Treatment of knee articular cartilage defects: surgical strategies, results and analysis of factors determining the clinical outcome

Articular cartilage lesions, with their inherent limited healing potential, are hard to treat and remain a challenging problem for orthopedic surgeons. Despite the development of several treatment strategies, the real potential of each procedure in terms of clinical benefit and effects on the joint degeneration processes is not clear. Aim of this PhD project was to evaluate the results, both in terms of clinical and imaging improvement, of new promising procedures developed to address the challenging cartilage pathology. Several studies have been followed in parallel and completed over the 3-year PhD, and are reported in detail in the following pages. In particular, the studies have been focused on the evaluation of the treatment indications of a scaffold based autologous chondrocyte implantation procedure, documenting its results for the classic indication of focal traumatic lesions, as well as its use for the treatment of more challenging patients, older, with degenerative lesions, or even as salvage procedure for more advanced stages of articular degeneration. The second field of study involved the analysis of the results obtained treating lesions of the articular surface with a new biomimetic osteochondral scaffold, which showed promise for the treatment of defects where the entire osteochondral unit is involved. Finally, a new minimally invasive procedure based on the use of growth factors derived from autologous platelets has been explored, showing results and underlining indicatios for the treatment of cartilage lesions and different stages of joint degeneration. These studies shed some light on the potential of the evaluated procedures, underlining good results as well as limits, they give some indications on the most appropriate candidates for their application, and document the current knowledge on cartilage treatment procedures suggesting the limitations that need to be addressed by future studies to improve the management of cartilage lesions.

Interference Management and Energy Efficiency in Satellite Communications

The main areas of research of this thesis are Interference Management and Link-Level Power Efficiency for Satellite Communications. The thesis is divided in two parts. Part I tackles the problem of interference environments in satellite communications, and interference mitigation strategies, not just in terms of avoidance of the interferers, but also in terms of actually exploiting the interference present in the system as a useful signal. The analysis follows a top-down approach across different levels of investigation, starting from system level consideration on interference management, down to link-level aspects and to intra-receiver design. Interference Management techniques are proposed at all the levels of investigation, with interesting results. Part II is related to efficiency in the power domain, for instance in terms of required Input Back-off at the power amplifiers, which can be an issue for waveform based on linear modulations, due to their varying envelope. To cope with such aspects, an analysis is carried out to compare linear modulation with waveforms based on constant envelope modulations. It is shown that in some scenarios, constant envelope waveforms, even if at lower spectral efficiency, outperform linear modulation waveform in terms of energy efficiency.

The role of proactive coping strategies and perceived health status for Social well-being and life-project in old age.

The latter part of the 20th century was a period characterized by a fundamental demographic transition of western society. This substantial and structural demographic change proposes several challenges to contemporary society and fosters the emergence of new issues and challenges. Among these, none is more crucial than the comprehension of the mechanisms and the processes that lead people to positive aging. Rowe and Kahn’s model of successful aging highlights the interplay between social engagement with life, health, and functioning for a positive aging experience. Other systemic models of successful aging (Kahana et al., 1996; 2003; Stevernik et al., 2006) emphasize the role of internal and external resources for attaining positive aging. Among these, the proactive coping strategies are indicated as important active strategies for avoiding the depletion of resources, counterbalancing the declines and maintaining social and civic involvement. The study has analyzed the role of proactive coping strategies for two facets of positive aging, the experience of a high social well-being and the presence of personal projects in fundamental life domains. As expected, the proactive coping strategies, referred to as the active management of the environment, the accumulation of resources and the actualization of human potentials are confirmed as positive predictors of high level of social well-being and of many personal projects focused on family, culture, leisure time, civic and social participation. Perceived health status give a significant contribution only to the possession of many personal projects. Gender and level of school education give also a significant contribution to these two dimensions of positive aging, highlighting how positive aging is rooted not only in the possession of personal resources, but also in historical models of education and in positive longitudinal chains related to early development.

Tutela e valorizzazione delle produzioni agroalimentari di qualità attraverso strategie di brand management.Il modello Coop.

Questa tesi di dottorato verte sull'individuazione di politiche industriali atte ad implementare il mercato dei prodotti a denominazione di origine. Inevitabilmente, l’analisi economica dei prodotti agroalimentari tipici di qualità implica anche l’approfondimento e l’individuazione, delle problematiche connesse con la creazione di un valore addizionale per il consumatore, rispetto a quello dei prodotti standardizzati. Questo approccio richiama l’attenzione, da una parte, sulle caratteristiche della domanda e sulla disponibilità del consumatore a riconoscere e apprezzare questo plus-valore, dall’altra sulle strategie che l’offerta può attivare per conseguire un premium price rispetto al prodotto standardizzato. Le certificazioni comunitarie Dop, Igp e Stg oltre che il marchio di prodotto biologico racchiudono, solitamente, tali dinamiche valoriali ma sono tutt’oggi poco conosciute dai consumatori. Diversi studi internazionali dimostrano, infatti, che la maggioranza dei cittadini comunitari ignorano il significato delle certificazioni di qualità. L’ipotesi di fondo di questo studio si basa sulla possibilità di fidelizzare questi marchi con i brand della grande distribuzione già affermati, come quello di Coop. Analizzare gli effetti dell’introduzione di prodotti private label a denominazione di origine nel mercato della grande distribuzione organizzata italiana ci permetterebbe di comprendere se questo segmento di mercato può aiutare il settore delle Dop/Igp. Questo studio ha cercato di verificare se il prodotto private label a denominazione di origine, riesca a sfruttare il doppio binario di fiducia rappresentato dal marchio comunitario unito a quello dell’impresa di distribuzione. Per comprendere la propensione del consumatore a spendere di più per questi prodotti, abbiamo utilizzato l’analisi dell’elasticità della domanda sul prezzo dei dati scanner fornitici da Coop Adriatica. Siamo riusciti a dimostrare tale positivo connubio confermato anche da una indagine demoscopica effettuata ad hoc sui consumatori.

The medical management after surgery for advanced heart failure

The aim of the Research of this Ph D Project is to improve the medical management after surgery for advanced heart failure, both after left ventricular assist devices (LVAD) implantation, and after heart transplantation in the long-term. Regarding heart transplantation (HTx), the Research Project is focused on diagnostics, classification, prevention and treatment of cardiac allograft vasculopathy (CAV), and on treatment of post-HTx cancers; the results are presented in the first part of this Thesis. In particular, the main aspect investigated are the prognostic role of information derived from coronary angiography, coronary tomography and intravascular ultrasound, and the different sensitivity of these techniques in predicting outcomes and in diagnosing CAV. Moreover, the role of mTOR inhibitors on CAV prevention or treatment is investigated, both alone and in combination with different anti-CMV prevention strategies, as well as the impact of mTOR inhibitors on clinical outcomes in the long term. Regarding LVAD, the main focus is on the role of transthoracic echocardiography in the management of patients with a continuous-flow, centrifugal, intrapericardial pump (HVAD, Heartware); this section is reported in the second part of this Thesis. The main aspects investigated are the use of echocardiography in patients with HVAD device and its interaction with the information derived from pump curves' analysis in predicting aortic valve opening status, a surrogate of the condition of support provided by the LVAD.