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Cold atmospheric pressure plasma (ionized gas) is an innovative medical tool for the treatment of infected wounds thanks to its potential to inactivate drug-resistant microorganisms and promote tissue regeneration and vascularization. The low power consumption, compactness, and versatility of Cold Atmospheric Pressure Plasma (CAPP) devices make them an ideal tool for risk mitigation associated with human spaceflights. This work presents results in microgravity on the operability of CAPP and its antimicrobial effect. The experiments carried out in parabolic flights make it possible to optimize the treatment conditions (i.e., the distance, the gas mixture) and to obtain the rapid inactivation (<15 s) of Escherichia coli samples. Interestingly, the inactivation efficiency of CAPP was higher during parabolic flights than under terrestrial conditions. Overall, these results encourage the further development of CAPP medical devices for its implementation during human spaceflights.

In order to evaluate the predictive value of positron emission tomography–computed tomography (PET/CT) in discriminating the presence of a Richter’s syndrome (RS) or a second malignancy (SM), as well as to evaluate its prognostic value in patients with chronic lymphocytic leukemia (CLL), we retrospectively analyzed the data of 90 patients who, in the suspicion of a RS or a SM, underwent PET/CT followed by the biopsy of the involved tissue. The median maximum Standardized Uptake Value (SUV max ) in the presence of a CLL/small lymphocytic lymphoma, a diffuse large B-cell lymphoma (DLBCL), a Hodgkin lymphoma (HL), a SM were 3.5, 14.6, 7.0 and 6.3, respectively ( P ⩽0.0001). A SUV max cutoff value ⩾5 showed a sensitivity, specificity, positive and negative predictive values of 88.2, 71.2, 51.3 and 94%, respectively, for the presence of a more aggressive disease (DLBCL, HL and SM). A SUV max ⩾5 identified also a subset of treatment naive patients with an inferior progression-free survival ( P =0.011) and overall survival ( P =0.067). These findings suggest that PET/CT may helpfully integrate the biologically-based prognostic stratification of CLL. Prospective clinical trials including larger cohorts of patients are needed to conclusively define the role and prognostic impact of PET/CT in the routine management of CLL patients.

Chronic lymphocytic leukemia (CLL) clones are characterized by loss of a critical region in 13q14.3, (del(13)(q14)) involving the microRNA (miRNA) cluster miR-15a and miR-16-1. We have investigated the effects of replacement of miR-15a and miR-16-1. CLL cells transfected with these miRNA mimics exhibited a decrease in cell viability in vitro and impaired capacity for engraftment and growth in NOD/Shi-scid,γcnull (NSG) mice. No synergistic effects were observed when the two miRNA mimics were combined. The phenomena were not restricted to CLL with the del(13)(q14) lesion. Similar effects induced by miRNA mimics were seen in cells with additional chromosomal abnormalities with the exception of certain CLL clones harboring TP53 alterations. Administration of miRNA mimics to NSG mice previously engrafted with CLL clones resulted in substantial tumor regression. CLL cell transfection with miR-15a and miR-16-1-specific inhibitors resulted in increased cell viability in vitro and in an enhanced capacity of the engrafted cells to grow in NSG mice generating larger splenic nodules. These data demonstrate that the strong control by miR-15a and miR-16-1 on CLL clonal expansion is exerted also at the level of full-blown leukemia and provide indications for a miRNA-based therapeutic strategy.

MicroRNAs (miRNAs) with tumor-suppressor potential might have therapeutic applications in multiple myeloma (MM) through the modulation of still undiscovered molecular pathways. Here, we investigated the effects of enforced expression of miR-29b on the apoptotic occurrence in MM and highlighted its role in the context of a new transcriptional loop that is finely tuned by the proteasome inhibitor bortezomib. In details, in vitro growth inhibition and apoptosis of MM cells was induced by either transient expression of synthetic miR-29b or its stable lentivirus-enforced expression. We identified Sp1, a transcription factor endowed with oncogenic activity, as a negative regulator of miR-29b expression in MM cells. Since Sp1 expression and functions are regulated via the 26S proteasome, we investigated the effects of bortezomib on miR-29b-Sp1 loop, showing that miR-29b levels were indeed upregulated by the drug. At the same time, the bortezomib/miR-29b combination produced significant pro-apoptotic effects. We also demonstrated that the PI3K/AKT pathway plays a major role in the regulation of miR-29b-Sp1 loop and induction of apoptosis in MM cells. Finally, MM xenografts constitutively expressing miR-29b showed significant reduction of their tumorigenic potential. Our findings indicate that miR-29b is involved in a regulatory loop amenable of pharmacologic intervention and modulates the anti-MM activity of bortezomib in MM cells.

