PHD PROGRAM IN CLINICAL AND MOLECULAR MEDICINE XXXVII CYCLE ACADEMIC YEAR 2021/2022
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Università degli Studi di Perugia Dipartimento di Medicina e Chirurgia Piazza Lucio Severi 1/8 - 06132 Perugia PhD Program in Clinical and Molecular Medicine XXXVII Cycle Academic Year 2021/2022 under accreditation process • 1. Brief presentation of the doctorate • 2. Available Curricula • 3. General aims • 4. Training program • 5. Educational activities in iter training • 6. Description of the training activities • 7. Verification of educational obligations • 8. Career opportunities • 9. Disciplinary and interdisciplinary didactic activity • 10. Activities of PhD students • 11. Operational and scientific structures • 12. Members of the Academic Board • 13. International collaborations • 14. Admission requirements • 15. Admission procedures Contacts: Coordinator: Prof. Cristina Mecucci MD, PhD Section of Hematology, University of Perugia, Department of Medicine and Surgery Ph. +39 075-5783808/3289 Fax. +39 075-5783691 e-mail: cristina.mecucci@unipg.it For information: Doctoral Office, University of Perugia Tel. 075 585 6692 – 075 585 6687 e-mail: ufficio.dottorati@unipg.it
1. Brief presentation of the doctorate: The PhD in Clinical and Molecular Medicine is established at the Department of Medicine and Surgery of the University of Perugia. It lasts three years. The doctorate provides five training curricula: Pathology and Clinical Studies of Atherosclerosis and Aging; Neurosciences; Surgical Sciences; Biotechnologies in Human Bone Marrow Transplantation; Radiotherapy in Oncology. The aim of the PhD course is training for high quality researchers in order to improve their scientific knowledge and research autonomy in diseases with a high social impact which occupy the first places for diffusion and cause of death. The PhD program is providing skills in strategic research areas at a European level for the prevention of cardiovascular diseases, the development of neuroscience, the application and development of innovative surgical methodologies, and the precise diagnosis and innovative treatments of leukemias. The PhD students are stimulated to become protagonists themselves. They may propose and conduct scientific research after careful examination of international literature. Job opportunities for PhDs in this fields are likely increasing in public or private research institutions. Career opportunities can be found in academia, health services, private research centers and national and international pharmaceutical industries. Calls for temporary or permanent positions published by scientific associations, scientific journals, pharmaceutical industries and universities are regularly announced to PhD students. The implementation of a system for monitoring the career opportunities of doctoral students is being planned. 2. Curricula available 1. "Pathology and Clinical Studies of Atherosclerosis and Aging", includes the study of lipid metabolism, methods for the study of hepatic steatosis and research on the regulation and modulation of immune-mediated IDO tolerance (indolamine 2,3 dioxygenase-1) in plasma and adipose tissue of people with obesity, sepsis and inflammation; 2. "Neurosciences", aims at improving the knowledge of the pathogenetic mechanisms and preclinical aspects of neurodegenerative, vascular, inflammatory diseases of the nervous system, underlying headache and epilepsy as well as aspects concerning the transmission and synaptic plasticity both physiological and in experimental models of diseases with particular regard to neurodegenerative diseases; 3. “Surgical Sciences", is dedicated to improving the surgical methodology of experimental research, particular in oncology, with potential application and translation in the clinical setting, and the development of new diagnostic tools and therapeutic strategies applied to diseases of different organs or systems ( stomach and intestines, respiratory and urinary tracts, ear, nose and throat); 4. "Biotechnologies in Bone Marrow Transplantation”, Perugia is an internationally recognized Centre in haplo-identical transplantation. The Course aims at genome analysis and at the use of monoclonal antibodies in precision diagnosis and personalized therapy, including cell therapy and CAR-T cells. Animal models are applied to study leukemia origin and immunological reconstitution post-transplant.
