On the banks of the Tiber : opportunity and transformation in early Rome

Funds for the research were generously provided by the Loeb Classical Library Foundation, Gerda Henkel Foundation, American Philosophical Society, Etruscan Foundation, Fondazione Lemmermann, University of Michigan and University of St Andrews. The lead author wrote this article while supported by an Early Career Fellowship from the Leverhulme Trust.A geoarchaeological coring survey of the Forum Boarium has shed considerable light on Rome's archaic landscape. We present the first empirical evidence that substantiates ancient and modern assumptions about the existence of a river harbour and ford in early Rome. Prior to the growth of the city, the riverbank-reconstructed as a high ledge at the base of the Capitoline Hill and a low-lying shore north of the Aventine-was particularly advantageous for river-related activities. However, the river valley changed significantly in the sixth century b.c.e., as a result of complex fluvial processes that were arguably spurred by urbanisation. Around the beginning of the Republic, Rome's original harbour silted up, and a high, wide riverbank emerged in its place. The siltation continued until the Forum Boarium was urbanised in the mid-Republic. In order to build their city and maintain river harbour operations, the Romans therefore had to adapt to dynamic ecological conditions.Publisher PDFPeer reviewe

Tectonics and fluvial dynamism affecting the Tiber River in prehistoric Rome

Open access funding provided by Istituto Nazionale di Geofisica e Vulcanologia within the CRUI-CARE Agreement. Research funding was provided by Loeb Classical Library Foundation, Gerda Henkel Foundation, American Philosophical Society, Etruscan Foundation, Fondazione Lemmermann, University of Michigan, University of St Andrews, and the Leverhulme Trust.Geomorphological investigations in Rome’s river valley are revealing the dynamism of the prehistoric landscape. It is becoming increasingly apparent that paleogeographic conditions that defined Rome in the historical era are the product of changes since the Bronze Age, which may be the result of local fault activity in addition to fluvial dynamism. Through a dedicated borehole chronostratigraphic study, integrated by 14C and archaeological dates, and paleomagnetic investigations, we offer here new evidence for fault displacement since ca. 4500 years/BP. We present the failure of the sedimentary fabric of a clay horizon caused by liquefaction processes commonly linked with seismic shaking, interpreting an (ca. 4 m) offset to signify the existence of a fault line located at the foot of the Capitoline Hill. In addition, we show evidence for another (ca. 1 m) offset affecting a stratigraphic horizon in the river channel, occurring along another hypothesized fault line crossing through the Tiber Valley. Movement along this fault may have contributed to a documented phase of fast overflooding dated to the sixth century BCE which eventually led to the birth of the Tiber Island. The most plausible scenario implies progressive deformation, with an average tectonic rate of 2 mm/year, along these inferred fault lines. This process was likely punctuated with moderate earthquakes, but no large event necessarily occurred. Together, the available evidence suggests that during the early centuries of sedentary habitation at the site of Rome, active fault lines contributed to significant changes to the Tiber River valley, capable of challenging lowland activities.Publisher PDFPeer reviewe

Anticoagulation for the long-term treatment of venous thromboembolism in patients with cancer

