Ibrutinib versus temsirolimus in patients with relapsed or refractory mantle-cell lymphoma: an international, randomised, open-label, phase study

Background: Mantle-cell lymphoma is an aggressive B-cell lymphoma with a poor prognosis. Both ibrutinib and temsirolimus have shown single-agent activity in patients with relapsed or refractory mantle-cell lymphoma. We undertook a phase 3 study to assess the efficacy and safety of ibrutinib versus temsirolimus in relapsed or refractory mantle-cell lymphoma. Methods: This randomised, open-label, multicentre, phase 3 clinical trial enrolled patients with relapsed or refractory mantle-cell lymphoma confirmed by central pathology in 21 countries who had received one or more rituximab-containing treatments. Patients were stratified by previous therapy and simplified mantle-cell lymphoma international prognostic index score, and were randomly assigned with a computer-generated randomisation schedule to receive daily oral ibrutinib 560 mg or intravenous temsirolimus (175 mg on days 1, 8, and 15 of cycle 1; 75 mg on days 1, 8, and 15 of subsequent 21-day cycles). Randomisation was balanced by using randomly permuted blocks. The primary efficacy endpoint was progression-free survival assessed by a masked independent review committee with the primary hypothesis that ibrutinib compared with temsirolimus significantly improves progression-free survival. The analysis followed the intention-to-treat principle. The trial is ongoing and is registered with ClinicalTrials.gov (number NCT01646021) and with the EU Clinical Trials Register, EudraCT (number 2012-000601-74). Findings: Between Dec 10, 2012, and Nov 26, 2013, 280 patients were randomised to ibrutinib (n=139) or temsirolimus (n=141). Primary efficacy analysis showed significant improvement in progression-free survival (p<0.0001) for patients treated with ibrutinib versus temsirolimus (hazard ratio 0.43 [95% CI 0.32-0.58]; median progression-free survival 14.6 months [95% CI 10.4-not estimable] vs 6.2 months [4.2-7.9], respectively). Ibrutinib was better tolerated than temsirolimus, with grade 3 or higher treatment-emergent adverse events reported for 94 (68%) versus 121 (87%) patients, and fewer discontinuations of study medication due to adverse events for ibrutinib versus temsirolimus (9 [6%] vs 36 [26%]). Interpretation: Ibrutinib treatment resulted in significant improvement in progression-free survival and better tolerability versus temsirolimus in patients with relapsed or refractory mantle-cell lymphoma. These data lend further support to the positive benefit-risk ratio for ibrutinib in relapsed or refractory mantle-cell lymphoma

The Impact of IFN-g; Receptor on SLPI Expression in Active Tuberculosis: Association with Disease Severity

Interferon (IFN)-g displays a critical role in tuberculosis (TB), modulating the innate and adaptive immune responses. Previously, we reported that secretory leukocyte protease inhibitor (SLPI) is a pattern recognition receptor with anti-mycobacterial activity against Mycobacterium tuberculosis (Mtb). Herein, we determined whether IFN-g modulated the levels of SLPI in TB patients. Plasma levels of SLPI and IFN-g were studied in healthy donors (HDs) and TB patients. Peripheral blood mononuclear cells from HDs and patients with TB or defective IFN-g receptor 1* were stimulated with Mtb antigen and SLPI, and IFN-gR expression levels were measured. Both SLPI and IFN-g were significantly enhanced in plasma from those with TB compared with HDs. A direct association between SLPI levels and the severity of TB was detected. In addition, Mtb antigen stimulation decreased the SLPI produced by peripheral blood mononuclear cells from HDs, but not from TB or IFN-gR patients. Neutralization of IFN-g reversed the inhibition of SLPI induced by Mtb antigen in HDs, but not in TB patients. Furthermore, recombinant IFN-g was unable to modify the expression of SLPI in TB patients. Finally, IFN-gR expression was lower in TB compared with HD peripheral blood mononuclear cells. These results show that Mtb-induced IFN-g down-modulated SLPI levels by signaling through the IFNgR in HDs. This inhibitory mechanism was not observed in TB, probably because of the low expression of IFN-gR detected in these individuals. (Am J Pathol 2014, 184: 1e6Fil: Tateosian, Nancy Liliana. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Centro de Estudios Farmacológicos y Botánicos; Argentina; ArgentinaFil: Pasquinelli, Virginia. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires; ArgentinaFil: Hernández Del Pino, Rodrigo Emanuel. Universidad de Buenos Aires; ArgentinaFil: Ambrosi, Nella Gabriela. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Centro de Estudios Farmacológicos y Botánicos; Argentina; ArgentinaFil: Guerrieri, Diego. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Centro de Estudios Farmacológicos y Botánicos; Argentina; ArgentinaFil: Pedraza Sánchez, Sigifredo. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; MéxicoFil: Santucci, Natalia Estefanía. Universidad Nacional de Rosario; ArgentinaFil: D'attilio, Luciano David. Universidad Nacional de Rosario; ArgentinaFil: Pellegrini, Joaquín Miguel. Universidad de Buenos Aires; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Araujo Solis, María A.. Instituto Mexicano del Seguro Social; MéxicoFil: Musella, Rosa M.. Hospital "F. J. Muñiz"; ArgentinaFil: Palmero, Domingo J.. Hospital "F. J. Muñiz"; ArgentinaFil: Hernandez Pando, Rogelio. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; MéxicoFil: Garcia, Veronica Edith. Universidad de Buenos Aires; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Chuluyan, Hector Eduardo. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Centro de Estudios Farmacológicos y Botánicos; Argentina; Argentin

