Summary Background On the basis of promising results that were reported in several phase 2 trials, we investigated whether the addition of the monoclonal antibody rituximab to first-line chemotherapy ...with fludarabine and cyclophosphamide would improve the outcome of patients with chronic lymphocytic leukaemia. Methods Treatment-naive, physically fit patients (aged 30–81 years) with CD20-positive chronic lymphocytic leukaemia were randomly assigned in a one-to-one ratio to receive six courses of intravenous fludarabine (25 mg/m2 per day) and cyclophosphamide (250 mg/m2 per day) for the first 3 days of each 28-day treatment course with or without rituximab (375 mg/m2 on day 0 of first course, and 500 mg/m2 on day 1 of second to sixth courses) in 190 centres in 11 countries. Investigators and patients were not masked to the computer-generated treatment assignment. The primary endpoint was progression-free survival (PFS). Analysis was by intention to treat. This study is registered with ClinicalTrials.gov , number NCT00281918. Findings 408 patients were assigned to fludarabine, cyclophosphamide, and rituximab (chemoimmunotherapy group) and 409 to fludarabine and cyclophosphamide (chemotherapy group); all patients were analysed. At 3 years after randomisation, 65% of patients in the chemoimmunotherapy group were free of progression compared with 45% in the chemotherapy group (hazard ratio 0·56 95% CI 0·46–0·69, p<0·0001); 87% were alive versus 83%, respectively (0·67 0·48–0·92; p=0·01). Chemoimmunotherapy was more frequently associated with grade 3 and 4 neutropenia (136 34% of 404 vs 83 21% of 396; p<0·0001) and leucocytopenia (97 24% vs 48 12%; p<0·0001). Other side-effects, including severe infections, were not increased. There were eight (2%) treatment-related deaths in the chemoimmunotherapy group compared with ten (3%) in the chemotherapy group. Interpretation Chemoimmunotherapy with fludarabine, cyclophosphamide, and rituximab improves progression-free survival and overall survival in patients with chronic lymphocytic leukaemia. Moreover, the results suggest that the choice of a specific first-line treatment changes the natural course of chronic lymphocytic leukaemia. Funding F Hoffmann-La Roche.
Background IgE sensitization against grass pollen is a cause of seasonal allergic rhinitis. Objective We sought to investigate the evolution at the molecular level and the preclinical predictive ...value of IgE responses against grass pollen. Methods The German Multicentre Allergy Study examined a birth cohort born in 1990. A questionnaire was administered yearly, and blood samples were collected at 1, 2, 3, 5, 6, 7, 10, and 13 years of age. Grass pollen–related seasonal allergic rhinitis (SARg) was diagnosed according to nasal symptoms in June/July. Serum IgE antibodies to Phleum pratense extract and 8 P pratense molecules were tested with immune-enzymatic singleplex and multiplex assays, respectively. Results One hundred seventy-seven of the 820 examined children had SARg. A weak monomolecular/oligomolecular IgE response to P pratense was observed very frequently before SARg onset. These initial IgE responses increased in concentration and molecular complexity during the preclinical and clinical process. A typical progression of IgE sensitization was observed: Phl p 1 (initiator in >75% of cases); then Phl p 4 and Phl p 5; then Phl p 2, Phl p 6, and Phl p 11; and then Phl p 12 and Phl p 7. At age 3 years, IgE sensitization predicted SARg by age 12 years (positive predictive value, 68% 95% CI, 50% to 82%; negative predictive value, 84% 95% CI, 80% to 87%). At this preclinical prediction time, the number of recognized molecules and the serum levels of IgE to P pratense were significantly lower than at 3 or more years after SARg onset. Conclusions The IgE response against grass pollen molecules can start years before disease onset as a weak monosensitization or oligosensitization phenomenon. It can increase in serum concentration and complexity through a “molecular spreading” process during preclinical and early clinical disease stages. Testing IgE sensitization at a preclinical stage facilitates prediction of seasonal allergic rhinitis at its molecular monosensitization or oligosensitization stage.
Left atrial appendage (LAA) occlusion with WATCHMAN has emerged as viable alternative to vitamin K antagonists in randomized controlled trials.
EWOLUTION was designed to provide data in routine ...practice from a prospective multicenter registry.
A total of 1025 patients scheduled for a WATCHMAN implant were prospectively and sequentially enrolled at 47 centers. Indication for LAA closure was based on European Society of Cardiology guidelines. Follow-up and transesophageal echocardiography (TEE) were performed per local practice.