5. “Radiotherapy in Oncology”, integration of radiotherapy with biomolecular markers and new treatments. Development of radiomics tools to predict the response to radiation treatments. Clinical research in the use of special radiotherapy techniques. The coordinator, Prof. Cristina Mecucci, is one of the main worldwide experts in cytogenetics and molecular genetics of tumors. She has produced more than 350 publications on preclinical and clinical aspects which significantly contributed to diagnostic and prognostic classifications of leukemias and lymphomas. The Academic Board includes 47 researchers and professors, of whom 37 belonging to the Perugia University, with consolidated experience in the doctoral curricula. The research doctorate benefits from the collaboration of numerous international research Institutes in which doctoral students are hosted to improve their training and to develop shared research projects. The doctorate also avails himself of the support of European consortia (Marie Curie 2020-2023). During the PhD program, stays abroad are foreseen for all students. DESCRIPTION AND AIMS OF THE COURSE 3. General aims The general aim of the Doctoral Course in Clinical and Molecular Medicine is to provide PhD students with a thorough theoretical and practical preparation in different aspects of basic and preclinical, and clinical research. Basic research is mainly focused at discovering the pathogenetic mechanisms of diseases. Preclinical research aims to transfer the results of basic research into clinical work. Clinical research is enriched by promotion and participation to multicentric studies and clinical trials, including fase 1 studies. Research activities can be described as follows: 1) investigations on the biology of human disorders to provide the scientific basis for the development or improvement of new therapies; 2) pre-clinical or animal model studies conducted with the aim of improving knowledge on pathogenesis and therapies; 3) basic scientific studies defining the biological effects of treatments in humans; 4) studies aimed at allowing adequate development of a treatment and of its clinical use. This applies both to medical and surgical disciplines. 4. Training program The course is divided into five curricula and a progression of theoretical and practical learning is distributed over the three years of the course, which also includes a staying abroad.
The first year is dedicated to theoretical knowledge and basic experimental laboratory / surgical techniques, through a program of lectures, seminars, journal clubs, and attendance at the laboratories and surgical theater under tutoring. Lectures include formal teachings, seminar cycles, webinars, journal clubs. • Pathology and Clinical Studies of Atherosclerosis and Aging: pathophysiological basis of lipid and glycidic metabolism. Identification and use of laboratory markers. • Neurosciences: introduction to the pathogenetic models of neurodegenerative diseases. Approaches to laboratory experimentation in biomarker evaluations. • Surgical Sciences: principles of surgery in oncology and hematology. Applications in the diagnostic and therapeutic field. • Biotechnologies in Human Bone Marrow Transplantation: training on genome methodologies: conventional cytogenetics - FISH - Next Generation Sequencing - use and interpretations. Target terapy: current principles and application. • Radiotherapy in Oncology: principles of radiobiology; integration between systemic therapies and radiotherapy in onco-hematology; radiotherapy equipment and techniques Common fields: enhancement and management of research. English and scientific writing. Computer technology. Bioinformatics. Laboratory approaches for molecular medicine. Animal models. Emerging infections: Coronavirus - clinical impact and experimental models. The second year is aimed at the development of research projects through an intense research and laboratory activity by a continuous updating of the topics of interest through the study of literature, participation in congresses and participation in teaching and training of students. • Pathology and Clinical Studies of Atherosclerosis and Aging: hepatic steatosis, classification, etiopathogenesis and animal models. Inflammation, inflammasome and immunity. • Neurosciences: diagnostic framework of neurodegenerative diseases. Pre-clinical and animal models for the study of