Background: Cancer increases the risk of thromboembolic events in patients including those receiving anticoagulation treatments. Objectives: To compare the efficacy and safety of low molecular weight heparin (LMWH) and oral anticoagulants for the long-term treatment of venous thromboembolism (VTE) in patients with cancer. Search methods: We conducted a comprehensive search for studies of anticoagulation in cancer patients including 1. a February 2013 electronic search of: the Cochrane Central Register of Controlled Trials (CENTRAL Issue 12, 2012), MEDLINE, and EMBASE; 2. a handsearch of conference proceedings; 3. checking of references of included studies; 4. use of the 'related citation' feature in PubMed; and 5. a search of clinicaltrials.gov for ongoing studies. Selection criteria: We included randomized controlled trials (RCTs) comparing long-term treatment with LMWH versus oral anticoagulants (vitamin K antagonist (VKA) or ximelagatran) in patients with cancer and symptomatic objectively confirmed VTE. Data collection and analysis: Using a standardized data form, we extracted data on methodological quality, participants, interventions and outcomes of interest: survival, recurrent VTE, major bleeding, minor bleeding, thrombocytopenia, and postphlebitic syndrome. We assessed the quality of evidence at the outcome level following the GRADE approach. Main results: Of 9559 identified citations, 10 RCTs (11 reports) were eligible and reported data for 1981 patients with cancer. We excluded 14 studies in which patients with cancer constituted study subgroups, but did not report outcome data for them. Meta-analysis of seven RCTs comparing LMWH with VKA found no statistically significant survival benefit (hazard ratio (HR) 0.96; 95% confidence interval (CI) 0.81 to 1.14) but a statistically significant reduction in VTE (HR 0.47; 95% CI 0.32 to 0.71). The remaining findings did not exclude a beneficial or harmful effect of LMWH compared with VKA for the outcomes of major bleeding (RR 1.07; 95% CI 0.52 to 2.19), minor bleeding (RR 0.89; 95% CI 0.51 to 1.55), or thrombocytopenia (RR 0.98; 95% CI 0.57 to 1.66). We judged the quality of evidence as low for mortality, major bleeding, and minor bleeding, and as moderate for recurrent VTE. One RCT comparing dabigatran with VKA did not exclude beneficial or harmful effects of one agent over the other. One RCT comparing six months' extension of anticoagulation with 18 months of ximelagatran 24 \u3bcg twice daily versus no extended ximelagatran did not exclude beneficial or harmful effects for the outcomes of reduction in VTE, mortality, and minor bleeding. One RCT comparing once-weekly subcutaneous injection of idraparinux for three or six months versus standard treatment (parenteral anticoagulation followed by warfarin or acenocoumarol) suggested a reduction in recurrent VTE (HR 0.39; 95% CI 0.14 to 1.11) at six months, but did not exclude beneficial or harmful effects for the outcomes of mortality (HR 0.99; 95% CI 0.66 to 1.48) and major bleeding (RR 1.04; 95% CI 0.39 to 2.83). Authors' conclusions: For the long-term treatment of VTE in patients with cancer, LMWH compared with VKA reduces venous thromboembolic events but not mortality. The decision for a patient with cancer and VTE to start long-term LMWH versus oral anticoagulation should balance the benefits and harms and integrate the patient's values and preferences for the important outcomes and alternative management strategies

Epidemiology of simultaneous medullary and papillary thyroid carcinomas (MTC/PTC): An Italian multicenter study

Background: The concomitant presence of papillary thyroid cancer (PTC) and medullary TC (MTC) is rare. In this multicentric study, we documented the epidemiological characteristics, disease conditions and clinical outcome of patients with simultaneous MTC/PTC. Methods: We collected data of patients with concomitant MTC/PTC at 14 Italian referral centers. Results: In total, 183 patients were enrolled. Diagnosis was mostly based on cytological examination (n = 58, 32%). At diagnosis, in the majority of cases, both PTC (n = 142, 78%) and MTC (n = 100, 54%) were at stage I. However, more cases of stage II\u2013IV were reported with MTC (stage IV: n = 27, 15%) compared with PTC (n = 9, 5%). Information on survival was available for 165 patients: 109 patients (66%) were disease-free for both PTC and MTC at the last follow-up. Six patients died from MTC. Median time to progression was 123 months (95% confidence interval (CI): 89.3\u2013156.7 months). Overall, 45% of patients were disease-free after >10 years from diagnosis (125 months); this figure was 72.5% for PTC and 51.1% for MTC. Conclusions: When MTC and PTC are concurrent, the priority should be given to the management of MTC since this entity appears associated with the most severe impact on prognosis

Analysis of the ATR-Chk1 and ATM-Chk2 pathways in male breast cancer revealed the prognostic significance of ATR expression

