated using conventional facies analysis and sedimentological logging, integrated with photogrammetric techniques and interpretation of drone-acquired imagery. Facies confinement between basement blocks suggests a subaqueous delta complex shed from the tectonically controlled margin of the ancient strait and entering shallowly submerged canyon heads. Basal breccias, conglomerates and pebbly sandstones exhibiting channel-form discontinuities and upslope dipping backsets are interpreted as cyclic-step and antidune deposits. Units composed of these facies are comprised between master erosional surfaces and tidal ravinement surfaces. The tidal ravinements suggest that canyon infill occurred during a major phase of sea-level rise, punctuated by minor falls and stillstands. These surfaces are overlain by mixed bioclastic–siliciclastic, arenitic, trough and planar cross-strata, representing dunes migrating roughly parallel to the palaeo-coastline and originated by tidal currents amplified by the narrowing of the ancient Messina Strait. Tidal-influenced sedimentation dominated over the fluvial-influenced processes during the late transgression, overfilling the canyon relief. The exceptionally good exposure of depositional architectures and facies characteristics is key to outline the general features of a specific type of delta system, fed by valley-bounded rivers and entering canyon heads in the nearshore of tectonically-controlled, tide-influenced steep strait margins. The pre-existing subaqueous incised topography forced the delta front to be split into lobe branches during the canyon infilling, hampering clinoform architectures and preserving large supercritical-flow sedimentary structures. This study suggests these as possible criteria for the recognition of similar systems in outcrop or subsurface

Tidal sedimentary dynamics of the Early Pleistocene Messina Strait (Calabria, southern Italy) based on its modern analogue

The Messina Strait excursion opens a series of geological field trips associated with the 10th International Congress of Tidal Sedimentology (Tidalites), Matera, Italy, 5-7 October 2021. This guide aims at documenting a number of selected outcrops located along the eastern margin of the modern Messina Strait, in order to illustrate the sedimentary dynamics of the Early Pleistocene tide-dominated Messina Strait. Since the Pliocene, this extensional basin separated Sicily from Calabria, forming a wide non-tidal seaway. Successively, this basin turned into a ca. 10-15 km-wide and 40 km-long, tide-dominated strait during the Early Pleistocene, prior to its definitive closure following a Middle Pleistocene phase of tectonic uplift. As for today in its modern analogue, the ancient strait acted as a major conduit for marine water exchanges between the Ionian and the Tyrrhenian seas. Semi-diurnal, reverse bidirectional tidal currents flowed in phase opposition parallel to the strait margins, being subject to tidal amplification due to bathymetric restriction across the shallower strait-centre zone. This oceanographic setting partitioned the strait into specific environments. Nowadays, their sedimentary record is exposed in a series of outcrops across the western (Sicily) and eastern (Calabria) margins of the modern strait. A series of stops along a south-to-north transect covers a total distance of ca. 20 km. Outcrops of the first day show coarse-grained deposits lying adjacent to a block-faulted central horst and transgressively overlain by cross-stratified, mixed bioclastic-siliciclastic arenites. These strata record bypass and residual sedimentation in the strait-centre zone of the ancient system. The second day, large- and medium-scale cross-stratification exhibiting a variety of tidal sedimentary indicators are observed, interpreted as the ancient northern tidal dune field. The third day focuses on one major section representing the north-eastern flank of the ancient strait, where subaqueous canyon-fill strata, mass-wasting deposits and tide-influenced delta front-facies are exposed

Virtual reality and live scenario simulation: options for training medical students in mass casualty incident triage