headache and epilepsy. • Surgical Sciences: thoracic surgery in solid tumors, surgery in malignant haemopathies. Invasive methods for diagnosis in oncology. • Biotechnology in Human Bone Marrow Transplantation: hematopoietic stem cells: identification, separation, enrichment. CAR-T cells: principles, production and technologies of genetic engineering. • Radiotherapy in Oncology: stereotaxic radiotherapy; radiotherapy in conditioning for hematopoietic stem cell transplantation (Total Body Irradiation and Total Marrow / Lymphoid Irradiation); radiotherapy as a bridge treatment in patients who will receive CAR T therapy The third year includes the preparation of the final experimental thesis, in addition to research and continuous updating related to the individual research project of each student,
• Pathology and Clinical Studies of Atherosclerosis and Aging: Innate immunity and tolerance. Immuno-modulatory mechanisms of IDO. The role in obesity, sepsis and inflammatory processes. • Neurosciences: biomarkers of neurodegenerative diseases. Cerebrospinal fluid biomarkers. Introduction of new laboratory methods. • Surgical Sciences: surgical techniques and biomarkers in oncology. • Biotechnology in Human Bone Marrow Transplantation: mono-clonal antibodies; production methods and application tests. Extensive use of mono-clonal antibodies: from diagnosis to therapy. • Radiotherapy in Oncology: clinical, dosimetric and biomolecular parameters predicting outcome in patients treated with Total Marrow / Lymphoid Irradiation; quantitative analysis of data extracted from diagnostic imaging methods for the development of predictive outcome models in patients undergoing radiation treatment; translational research on the role of the microbiota in radiotherapy. Lessons for the academic year 2021-2022 are planned at CREO, Hemato-Oncological Research Center, Aula Rita Levi Montalcini, Piazzale G. Menghini, 9, 06132 Perugia. Alternatively online lectures will use The Teams platform through the University of Perugia facilities. The dates and times will be updated on the site and emailed to students and faculty. 5. Educational activity iter training Calendar Description HOURS ECTS COVID19. First Module. 12 2 Clinical and Molecular Medicine facing a new challenge. Speaker: Prof. Antonella Mencacci 2021 University of Perugia November 2022 2023 COVID19. Second Module. 12 2 Clinical impact in affected and unaffected patients. Speakers: Prof. Patrizia Mecocci Prof. Alfonso Tortorella University of Perugia Pathophysiology of neoplastic diseases and molecular 12 3 2022 diagnosis. January 2023 Speakers: 2024 Prof. Cristina Mecucci Prof. Enrico Tiacci Prof. Giovanni Cochetti University of Perugia Pathophysiology of neoplastic diseases and target therapy. 12 3 Speakers: 2022 Prof. Maria Paola Martelli
Calendar Description HOURS ECTS February 2023 Prof. Paolo Sportoletti 2024 Prof. Cynthia Aristei University of Perugia Biomarkers: definition, identification and validation. 12 3 Speakers: 2022 Prof. Lucilla Parnetti March 2023 Prof. Matteo Pirro 2024 Prof. Ettore Mearini Prof. Lucio Cagini University of Perugia The multiple faces of immunology in the pathophysiology of 12 3 2022 neoplastic and non-neoplastic diseases. April 2023 Speakers: 2024 Prof. Massimiliano Di Filippo Prof. Luca Stingeni Prof. Guido Bellezza University of Perugia “Target” Surgery 12 2 2022 Speakers: May 2023 Prof. Francesco Puma 2024 Prof. Lucio Cagini University of Perugia 2022 Cell Therapy 12 3 June 2023 Speaker: 2024 Prof. Cristina Mecucci Prof. Enrico Tiacci University of Perugia 12 3 Pathophysiological bases of targeted therapies in non - 2022 neoplastic pathologies July 2023 Speakers: 2024 Prof. Paola Sarchielli Prof. Carmelinda Ruggiero Prof. Gabrio Bassotti Prof. Matteo Pirro Prof. Alessandro Tozzi University of Perugia Topics may undergo updates and even variations in step with scientific discoveries and international literature relating to the curriculum of the Course. 6. Description of the training activities Type Description Linguistics Participation at foreign language courses held at the University Language Center (CLA). The level of language courses offered at the CLA refer to the Common European Framework of Reference (CEFR). Language courses can last six months (10 ECTS) or one year (13 ECTS). At the end of the course, the level achieved in the individual language skills will be assessed.
