'Real-life' report on the management of chronic GvHD in the Gruppo Italiano Trapianto Midollo Osseo (GITMO).

Several guidelines have been published about management of chronic GvHD (cGvHD), but the clinical practice still remains demanding. The Gruppo Italiano Trapianto di Midollo Osseo (GITMO) has planned a prospective observational study on cGvHD, supported by a dedicated software, including the updated recommendations. In view of this study, two surveys have been conducted, focusing the management of cGvHD and ancillary therapy in cGvHD, to address the current 'real life' situation. The two surveys were sent to all 57 GITMO centers, performing allografting in Italy; the response rate was 57% and 66% of the interviewed centers, respectively. The first survey showed a great disparity especially regarding steroid-refractory cGvHD, although extracorporeal photo-apheresis resulted as the most indicated treatment in this setting. Another challenging issue was the strategy for tapering steroid: our survey showed a great variance, and this disagreement could be a real bias in evaluating outcomes in prospective studies. As for the second survey, the results suggest that the ancillary treatments are not standardized in many centers. All responding centers reported a strong need to standardize management of cGvHD and to participate in prospective trials. Before starting observational and/or interventional studies, a detailed knowledge of current practice should be encouraged.

A method for coronary bifurcation centerline reconstruction from angiographic images based on focalization optimization.

A method for the reconstruction of a vessel centerline from angiographic images is outlined in this work. A typical coronary artery segment with bifurcations was emulated with a 3D printed static phantom and several angiograms were acquired at various angular positions on the C-Arm. The effectiveness of the reconstruction turned out to be largely influenced by the intrinsic parameters of the angiographic system, particularly the homogeneous coordinates system scaling factor λ. Therefore, recourse was made to a heuristic optimization method to estimate the optimal value of λ for each view. We measured the reliability of the reconstruction method by varying the fitness function of the optimization step and measuring the distances of 8 test points in comparison to the corresponding points identified in the µCT centerline. Preliminary results showed that, with an adequate number of views, the adoption of the optimal fitness function allowed the median distance error to be decreased below the acceptance threshold of 10%. As expected, the reliability of the method is improved by increasing the number of processed views.

Short and long-term safety of lenograstim administration in healthy peripheral haematopoietic progenitor cell donors: a single centre experience.

Healthy donors (HDs) who were mobilized using lenograstim (LENO) and who were undergoing peripheral haematopoietic progenitor cell collection with apheresis (HPC-A) were enrolled in a surveillance protocol. In all, 184 HDs have been assessed with a median follow-up of 62 months (range 2-155). HDs received LENO at a median dose of 10 microg/kg (range 5-15). Bone pain was reported as the most frequent short-term adverse event (71.2%). Other commonly observed short-term symptoms included fatigue (19.0%), fever (5.4%), headache (27.7%), nausea (12.0%) and insomnia (22.3%). Spleen size increased in 4.3% of the donors. No vascular disorders or cardiac disease occurred. Long-term follow-up included monitoring of adverse events, neoplastic disease or other pathologies. Transit ischaemic attack occurred in one donor (39 months post-donation). One autoimmune event was reported at 28 months post-recombinant human granulocyte (rhG)-CSF (ankylosing spondylitis); one donor with a history of chronic obstructive pulmonary disease developed secondary polyglobulia (50 months post-rhG-CSF). One donor was diagnosed with lung cancer at 19 months post-donation. No haematological disease was observed. In conclusion, the short-term safety appears to be verified, whereas, although the study identified no increased risks of malignancy among HDs who received rhG-CSF, long-term safety requires more complete data sets, especially a longer follow-up and a larger number of HDs.

[Idiopathic hypereosinophilic syndrome associated with rheumatoid arthritis. A case report]. / Sindrome ipereosinofila idiopatica ed artrite reumatoide. Descrizione di un caso.

The idiopathic hypereosinophilic sindrome (HES) is a disease characterized by persistent blood eosinophilia (> 1500 eosinophils/mm3 > 6 months) -in absence of other ethiologies for eosinophilia (parasitic, allergic, immunological or malignant diseases)- associated with multiple organ involvement (heart, lung, central nervous system, skin, bone marrow, gastrointestinal tract). Reports on rheumatologic manifestations in patients with HES are very rare. In the case we report a typical rheumatoid arthritis developed in a 58-year-old woman with HES treated with glucocorticoids. Because of the marked glucocorticoids side effects shown by the patient (cushingoid habitus, hyperglycemia), we stopped this treatment and replaced it at first by methotrexate and later by cyclosporin, both of them associated with sulfasalazine. These drugs revealed very efficacious both on articular pathology and on the clinical and laboratory manifestations of HES. These data suggest that common pathogenetic mechanisms are likely acting in rheumatoid arthritis and idiopathic hypereosinophilic syndrome.

Statistical theory for incoherent light propagation in nonlinear media.

A statistical approach based on the Wigner transform is proposed for the description of partially incoherent optical wave dynamics in nonlinear media. An evolution equation for the Wigner transform is derived from a nonlinear Schrödinger equation with arbitrary nonlinearity. It is shown that random phase fluctuations of an incoherent plane wave lead to a Landau-like damping effect, which can stabilize the modulational instability. In the limit of the geometrical optics approximation, incoherent, localized, and stationary wave fields are shown to exist for a wide class of nonlinear media.

