McMaster Model of Family Functioning: adattamento alla realtà italiana, implicazioni cliniche e di ricerca

Il presente lavoro comincia con una descrizione dettagliata del “McMaster Model of Family Functionig” (MMFF), modello che al suo interno integra una teoria multidimensionale sul funzionamento familiare, diversi strumenti di auto ed etero valutazione e chiare indicazioni terapeutiche racchiuse all’interno della “Problem Centered System Therapy of the Family” (PCSTF). Grazie alla sua completezza il Modello fornisce ai clinici metodi coerenti, pratici ed empiricamente validi per valutare e trattare le famiglie, essi inoltre, sono stati formulati in modo da essere adattabili a differenti setting clinici e di ricerca, applicabili ad un’ampia gamma di problematiche e verificabili empiricamente. Obiettivo finale della presente ricerca è stato quello di porre le basi per l’esportazione del MMFF in Italia e poter quindi procedere alla sua applicazione in ambito clinico. La ricerca è cominciata alla Brown University con la traduzione dall’inglese all’italiano del Family Assessment Device (FAD), uno degli strumenti di autovalutazione compresi nel MMFF, ed è in seguito continuata con la validazione del suddetto strumento in un campione di 317 soggetti appartenenti alla popolazione generale italiana. Il FAD si è dimostrato uno strumento valido ed affidabile, in grado quindi di fornire valutazioni stabili e coerenti anche nella sua versione italiana. Il passo successivo è stato caratterizzato dalla somministrazione di FAD, Symptom Questionnaire (SQ) e delle Psychological Well-Being scales (PWB) a 289 soggetti reclutati nella popolazione generale. In accordo con il modello bipsicosociale che vede l’ambiente familiare come il più immediato gruppo di influenza psicosociale dello stato di benessere o malessere dell’individuo, i nostri dati confermano una stretta relazione tra scarso funzionamento familiare, spesso espresso attraverso difficoltà di comunicazione, di problem solving e scarso coinvolgimento affettivo e distress psicologico esperito con sintomi depressivi, ansiogeni ed ostilità. I nostri dati sottoliano inoltre come un funzionamento familiare positivo sia altamente correlato ad elevati livelli di benessere psicologico. Obiettivo della parte finale del lavoro ed anche il più importante, è stato quello di esplorare l’efficacia della Problem Centered Systems Therapy of the Family nella gestione della perdita di efficacia degli antidepressivi nel trattamento della depressione ricorrente. 20 soggetti con diagnosi di depressione maggiore ricorrente secondo il DSM-IV sono stati randomizzati a due diverse condizioni di trattamento: 1) aumento del dosaggio dell’antidepressivo e clinical management, oppure 2) mantenimento dello stesso dosaggio di antidepressivo e PCSTF. I dati di questo studio mettono in evidenza come, nel breve termine, PCSTF e farmacoterapia sono ugualmente efficaci nel ridurre la sintomatologia depressiva. Diversamente, ad un follow-up di 12 mesi, la PCSTF si è dimostrata altamente superiore all’aumento del farmaco ner prevenire le ricadute. Nel gruppo sottoposto all’aumento del farmaco infatti ben 6 soggetti su 7 ricadono entro l’anno. Nel gruppo assegnato a terapia familiare invece solo 1 soggetto su 7 ricade. Questi risultati sono in linea con i dati della letteratura che sottolineano l’elevata probabilità di una seconda ricaduta dopo l’aumento dell’antidepressivo all’interno di una farmacoterapia di mantenimento e suggeriscono l’efficacia dell’utilizzo di strategie psicoterapiche nella prevenzione della ricaduta in pazienti con depressione ricorrente.

