Le fratture multifocali di omero

Le fratture multifocali di omero possono interessare l'epifisi prossimale e la diafisi, punti diversi della diafisi, epifisi distale e diafisi. In questa tesi abbiamo confrontato i nostri dati con quelli presenti in letteratura

Motherhood and female identity in Oriana Fallaci and Valeria Parrella: A case of literary matérnage?

Contemporary women writers have provided a wide range of interpretations of the relationship between motherhood and female identity, drawing into their stories a range of issues related to the various experiences of motherhood. Among this rich variety, I analyse here two contemporary Italian novels: Lo spazio bianco (2008) by Valeria Parrella, and Lettera a un bambino mai nato (1975) by Oriana Fallaci. I argue that Parrella engages with the same question tackled by Fallaci thirty years earlier: can motherhood find its place in the life of an independent woman? Have thirty years opened up any possibility of negotiating a different balance? The two novels share many similarities in structure, length and theme. Both texts centre on female protagonists who are alone in their experience of pregnancy. Neither novel depicts motherhood as an unavoidable destiny for women, but as a choice. However, the change in the social, political and economic context underlying the two texts leads to radically different outcomes. In spite of the obvious differences in style and generational background, the continuity between the two works provides the opportunity for a case study of the shifts (or the lack thereof) in the relationship between motherhood and female identity in contemporary Italian society. In addition, the affinity between the two novels allows a reflection on “the corrective and conflictual nature of inter-female intertextuality” (Giorgio 2002, 13), which I analyse using the tools provided by Italian Feminist Theorists

Three-dimensional advanced numerical approaches to the seismic soil and structural response analyses

A 3D non-linear finite element approach is developed to study the free-field seismic ground response and the soil-structure interaction (SSI) phenomena at the Lotung site (Taiwan) during the earthquake event occurred on May 20 1986. The site was extensively instrumented with down-hole and surface ac- celerometers, these latter located also on a 1/4–scale nuclear power plant containment structure. An advanced constitutive model is adopt- ed for simulating the soil behaviour, while a linear visco-elastic be- haviour is assumed for the structural model. The free-field and SSI analyses are carried out applying both the NS and EW horizontal components of the acceleration time history as recorded at the depth of 47 m b.g.l. The predicted ground response re- sults are in fair agreement with the recorded motion at depth and at the surface. The dynamic response of structure is well captured for this specific seismic event, thus confirming the validity of the numerical approach

An investigation into the role of adenoma and host-specific factors on the incidence and recurrence of colorectal neoplasia