Type Description Informatics Possibility to participate in computer laboratories already offered in other University courses. Specific courses will also be organized in modules of 1 ECTS (use of software for data analysis, word processing programs, programs for archiving and importing bibliographic data; in-depth study of databases and their consultation). For these courses, a verification of the level of knowledge acquired will be provided. Management of research, Possibility to participate in 1 ECTS courses on research management, knowledge of knowledge of research research systems and funding systems. The courses will deal in particular with: research systems and funding design and development techniques; drafting and management of financial plans for systems research projects; project management by stages of work progress and their reporting; management of relations with sponsors. The courses include a final exam. Enhancement of research The PhD course offers the opportunity to participate in 6 courses of 1 ECTS on the results and intellectual enhancement of research and intellectual property. The 6 courses will deal with: the property transition from basic research to applied research; research enhancement techniques; funding of applied research; the protection of intellectual property; the intervention of universities in favor of patents; business creation and research spin-offs. The courses include a final exam. Animal Models As part of the PhD course there are courses for the use of animal models at the University with final exam. Other active courses for all - Biostatistics and Data Analysis; curricula - Scientific Writing Course with final exam; 7. Verification of educational obligations At the end of each year, PhD students are required to submit an individual annual report regarding the research activity carried out and the results achieved, any participation in seminars, congresses and other scientific initiatives, together with any publications produced. The progress of the activities scheduled at the beginning of the year must emerge from the final report. The coordinator will submit the reports to the Academic Board for approval by October 31 of each year. The Academic Board may at any time request an extraordinary verification of the activities carried out by a PhD student and order the forfeiture of the course in the event of a negative judgment. 8. Career opportunities The PhD in Clinical and Molecular Medicine represents a post-graduate advanced training course on wide-ranging research topics with a high social impact concerning diseases that, in epidemiological terms, occupy the first places in terms of diffusion, according to WHO perspectives. Therefore, job opportunities in public or private research institutions are set to increase. Career opportunities can be found in academia, in research centers and private laboratories and in pharmaceutical industries, both national and international, and within the national health service. Calls for temporary or permanent positions published by scientific associations, scientific journals, pharmaceutical industries and universities will be made known to PhDs. The implementation of a system for monitoring the career opportunities that the doctoral students will be able to achieve is being planned.
9. Disciplinary and interdisciplinary didactic activity Tot ECTS: n. teachings: 36 with final exam: 36 Ad hoc courses in the training process 72 Mutual courses with master's degree Yes n.: 20 with final exam : 20 curricula No Mutual courses with other degree courses (first level) Yes Seminars Research Opportunities Yes Italy- outside the institutions involved expected period (in months per Abroad - inside the institutions involved student): 12 Abroad - outside the institutions involved 10. Activities of PhD students It is expected that PhD students can carry out tutoring activities of supplementary teaching activities for a maximum of 20 hours. 