The ATR-Chk1 and ATM-Chk2 pathways are central in DNA damage repair (DDR) and their over-activation may confer aggressive molecular features, being an adaptive response to endogenous DNA damage and oncogene-induced replication stress. Herein we investigated the ATR-Chk1 and ATM-Chk2 signalings in male breast cancer (MBC). The expression of DDR kinases (pATR, pATM, pChk1, pChk2, and pWee1) and DNA damage markers (pRPA32 and γ-H2AX) was evaluated by immunohistochemistry in 289 MBC samples to assess their association. Survival analyses were carried out in 112 patients. Survival curves were estimated with the Kaplan-Meier method and compared by log-rank test. Cox proportional regression models were generated to identify variables impacting survival outcomes. The expression of pATR conferred poorer survival outcomes (log rank p = 0.013, p = 0.007 and p = 0.010 for overall, 15- and 10-year survival, respectively). Multivariate Cox models of 10-year survival and overall indicated that pATR expression, alone or combined with pChk2, was an independent predictor of adverse outcomes (10-year survival: pATR: HR 2.74, 95% CI: 1.23–6.10; pATR/pChk2: HR 2.92, 95% CI: 1.35–6.33; overall survival: pATR: HR 2.58, 95% CI: 1.20–5.53; pATR/pChk2: HR 2.89, 95% CI: 1.37–6.12). Overall, the ATR/ATM-initiated molecular cascade seems to be active in a fraction of MBC patients and may represent a negative prognostic factor

Rome in its setting. Post-glacial aggradation history of the Tiber River alluvial deposits and tectonic origin of the Tiber Island

Support for this work was provided by the DTS-MIUR NextData project, the University of Michigan, the Etruscan Foundation, and the Fondazione Lemmermann. This work includes data collected with funding from the National Science Foundation under Grant No. 1259122 (ALB).The Tiber valley is a prominent feature in the landscape of ancient Rome and an important element for understanding its urban development. However, little is known about the city’s original setting. Our research provides new data on the Holocene sedimentary history and human-environment interactions in the Forum Boarium, the location of the earliest harbor of the city. Since the Last Glacial Maximum, when the fluvial valley was incised to a depth of tens of meters below the present sea level, 14C and ceramic ages coupled with paleomagnetic analysis show the occurrence of three distinct aggradational phases until the establishment of a relatively stable alluvial plain at 6–8 m a.s.l. during the late 3rd century BCE. Moreover, we report evidence of a sudden and anomalous increase in sedimentation rate around 2600 yr BP, leading to the deposition of a 4-6m thick package of alluvial deposits in approximately one century. We discuss this datum in the light of possible tectonic activity along a morpho-structural lineament, revealed by the digital elevation model of this area, crossing the Forum Boarium and aligned with the Tiber Island. We formulate the hypothesis that fault displacement along this structural lineament may be responsible for the sudden collapse of the investigated area, which provided new space for the observed unusually large accumulation of sediments. We also posit that, as a consequence of the diversion of the Tiber course and the loss in capacity of transport by the river, this faulting activity triggered the origin of the Tiber Island.Publisher PDFPeer reviewe

Chronic non-cancer pain in primary care: an Italian cross-sectional study

Chronic non-cancer pain is a complex health condition that affects more than a quarter of the Italian population who mainly refers to general practitioners and primary care for their treatment. There are little information on the epidemiological and clinical characteristics and types of treatments for these patients who suffer from chronic pain. The aim of the study was to provide epidemiological and clinical information about patients with chronic non-cancer pain who refers to GPs for their treatment. An observational, multicentre, cross-sectional study was carried out using retrospectively reviewed clinical records from 29 GPs. Some pharmacoeconomic aspects were also investigated. A total of 1,007 patients who had chronic pain were selected for the study. Chronic pain was more common in women than in men (ratio 2.7 : 1) (P = 0.002). With regard to incomes, the women earned less than the men (P = 0.017). The chronic pain was musculoskeletal (73.4%), mixed (21.4%), neuropathic (4.9%) and visceral (0.3%). More women than men had pain in two or more sites, and 33.5% of the patients reported more than one diagnosis that related to chronic pain. The general practitioners had prescribed nonsteroidal anti-inflammatory drugs for 71.8% of the cases, opioids for 16.9%, adjuvants for 9.0% and acetaminophen for 2.4%, and about pharmacoeconomic aspects, the total cost for the sample was €111,331.42. Primary care is the essential frontline for patients who suffer from non-cancer pain. An interdisciplinary assessment and approach should start in primary care delivery to maximize the clinical outcomes