Colorectal cancer (CRC) is the fourth most common cancer in the United Kingdom. For males and females combined, it is the second most common cause of cancer death in the UK. The majority of CRC develops as a result of malignant transformation of adenomas via the adenoma-carcinoma sequence. Firm evidence exists that bowel screening, colonoscopy, and polypectomy results in a reduction of CRC incidence and death. An understanding of the association between both adenoma-specific and host characteristics, on the incidence and recurrence of colorectal neoplasia, is necessary to target finite colonoscopy resources, enhance post-polypectomy surveillance guidelines and reduce CRC incidence. An improved understanding of the host mechanisms underpinning the early and pre-malignant stage of CRC could encourage the development of targeted intervention strategies aimed at reducing the primary incidence, post-polypectomy recurrence, and progression of colorectal adenomas to cancer. Notably, bowel screening is now understandably an integral part of the strategy to reduce CRC incidence and mortality, mainly by intervention at the pre-malignant stage. However, it must be ensured that several inherent risks of screening are considered, especially in the era of CT colonography (CTC), where the entire abdomen is imaged, resulting in the identification of extracolonic findings. Chapter 1 presents an overview of CRC, including the risk factors, treatment, and determinants of prognosis and outcome. This is followed by an outline of the process, evidence for, risks, benefits, and outcomes of CRC screening in Scotland. Finally, a detailed summary of the potential risk factors, natural history, management, and surveillance strategies relating to colorectal adenomatous polyps is presented. Chapter 2 presents findings from a systematic review and meta-analysis using pooled, raw data with regards to post-polypectomy colorectal adenoma recurrence. The work found that age ≥60 years, OR 1.56 [95% CI; 1.13-2.14, p<0.01], male sex, OR 1.58 [95% CI; 1.42-1.76, p<0.001] and BMI ≥25, OR 1.35 [95% CI; 1.14-1.58, p<0.001] were associated with post-polypectomy adenoma recurrence. The work concluded that these host factors could be considered for inclusion in post-polypectomy surveillance guidelines. Chapter 3 presents original data from the Scottish Bowel Screening Programme (SBoSP). An examination was undertaken of the association between adenoma-specific and host characteristics, on subsequent adenoma recurrence post-polypectomy in intermediate and high-risk bowel screening patients. The work reported that in high-risk groups, 50% of patients were found to have adenoma recurrence at follow-up, and a third of these patients harbour advanced adenomas. The work also demonstrates that although host characteristics, other than male sex, were not associated with adenoma recurrence, a higher baseline adenoma number was associated with the finding of subsequent adenomas at follow-up (OR 2.23 [95% CI; 1.53-3.25, p<0.001] and 4.19 [9% CI; 2.53-6.97, p<0.001], for 3–4 and ≥5 vs. 1–2 adenomas at baseline respectively). While elevated adenoma number at baseline did not increase the risk of subsequent advanced adenomas at follow-up, the presence of advanced adenomas at baseline was itself a risk for subsequent advanced adenomas, OR 2.34 [95% CI; 1.18-4.61, p<0.05]. This chapter concluded that adenoma-specific factors are superior to host characteristics in predicting future risk for bowel screening patients. On that basis, additional work is required to explore the adenoma further at a genetic level, while additional adenoma-specific factors, other than solely size, should be considered for inclusion in post-polypectomy surveillance guidelines. Chapter 4 presents original, prospectively collected data, from patients attending for colonoscopy as part of the SBoSP. In contrast to Chapter 2 and Chapter 3, which focussed on secondary prevention (post-polypectomy) of colorectal adenomas, Chapter 4 focussed on primary prevention. The association between host characteristics, systemic inflammation, and colorectal neoplasia incidence at bowel screening was examined. The work reported that obesity, adjusted OR 2.72 [95% CI; 1.35–5.49, p<0.01], smoking, OR 2.26 [95% CI; 1.33-3.84, p<0.01] and aspirin use, OR 2.59 [95% CI; 1.15-5.86, p<0.05] were associated with a systemic inflammatory response. Despite this, none of the host factors were associated with an increased risk of incident colorectal neoplasia, while aspirin was associated with reduced risk, OR 0.51 [95% CI; 0.29–0.89, p<0.05] when adjusting for age, sex and smoking. The work concluded that while several host factors are associated with systemic inflammation, a direct link between these host factors, systemic inflammation and incident colorectal neoplasia remains unclear. It also concluded that BMI might be an inferior measure with which to study the effects of adiposity on colorectal neoplasia incidence, and suggested more precise measures of body composition could be used to explore the relationship further. Chapter 5 presents original data collected from patients undergoing CTC as part of the SBoSP. The association between CT derived body composition and colorectal neoplasia incidence was examined. The work concludes that; similar to Chapter 4, BMI was not useful in predicting the risk of colorectal neoplasia, but the presence of visceral obesity was strongly associated with neoplasia incidence, adjusted OR 2.79 [95% CI; 1.48-5.25, p<0.01]. In addition, no association was found between the presence of sarcopenia and early, largely pre-malignant disease. The chapter concluded that targeted interventions specifically for visceral obesity, and further investigation into the mechanism for its association with neoplastic findings should be sought. Moreover, a further examination into the role of sarcopenia and its development between the pre-malignant and malignant stage of CRC is required. Chapter 6 presents original data collected from patients undergoing CTC as part of the SBoSP with a focus on the risks of bowel screening, where CTC is increasingly being utilised. Original data are reported on the incidence, risk factors for, cost and implications of both colorectal (CRF) and incidental extracolonic findings (ECF) at CTC conducted as part of the SBoSP. The work reported that ECFs were very common in the bowel screening cohort (62% of patients) and that the subsequent additional yield of useful CRF (11%) from completion CTCs was lower than the incidence of important ECFs (15%). The majority of ECFs that required further investigation were subsequently benign (63%), and as a result of the investigation process, there was an additional estimated cost of £45 per CTC. The work concluded that while CTC remains a useful adjunct for screening programmes, it should be utilised with caution. Both the clinician and patient must have an awareness of the additional risk, cost and implications of a test designed to investigate the colon and rectum, which may have a higher yield of ECFs than important CRFs. Chapter 7 summarises the main findings presented in the thesis, provides a relevant update on newly published work during the thesis preparation period and suggests some recommendations for future study

