Efficacy and safety of nilotinib as frontline treatment in elderly (> 65 years) chronic myeloid leukemia patients outside clinical trials.

Here, we report real-world evidence on the safety and efficacy of nilotinib as a first-line treatment in elderly patients with chronic phase CML, treated in 18 Italian centers. Sixty patients aged > 65 years (median age 72 years (65-84)) were reported: 13 patients were older than 75 years. Comorbidities were recorded at baseline in 56/60 patients. At 3 months of treatment, all patients obtained complete hematological response (CHR), 43 (71.6%) an early molecular response (EMR), while 47 (78%) reached a complete cytogenetic response (CCyR). At last follow-up, 63.4% of patients still had a deep molecular response (MR4 or better), 21.6% reached MR3 as best response and 11.6% persisted without MR. Most patients (85%) started the treatment at the standard dose (300 mg BID), maintained at 3 months in 80% of patients and at 6 months in 89% of them. At the last median follow-up of 46.3 months, 15 patients discontinued definitively the treatment (8 due to side effects, 4 died for unrelated CML causes, 1 for failure, 2 were lost to follow-up). One patient entered in treatment-free remission. As to safety, 6 patients (10%) experienced cardiovascular events after a median time of 20.9 months from the start. Our data showed that nilotinib could be, as first-line treatment, effective and relatively safe even in elderly CML patients. In this setting, more data in the long term are needed about possible dose reduction to improve the tolerability, while maintaining the optimal molecular response.

A Very "Distilled" Emblem in Baroque Rome: Natural Philosophy, Alchemy, and Atomism in the Academy of the Umoristi.

Created and published in a printed volume in 1611, the emblem chosen by the literary Academy of the Umoristi is intriguing at multiple levels. At a time when the water cycle was still unknown, the image engaged the thorny question of how the evaporation of salty seawater, condensed into clouds, could subsequently pour down as sweet rain. Additionally, the Lucretian motto "Redit agmine dulci" audaciously evoked the philosophy of atoms. The combination of the image and the motto suggested looking at the meteorological phenomenon on display as a sort of natural distillation process, not different from the circulations taking place in the alembic. This enquiry will document how the Academy of the Umoristi was influenced in the choice of its emblem by the scientific Academy of the Lincei and how, towards the end of the seventeenth century, under the patronage of Christina of Sweden, the interconnection of alchemy and atomism alluded to in the academic emblem was reclaimed as a distinctive philosophical banner.

The effects of ACE inhibitor Enalapril on Mytilus galloprovincialis: Insights into morphological and functional responses.

In the last decades, pharmaceuticals have emerged as a new class of environmental contaminants. Antihypertensives, including angiotensin-converting enzyme (ACE) inhibitors, are of special concern due to their increased consumption over the past years. However, the available data on their putative effects on the health of aquatic animals, as well as the possible interaction with biological systems are still poorly understood. This study analysed whether and to which extent the exposure to Enalapril, an ACE inhibitor commonly used for treating hypertension and heart failure, may induce morpho-functional alterations in the mussel Mytilus galloprovincialis, a sentinel organism of water pollution. By mainly focusing on the digestive gland (DG), a target tissue used for analysing the effects of xenobiotics in mussels, the effects of 10-days exposure to 0.6 ng/L (E1) and 600 ng/L (E2) of Enalapril were investigated in terms of cell viability and volume regulation, morphology, oxidative stress, and stress protein expression and localization. Results indicated that exposure to Enalapril compromised the capacity of DG cells from the E2 group to regulate volume by limiting the ability to return to the original volume after hypoosmotic stress. This occurred without significant effects on DG cell viability. Enalapril unaffected also haemocytes viability, although an increased infiltration of haemocytes was histologically observed in DG from both groups, suggestive of an immune response. No changes were observed in the two experimental groups on expression and tissue localization of heat shock proteins 70 (HSPs70) and HSP90, and on the levels of oxidative biomarkers. Our results showed that, in M. galloprovincialis the exposure to Enalapril did not influence the oxidative status, as well as the expression and localization of stress-related proteins, while it activated an immune response and compromised the cell ability to face osmotic changes, with potential consequences on animal performance.

Adding hydroxyurea in combination with ruxolitinib improves clinical responses in hyperproliferative forms of myelofibrosis.