11. Operational and scientific structures Type Brief description Molecular pathology haemopathies, cytogenetics and molecular genetics, Equipment and / or Laboratories next generation sequencing (NGS), transplant immunology flow cytometry, molecular biology, laser microscopy, GMP manipulating stem cells and other cell populations, including CAR-T. Positive press chambers. Non-invasive vascular diagnostics, functional / morphological macro / microcirculation, echocardiography, lipid metabolism. Early diagnosis of neurodegenerative diseases: Cerebrospinal fluid biomarkers dosage specific markers. Elekta Brachytherapy, 2008. Library consistency in volumes and Centralized Library Faculty of Medicine heritage coverage of the topics of the course Journal subscriptions (number, Centralized Library Faculty of Medicine years owned, coverage of the course topics) E-resources Databases (access to the University newspaper library content of sets of journal and / or editorial series) Software specifically related to Office (Excel, power point, word), SPSS, SAS, Fastqc, BWA-MEM, GATK, the research areas provided Bistmark, Botwie (1/2), STAR, TopHat, HTseq, Cutadapt, Trimmomatic, Flexbar, Picard, Methclone, Hypergeometric Optimization of Motif EnRichment (HOMER), SAMTools, BEDTools, MethylKit, Methylsig, EdgeR, DESeq2, DexSeq, Limma, ChipEnrich, CEQer2, MuTect, Annovar, Varscan,
Type Brief description LRpath, GSEA, ConsensusPathDB e Fusion Analyser. MIM Software Inc. for multi-modal imaging management. Oncentra Brachy treatment planning system by Elekta. Spaces and resources for PhD n. 40 computer stations with related software students and for electronic computing 12. Members of the Academic Board: Internal Members n. Surname Name University Department / Structure Title Academic Recruitment Field 1. PIRRO Matteo PERUGIA MEDICINE AND SURGERY Associate Professor 06/B1 2. BELLEZZA Guido PERUGIA MEDICINE AND SURGERY Confirmed Researcher 06/A4 3. MANNARINO Massimo PERUGIA MEDICINE AND SURGERY Confirmed Researcher 06/B1 Raffaele 4. BISCARINI Andrea PERUGIA MEDICINE AND SURGERY Associate Professor 02/D1 5. PARNETTI Lucilla PERUGIA MEDICINE AND SURGERY Associate Professor 06/D6 6. SARCHIELLI Paola PERUGIA MEDICINE AND SURGERY Confirmed Researcher 06/D6 7. COSTA Cinzia PERUGIA MEDICINE AND SURGERY Confirmed Researcher 06/D6 8. DI FILIPPO Massimiliano PERUGIA MEDICINE AND SURGERY Associate Professor 06/D6 9. PUMA Francesco PERUGIA MEDICINE AND SURGERY Full Professor 06/E1 10. MEARINI Ettore PERUGIA MEDICINE AND SURGERY Full Professor 06/E2 11. RICCI Giampietro PERUGIA MEDICINE AND SURGERY Associate Professor 06/F3 12. SCIALPI Michele PERUGIA MEDICINE AND SURGERY Full Professor 06/I1 13. ASCANI Stefano PERUGIA MEDICINE AND SURGERY Associate Professor 06/A4 14. MECUCCI Cristina PERUGIA MEDICINE AND SURGERY Full Professor 06/D3 15. MARTELLI Maria Paola PERUGIA MEDICINE AND SURGERY Associate Professor 06/D3 16. ARISTEI Cynthia PERUGIA MEDICINE AND SURGERY Full Professor 06/I1 17. BASSOTTI Gabrio PERUGIA MEDICINE AND SURGERY Associate Professor 06/D4 18. CAGINI Lucio PERUGIA MEDICINE AND SURGERY Associate Professor 06/E1
n. Surname Name University Department / Structure Title Academic Recruitment Field 19. STINGENI Luca PERUGIA MEDICINE AND SURGERY Associate Professor 06/D4 20. BOSELLI Carlo PERUGIA MEDICINE AND SURGERY Confirmed Researcher 06/C1 21. MECOCCI Patrizia PERUGIA MEDICINE AND SURGERY Full Professor 06/B1 22. TOZZI Alessandro PERUGIA MEDICINE AND SURGERY Associate Professor 05/D1 23. MENCACCI Antonella PERUGIA MEDICINE AND SURGERY Full Professor 06/A3 24. RUGGIERO Carmelinda PERUGIA MEDICINE AND SURGERY Associate Professor 06/B1 25. TORTORELLA Alfonso Antonio PERUGIA MEDICINE AND SURGERY Full Professor 06/D5 Vincenzo 26. HANSEL Katharina PERUGIA MEDICINE AND SURGERY Associate Professor 06/D4 27. RABALLO Andrea PERUGIA MEDICINE AND SURGERY Associate Professor 06/D5 28. SPORTOLETTI Paolo PERUGIA MEDICINE AND SURGERY Associate Professor 06/N1 29. TIACCI Enrico PERUGIA MEDICINE AND SURGERY Associate Professor 06/D3 30. COCHETTI Giovanni PERUGIA MEDICINE AND SURGERY Fixed-Term Researcher 06/E2 31. COSTARELLI Danilo PERUGIA MATHEMATICS AND Fixed-Term Researcher 01/A3 COMPUTER SCIENCE 32. PALUMBO Isabella PERUGIA MEDICINE AND SURGERY Confirmed Researcher 06/I1 33. FILIPPI Andrea PAVIA CLINICAL-SURGICAL, Full Professor “Straordinario” 06/I1 Riccardo DIAGNOSTIC AND PEDIATRIC SCIENCES 34. CIANETTI Stefano PERUGIA MEDICINE AND SURGERY Full Professor 06/F1 35. FIORE Tito PERUGIA MEDICINE AND SURGERY Confirmed Researcher 06/F2 36. LA STARZA Roberta PERUGIA MEDICINE AND SURGERY Confirmed Researcher 06/D3 37. VAUDO Gaetano PERUGIA MEDICINE AND SURGERY Associate Professor 06/B1 External and Foreign Members n. Surname Name Ateneo/Ente di Department / Structure Title SSD CUN-VQR Curriculum appartenenza area affiliation assigned 1. BIERSMA LIESBETH MAASTRICHT FAC. HEALTH, MEDICINE AND Professor MED/36 06 RADIOTHERAPY IN UNIVERSITY LIFE SCIENCES,RADIOTHERAPIE