Sítios Paleontológicos das Bacias do Rio do Peixe: Georreferenciamento, Diagnóstico de Vulnerabilidade e Medidas de Proteção

The abandoned state and depredation of the paleontological geosites at the Rio do Peixe basins have been for some time a reason for concern to authorities and the society. Removal of sand from the Monumento Natural Vale dos Dinossauros Park and removal of fossils from sites catalogued by SIGEP (Comissão Brasileira de Sítios Geológicos e Paleobiológicos) have been made public and recognized through this study. The aims of this paper are to: georeference the paleontological sites from the Rio do Peixe basins, provide a diagnostic of vunerability for these sites, and establish proposals for protection measures. Ten field work were carried out, in 2008 and 2009, by the technicians from DNPM. Besides a georeferenced map of the paleontological sites from the Rio do Peixe basins, nine factors that strongly contribute for the vulnerability of the sites were defined, the main ones being the natural action of weathering and the antropic action. Most of the studied sites have medium to high vulnerability degree. The most vulnerable site are: Pedregulho, Piau/Caiçara, Várzea dos Ramos, Lagoa dos Patos, Cabra Assada, and Matadouro. Currently, Matadouro Site can be considered a completely destroyed, being, its recovery no longer possible. Ten protection measures were proposed for these paleontological sites.O estado de abandono e depredação dos sítios paleontológicos das bacias do Rio do Peixe é motivo de preocupação para as autoridades e para a sociedade há algum tempo. Denúncias foram feitas e constatadas, tanto de extração de areia no Parque Monumento Natural Vale dos Dinossauros quanto de retiradas de fósseis de sítios cadastrados pela SIGEP (Comissão Brasileira de Sítios Geológicos e Paleobiológicos). O presente trabalho teve como objetivo georreferenciar os sítios paleontológicos das bacias do Rio do Peixe, definir um diagnóstico de vulnerabilidade desses sítios e estabelecer propostas para medidas de proteção. Foram realizadas dez etapas de trabalhos de campo, nos anos de 2008 e 2009, com o revezamento de técnicos do DNPM. Além de um mapa georreferenciado, com os sítios paleontológicos das bacias do Rio do Peixe, foram definidos nove fatores que contribuem mais acentuadamente para a vulnerabilidade dos sítios, sendo que a ação natural do intemperismo e a ação antrópica são os dois principais. A maioria dos sítios estudados possui vulnerabilidade de média a alta, sendo que os sítios com maior vulnerabilidade são: Pedregulho, Piau/Caiçara, Várzea dos Ramos, Lagoa dos Patos, Cabra Assada e Matadouro. Entre eles, atualmente, o Sítio Matadouro pode ser considerado como um sítio destruído, não sendo possível a sua recuperação. Dez propostas foram estabelecidas como medidas de proteção desses sítios paleontológicos

