The impact of IVF on deep invasive endometriosis

Objective: Ovarian hyper-stimulation during IVF is associated with a significant raise in serum estrogens and one may expect detrimental effects on estrogen-dependent diseases such as endometriosis. However, available evidence from large case series of affected women performing IVF is generally reassuring with the possible exception of women carrying deep invasive lesions. On this basis we deemed important investigating more in depth whether women with deep invasive endometriosis could be a subgroup at higher risk of recurrence or disease progression during IVF. Study design: Women with endometriosis who underwent IVF and who had a second evaluation after 3\u20136 months from a failed cycle were retrospectively reviewed. The main inclusion criteria were the presence of deep invasive endometriosis and/or a history of surgery for this form of the disease. The primary aim of the study was to determine the frequency of endometriosis-related complications in the interval between the two evaluations. Secondary aims were pain symptoms and lesion size modifications. Results: Eighty-four women were ultimately selected: baseline ultrasound documented deep invasive lesions in 60 of them. One case of possible endometriosis-related complication was recorded, corresponding to a rate of 1.2% (95%: 0.05%\u20135.5%) for the whole cohort and 1.7% (95%CI: 0.08\u20137.6%) for the subgroup of women with ultrasound detected lesions. This rate appears similar to the reported frequency of endometriosis progression in women not receiving IVF. No significant modifications in pain symptoms or lesions size occurred. Conclusions: Women with deep invasive endometriosis who underwent IVF do not seem to be exposed to a substantially increased risk of recurrence/disease progression. Larger evidence from independent groups is however required for a definitive conclusion

Diffuse large B-cell lymphoma in octogenarians aged 85 and older can benefit from treatment with curative intent: a report on 129 patients prospectively registered in the Elderly Project of the Fondazione Italiana Linfomi (FIL)

Octogenarian patients with diffuse large B-cell lymphoma are managed mainly with palliation, but recent improvement in their overall condition makes potentially curative treatment a possibility. Studies have shown that half of selected octogenarians may be cured using reduced-dose anthracycline chemoimmunotherapy. However, patients aged >85 (late octogenarians [LO]) were underrepresented, and selection criteria were poorly defined. We analyzed the clinical characteristics and outcomes of LO enrolled in the FIL Elderly Project in terms of the treatment received (palliative vs. curative) and of their simplified geriatric assessment (sGA), then compared them with early octogenarians (EO) aged 80-84 and with those aged 65-79 classified as UNFIT or FRAIL according to sGA enrolled in the same study. Of the 1,163 patients, 370 were >80 and 129 LO. Clinical characteristics were similar between LO and EO, but LO more frequently received palliation (50% vs. 23%; P=0.001) and had worse 2-year overall survival (OS) (48% vs. 63%; P=0.001) and 2-year progression-free survival (PFS) (43% vs. 56%; P=0.01). Patients receiving anthracycline did better than patients receiving palliation (P<0.001), without any difference between full or reduced doses. Rituximab within palliation improved outcome (2-yr OS with or without rituximab 42% vs. 22%; P=0.008). Elderly Prognostic Index (EPI) performed better than sGA in identifying different risk categories, and high-risk EPI retained an independent unfavorable effect on OS and PFS, together with treatment without anthracycline. In conclusion, late octogenarians can benefit from a curative approach with reduced-dose anthracycline and from rituximab within palliation. EPI may help in patient selection more than sGA can

Galathea: a Case-Based Planning Tool for Knowledge Navigation in the Architectural Design Process

We report on an on-going Ph.D. research aimed at the analysis of the nature of process knowledge in architectural design and the development of a conceptual model for a case-based navigation tool for its support. We describe architectural design from a process viewpoint and assume it as a form of intentional planning, leading from an initial state configuration toward a desired situation, by means of an incremental specification of goals, constraints and involved variables. We consider the very essence of design and of the specific professional skill characterising designers as the continual recursive transformation of the initial solution model, in order to map the desired state onto the enacted one and the capability to govern a number of continually changing variables in this direction. On the basis of this general concept of the design process, we describe the model of Galathea, a case-based planning tool, aimed at progressively representing the enlarging space of acquired knowledge, and at supporting the designeris central role in the management of the design process

Applying CBR to the Teaching of Architectural Design

This paper presents an approach to the analysis and description of the nature of process knowledge in architectural design, the development of a conceptual model for Galathea, a case-based navigation tool for its support, and the application of this theoretical foundation to the teaching of design to a group of about 100 second-year architecture students. Design is assumed as a globally coherent information, memory and experience-intensive process in which professional skill is the capability to govern a large number of continually evolving variables in the direction of desired change. This viewpoint on design has guided the development of Galathea, the model of a tool aimed at describing architectural design through the description, mapping and management of the complete decision-making path of projects by means of the dynamic representation of the relationship between goals, constraints and the decisions/actions adopted at specific nodes and through the creation of a case-base aimed at the storage, retrieval and adaptation of relevant design moves in similar project contexts. This conceptual model is applied to educational activity at the faculty of Architecture of Milan, with the aim of teaching how to govern a project from the outset considering it as an evolving but coherent map of design moves, which allow the adoption of the correct decisions involving the most disparate types of information, experience and memory, and which altogether conduct to the desired goal. The resolution paths of the students, all applied to the same architecture problem, result in a design move case-base, the further utilisation and interest of which is open to collegial discussion