ABVD plus radiotherapy versus EVE plus radiotherapy in unfavorable stage IA and IIA Hodgkin's lymphoma: results from an Intergruppo Italiano Linfomi randomized study.

BACKGROUND: In 1997, the Intergruppo Italiano Linfomi started a randomized trial to evaluate, in unfavorable stage IA and IIA Hodgkin's lymphoma (HL) patients, the efficacy and toxicity of the low toxic epirubicin, vinblastine and etoposide (EVE) regimen followed by involved field radiotherapy in comparison to the gold standard doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD) regimen followed by the same radiotherapy program. PATIENTS AND METHODS: Patients should be younger than 65 years with unfavorable stage IA and IIA HL (i.e. stage IA or IIA with bulky disease and/or subdiaphragmatic disease, erythrocyte sedimentation rate higher than 40, extranodal (E) involvement, hilar involvement and more than three involved lymph node areas). RESULTS: Ninety-two patients were allocated to the ABVD arm and 89 to the EVE arm. Complete remission (CR) rates at the end of treatment program [chemotherapy (CT) + RT] were 93% and 92% for ABVD and EVE arms, respectively (P = NS). The 5-year relapse-free survival (RFS) rate was 95% for ABVD and 78% for EVE (P < 0.05). As a consequence of the different relapse rate, the 5-year failure-free survival (FFS) rate was significantly better for ABVD (90%) than for EVE (73%) arm (P < 0.05). No differences in terms of overall survival (OS) were observed for the two study arms. CONCLUSIONS: In unfavorable stage IA and IIA HL patients, no differences were observed between ABVD and EVE arms in terms of CR rate and OS. EVE CT, however, was significantly worse than ABVD in terms of RFS and FFS and cannot be recommended as initial treatment for HL

Biomarker-guided implementation of the KDIGO guidelines to reduce the occurrence of acute kidney injury in patients after cardiac surgery (PrevAKI-multicentre) : protocol for a multicentre, observational study followed by randomised controlled feasibility trial

Acute kidney injury (AKI) is a frequent complication after cardiac surgery with adverse short-term and long-term outcomes. Although prevention of AKI (PrevAKI) is strongly recommended, the optimal strategy is uncertain. The Kidney Disease: Improving Global Outcomes (KDIGO) guideline recommended a bundle of supportive measures in high-risk patients. In a single-centre trial, we recently demonstrated that the strict implementation of the KDIGO bundle significantly reduced the occurrence of AKI after cardiac surgery. In this feasibility study, we aim to evaluate whether the study protocol can be implemented in a multicentre setting in preparation for a large multicentre trial. We plan to conduct a prospective, observational survey followed by a randomised controlled, multicentre, multinational clinical trial including 280 patients undergoing cardiac surgery with cardiopulmonary bypass. The purpose of the observational survey is to explore the adherence to the KDIGO recommendations in routine clinical practice. The second phase is a randomised controlled trial. The objective is to investigate whether the trial protocol is implementable in a large multicentre, multinational setting. The primary endpoint of the interventional part is the compliance rate with the protocol. Secondary endpoints include the occurrence of any AKI and moderate/severe AKI as defined by the KDIGO criteria within 72 hours after surgery, renal recovery at day 90, use of renal replacement therapy (RRT) and mortality at days 30, 60 and 90, the combined endpoint major adverse kidney events consisting of persistent renal dysfunction, RRT and mortality at day 90 and safety outcomes. The PrevAKI multicentre study has been approved by the leading Research Ethics Committee of the University of Münster and the respective Research Ethics Committee at each participating site. The results will be used to design a large, definitive trial. Trial registration number NCT03244514

Common genetic variants on chromosome 9p21 are associated with myocardial infarction and type 2 diabetes in an Italian population