This phase II trial evaluates, for the first time, the safety and efficacy of bendamustine plus high-dose melphalan (HDM) as a conditioning regimen before the second autologous stem cell transplantation (ASCT) in previously untreated multiple myeloma (MM) patients. In total, 32 ASCT patients received HDM (200 mg/m 2 ) as conditioning for the first ASCT. After 3–6 months from the first ASCT, responding patients underwent a second ASCT following bendamustine (200 mg/m 2 ) and HDM (140 mg/m 2 ). High-dose chemotherapy and ASCT were performed with complete neutrophil and platelet recovery in all patients. The median number of days to neutrophil and platelet engraftment was 11 (range 9–15) and 12 (range 10–19), respectively. Only one subject experienced grade 3 diarrhea; the rate of mucositis and vomiting was significantly lower with the bendamustine plus HDM regimen compared with the HDM-only regimen (81.2 vs 96.9%, P =0.025 and 78.1 vs 100%, P =0.008). Overall response rate (ORR) was 81.2% after the first transplant, and 90.6% after the second, while complete response rates were 46.8 and 62.5%, respectively ( P =0.016). Actuarial 2-year PFS and OS were 79% (95% confidence interval (CI), 60–98) and 97% (95% CI, 91–100), respectively. Bendamustine+HDM is feasible as the conditioning regimen for second ASCT in MM patients. The present study may pave the way for phase III studies specifically aimed at further investigating this combination strategy. The role of this combination in MM for conditioning regimen in a first or single ASCT setting should be also investigated.

This phase 2 trial evaluated three low-dose intensity subcutaneous bortezomib-based treatments in patients ⩾75 years with newly diagnosed multiple myeloma (MM). Patients received subcutaneous bortezomib plus oral prednisone (VP, N= 51) or VP plus cyclophosphamide (VCP, N= 51) or VP plus melphalan (VMP, N= 50), followed by bortezomib maintenance, and half of the patients were frail. Response rate was 64% with VP, 67% with VCP and 86% with VMP, and very good partial response rate or better was 26%, 28.5% and 49%, respectively. Median progression-free survival was 14.0, 15.2 and 17.1 months, and 2-year OS was 60%, 70% and 76% in VP, VCP, VMP, respectively. At least one drug-related grade ⩾3 non-hematologic adverse event (AE) occurred in 22% of VP, 37% of VCP and 33% of VMP patients; the discontinuation rate for AEs was 12%, 14% and 20%, and the 6-month rate of toxicity-related deaths was 4%, 4% and 8%, respectively. The most common grade ⩾3 AEs included infections (8–20%), and constitutional (10–14%) and cardiovascular events (4–12%); peripheral neuropathy was limited (4–6%). Bortezomib maintenance was effective and feasible. VP, VCP and VMP regimens demonstrated no substantial difference. Yet, toxicity was higher with VMP, suggesting that a two-drug combination followed by maintenance should be preferred in frail patients.

We conducted a phase II, noncomparative, open-label, multicenter GIMEMA (Gruppo Italiano Malattie EMatologiche dell'Adulto) study (CLL0809) to assess the efficacy and safety of bendamustine in combination with ofatumumab (BendOfa) in relapsed/refractory chronic lymphocytic leukemia (CLL). Forty-seven patients from 14 centers were evaluated. Therapy consisted of bendamustine (70 mg/m 2 ) for 2 consecutive days every 28 days, and ofatumumab 300 mg on day 1 and 1000 mg on day 8 during the first cycle, and 1000 mg on day 1 subsequently. Treatment was administered up to six cycles. The overall response rate (ORR), as per intention-to-treat analysis, was 72.3% (95% confidence of interval (CI), 57–84%), with 17% complete responses. After a median follow-up of 24.2 months, the overall survival was 83.6% (95% CI, 73.0–95.7%) and the progression-free survival (PFS) was 49.6% (95% CI, 35.9–68.6%). The median PFS was 23.6 months. Univariate and multivariate analyses were used to identify clinical and biological characteristics associated with ORR and PFS. Myelosuppression was the most common toxicity; grade ⩾3 neutropenia was observed in 61.7% of patients; however, grade ⩾3 infections occurred in 6% of patients. BendOfa is feasible and effective in relapsed/refractory CLL patients, including patients with high-risk clinical and biological features.

Plasma diagnostics is a topic of great interest in the physics and engineering community because the monitoring of plasma parameters plays a fundamental role in the development and optimization of plasma reactors. Towards this aim, microwave diagnostics, such as reflectometric, interferometric, and polarimetric techniques, can represent effective means. Besides the above, microwave imaging profilometry (MIP) may allow the obtaining of tomographic, i.e., volumetric, information of plasma that could overcome some intrinsic limitations of the standard non-invasive diagnostic approaches. However, pursuing MIP is not an easy task due to plasma’s electromagnetic features, which strongly depend on the working frequency, angle of incidence, polarization, etc., as well as on the need for making diagnostics in both large (meter-sized) and small (centimeter-sized) reactors. Furthermore, these latter represent extremely harsh environments, wherein different systems and equipment need to coexist to guarantee their functionality. Specifically, MIP entails solution of an inverse scattering problem, which is non-linear and ill-posed, and, in addition, in the one-dimensional case, is also severely limited in terms of achievable reconstruction accuracy and resolution. In this contribution, we address microwave inverse profiling of plasma assuming a high-frequency probing regime when magnetically confined plasma can be approximated as both an isotropic and weak penetrable medium. To this aim, we adopt a finite-difference frequency-domain (FDFD) formulation which allows dealing with non-homogeneous backgrounds introduced by unavoidable presence of plasma reactors.