A multistep process for the dispersal of a Y chromosomal lineage in the Mediterranean area

Tn this work we focus on a microsatellite-defined Y-chromosomal lineage (network 1.2) identified by us and reported in previous studies, whose geographic distribution and antiquity appear to be compatible with the Neolithic spread of farmers. Here, we set network 1.2 in the Y-chromosomal phylogenetic tree, date it with respect to other lineages associated with the same movements by other authors, examine its diversity by means of tri- and tetranucleotide loci and discuss the implications hi reconstructing the spread of this group of chromosomes in the Mediterranean area. Our results define a tripartite phylogeny wit-bin HG 9 (Rosser et al. 2000) with the deepest branching defined by alleles T (Haplogroup Eu 10) or G (Haplogroup Eu9) at M172 (Semino et al. 2000), and a subsequent branching within Eu9 defined by network 1.2. Population distributions of HG 9 and network 1.2 show that their occurrence in the surveyed area is not due to the spread of people from a single parental population but, rather, to a process punctuated by at least two phases. Our data identify the wide area of the Balkans, Aegean and Anatolia as the possible homeland harbouring the largest variation within network 1.2. The use of recently proposed tests based on the stepwise mutation model suggests that its spread was associated to a population expansion, xvith a high rate of male gene flow in the Turkish Greek area

High Incidence of Invasive Fungal Diseases in Patients with FLT3-Mutated AML Treated with Midostaurin: Results of a Multicenter Observational SEIFEM Study

The potential drug-drug interactions of midostaurin may impact the choice of antifungal (AF) prophylaxis in FLT3-positive acute myeloid leukemia (AML) patients. To evaluate the incidence of invasive fungal diseases (IFD) during the treatment of FLT3-mutated AML patients and to correlate it to the different AF prophylaxis strategies, we planned a multicenter observational study involving 15 SEIFEM centers. One hundred fourteen patients treated with chemotherapy + midostaurin as induction/reinduction, consolidation or both were enrolled. During induction, the incidence of probable/proven and possible IFD was 10.5% and 9.7%, respectively; no statistically significant difference was observed according to the different AF strategy adopted. The median duration of neutropenia was similar in patients with or without IFD. Proven/probable and possible IFD incidence was 2.4% and 1.8%, respectively, during consolidation. Age was the only risk factor for IFD (OR, 95% CI, 1.10 [1.03–1.19]) and complete remission achievement after first induction the only one for survival (OR, 95% CI, 5.12 [1.93–13.60]). The rate of midostaurin discontinuation was similar across different AF strategies. The IFD attributable mortality during induction was 8.3%. In conclusion, the 20.2% overall incidence of IFD occurring in FLT3-mutated AML during induction with chemotherapy + midostaurin, regardless of AF strategy type, was noteworthy, and merits further study, particularly in elderly patients

Patterns of male-specific inter-population divergence in Europe, West Asia and North Africa

We typed 1801 males from 55 locations for the Y-specific binary markers YAP! DYZ3, SRY10831 and the (CA)n microsatellites YCAII and DYS413. Phylogenetic relationships of chromosomes with the same binary haplotype were condensed in seven large one-step networks! which accounted for 95% of all chromosomes. Their coalescence ages were estimated based on microsatellite diversity. The three largest and oldest networks undergo sharp frequency changes in three areas. The more recent network; 3.1A clearly discriminates between Western and Eastern European populations. Pairwise Pst showed an overall increment with increasing geographic distance but with a slope greatly reduced when compared to previous reports. BI sectioning the entire data set according to geographic and linguistic criteria, we found higher Fst-on-distance slopes within Europe than in West Asia or across the tno continents