<p>Abstract</p> <p>Background</p> <p>A genomic region on chromosome 9p21 has been identified as closely associated with increased susceptibility to coronary artery disease (CAD) and to type 2 diabetes (T2D) although the evidence suggests that the genetic variants within chromosome 9p21 that contribute to CAD are different from those that contribute to T2D.</p> <p>We carried out an association case-control study in an Italian population to test the association between two single nucleotide polymorphisms (SNPs) on the 9p21 locus, rs2891168 and rs10811661, previously reported by the PROCARDIS study, and respectively myocardial infarction (MI) and T2D. Our aim was to confirm the previous findings on a larger sample and to verify the independence of their susceptibility effects: rs2891168 associated with MI but not with T2D and rs10811661 associated with T2D but not with MI.</p> <p>Methods</p> <p>Genomic DNA samples of 2407 Italians with T2D (602 patients), who had had a recent MI (600), or had both diseases (600) and healthy controls (605) were genotyped for the two SNPs. The genotypes were determined by allelic discrimination using a fluorescent-based TaqMan assay.</p> <p>Results</p> <p>SNP rs2891168 was associated with MI, but not with T2D and the G-allele odds ratio (OR) was 1.20 (95% CI 1.02-1.41); SNP rs10811661 was associated with T2D, but not with MI, and the T-allele OR was 1.27 (95% CI 1.04-1.55). ORs estimates from the present study and the PROCARDIS study were pooled and confirmed the previous findings, with greater precision.</p> <p>Conclusions</p> <p>Our replication study showed that rs2891168 and rs10811661 are independently associated respectively with MI and T2D in an Italian population. Pooling our results with those reported by the PROCARDIS group, we also obtained a significant result of association with diabetes for rs10811661 in the European population.</p

Intelligenza artificiale e sicurezza: opportunità, rischi e raccomandazioni

L'IA (o intelligenza artificiale) è una disciplina in forte espansione negli ultimi anni e lo sarà sempre più nel prossimo futuro: tuttavia è dal 1956 che l’IA studia l’emulazione dell’intelligenza da parte delle macchine, intese come software e in certi casi hardware. L’IA è nata dall’idea di costruire macchine che - ispirandosi ai processi legati all’intelligenza umana - siano in grado di risolvere problemi complessi, per i quali solitamente si ritiene che sia necessario un qualche tipo di ragionamento intelligente. La principale area di ricerca e applicazione attuale dell’IA è il machine learning (algoritmi che imparano e si adattano in base ai dati che ricevono), che negli ultimi anni ha trovato ampie applicazioni grazie alle reti neurali (modelli matematici composti da neuroni artificiali) che a loro volta hanno consentito la nascita del deep learning (reti neurali di maggiore complessità). Appartengono al mondo dell’IA anche i sistemi esperti, la visione artificiale, il riconoscimento vocale, l’elaborazione del linguaggio naturale, la robotica avanzata e alcune soluzioni di cybersecurity. Quando si parla di IA c'è chi ne è entusiasta pensando alle opportunità, altri sono preoccupati poiché temono tecnologie futuristiche di un mondo in cui i robot sostituiranno l'uomo, gli toglieranno il lavoro e decideranno al suo posto. In realtà l'IA è ampiamente utilizzata già oggi in molti campi, ad esempio nei cellulari, negli oggetti smart (IoT), nelle industry 4.0, per le smart city, nei sistemi di sicurezza informatica, nei sistemi di guida autonoma (drive o parking assistant), nei chat bot di vari siti web; questi sono solo alcuni esempi basati tutti su algoritmi tipici dell’intelligenza artificiale. Grazie all'IA le aziende possono avere svariati vantaggi nel fornire servizi avanzati, personalizzati, prevedere trend, anticipare le scelte degli utenti, ecc. Ma non è tutto oro quel che luccica: ci sono talvolta problemi tecnici, interrogativi etici, rischi di sicurezza, norme e legislazioni non del tutto chiare. Le organizzazioni che già adottano soluzioni basate sull’IA, o quelle che intendono farlo, potrebbero beneficiare di questa pubblicazione per approfondirne le opportunità, i rischi e le relative contromisure. La Community for Security del Clusit si augura che questa pubblicazione possa fornire ai lettori un utile quadro d’insieme di una realtà, come l’intelligenza artificiale, che ci accompagnerà sempre più nella vita personale, sociale e lavorativa.AI (or artificial intelligence) is a booming discipline in recent years and will be increasingly so in the near future.However, it is since 1956 that AI has been studying the emulation of intelligence by machines, understood as software and in some cases hardware. AI arose from the idea of building machines that-inspired by processes related to human intelligence-are able to solve complex problems, for which it is usually believed that some kind of intelligent reasoning is required. The main current area of AI research and application is machine learning (algorithms that learn and adapt based on the data they receive), which has found wide applications in recent years thanks to neural networks (mathematical models composed of artificial neurons), which in turn have enabled the emergence of deep learning (neural networks of greater complexity). Also belonging to the AI world are expert systems, computer vision, speech recognition, natural language processing, advanced robotics and some cybersecurity solutions. When it comes to AI there are those who are enthusiastic about it thinking of the opportunities, others are concerned as they fear futuristic technologies of a world where robots will replace humans, take away their jobs and make decisions for them. In reality, AI is already widely used in many fields, for example, in cell phones, smart objects (IoT), industries 4.0, for smart cities, cybersecurity systems, autonomous driving systems (drive or parking assistant), chat bots on various websites; these are just a few examples all based on typical artificial intelligence algorithms. Thanks to AI, companies can have a variety of advantages in providing advanced, personalized services, predicting trends, anticipating user choices, etc. But not all that glitters is gold: there are sometimes technical problems, ethical questions, security risks, and standards and legislation that are not entirely clear. Organizations already adopting AI-based solutions, or those planning to do so, could benefit from this publication to learn more about the opportunities, risks, and related countermeasures. Clusit's Community for Security hopes that this publication will provide readers with a useful overview of a reality, such as artificial intelligence, that will increasingly accompany us in our personal, social and working lives