Phantom Limb Pain: Low Frequency Repetitive Transcranial Magnetic Stimulation in Unaffected Hemisphere

Phantom limb pain is very common after limb amputation and is often difficult to treat. The motor cortex stimulation is a valid treatment for deafferentation pain that does not respond to conventional pain treatment, with relief for 50% to 70% of patients. This treatment is invasive as it uses implanted epidural electrodes. Cortical stimulation can be performed noninvasively by repetitive transcranial magnetic stimulation (rTMS). The stimulation of the hemisphere that isn't involved in phantom limb (unaffected hemisphere), remains unexplored. We report a case of phantom limb pain treated with 1 Hz rTMS stimulation over motor cortex in unaffected hemisphere. This stimulation produces a relevant clinical improvement of phantom limb pain; however, further studies are necessary to determine the efficacy of the method and the stimulation parameters

Role of 5α-reductase type 1 in modifying anxiety, appetite and the HPA axis

Glucocorticoid excess is associated with adverse effects on a number of physiological parameters, leading to obesity, dysfunction of the hypothalamic-pituitary- adrenal (HPA) axis and behavioural changes such as anxiety and impaired learning and memory. Circulating and local tissue glucocorticoid levels are tightly controlled by the HPA axis but an additional level of control exists in tissues such as brain, liver and adipose tissue. In these structures, enzymes including 5α-reductase 1 (5αR1), catalyse the conversion of corticosterone to A-ring reduced metabolites, which have a different spectrum of activities. This thesis investigates the role of 5αR1 in regulating central glucocorticoid actions which control HPA axis function and behaviour in a mouse model with genetic disruption of 5αR1 (5αR1-KO). Preliminary data showed 5αR1-KO mice were susceptible to developing insulin resistance and obesity and had reduced HPA axis responses to acute stress. Additionally, male 5αR1-KO mice were more prone to obesity than wild-type (WT) when fed a high-fat diet whilst female 5αR1-KO mice gained more weight than WT even on a normal chow diet. Intriguingly, female 5αR1-KO mice subjected to social isolation stress lost this extra weight and became comparable to WT controls. This study tested the hypothesis that 5αR1-KO mice are less able to inactivate glucocorticoids in the periphery and within tissues, resulting in a predisposition to metabolic disturbances and behavioural alterations. These were hypothesised to include hyperphagia, weight gain, impaired stress responses, anxiety (exacerbated by environmental stress) and cognitive deficits. It was also thought that many of these features would be more pronounced in female vs. male mice. The main aims of this study were to determine if 5αR1-KO induced weight gain and if this was correlated to altered gene expression of key hypothalamic neuropeptides which regulate appetite, to determine the central mechanisms which underpin attenuated HPA axis responses to acute stress and to determine whether behaviours such as anxiety and learning and memory ability are affected by global 5αR1 loss. It was hypothesised that female 5αR1-KO mice have increased appetite and reduced locomotor activity compared with WT and male 5αR1-KOs. However, male 5αR1- KO mice (on a mixed genetic background, C57Bl/6j/SvEv/129) were hyperphagic on a normal chow diet but did not gain extra weight, while female 5αR1-KO mice gained more weight vs. WT despite hypophagia. Free ambulatory activity was unaffected by genotype in either sex. Male 5αR1-KO mice appeared less anxious but responses of female 5αR1-KO mice in tests of anxiety did not differ from WT controls. Mice lacking 5αR1 generally had a poorer metabolic profile with impaired glucose tolerance and hyperinsulinaemia; with hepatic steatosis evident in female mice. There was evidence of compensatory changes in hypothalamic orexigenic and anorexigenic peptides. Phenotypes were sexually dimorphic such that male mice had a poorer metabolic profile vs. females, which was particularly marked in male 5αR1- KO animals. 