Study of apoptotic deletion mediated by Bifidobacterium longum with construction of recombinant strains for Serpin encoding gene and phenotypes comparison in a pig cell model

The first part of the research project of the Co-Advisorship Ph.D Thesis was aimed to select the best Bifidobacterium longum strains suitable to set the basis of our study. We were looking for strains with the abilities to colonize the intestinal mucosa and with good adhesion capacities, so that we can test these strains to investigate their ability to induce apoptosis in “damaged” intestinal cells. Adhesion and apoptosis are the two process that we want to study to better understand the role of an adhesion protein that we have previously identified and that have top scores homologies with the recent serpin encoding gene identified in B. longum by Nestlè researchers. Bifidobacterium longum is a probiotic, known for its beneficial effects to the human gut and even for its immunomodulatory and antitumor activities. Recently, many studies have stressed out the intimate relation between probiotic bacteria and the GIT mucosa and their influence on human cellular homeostasis. We focused on the apoptotic deletion of cancer cells induced by B. longum. This has been valued in vitro, performing the incubation of three B.longum strains with enterocyte-like Caco- 2 cells, to evidence DNA fragmentation, a cornerstone of apoptosis. The three strains tested were defined for their adhesion properties using adhesion and autoaggregation assays. These features are considered necessary to select a probiotic strain. The three strains named B12, B18 and B2990 resulted respectively: “strong adherent”, “adherent” and “non adherent”. Then, bacteria were incubated with Caco-2 cells to investigate apoptotic deletion. Cocultures of Caco-2 cells with B. longum resulted positive in DNA fragmentation test, only when adherent strains were used (B12 and B18). These results indicate that the interaction with adherent B. longum can induce apoptotic deletion of Caco-2 cells, suggesting a role in cellular homeostasis of the gastrointestinal tract and in restoring the ecology of damaged colon tissues. These results were used to keep on researching and the strains tested were used as recipient of recombinant techniques aimed to originate new B.longum strains with enhanced capacity of apoptotic induction in “damaged” intestinal cells. To achieve this new goal it was decided to clone the serpin encoding gene of B. longum, so that we can understand its role in adhesion and apoptosis induction. Bifidobacterium longum has immunostimulant activity that in vitro can lead to apoptotic response of Caco-2 cell line. It secretes a hypothetical eukaryotic type serpin protein, which could be involved in this kind of deletion of damaged cells. We had previously characterised a protein that has homologies with the hypothetical serpin of B. longum (DD087853). In order to create Bifidobacterium serpin transformants, a B. longum cosmid library was screened with a PCR protocol using specific primers for serpin gene. After fragment extraction, the insert named S1 was sub-cloned into pRM2, an Escherichia coli - Bifidobacterium shuttle vector, to construct pRM3. Several protocols for B. longum transformation were performed and the best efficiency was obtained using MRS medium and raffinose. Finally bacterial cell supernatants were tested in a dotblot assay to detect antigens presence against anti-antitrypsin polyclonal antibody. The best signal was produced by one starin that has been renamed B. longum BLKS 7. Our research study was aimed to generate transformants able to over express serpin encoding gene, so that we can have the tools for a further study on bacterial apoptotic induction of Caco-2 cell line. After that we have originated new trasformants the next step to do was to test transformants abilities when exposed to an intestinal cell model. In fact, this part of the project was achieved in the Department of Biochemistry of the Medical Faculty of the University of Maribor, guest of the abroad supervisor of the Co-Advisorship Doctoral Thesis: Prof. Avrelija Cencic. In this study we examined the probiotic ability of some bacterial strains using intestinal cells from a 6 years old pig. The use of intestinal mammalian cells is essential to study this symbiosis and a functional cell model mimics a polarised epithelium in which enterocytes are separated by tight junctions. In this list of strains we have included the Bifidobacterium longum BKS7 transformant strain that we have previously originated; in order to compare its abilities. B. longum B12 wild type and B. longum BKS7 transformant and eight Lactobacillus strains of different sources were co-cultured with porcine small intestine epithelial cells (PSI C1) and porcine blood monocytes (PoM2) in Transwell filter inserts. The strains, including Lb. gasseri, Lb. fermentum, Lb. reuterii, Lb. plantarum and unidentified Lactobacillus from kenyan maasai milk and tanzanian coffee, were assayed for activation of cell lines, measuring nitric oxide by Griess reaction, H202 by tetramethylbenzidine reaction and O2 - by cytochrome C reduction. Cytotoxic effect by crystal violet staining and induction on metabolic activity by MTT cell proliferation assay were tested too. Transepithelial electrical resistance (TER) of polarised PSI C1 was measured during 48 hours co-culture. TER, used to observe epithelium permeability, decrease during pathogenesis and tissue becomes permeable to ion passive flow lowering epithelial barrier function. Probiotics can prevent or restore increased permeability. Lastly, dot-blot was achieved against Interleukin-6 of treated cells supernatants. The metabolic activity of PoM2 and PSI C1 increased slightly after co-culture not affecting mitochondrial functions. No strain was cytotoxic over PSI C1 and PoM2 and no cell activation was observed, as measured by the release of NO2, H202 and O2 - by PoM2 and PSI C1. During coculture TER of polarised PSI C1 was two-fold higher comparing with constant TER (~3000 ) of untreated cells. TER raise generated by bacteria maintains a low permeability of the epithelium. During treatment Interleukin-6 was detected in cell supernatants at several time points, confirming immunostimulant activity. All results were obtained using Lactobacillus paracasei Shirota e Carnobacterium divergens as controls. In conclusion we can state that both the list of putative probiotic bacteria and our new transformant strain of B. longum are not harmful when exposed to intestinal cells and could be selected as probiotics, because can strengthen epithelial barrier function and stimulate nonspecific immunity of intestinal cells on a pig cell model. Indeed, we have found out that none of the strains tested that have good adhesion abilities presents citotoxicity to the intestinal cells and that non of the strains tested can induce cell lines to produce high level of ROS, neither NO2. Moreover we have assayed even the capacity of producing certain citokynes that are correlated with immune response. The detection of Interleukin-6 was assayed in all our samples, including B.longum transformant BKS 7 strain, this result indicates that these bacteria can induce a non specific immune response in the intestinal cells. In fact, when we assayed the presence of Interferon-gamma in cells supernatant after bacterial exposure, we have no positive signals, that means that there is no activation of a specific immune response, thus confirming that these bacteria are not recognize as pathogen by the intestinal cells and are certainly not harmful for intestinal cells. The most important result is the measure of Trans Epithelial Electric Resistance that have shown how the intestinal barrier function get strengthen when cells are exposed to bacteria, due to a reduction of the epithelium permeability. We have now a new strain of B. longum that will be used for further studies above the mechanism of apoptotic induction to “damaged cells” and above the process of “restoring ecology”. This strain will be the basis to originate new transformant strains for Serpin encoding gene that must have better performance and shall be used one day even in clinical cases as in “gene therapy” for cancer treatment and prevention.