n. Surname Name Ateneo/Ente di Department / Structure Title SSD CUN-VQR Curriculum appartenenza area affiliation assigned ONCOLOGY 2. COLLAMATI FRANCESCO Istituto Nazionale di Fisica INFN - Sezione di Roma Researcher FIS/07 02 RADIOTHERAPY IN Nucleare ONCOLOGY 3. COOLS JAN UNIVERSITY OF LEUVEN CENTRE FOR HUMAN Professor MED/15 06 BIOTECHNOLOGY IN GENETICS BONE MARROW TRANSPLANTATION 4. DAL CIN PAOLA HARVARD UNIVERSITY DEPARTMENT OF Professor MED/15 06 BIOTECHNOLOGY IN BOSTON PATHOLOGY BONE MARROW TRANSPLANTATION 5. FIGUEROA MARIA UNIVERSITY OF MIAMI - DEPARTMENT OF HUMAN Professor MED/15 06 BIOTECHNOLOGY IN MILLER SCHOOL OF GENETICS/ SYLVESTER BONE MARROW MEDICINE COMPREHENSIVE CANCER TRANSPLANTATION CENTER 6. HUI SUSANTA UNIVERSITY OF CITY OF HOPE NATIONAL Professor MED/36 06 RADIOTHERAPY IN MINNESOTA MED CENTER, DEP. OF ONCOLOGY RADIATION ONCOLOGY 7. LANCIA ANDREA Fondazione IRCCS Radioterapia Oncologica Researcher MED/36 06 RADIOTHERAPY IN Policlinico San Matteo ONCOLOGY 8. OFFERSEN BIRGITTE AARHUS DEPARTMENT OF CLINICAL Professor MED/36 06 RADIOTHERAPY IN UNIVERSITETSHOSPITAL MEDICINE ONCOLOGY 9. POORTMANS PHILIP UNIVERSITY OF Department of Professor MED/36 06 RADIOTHERAPY IN ANTWERP Radiotherapy ONCOLOGY 10. STEGMAIER KIMBERLEY HARVARD UNIVERSITY DANA FARBER CANCER Professor MED/15 06 BIOTECHNOLOGY IN BOSTON INSTITUTE BONE MARROW TRANSPLANTATION 13. International collaborations: Main universities and international research centers with which the college maintains research collaborations: n. Name Country Type of collaboration 1. NEUROCHEMISTRY, DEPT. Sweden Collaboration on projects aimed at the development of molecular markers for early diagnosis for CLINICAL NEUROSCIENCE, neurodegenerative diseases with dementia GOTEBORG 2. MOVEMENT DISORDER CENTRE, Canada Implementation and monitoring of deep brain stimulation methods in stereotaxic neurosurgery TORONTO WESTERN HOSPITAL, of Parkinson's disease UNIVERSITY OF TORONTO, ONTARIO 3. INSTITUTE FOR CANCER USA Use of whole genome sequencing, RNA sequencing, exome sequencing techniques in research on GENETICS, COLUMBIA lymphoproliferative diseases This approach has identified genetic alterations in orphan UNIVERSITY pathologies, i.e. not characterized from a molecular point of view, new disease markers to aid in
n. Name Country Type of collaboration the diagnosis and prognostic stratification of patients and that can represent targets of molecular therapies 4. DANA FARBER CANCER USA Use of Gene Expression-based High-Throughput Screening (GE-HTS) to identify small molecules INSTITUTE, HARVARD capable of modulating gene expression profiles (GEP) induced by the ectopic expression of UNIVERSITY, BOSTON transcription factors that unfortunately do not yet represent effective therapeutic targets. The GE-HTS approach studies the GEP of cell lines derived from acute leukemia in basal conditions and after the use of small molecules in order to identify a modulation action on deregulated pathhawys 5. AGING RESEARCH CENTER (ARC) Sweden Evaluation of risk factors and protective factors in brain aging and dementia related to nutrition, KAROLINSKA INSTITUTET, oxidative stress and inflammation (Kungholmen Project, Snac-K project in collaboration with STOCCOLMA Prof. Laura Fratiglioni; CAIDE and FINGER Projects in collaboration with Prof. Miia Kivipelto) 6. SYLVESTER COMPREHENSIVE USA Epigenetic mechanisms in the pathogenesis of the leukemic process; projects in collaboration CANCER CENTER, UNIVERSITY OF with Prof. Maria E. Figueroa MIAMI MILLER SCHOOL OF MEDICINE 14. Admission requirements All master's degrees obtained in Italy and equivalent, if obtained abroad, are able to apply for the selection. 15. Admission procedures Evaluation of CV. Individual Research Project. Oral Examination. Language test.
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