5αR1-KO mice were previously shown to have attenuated HPA axis responses to acute stress and it was hypothesised that disruption of 5αR1 would result in altered expression of genes related HPA axis regulation with a view to increased negative feedback. Here, male and female 5αR1-KO mice demonstrated altered corticosteroid receptor expression within the hippocampus and the pituitary, two key structures in the HPA cascade. In situ hybridisation showed reduced mRNA for MR in the hippocampus and for Crh in the hypothalamus of 5αR1-KO mice. These modifications along with decreased Crhr-1 mRNA (CRH‘s main receptor) may be due to a lack of corticosterone metabolism within the brain resulting in enhanced negative feedback and reduced HPA axial drive. In order to study behaviour in detail and also to test whether potential central glucocorticoid excess may predispose to cognitive decline with ageing, a separate cohort of female 5αR1-KO backcrossed onto a uniform C57Bl/6j background was studied both when young (6 months) and when aged (14-15 months). Additionally, mice were housed in either groups or singly (social isolation) to investigate the potentially additive effects of environmental stress. It was hypothesised that local glucocorticoid increases in the brains of 5αR1-KO mice would be associated with anxiety and cognitive deficiencies and that these phenotypes would be exaggerated by the stress of social isolation as well as ageing. Behavioural differences were not observed at 6 months of age. However aged, 5αR1-KO mice housed singly showed increased anxiety and had higher plasma corticosterone levels than group-housed mice. Moreover, aged mice lacking 5αR1 performed less well than WT in tests of memory and had a marginally greater cognitive decline when learning ability at 14- 15 months old was compared to that of the same animals tested at 6 months old. Overall, mice with global 5αR1 loss appeared susceptible to anxiety as well as some degree of age-associated cognitive impairment, but only when subjected to social isolation stress which is a known chronic stressor. The final set of experiments aimed to determine the effect of mouse strain on 5αR1- KO phenotypes. It was hypothesised that glucocorticoid clearance would be attenuated to a lesser degree in 5αR1-KO mice bred onto a congenic C57Bl/6j strain compared to those of the mixed strain and that this would manifest as less disruption of metabolism and less suppression of HPA axis stress responses. Although social isolation again induced weight-loss in female mice and more so in 5αR1-KO animals, mice on the C57Bl/6j background strain did not show dampened HPA axis responses to acute stress as seen previously. It was subsequently shown in adrenalectomised mice that animals bred on the C57Bl/6j strain cleared active corticosterone from plasma and liver faster than mixed strain mice. This may have rendered mixed strain 5αR1-KO mice more susceptible to excessive corticosterone levels producing a more exaggerated phenotype in this group. In conclusion, these data suggest a role for the enzyme 5αR1 in modifying glucocorticoid concentrations in the brain and liver, influencing not only metabolic and peripheral effects such as weight gain and insulin resistance, but also in modifying cognition, appetite stimulation and affective behaviours. It has been highlighted that outside factors such as housing and age can modify these phenotypes and are important considerations for future studies. This study has also highlighted the importance of choosing an appropriate genetic background for genetically modified animals since phenotypes can be enhanced or attenuated depending on strain. Finally, 5αR inhibitors are used to treat disorders such as benign prostatic hyperplasia in men, and it is important to consider that these drugs may have a wide array of associated side effects both systemically and in the central nervous system

Two Sides of the Same Coin: Challenging the Mother-Daughter Trope in Contemporary Italian Women's Writings