The role of mitochondria in the regulation of gamma rays induced mTOR-dependent senescence

The first aims of this study were to demonstrate if mitochondrial biogenesis and senescence can be induced simultaneously in cell lines upon exposure to a genotoxic stress, and if the presence of mtDNA mutations which impair the functionality of respiratory complexes can influence the ability of a cell to activate senescence. The data obtained on the oncocytic model XTC.UC1 demonstrated that the presence of mitochondrial dysfunction is involved in the maintenance of a senescent phenotype induced by γ-rays treatment. The involvement of mTORC1 in the regulation of senescence has been shown in this cell line. On the other hand, in cells which do not present mitochondrial dysfunction it has been verified that genotoxic stress determines the activation of both mitochondrial biogenesis and senescence. Further studies are necessary in order to verify if mitochondrial biogenesis sustains the activation of senescence. The second aim of this thesis was to determine the involvement of mTORC1 in the regulation of PGC-1α expression, in order to verify what is the cause of the development of oncocytoma in patients affected by two hereditary cancer syndromes; Cowden and Birt-hogg-Dubé . The study of oncocytic tumors developed by patients affected by these syndromes suggested that the double heterozigosity of the two causative genes, PTEN and FLCN respectively, induce the activation of mTORC1 and therefore the activation of PGC-1α expression. On XTC.UC1 cell line, the most suitable in vitro model, experiments of complementation of PTEN and FLCN were conducted. To date, these results demonstrated that mTORC1 is not involved in the regulation of PGC-1α expression, and PTEN and FLCN seem to have opposite effect on PGC-1α expression.

