INCREMENTO DELLA SOPRAVVIVENZA IN PAZIENTI AFFETTI DA IPERTENSIONE POLMONARE TROMBOEMBOLICA INOPERABILE

Pazienti affetti da ipertensione polmonare tromboembolica inoperabili (Inop-CTEPH) trattati con le terapie convenzionali hanno una scarsa sopravvivenza. Abbiamo comparato la sopravvivenza a tre anni dei pazienti trattati con terapia convenzionale e quelli trattati con terapia convenzionale associati ad una combinazione di nuovi farmaci vasodilatatori polmonari. Abbiamo inoltre valutato il loro decorso clinico. Sono stati valutati, dal 1991 al 2009, 34 pazienti Inop-CTEPH consecutivi tramite cateterismo cardiaco destro (RHC) e scintigrafia polmonare da perfusione (PLS): 7 pazienti sono stati sottoposti a trattamento chirurgico mentre i restanti 27 casi non erano risultati suscettibili all’intervento di tromboendoarterectomia. Di questi 27 pazienti, i 12 valutati dal 1991 al 2003 sono stati trattati con le sole terapie convenzionali (Gruppo 1), mentre i 15 pazienti valutati dal 2004 al 2009 (Gruppo 2) sono stati trattati con terapie convenzionali in combinazione a farmaci di nuova generazione. Nella valutazione emodinamica basale non emergevano differenze significative tra i due gruppi in studio. Basandoci sul decorso clinico dei pazienti, sono stati intrapresi i nuovi farmaci vasodilatatori e la supplementazione di ossigeno nei pazienti del Gruppo 2. Di questi, 7 pazienti con decorso clinico peggiore sono stati sottoposti a rivalutazione emodinamica tramite RHC durante terapia e 4 di essi anche a scintigrafia polmonare da perfusione di controllo. Coloro che non hanno ripetuto il RHC avevano basalmente valori più bassi di pressione arteriosa media in arteria polmonare e di livelli di proormone del peptide natriuretico cerebrale (NT-proBNP), oltre che una maggiore saturazione venosa mista (SvO2) e una migliore tolleranza allo sforzo (p = 0.022, 0.015, 0.044 e 0.003 rispettivamente). Durante terapia, i pazienti che avevano ripetuto il RHC si caratterizzavano per una ridotta resistenza vascolare polmonare (p = 0.012), un incremento del valore di eccesso basi (p = 0.002) e una significativa redistribuzione del flusso ematico polmonare evidenziabile alla scintigrafia polmonare da perfusione. Dopo un follow-up di 3 anni la sopravvivenza del Gruppo 2 era 86% contro il 31% di quella dei pazienti del Gruppo 1 (p = 0.031). Nei pazienti Inop-CTEPH il decorso clinico potrebbe aiutare a scegliere farmaci ed ossigenoterapia al fine di migliorare i parametri emodinamici, lo scambio gassoso respiratorio e la sopravvivenza a lungo termine

Redacción impura

The tour that Dino Pancani invites us to includes the writings he disseminated in the digital newspaper El Mostrador and the most recent in the column section of the Cooperativa radio station edited by the journalist Manola Robles, who left us a few months ago. The selection of the articles is not chronological, nor is it random, but rather has a logic that readers understand as we turn the pages, with the memory aid of the titles of the different chapters or sections. It is a division by major themes to which the author devoted special time and attention at his time, because of what he was observing with his critical and inquisitive gaze or because of the reminiscences they brought to him. Some lived them as a protagonist or witness. Others studied them or on them has stopped to reflect until today. But there is something very special in these writings. An interesting mix of styles, almost a hybrid between the expression of his committed and challenging thinking and the story rich in descriptions. Between the column and the chronicle. Between a journalism of clear, clear and strong opinion that with arguments tries to demonstrate to the reader the validity of its judgment on a certain topic and an attractive chronicle abundant in nouns and especially in adjectives that give color and life to what it exposes

Assessing residual neck mobility when wearing a cervical orthosis: an application in patients with Motor Neurone Disease

Severe weakness of the neck extensor muscles has been observed in neuromuscular pathologies, such as motor neurone disease (MND). This condition reduces the ability to perform daily activities and communicate, leading to the adoption of a cervical orthosis. However, commercially available devices are designed to immobilize the neck, which makes them uncomfortable and strenuous to wear for a long time. The lack of a device specifically designed for those patients led to the development of the Sheffield Support Snood (SSS) which enables to adjust the support given to the head, according to the task performed and to the disease progression. The following step toward the SSS commercialisation and adoption was an objective evaluation of its performance and the assessment with the end users, which was the aim of this thesis. To this purpose, an experimental protocol designed to quantitatively assess neck mobility when wearing cervical orthoses, has been developed. This protocol and the associated signal processing techniques proved to be suitable for the assessment of neck mobility through the measurement of head movements, both in laboratory and clinical settings. After having quantitatively assessed head movement limitation in MND patients, filling an existing gap in the current literature, the effects of the SSS were tested. Compared to controls, patients presented an overall impaired ability to perform head movements in terms of reduced velocity (mean values between 27% and 41% lower in movements performed reaching the maximum range of motion and between 34% and 48% lower in movements performed reaching the maximum angular velocity), reduced smoothness (mean values between 21% and 44% lower in movements performed reaching the maximum range of motion) and increased presence of coupled movements (mean values between 37% and 58% higher in movements performed reaching the maximum range of motion and between 44% and 53% in movements performed reaching the maximum angular velocity). The SSS was effective in facilitating the head movements in MND patients. Among those 9 individuals that were fitted with anterior or anterior plus lateral supports 5 of them had a reduced presence on coupled movements in at least one of the movements performed. However, a proper fitting of the orthosis appeared crucial and in the future it should be based on a quantitative approach similar to the one developed in this thesis. This study paved the way for improvements in the SSS design and for future quantitative assessment of the characteristics of motor control and movement strategies in MND patients and of how these change when using a device aiming at compensating for functional impairments