In this thesis I engage with the tradition of writing about the mother in order to explore how the representation of the mother-daughter relationship has evolved in the works of contemporary Italian women writers. Within the corpus of mother-daughter narratives, I have looked for novels that, departing from the dominant pattern characterised by maternal passivity and by the predominance of daughters' narrations, endowed the mother and the daughter with the same degree of agency. I have focused on the expression of maternal subjectivity and I demonstrate how select women writers have subverted the passive idealisation of the maternal figure by challenging the wide-spread representation of the mother as a silent object. I have chosen four novels, which allowed me to trace an evolution in the expression of the maternal voice, framed in a mother-daughter plot: Goliarda Sapienza's L'Arte della Gioia (1994 and 2008), Igiaba Scego's Oltre Babilonia (2008), Valeria Parrella's Lo Spazio Bianco (2008) and Michela Murgia's Accabadora (2009). While still placing a definite stress on the mother-daughter relationship, these texts present maternal models that challenge the male-dominated symbolic order, forge filial bonds outside of bloodlines and normative family paradigms, and widen the notion of motherhood to include tasks that do not necessarily hinge on child-rearing. Drawing from ancient Greek myth, psychoanalysis, feminist thought and literary theory, I analyse how the experience of motherhood, disentangled from its bodily functions, becomes a relational practice, where the maternal perspective gradually emerges as dominant, although never completely severed from the daughter's. By redesigning the mother-daughter relationship, the novels discussed in the thesis also challenge the cultural context in which the mother-daughter plot is inscribed, revealing an underpinning logic that differs from a patriarchal symbolic through recurrent slippage between a patriarchal and a non-patriarchal frame of reference, which is, to some extent, consequential to their critique of maternal silence and passivity