Radar based improvements and diagnosis of the convective capabilities of the cosmo-2 model

In the last few years the resolution of numerical weather prediction (nwp) became higher and higher with the progresses of technology and knowledge. As a consequence, a great number of initial data became fundamental for a correct initialization of the models. The potential of radar observations has long been recognized for improving the initial conditions of high-resolution nwp models, while operational application becomes more frequent. The fact that many nwp centres have recently taken into operations convection-permitting forecast models, many of which assimilate radar data, emphasizes the need for an approach to providing quality information which is needed in order to avoid that radar errors degrade the model's initial conditions and, therefore, its forecasts. Environmental risks can can be related with various causes: meteorological, seismical, hydrological/hydraulic. Flash floods have horizontal dimension of 1-20 Km and can be inserted in mesoscale gamma subscale, this scale can be modeled only with nwp model with the highest resolution as the COSMO-2 model. One of the problems of modeling extreme convective events is related with the atmospheric initial conditions, in fact the scale dimension for the assimilation of atmospheric condition in an high resolution model is about 10 Km, a value too high for a correct representation of convection initial conditions. Assimilation of radar data with his resolution of about of Km every 5 or 10 minutes can be a solution for this problem. In this contribution a pragmatic and empirical approach to deriving a radar data quality description is proposed to be used in radar data assimilation and more specifically for the latent heat nudging (lhn) scheme. Later the the nvective capabilities of the cosmo-2 model are investigated through some case studies. Finally, this work shows some preliminary experiments of coupling of a high resolution meteorological model with an Hydrological one.

Rainfall spatial predictions: a two-part model and its assessment

Spatial prediction of hourly rainfall via radar calibration is addressed. The change of support problem (COSP), arising when the spatial supports of different data sources do not coincide, is faced in a non-Gaussian setting; in fact, hourly rainfall in Emilia-Romagna region, in Italy, is characterized by abundance of zero values and right-skeweness of the distribution of positive amounts. Rain gauge direct measurements on sparsely distributed locations and hourly cumulated radar grids are provided by the ARPA-SIMC Emilia-Romagna. We propose a three-stage Bayesian hierarchical model for radar calibration, exploiting rain gauges as reference measure. Rain probability and amounts are modeled via linear relationships with radar in the log scale; spatial correlated Gaussian effects capture the residual information. We employ a probit link for rainfall probability and Gamma distribution for rainfall positive amounts; the two steps are joined via a two-part semicontinuous model. Three model specifications differently addressing COSP are presented; in particular, a stochastic weighting of all radar pixels, driven by a latent Gaussian process defined on the grid, is employed. Estimation is performed via MCMC procedures implemented in C, linked to R software. Communication and evaluation of probabilistic, point and interval predictions is investigated. A non-randomized PIT histogram is proposed for correctly assessing calibration and coverage of two-part semicontinuous models. Predictions obtained with the different model specifications are evaluated via graphical tools (Reliability Plot, Sharpness Histogram, PIT Histogram, Brier Score Plot and Quantile Decomposition Plot), proper scoring rules (Brier Score, Continuous Rank Probability Score) and consistent scoring functions (Root Mean Square Error and Mean Absolute Error addressing the predictive mean and median, respectively). Calibration is reached and the inclusion of neighbouring information slightly improves predictions. All specifications outperform a benchmark model with incorrelated effects, confirming the relevance of spatial correlation for modeling rainfall probability and accumulation.