Ruxolitinib, an orally bioavailable and selective inhibitor of Janus kinase 1 (JAK1) and JAK2, significantly reduces splenomegaly and disease-related symptoms in patients with myelofibrosis (MF). However, no clear survival benefit has been demonstrated, which may in part reflect suboptimal drug exposure related to lower dosages needed to minimize hematological toxicity, specifically cytopenias. Furthermore, the optimal management of specific conditions such as leukocytosis or thrombocytosis in patients under ruxolitinib therapy is still undefined. In these cases, combining ruxolitinib with a cytoreductive agent like hydroxyurea might improve hematological response. This observational multi-center study enrolled 20 adult patients with intermediate- or high-risk primary MF, post- polycythemia vera MF, or postessential thrombocythemia MF with hyperproliferative manifestations of the disease and WBC and/or platelet counts not controlled by ruxolitinib therapy. The patients received treatment with a combination of ruxolitinib and hydroxyurea. A clinical response of any type was obtained in 8 patients (40%) during ruxolitinib monotherapy and in 17 patients (85%) during ruxolitinib-hydroxyurea combination (P = 0.003). After a median duration of 12.4 months of combination therapy, 16/20 patients had a hematological response; 14/17 patients who had started combination therapy to control WBC count and 2/3 who started in order to reduce platelets count. The number of patients requiring ruxolitinib dosage reduction or discontinuations was lower during combination therapy and, at the end of follow-up the median ruxolitinib dose was increased in 50% of patients. In conclusion, the combination of hydroxyurea with ruxolitinib yielded a high clinical response rate and increased ruxolitinib exposure in patients with hyperproliferative forms of MF.

Lasker's coefficient of isonymy between and within 16 Sardinian villages in the periods 1825-1849, 1875-1899, and 1925-1949.

Coefficients of relationship by isonymy, based on the frequency of common surnames, were used to estimate the biological affinity between (R(ib)) and within (R(iw)) 16 Sardinian villages in the periods 1825-1849, 1875-1899, and 1925-1949. The database for the surname analysis consisted of 13,515 marriages registered in the parishes of villages, all belonging to the Sardinian linguistic area. The values of R(ib) and R(iw) tend to decrease in time. In all three periods, the R(ib) values generally decrease as the geographical distance between villages increases. The negative values of the Bravais-Pearson coefficient of correlation between the matrix of R(ib) values and the matrices of geographical distances (calculated both in a straight line and from road distances) are significant for each period (modified Mantel test), with slightly higher correlation coefficients for road distances. Moreover, the plots of isonymic relationships obtained by nonmetric multidimensional scaling for 1825-1849 and 1925-1949 show that the biological relationships between neighboring villages increase in the latter period. The positive values of the Bravais-Pearson coefficients of correlation between R(iw) and altitude are significant in all three periods, while the correlation between R(iw) and population size is not significant, even when altitude is controlled for. Since altitude is considered an indicator of isolation, the results obtained with the coefficient of relationship by isonymy within villages also support the isolation-by-distance model. R(ib) values provided a reliable picture of the biological relationships between 16 Sardinian villages, while R(iw) values illustrated the biological affinity within the communities for a period of 100 years, from 1825-1849 to 1925-1949.

Evolution of marital structure in 20 Sardinian villages from 1800 to 1974.

This paper reports the data for endogamy, exogamy and consanguinity in 20 Sardinian villages from 1800 to 1974, divided into generational periods (25 years). The data are taken from the records of 48,262 marriages celebrated in the parishes of 20 Sardinian villages. The results for Spearman's rank correlation coefficient indicate significant positive correlations of endogamy with consanguinity (r(s) = 0.6551, percentage of consanguineous marriages; r(s) = 0.5477, Bernstein's alpha), with altitude (r(s) = 0.6386), with population size (r(s) = 0.2519), as well as a significant negative correlation of endogamy with time (r(s) = -0.4210). In addition, consanguinity shows a significant positive correlation with altitude (r(s) = 0.5717, percentage of consanguineous marriages; r(s) = 0.6295, Bernstein's alpha) and a significant negative correlation with time (r(s) = -0.2363, percentage of consanguineous marriages); the negative correlation between the mean level of consanguinity (alpha) and time is statistically not significant. In the single parishes, the levels of endogamy and consanguinity are generally higher in the mountain villages than in those situated in the hill and plain areas. Finally, it is hypothesized that, in the time period considered, the level of consanguinity and especially of endogamy were largely determined by isolation.