Escala e qualidade na produção de vinho : caso dos Vinhos do Dão

Neste trabalho final de mestrado pretende-se dar resposta à questão “Existe alguma relação causal entre a escala de produção vinícola e a qualidade dos vinhos produzidos?”. Para tal, realizamos uma investigação focada nos vinhos que a Comissão Vitivinícola Regional do Dão (CVRD) certificou (ou não), mais especificamente aqueles cuja certificação pretendida foi a Denominação de Origem (DO) Dão, e foi pedida pelos produtores entre os anos de 2010 a 2014. De forma a possibilitar o desenvolvimento desta investigação foi necessário, numa fase inicial, uma compreensão do funcionamento do sector vitivinícola de forma a podermos definir com conhecimento de causa as variáveis que deveriam ser utilizadas para representar os conceitos em estudo, escala de produção e qualidade do vinho produzido. Os agentes económicos que pretendem certificar os seus vinhos pela CVRD são sujeitos a um rigoroso controlo, nomeadamente o das suas instalações produtivas (adegas e armazéns), onde, entre outros aspetos, é avaliada e medida a capacidade de armazenagem de vinho e derivados. Assumimos esta variável, capacidade de armazenamento, como proxy da escala de produção de cada agente económico produtor de vinho DO Dão. Da análise do processo de certificação dos vinhos, concluímos que uma das principais etapas do mesmo passa pela avaliação sensorial de amostras de lotes de vinho, através do qual a Câmara de Provadores da CVRD atribui uma classificação a cada lote de vinho candidato a certificação, classificação essa que assumimos como a nossa proxy da qualidade de cada lote submetido ao processo de certificação. Percebemos rapidamente que poderiam ser muitos os fatores com potencial de influencia na qualidade dos vinhos, para além da escala de produção. Apesar viii de não ser a prioridade da nossa investigação, consideramos relevante introduzir alguns desses fatores no nosso modelo de forma a controlar a influência dos mesmos na qualidade dos vinhos e dessa forma garantir que a influência eventualmente encontrada na capacidade não mascarava outros efeitos não controlados. São esses outros fatores a sub-região do Dão onde foram cultivadas as uvas utilizadas na produção do vinho, o ano de colheita dessas uvas, a idade do lote no final do processo de certificação e a tipologia do produtor que desenvolveu o vinho. Foi com recurso a um modelo de regressão linear multivariada que nos foi possível obter resultados quantitativos que oferecessem uma resposta à nossa questão de investigação e que identificamos os fatores, para além da escala de produção, com influencia significativa na qualidade dos vinhos produzidos. Os resultados obtidos foram diferentes para os vinhos DO Dão tintos e brancos, os dois casos que estudamos no decurso da nossa investigação, por termos expectativas de influência de sinal diferente da escala na qualidade para uns e para outros. A principal conclusão obtida através da resolução do nosso modelo de regressão linear é que existe uma relação negativa entre a escala de produção e a qualidade do vinho tinto. No caso do vinho branco, tal relação não foi comprovada devido à insignificância dos resultados obtidos. Um fator que comprovou ter um impacto significativo na qualidade dos vinhos, tintos e brancos, foi a idade do lote que parece ter uma relação positiva com a variável explicada em estudo.In this dissertation, we intend to answer the following question “Is there any causal relation between the wine production scale and the quality of the production of wine?”. To do so, we performed an investigation focused on the wines that the Comissão Vitivinícola Regional do Dão (CVRD) certified (or not), more specifically, the ones that the desired certification was the Denomination of Origin (DO) Dão, and was requested by the producers between 2010 and 2014. To enable the development of this investigation, in an initial phase, it was necessary an understanding of the functioning of the wine sector to define, with knowledge of cause, the variables that should be used to represent the concepts being studied, production scale and quality of the produced wine. The economic agents that want to certify their wines through CVRD are constrained to a rigorous control of their production facilities (wineries and warehouses), where, among other aspects, it is assessed and measured the capacity of storage of wine and derivatives. We assumed this variable, capacity of storage, as a proxy of the scale of production of each economic agent, that is, DO Dão wine producer. From the analysis of the certification of the wine, we conclude that one of the main stages is the sensorial assessment of the wine batch samples, of which the tasting board of CVRD assigns a rating to each wine batch that is applying to be certified. We assumed this rating as our proxy of the quality of each batch that was submitted to the process of certification. Rapidly, we understood that there could be many factors potentially influencing the quality of wine besides the scale of production. Even though it isn’t the priority of our investigation, we consider relevant to introduce some of these factors into our model and control its impact in the quality of wine to ensure xi that the influence, eventually found in the capacity, is not masked by other effects that weren’t monitored. The other factors are the sub-region of Dão, where the grapes used in the wine production were cultivated, the harvest year of the grapes, the age of the batch at the end of the certification process and the typology of the producer that developed the wine. We resorted to a multivariate linear regression model to obtain quantitative results that provided us an answer to our research question and to help us identify the factors, besides the scale of production that impacted significantly the quality of the produced wine. The obtained results were different for red and white DO Dão wines, the two cases that we studied during our investigation since we had different expectations regarding the impact of the scale in the quality for white and red wine. The main conclusion obtained by solving our linear regression model is that there is a negative relationship between the scale of production and the quality of red wine. Regarding the case of white wine, this relationship was not shown due to the insignificance of the results obtained. One factor that proved to have a significant impact on the red and white wines was the age of the batch that seems to have a positive relation with the explained variable of this investigation

Deep learning methods to predict amyotrophic lateral sclerosis disease progression

Amyotrophic lateral sclerosis (ALS) is a highly complex and heterogeneous neurodegenerative disease that affects motor neurons. Since life expectancy is relatively low, it is essential to promptly understand the course of the disease to better target the patient’s treatment. Predictive models for disease progression are thus of great interest. One of the most extensive and well-studied open-access data resources for ALS is the Pooled Resource Open-Access ALS Clinical Trials (PRO-ACT) repository. In 2015, the DREAM-Phil Bowen ALS Prediction Prize4Life Challenge was held on PRO-ACT data, where competitors were asked to develop machine learning algorithms to predict disease progression measured through the slope of the ALSFRS score between 3 and 12 months. However, although it has already been successfully applied in several studies on ALS patients, to the best of our knowledge deep learning approaches still remain unexplored on the ALSFRS slope prediction in PRO-ACT cohort. Here, we investigate how deep learning models perform in predicting ALS progression using the PRO-ACT data. We developed three models based on different architectures that showed comparable or better performance with respect to the state-of-the-art models, thus representing a valid alternative to predict ALS disease progression