Research needs in allergy: an EAACI position paper, in collaboration with EFA

Abstract In less than half a century, allergy, originally perceived as a rare disease, has become a major public health threat, today affecting the lives of more than 60 million people in Europe, and probably close to one billion worldwide, thereby heavily impacting the budgets of public health systems. More disturbingly, its prevalence and impact are on the rise, a development that has been associated with environmental and lifestyle changes accompanying the continuous process of urbanization and globalization. Therefore, there is an urgent need to prioritize and concert research efforts in the field of allergy, in order to achieve sustainable results on prevention, diagnosis and treatment of this most prevalent chronic disease of the 21 st century. The European Academy of Allergy and Clinical Immunology (EAACI) is the leading professional organization in the field of allergy, promoting excellence in clinical care, education, training and basic and translational research, all with the ultimate goal of improving the health of allergic patients. The European Federation of Allergy and Airways Diseases Patients&apos; Associations (EFA) is a non-profit network of allergy, asthma and Chronic Obstructive Pulmonary Disorder (COPD) patients&apos; organizations. In support of their missions, the present EAACI Position Paper, in collaboration with EFA, highlights the most important research needs in the field of allergy to serve as key recommendations for future research funding at the national and European levels. Although allergies may involve almost every organ of the body and an array of diverse external factors act as triggers, there are several common themes that need to be prioritized in research efforts. As in many other chronic diseases, effective prevention, curative treatment and accurate, rapid diagnosis represent major unmet needs. Detailed phenotyping/endotyping stands out as widely required in order to arrange or re-categorize clinical syndromes into more coherent, uniform and treatment-responsive groups. Research efforts to unveil the basic pathophysiologic pathways and mechanisms, thus leading to the comprehension and resolution of the pathophysiologic complexity of allergies will allow for the design of novel patient-oriented diagnostic and treatment protocols. Several allergic diseases require well-controlled epidemiological description and surveillance, using disease registries, pharmacoeconomic evaluation, as well as large biobanks. Additionally, there is a need for extensive studies to bring promising new biotechnological innovations, such as biological agents, vaccines of modified allergen molecules and engineered components for allergy diagnosis, closer to clinical practice. Finally, particular attention should be paid to the difficult-to-manage, precarious and costly severe disease forms and/or exacerbations. Nonetheless, currently arising treatments, mainly in the fields of immunotherapy and biologicals, hold great promise for targeted and causal management of allergic conditions. Active involvement of all stakeholders, including Patient Organizations and policy makers are necessary to achieve the aims emphasized herein

Data from: Body size evolution in Titanosauriformes (Sauropoda, Macronaria)

Titanosauriformes is a conspicuous and diverse group of sauropod dinosaurs that inhabited almost all land masses during Cretaceous times. Besides the diversity of forms, the clade comprises one of the largest land animals found so far, Argentinosaurus, as well as some of the smallest sauropods known to date, Europasaurus and Magyarosaurus. They are therefore good candidates for studies on body size trends such as the Cope's rule, the tendency towards an increase in body size in an evolutionary lineage. We used statistical methods to assess body size changes under both phylogenetic and nonphylogenetic approaches to identify body size trends in Titanosauriformes. Femoral lengths were collected (or estimated from humeral length) from 46 titanosauriform species and used as a proxy for body size. Our findings show that there is no increase or decrease in titanosauriform body size with age along the Cretaceous and that negative changes in body size are more common than positive ones (although not statistically significant) for most of the titanosauriform subclades (e.g. Saltasaridae, Lithostrotia, Titanosauria and Somphospondyli). Therefore, Cope's rule is not supported in titanosauriform evolution. Finally, we also found a trend towards a decrease of titanosauriform mean body size coupled with an increase in body size standard deviation, both supporting an increase in body size variation towards the end of Cretaceous

Appendix 1

Femur and/or humerus lengths, associated geologic unit, age interval, geographic localities, and identification of the material

Appendix 2

Parenthetical notation of the trees used to calculate the supertree

Appendix 3 (Mesquite file)

Data file used in Mesquite