P187 DRUCEBO EFFECT IN STATIN THERAPY: MORE ATTRIBUTABLE TO THE PATIENT, THE DOCTOR, OR THE MASS MEDIA?

Abstract In recent years, the term “drucebo effect” (drug + nocebo) has been coined to mean the nocebo effect attributable more to the patient‘s expectations, the doctor‘s preferences and the interference of the mass media rather than the actual pharmacological effect . We evaluated this effect in 9,605 patients treated with statins, in primary (27%) and secondary (73%) prevention. Presumed statin intolerance was reported in 1,729 patients (18%) with discontinuation of therapy for 5 days to 4 weeks. Table 1 shows the causes of the presumed intolerance and the related SMIS (Statin Myalgia Index Score). Patients with myalgia with or without CPK elevation and probable or possible SMIS were advised to halve the dose, with reassessment after 2–4 weeks. With persisting symptoms, the statin was changed. If symptoms were also present with the second statin, the patient was advised to take the drug every other day. In patients with unlikely SMIS, the decision to resume therapy was shared with the patient, informing him of the benefits of statins on mortality and morbidity. Probable true intolerance was found in 576 patients (6% of the overall population on statin therapy: 332 with myalgia with or without CPK elevation and SMIS probable, 152 with myalgia and CPK elevation with SMIS possible, 46 with asymptomatic CPK elevation, 15 transaminase increased, 21 with general malaise, 10 with severe depression). In 12% of patients, on the other hand, the interruption is attributable to a nocebo effect due to both the patient and the treating physician or other specialist, who are inclined to attribute the unwanted symptoms more to the drug than to other factors or to consider it non–modifiable by modifying the drug or the doses. Interference from the mass media is common, and it is difficult to distinguish a greater responsibility of one or the other.In patients treated with statins, a drucebo effect is frequently found, which is partly attributable to the patient, partly to the doctor and the mass media, who tend to attribute muscle symptoms to the treatment with statins and to interrupt therapy without taking into account the benefits regarding the reduction of mortality and morbidity found in numerous studies with indisputable evidence of efficacy and safety. In our study, a probable true intolerance to statins is found in about one third of patients who report symptoms. <jats:p /

Semi-automatic detection of linear archaeological traces from orthorectified aerial images

This paper presents a semi-automatic approach for archaeological traces detection from aerial images. The method developed was based on the multiphase active contour model (ACM). The image was segmented into three competing regions to improve the visibility of buried remains showing in the image as crop marks (i.e. centuriations, agricultural allocations, ancient roads, etc.). An initial determination of relevant traces can be quickly carried out by the operator by sketching straight lines close to the traces. Subsequently, tuning parameters (i.e. eccentricity, orientation, minimum area and distance from input line) are used to remove non-target objects and parameterize the detected traces. The algorithm and graphical user interface for this method were developed in a MATLAB environment and tested on high resolution orthorectified aerial images. A qualitative analysis of the method was lastly performed by comparing the traces extracted with ancient traces verified by archaeologists

The evolution of the mantle source beneath Mt. Etna (Sicily, Italy): from the 600 ka tholeiites to the recent trachybasaltic magmas

The spatial/temporal proximity of Mt. Etna to the Hyblean Plateau and the Aeolian slab makes the discussion on the nature of its mantle source/s extremely controversial. In this study, a detailed geochemical overview of the entire Mt. Etna evolutionary sequence and a comparison with the magmatism of the Hyblean Plateau was proposed to: (i) simulate the composition of Mt. Etna tholeiitic to alkaline primitive magmas in equilibrium with a fertile mantle source; (ii) model the nature, composition and evolution of the mantle source from the tholeiitic stage (600 ka) to present magmatism. According to our simulations, two amphibole + phlogopite-bearing spinel lherzolite sources are able to explain the wide range of Etnean primary magmas. The enrichment in LILE, 87Sr/86Sr, Rb and H2O of the magmas emitted after 1971 (but also discontinuously generated in both historic and prehistoric times) are caused by different melting proportions of amphibole and phlogopite in a modally and compositionally homogeneous mantle domain, with melting degrees analogous to those required to produce magmas erupted prior to 1971. The behaviour of the hydrous phases during melting could be ascribed to a variable H2O/CO2 activity in the mantle source, in turn related to the heat/fluxes supply from the asthenospheric upwelling beneath Mt. Etna. All these considerations, strengthened by numerical models, are then merged to review the complex Pliocene/Lower Pleistocene to present day’s geodynamic evolution of eastern Sicily