Il Futuro della Cybersecurity in Italia: Ambiti Progettuali Strategici

Il presente volume nasce come continuazione del precedente, con l’obiettivo di delineare un insieme di ambiti progettuali e di azioni che la comunità nazionale della ricerca ritiene essenziali a complemento e a supporto di quelli previsti nel DPCM Gentiloni in materia di sicurezza cibernetica, pubblicato nel febbraio del 2017. La lettura non richiede particolari conoscenze tecniche; il testo è fruibile da chiunque utilizzi strumenti informatici o navighi in rete. Nel volume vengono considerati molteplici aspetti della cybersecurity, che vanno dalla definizione di infrastrutture e centri necessari a organizzare la difesa alle azioni e alle tecnologie da sviluppare per essere protetti al meglio, dall’individuazione delle principali tecnologie da difendere alla proposta di un insieme di azioni orizzontali per la formazione, la sensibilizzazione e la gestione dei rischi. Gli ambiti progettuali e le azioni, che noi speriamo possano svilupparsi nei prossimi anni in Italia, sono poi accompagnate da una serie di raccomandazioni agli organi preposti per affrontare al meglio, e da Paese consapevole, la sfida della trasformazione digitale. Le raccomandazioni non intendono essere esaustive, ma vanno a toccare dei punti che riteniamo essenziali per una corretta implementazione di una politica di sicurezza cibernetica a livello nazionale. Politica che, per sua natura, dovrà necessariamente essere dinamica e in continua evoluzione in base ai cambiamenti tecnologici, normativi, sociali e geopolitici. All’interno del volume, sono riportati dei riquadri con sfondo violetto o grigio; i primi sono usati nel capitolo introduttivo e nelle conclusioni per mettere in evidenza alcuni concetti ritenuti importanti, i secondi sono usati negli altri capitoli per spiegare il significato di alcuni termini tecnici comunemente utilizzati dagli addetti ai lavori. In conclusione, ringraziamo tutti i colleghi che hanno contribuito a questo volume: un gruppo di oltre 120 ricercatori, provenienti da circa 40 tra Enti di Ricerca e Università, unico per numerosità ed eccellenza, che rappresenta il meglio della ricerca in Italia nel settore della cybersecurity. Un grazie speciale va a Gabriella Caramagno e ad Angela Miola che hanno contribuito a tutte le fasi di produzione del libro. Tra i ringraziamenti ci fa piacere aggiungere il supporto ottenuto dai partecipanti al progetto FILIERASICURA