Introduction Multicasualty triage is the process of establishing the priority of care among casualties in disaster management. Recent mass casualty incidents (MCI) revealed that health personnel are unfamiliar with the triage protocols. The objective of this study is to compare the relative impact of two simulation-based methods for training medical students in mass casualty triage using the Simple Triage and Rapid Treatment (START) algorithm. Methods A prospective randomized controlled longitudinal study. Medical students enrolled in the emergency medicine course were randomized into two groups (A and B). On day 1, group A students were exposed to a virtual reality (VR) scenario and group B students were exposed to a live scenario (LS), both exercises aiming at triaging 10 victims in a limited period of time (30 seconds/victim). On day 2 all students attended a 2-hour lecture about medical disaster management and START. On day 3 group A and B students were exposed to a LS and to a VR scenario respectively. The vital signs and clinical condition of the 10 victims were identical in the two scenarios. Ability of the groups to manage a simulated triage scenario was then compared (times and triage accuracy). Results Groups A and B were composed of 25 and 28 students respectively. During day 1 group A LS triage accuracy was 58%, while the average time to assess all patients was 4 minutes 28 seconds. The group B VR scenario triage accuracy was 52%, while the average time to complete the assessment was 5 minutes 18 seconds. During day 3 the triage accuracy for group A VR simulation was 92%, while the average time was 3 minutes 53 seconds. Group B triage accuracy during the LS was 84%, with an average time of 3 minutes 25 seconds. Triage scores improved significantly during day 3 (P < 0.001) in the two groups. The time to complete each scenario decreased significantly from day 1 to day 3. Conclusions The study demonstrates that the training course generates significant improvement in triage accuracy and speed. It also reveals that VR simulation compared to live exercises has equivalent results in prompting critical decisions in mass casualty drills. In the beginning the average time to complete the VR scenario was higher than the LS. This could be due to the fact that on day 1 very detailed VR victims created a higher challenge for untaught students. However, the higher triage accuracy recorded at the end of day 3 in VR could be explained by a lower stress level compared to the LS, which could be creating a more stressful environment in taught students

Questions concerning tyrosine kinase-inhibitor therapy and transplants in chronic phase chronic myeloid leukaemia

In this provocative commentary, we consider several questions posed by the late chronic myeloid leukaemia (CML) expert Prof. Michele Baccarani, which he challenged us to address after his death. He noted only a small proportion of people with chronic phase CML receiving tyrosine kinase-inhibitor (TKI)-therapy are likely to achieve sustained therapy-free remission (TFR) and even fewer are likely to be cured. Persons most likely to fail TKItherapy can be identified at diagnosis or soon after starting TKI-therapy. These persons are likely to need lifetime TKI-therapy with attendant risks of adverse events, cost and psychological consequences. Allogeneic transplants achieve much higher rates of leukaemia-free survival compared with TKI-therapy but are associated with transplant-related adverse events including an almost 20 percent risk of transplant-related deaths within 1 year post-transplant and a compromised quality-of-life because of complications such as chronic graft-versus-host disease. Subject-, disease- and transplant-related co-variates associated with transplant outcomes are known with reasonable accuracy. Not everyone likely to fail TKI-therapy is a transplant candidate. However, in those who candidates are physicians and patients need to weigh benefits and risks of TKI-therapy versus a transplant. We suggest transplants should be more often considered in the metric when counseling people with chronic phase CML unlikely to achieve TFR with TKI-therapy. We question whether we are discounting a possible important therapy intervention; we think so

Robotic versus laparoscopic sacrocolpopexy for apical prolapse: a case-control study

The apical prolapse has always been considered the most complex of the defects of the pelvic floor, for both the difficulty of the surgical corrective technique and for the high post-surgical recurrence rate. Today, the laparoscopic sacrocolpopexy can be considered the standard treatment for apical prolapse. In the last years, several author performed robotic sacrocolpopexy, obtaining positive results. So, we developed a casecontrol study in order to compare the surgical outcome of robotic group with a control group of laparoscopic approach in patients with symptomatic apical pro-lapsed between January 2015 and December 2015 at University Hospital Policlinico "P. Giaccone" and Ospedali Riuniti "Villa Sofia-Cervello", Palermo. Our experience shows that robotic sacrocolpopexy can be considered in positive way for clinical results obtained: all procedures were executed with no complications, we noted a lower intraoperative blood loss and a shorter hospital stay than in laparoscopic group. Although the mean operative time and the economic costs are higher in robotic surgery, this study demonstrates that the use of robotic platform for repairing of symptomatic apical vaginal prolapse is feasible, safe and associated with short-term satisfactory results, representing therefore a valid alternative to laparoscopic approach