The baseline CHA
DS
-VASc score was 4.5 ± 1.6; the mean age was 73.4 ± 9 years; previous transient ischemic attack/ischemic stroke was present in 312 (30.5%), 155 (15.1%) had previous hemorrhagic stroke, and 320 (31.3%) had a history of major bleeding; and 750 (73%) were deemed unsuitable for oral anticoagulation therapy. WATCHMAN implant succeeded in 1005 (98.5%) of patients, without leaks >5 mm in 1002 (99.7%) with at least 1 TEE follow-up in 875 patients (87%). Antiplatelet therapy was used in 784 (83%), while vitamin K antagonists were used in only 75 (8%). At 1 year, mortality was 98 (9.8%), reflecting the advanced age and comorbidities in this population. Device thrombus was observed in 28 patients at routine TEE (3.7%) and was not correlated with the drug regimen (P = .14). Ischemic stroke rate was 1.1% (relative risk 84% vs estimated historical data); the major bleeding rate was 2.6% and was predominantly (2.3%) nonprocedure/device related.
LAA closure with the WATCHMAN device has a high implant and sealing success. This method of stroke risk reduction appears to be safe and effective with an ischemic stroke rate as low as 1.1%, even though 73% of patients had a contraindication to and were not using oral anticoagulation.
Background The lack of longitudinal data analyses from birth to adulthood is hampering long-term asthma prevention strategies. Objective We aimed to determine early-life predictors of asthma ...incidence up to age 20 years in a birth cohort study by applying time-to-event analysis. Methods In 1990, the Multicenter Allergy Study included 1314 newborns in 5 German cities. Children were evaluated from birth to age 20 years at 19 time points. Using a Cox regression model, we examined the associations between 36 early-life factors and onset of asthma based on a doctor's diagnosis or asthma medication (primary outcome), typical asthma symptoms, or allergic asthma (including positive IgE measurements). Results Response at 20 years was 71.6%. Two hundred eighteen subjects met the primary outcome criteria within 16,257 person years observed. Asthma incidence was lower in participants who were vaccinated (measles, mumps, and rubella vaccine/tick-borne encephalitis vaccine/BCG vaccine: adjusted hazard ratio HR, 0.66 95% CI, 0.47-0.93). Up to age 20 years, asthma incidence was higher in subjects who had parents with allergic rhinitis (adjusted HR, 2.24 95% CI, 1.67-3.02), started day care early or late (before 18 months: adjusted HR, 1.79 95% CI, 1.03-3.10; after 3 years: adjusted HR, 1.64 95% CI, 0.96-2.79), had mothers who smoked during pregnancy (adjusted HR, 1.79 95% CI, 1.20-2.67), had poor parents (adjusted HR, 1.55 95% CI, 1.09-2.22), and had parents with asthma (adjusted HR, 1.65 95% CI, 1.17-2.31). Not associated with asthma were aspects of diet and breast-feeding, pet ownership, presence of older siblings, and passive smoking. Conclusion Parental asthma and nasal allergy increase asthma incidence in offspring up to adulthood. Avoiding tobacco smoke exposure during pregnancy, receiving vaccinations in early childhood, and starting day care between 1.5 and 3 years of age might prevent or delay the development of asthma.
Small-angle X-ray scattering (SAXS) is used to demonstrate the presence of density fluctuations in ambient water on a physical length-scale of almost equal to1 nm; this is retained with decreasing ...temperature while the magnitude is enhanced. In contrast, the magnitude of fluctuations in a normal liquid, such as CCl₄, exhibits no enhancement with decreasing temperature, as is also the case for water from molecular dynamics simulations under ambient conditions. Based on X-ray emission spectroscopy and X-ray Raman scattering data we propose that the density difference contrast in SAXS is due to fluctuations between tetrahedral-like and hydrogen-bond distorted structures related to, respectively, low and high density water. We combine our experimental observations to propose a model of water as a temperature-dependent, fluctuating equilibrium between the two types of local structures driven by incommensurate requirements for minimizing enthalpy (strong near-tetrahedral hydrogen-bonds) and maximizing entropy (nondirectional H-bonds and disorder). The present results provide experimental evidence that the extreme differences anticipated in the hydrogen-bonding environment in the deeply supercooled regime surprisingly remain in bulk water even at conditions ranging from ambient up to close to the boiling point.
This paper presents the first ensemble modelling experiment in relation to birch pollen in Europe. The seven-model European ensemble of MACC-ENS, tested in trial simulations over the flowering season ...of 2010, was run through the flowering season of 2013. The simulations have been compared with observations in 11 countries, all members of the European Aeroallergen Network, for both individual models and the ensemble mean and median. It is shown that the models successfully reproduced the timing of the very late season of 2013, generally within a couple of days from the observed start of the season. The end of the season was generally predicted later than observed, by 5 days or more, which is a known feature of the source term used in the study. Absolute pollen concentrations during the season were somewhat underestimated in the southern part of the birch habitat. In the northern part of Europe, a record-low pollen season was strongly overestimated by all models. The median of the multi-model ensemble demonstrated robust performance, successfully eliminating the impact of outliers, which was particularly useful since for most models this was the first experience of pollen forecasting.
