Assessment and risk stratification of ageing-related target organ damage and adverse health outcomes in the general population

The objectives of this doctoral thesis are to address the contribution of blood pressure to the presence of subclinical target-organ damage and the development of adverse health complications that associate with a poor life course of aging. This thesis focuses on ambulatory blood pressure monitoring to provide the most accurate information about the blood pressure level and variability over a 24-hour period. Moreover, by investigating the role of novel markers, including imaging markers and biomarkers, this thesis also provides possible pathophysiological and biological mechanisms that might explain the association between vascular risk factors and adverse health complications. We envisage that the results of our study will contribute to the refinement of risk stratification of major micro- (ophthalmological, neurological) and macro‑vascular (neurological, cardiovascular) complications associated with poor aging

Microcirculatory dysfunction and glucose homeostasis in peritoneal dialysis

Abstract Compared with hospital based therapies, peritoneal dialysis (PD) offers many advantages to patients with end stage renal disease in terms of greater autonomy and independence in addition to its health economic benefits. Cardiovascular morbidity and mortality in dialysis cohorts remains well in excess of the general population. The majority of this excess risk is attributable to a high prevalence of traditional cardiovascular risk factors and the consequences of chronic uraemia. However dialysis patients are at significant risk for systemic microvascular dysfunction which may represent an important non-traditional risk factor for cardiovascular disease in this group. In this thesis I present evidence of impairment in multiple aspects of cutaneous microvascular reactivity in PD patients compared with healthy controls and patients with similar metabolic and cardiovascular risk profiles. This impairment appears to be the result of deficiencies in multiple vasodilatory pathways and is attributable to uraemia or an aspect of PD therapy and not to co-morbidities. During peritoneal dialysis the rate of peritoneal small solute transport is governed primarily by the peritoneal microcirculation. However in this study there was no relationship between rate of small solute transport and the degree of systemic microvascular dysfunction. Data from this study adds to the increasingly compelling evidence for intraperitoneal inflammation as the major determinant of small solute transport. It has been suggested that the process of PD itself may also contribute to the increased cardiovascular risk, specifically the systemic effects of peritoneally absorbed glucose. In this thesis continuous glucose monitors provide novel insight into the 72 glycaemic profiles of PD patients and patients with stage 5 chronic kidney disease who are not on dialysis. In this cohort there was no significant increase in average interstitial glucose levels or the degree of glycaemic variability in PD patients compared with their non-dialysis controls. Neither was there any strong relationship between dialysate glucose exposure and interstitial glucose levels. However distinctly different patterns of glycaemia were noted in patients receiving automated peritoneal dialysis compared with those receiving continuous ambulatory peritoneal dialysis which require further investigation

Sensor-based evaluation of Circadian motor behavior in people with Dementia. Development and validation of analysis strategies

[ITA]La demenza consiste nel deterioramento, spesso progressivo, dello stato cognitivo di un individuo. Chi è affetto da demenza, presenta alterazioni a livello cognitivo, comportamentale e motorio, ad esempio compiendo gesti ossessivi, ripetitivi, senza uno scopo preciso. La condizione dei pazienti affetti da demenza è valutata clinicamente tramite apposite scale e le informazioni relative al comportamento vengono raccolte intervistando chi se ne occupa, come familiari, il personale infermieristico o il medico curante. Spesso queste valutazioni si rivelano inaccurate, possono essere fortemente influenzate da considerazioni soggettive, e sono dispendiose in termini di tempo. Si ha quindi l'esigenza di disporre di metodiche oggettive per valutare il comportamento motorio dei pazienti e le sue alterazioni patologiche; i sensori inerziali indossabili potrebbero costituire una valida soluzione, per questo scopo. L'obiettivo principale della presente attività di tesi è stato definire e implementare un software per una valutazione oggettiva, basata su sensori, del pattern motorio circadiano, in pazienti affetti da demenza ricoverati in un'unità di terapia a lungo termine, che potrebbe evidenziare differenze nei sintomi della malattia che interessano il comportamento motorio, come descritto in ambito clinico. Lo scopo secondario è stato quello di verificare i cambiamenti motori pre- e post-intervento in un sottogruppo di pazienti, a seguito della somministrazione di un programma sperimentale di intervento basato su esercizi fisici. --------------- [ENG]Dementia involves deterioration, often progressive, of a person's cognitive status. Those who suffer from dementia, present alterations in cognitive and motor behavior, for example performing obsessive and repetitive gestures, without a purpose. The condition of patients suffering from dementia is clinically assessed by means of specific scales and information relating to the behavior are collected by interviewing caregivers, such as the family, nurses, or the doctor. Often it turns out that these are inaccurate assessments that may be heavily influenced by subjective evaluations and are costly in terms of time. Therefore, there is the need for objective methods to assess the patients' motor behavior and the pathological changes; wearable inertial sensors may represent a viable option, so this aim. The main objective of this thesis project was to define and implement a software for a sensor-based assessment of the circadian motor pattern in patients suffering from dementia, hospitalized in a long-term care unit, which could highlight differences in the disease symptoms affecting the motor behavior, as described in the clinical setting. The secondary objective was to verify pre- and post-intervention changes in the motor patterns of a subgroup of patients, following the administration of an experimental program of intervention based on physical exercises

12th Man in Space Symposium: The Future of Humans in Space. Abstract Volume

The National Aeronautics and Space Administration (NASA) is pleased to host the 12th IAA Man in Space Symposium. A truly international forum, this symposium brings together scientists, engineers, and managers interested in all aspects of human space flight to share the most recent research results and space agency planning related to the future of humans in space. As we look out at the universe from our own uniquely human perspective, we see a world that we affect at the same time that it affects us. Our tomorrows are highlighted by the possibilities generated by our knowledge, our drive, and our dreams. This symposium will examine our future in space from the springboard of our achievements