Immediate reaction to clarithromycin.

We present the case of bronchospastic reaction to clarithromycin had during a drug challenge test. Personal allergic history was negative for respiratory allergies and positive for adverse drug reactions to general and regional anesthesia and to ceftriaxone. After the administration of 1/4 of therapeutic dose of clarithromycin the patient showed dyspnea, cough and bronchospasm in all the lung fields. The positivity of the test was confirmed by the negativity to the administration of placebo. The quickness and the clinical characteristic of the adverse reaction suggest a pathogenic mechanism of immediate-type hypersensitivity. On reviewing the literature we have found no reports of bronchospastic reaction to clarithromycin. Macrolides are a class of antibiotics mainly used in the last years in place of beta-lactams because of a broad spectrum of action and a low allergic power. In fact, there are few reports on allergic reactions to these molecules. Clarithromycin is one of the latest macrolides, characterised by the presence of a 14-carbon-atom lactone ring as erythromycin, active on a wide spectrum of pathogens.

Immediate reaction to clarithromycin

We present the case of bronchospastic reaction to clarithromycin had during a drug challenge test. Personal allergic history was negative for respiratory allergies and positive for adverse drug reactions to general and regional anesthesia and to ceftriaxone. After the administration of 1/4 of therapeutic dose of clarithromycin the patient showed dyspnea, cough and bronchospasm in all the lung fields. The positivity of the test was confirmed by the negativity to the administration of placebo. The quickness and the clinical characteristic of the adverse reaction suggest a pathogenic mechanism of immediate-type hypersensitivity. On reviewing the literature we have found no reports of bronchospastic reaction to clarithromycin. Macrolides are a class of antibiotics mainly used in the last years in place of b-lactams because of a broad spectrum of action and a low allergic power. In fact, there are few reports on allergic reactions to these molecules. Clarithromycin is one of the latest macrolides, characterised by the presence of a 14-carbon-atom lactone ring as erythromycin, active on a wide spectrum of pathogens (AU)

Presentamos un caso de reacción broncospástica a claritromicina que tuvo lugar durante la prueba de provocación con el fármaco. La historia alérgica personal fue negativa para alergias respiratorias y positiva para reacciones farmacológicas adversas a la anestesia general y regional y a la ceftriaxona. Después de la administración de un cuarto de la dosis terapéutica de claritromicina, el paciente presentó disnea, tos y broncospasmo en todos los campos pulmonares. La prueba se confirmó mediante la negatividad de la respuesta frente a la administración de placebo. La rapidez y características clínicas de la reacción adversa sugieren un mecanismo patogénico de hipersensibilidad de tipo inmediato. En la revisión de los estudios publicados no identificamos ninguna descripción de reacción broncospástica a claritromicina (AU)

Vortices in relativistic electron beams

We demonstrate that a relativistic electron beam is properly described in the moving frame by the electron-magnetohydrodynamic equations of plasma physics. For large beam currents, the accelerator magnetic field is expected to be unstable to the fast magnetic reconnection. We present a plausible saturated state of the fast reconnection, in the form of a complex vortex pattern. The nonlinear dispersion equations of the vortex are derived and the relationship between the vortex structure and the background magnetic field is discussed.

Charged-particle-beam propagator in wave-electron optics: phase-space and tomographic pictures.

Within the framework of the thermal-wave model, the quantumlike description of electron optics in terms of the propagator is given. First we briefly review the standard description in configuration space by analogy to quantum mechanics and in connection with recent investigations of charged-particle-beam transport that have used the concept of propagator. Then new insights are given by extension of the analysis of the particle-beam propagator to the phase-space context for which our system is described by the Wigner quasi-distribution function, as well as to the tomography context for which our system is described by the marginal distribution. Furthermore, the integrals of motion of a charged-particle beam and their relation to the propagator concept are discussed. Finally, the perturbation theory for a charged-particle-beam propagator is developed in the above-described two contexts and is applied to some simple optical devices.

Role of semiclassical description in the quantumlike theory of light rays.

An alternative procedure to the one by Gloge and Marcuse [J. Opt. Soc. Am. 59, 1629 (1969)] for performing the transition from geometrical optics to wave optics in the paraxial approximation is presented. This is done by employing a recent "deformation" method used to give a quantumlike phase-space description of charged-particle-beam transport in the semiclassical approximation. By taking into account the uncertainty relation (diffraction limit) that holds between the transverse-beam-spot size and the rms of the light-ray slopes, the classical phase-space equation for light rays is deformed into a von Neumann-like equation that governs the phase-space description of the beam transport in the semiclassical approximation. Here, Planck's constant and the time are replaced by the inverse of the wave number, not lambda, and the propagation coordinate, respectively. In this framework, the corresponding Wigner-like picture is given and the quantumlike corrections for an arbitrary refractive index are considered. In particular, it is shown that the paraxial-radiation-beam transport can also be described in terms of a fluid motion equation, where the pressure term is replaced by a quantumlike potential in the semiclassical approximation that accounts for the diffraction of the beam. Finally, a comparison of this fluid model with Madelung's fluid model is made, and the classical-like picture given by the tomographic approach to radiation beams is advanced as a future perspective.