Prospective identification of patients with chronic lymphocytic leukemia (CLL) destined to progress would greatly facilitate their clinical management. Recently, whole-genome DNA methylation analyses ...identified three clinicobiologic CLL subgroups with an epigenetic signature related to different normal B-cell counterparts. Here, we developed a clinically applicable method to identify these subgroups and to study their clinical relevance. Using a support vector machine approach, we built a prediction model using five epigenetic biomarkers that was able to classify CLL patients accurately into the three subgroups, namely naive B-cell-like, intermediate and memory B-cell-like CLL. DNA methylation was quantified by highly reproducible bisulfite pyrosequencing assays in two independent CLL series. In the initial series (n=211), the three subgroups showed differential levels of IGHV (immunoglobulin heavy-chain locus) mutation (P<0.001) and VH usage (P<0.03), as well as different clinical features and outcome in terms of time to first treatment (TTT) and overall survival (P<0.001). A multivariate Cox model showed that epigenetic classification was the strongest predictor of TTT (P<0.001) along with Binet stage (P<0.001). These findings were corroborated in a validation series (n=97). In this study, we developed a simple and robust method using epigenetic biomarkers to categorize CLLs into three subgroups with different clinicobiologic features and outcome.
•We analyze route efficiency trade-offs emerging from combining pickups and deliveries in an urban distribution system.•We extend continuum approximation-based route length estimations by proposing ...adjustment factors for integrated pickup and delivery operations.•Local route efficiency can improve by up to 30%, while being highly sensitive to vehicle capacity and precedence constraints.•We apply our method to a real-world case study to inform the strategic design and operational planning of an urban distribution system.
In this paper, we analyze the route efficiency trade-offs that emerge from combining first-mile pickup and last-mile delivery operations in an urban distribution system. We build on the extant literature on continuum approximation of optimal route distances and propose adjustment factors that account for the effects of integrated pickup and delivery operations. By means of comprehensive numerical experiments and regression analysis, we further propose a set of closed-form adjustment factors that improve existing continuum approximation-based route length estimations. These adjustment factors incorporate some non-trivial route efficiency trade-offs emerging from first-mile and last-mile integration that cannot easily be captured through continuum approximation. The proposed extensions are particularly relevant for the optimal strategic design and operational planning of large-scale, high-density last-mile distribution systems that are gaining in importance in light of e-commerce and omni-channel retailing. Our analyses suggest that the efficiency gains emerging from integrating first-mile pickup and last-mile delivery operations can be as high as 30%. However, the effective efficiency gains are sensitive to vehicle capacity constraints and other factors complicating the optimal stop sequence in integrated routes. We apply our proposed method to a real-world case study informed by operational data from one of India’s largest e-commerce platforms for the city of Bengaluru. We find that by properly integrating its first-mile and last-mile operations, the company could reduce its urban traffic and emissions impact by up to 16%, while increasing the asset utilization and reducing the cost of operations of its vehicle fleet.
Haptic perception is bidirectionally related to exploratory movements, which means that exploration influences perception, but perception also influences exploration. We can optimize or change ...exploratory movements according to the perception and/or the task, consciously or unconsciously. This paper presents a psychophysical experiment on active roughness perception to investigate movement changes as the haptic task changes. Exerted normal force and scanning velocity are measured in different perceptual tasks (discrimination or identification) using rough and smooth stimuli. The results show that humans use a greater variation in contact force for the smooth stimuli than for the rough stimuli. Moreover, they use higher scanning velocities and shorter break times between stimuli in the discrimination task than in the identification task. Thus, in roughness perception humans spontaneously use different strategies that seem effective for the perceptual task and the stimuli. A control task, in which the participants just explore the stimuli without any perceptual objective, shows that humans use a smaller contact force and a lower scanning velocity for the rough stimuli than for the smooth stimuli. Possibly, these strategies are related to aversiveness while exploring stimuli.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The 2020 skyrmionics roadmap Back, C; Cros, V; Ebert, H ...
Journal of physics. D, Applied physics,
09/2020, Letnik:
53, Številka:
36
Journal Article
Recenzirano
Odprti dostop
The notion of non-trivial topological winding in condensed matter systems represents a major area of present-day theoretical and experimental research. Magnetic materials offer a versatile platform ...that is particularly amenable for the exploration of topological spin solitons in real space such as skyrmions. First identified in non-centrosymmetric bulk materials, the rapidly growing zoology of materials systems hosting skyrmions and related topological spin solitons includes bulk compounds, surfaces, thin films, heterostructures, nano-wires and nano-dots. This underscores an exceptional potential for major breakthroughs ranging from fundamental questions to applications as driven by an interdisciplinary exchange of ideas between areas in magnetism which traditionally have been pursued rather independently. The skyrmionics Roadmap provides a review of the present state of the art and the wide range of research directions and strategies currently under way. These are, for instance, motivated by the identification of the fundamental structural properties of skyrmions and related textures, processes of nucleation and annihilation in the presence of non-trivial topological winding, an exceptionally efficient coupling to spin currents generating spin transfer torques at tiny current densities, as well as the capability to purpose-design broad-band spin dynamic and logic devices.
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