Effetti del trapianto d'organo sui marcatori di senescenza cellulare

I telomeri sono strutture nucleoproteiche specializzate localizzate alle estremità dei cromosomi lineari eucariotici, costituite da sequenze nucleotidiche altamente ripetute. La loro principale funzione risiede nel mantenimento dell’integrità genomica, nella protezione del DNA contro il rischio dei fenomeni di degradazione o ricombinazione nel corso della replicazione cellulare. La Telomerasi è un complesso enzimatico che ha come principale compito il mantenimento della lunghezza telomerica, e pertanto dell’integrità dei cromosomi. Il nostro scopo è stato quello di valutare l’effetto del trapianto d’organo (PTA e SPK) sui più importanti marcatori di cellular senescence e stress ossidativo nei soggetti riceventi trapianto di pancreas. Abbiamo valutato 39 pazienti (LISTA TX) che hanno effettuano la valutazione per l'inserimento in lista attiva per il trapianto combinato di rene-pancreas (SPK) o pancreas isolato (PTA). Sono inoltre stati valutati soggetti già sottoposti a trapianto (TX), soggetti affetti da diabete mellito tipo 1 non complicato (T1DM), soggetti affetti da diabete mellito tipo 2 (T2DM) ed infine soggetti sani (ND). I pazienti sono stati sottoposti a valutazione del profilo glicometabolico ed alla raccolta di un campione ematico. Sono stati valutati: lunghezza telomerica, attività telomerasica e concentrazione plasmatica di nitrotirosina. Sono emerse una correlazione negativa significativa fra la lunghezza dei telomeri e l’età ed in BMI del soggetto. Valutando la correlazione tra lunghezza dei telomeri e parametri di controllo metabolico, abbiamo documentato un’associazione negativa significativa con il livello di colesterolo totale ed il colesterolo LDL. Inoltre, è emersa una correlazione positiva significativa fra la lunghezza dei telomeri ed il colesterolo HDL. Rispetto ai controlli sani, la lunghezza dei telomeri è risultata significativamente aumentata nei soggetti in valutazione per trapianto. Per quanto concerne l’attività telomerasica, essa è risultata significativamente aumentata. I parametri di studio telomerico tendevano alla normalizzazione nel gruppo trapiantato. In merito alla concentrazione di nitrotirosina come marker di stress ossidativo, i suoi livelli sono risultati significativamente maggiori in tutti i gruppi studiati rispetto ai non diabetici. In conclusione le alterazioni del metabolismo telomerico presenti nel diabete sembrano tendere verso la normalizzazione dopo il trapianto di pancreas

PREVIEW AND PRIMING: BRIDGING THE GAP BETWEEN BEAVIORAL AND NEURAL MEASURES OF READING

Behavioral and neural measures of reading offer divergent estimates of the time-course of word recognition. The current work aims to reconcile Eye-Movement (EM) and Event-Related Potential (ERP) measures with a series of experiments in which methodological differences are reduced or eliminated. Experiment 1 shows that Masked Repetition priming affects an early ERP component (N250) which overlaps with the timeframe of EM effects, and a later component (N400). These effects occur in both isolated word recognition and sentence reading tasks. Experiments 2-4 show that processing is delayed when semantically unrelated or physically deviant information is present in the parafovea. The time-course of the effect of physically deviant previews shows overlap between EMs and Fixation Related Potentials (FRPs), where it impacts the P300. In contrast, Unrelated stimuli impact EMs incrementally as fixations grow longer, but they do not impact the FRP until later, on the N400 component.Master of Art

Il centro storico di Poppi, analisi a livello urbano per la valutazione del rischio sismico

The town of Poppi as a case study to address the question of analysing historic centres in terms of their documentation, preservation and safety. The work was divided into three areas: the realization of a reliable survey, an  appropriate reconstruction of the current state and the identification of the critical elements of the building fabric. The survey was carried out using 3D laser scanning technology to obtain high quality documentation of the artifacts and a graphic display able to show their architectural value.  Cataloguing was used to gather the information needed to identify the building system. The question of safety was also addressed both through the analysis of street fronts to identify possible deformations, and by examining the inclination of the straight sides of the arcades. A thematic summary map was realized using this data system

THE IMPACT OF FOVEAL AND COGNITIVE LOAD ON PARAFOVEAL PREVIEW PROCESSING

Measures of parafoveal processing during reading reflect both the benefits associated with pre-processing valid information in the parafovea and the costs associated with the invalid preview masks that are used as baselines in the boundary paradigm. Previous studies suggest that visually distinctive preview masks disrupt reading, though the processes involved are poorly understood. This work explores the costs associated with preview masks that are not visually distinctive and applies the framework of Load Theory of Attention to determine whether parafoveal processing is affected by the availability of perceptual and cognitive resources. Results of Experiment 1 show that invalid word preview masks disrupt reading even though they are indistinguishable from other words while they are still in the parafovea. They further show a pattern of reverse priming when invalid preview masks are presented foveally later in the list. This finding implies that representations of disruptive preview masks are suppressed by the system to reduce their interference with the readers’ goals. Experiment 2 employs the same type of preview mask and shows that foveal and cognitive load impact neural measures of preview processing associated with fixations on the pre-target word n but not the behavioral preview benefit effect or the neural preview positivity associated with fixations on n+1.Doctor of Philosoph