The cardio-renal axis. Non ST-segment elevation myocardial infarction risk stratification according to renal dysfunction

Background: Chronic kidney disease (CKD) is one of the strongest risk factor for myocardial infarction (MI) and mortality. The aim of this study was to assess the association between renal dysfunction severity, short-term outcomes and the use of in-hospital evidence-based therapies among patients with non–ST-segment elevation myocardial infarction (NSTEMI). Methods: We examined data on 320 patients presenting with NSTEMI to Maggiore’s Emergency Department from 1st Jan 2010 to 31st December 2011. The study patients were classified into two groups according to their baseline glomerular filtration rate (GFR): renal dysfunction (RD) (GFR<60) and non-RD (GFR≥60 ml/min). Patients were then classified into four groups according to their CKD stage (GFR≥60, GFR 59-30, GFR 29-15, GFR <15). Results: Of the 320 patients, 155 (48,4%) had a GFR<60 ml/min at baseline. Compared with patients with a GFR≥60 ml/min, this group was, more likely to be female, to have hypertension, a previous myocardial infarction, stroke or TIA, had higher levels of uric acid and C-reactive protein. They were less likely to receive immediate (first 24 hours) evidence-based therapies. The GFR of RD patients treated appropriately increases on average by 5.5 ml/min/1.73 m2. The length of stay (mean, SD) increased with increasing CKD stage, respectively 5,3 (4,1), 7.0 (6.1), 7.8 (7.0), 9.2 (5.8) (global p <.0001). Females had on average a longer hospitalization than males, regardless of RD. In hospital mortality was higher in RD group (3,25%). Conclusions: The in-hospital mortality not was statically difference among the patients with a GFR value ≥60 ml/min, and patients with a GFR value <60 ml/min. The length of stay increased with increasing CKD stages. Despite patients with RD have more comorbidities then without RD less frequently receive guideline –recommended therapy. The GFR of RD patients treated appropriately improves during hospitalization, but not a level as we expected.

Model reduction of stochastic groundwater flow and transport processes

This work presents a comprehensive methodology for the reduction of analytical or numerical stochastic models characterized by uncertain input parameters or boundary conditions. The technique, based on the Polynomial Chaos Expansion (PCE) theory, represents a versatile solution to solve direct or inverse problems related to propagation of uncertainty. The potentiality of the methodology is assessed investigating different applicative contexts related to groundwater flow and transport scenarios, such as global sensitivity analysis, risk analysis and model calibration. This is achieved by implementing a numerical code, developed in the MATLAB environment, presented here in its main features and tested with literature examples. The procedure has been conceived under flexibility and efficiency criteria in order to ensure its adaptability to different fields of engineering; it has been applied to different case studies related to flow and transport in porous media. Each application is associated with innovative elements such as (i) new analytical formulations describing motion and displacement of non-Newtonian fluids in porous media, (ii) application of global sensitivity analysis to a high-complexity numerical model inspired by a real case of risk of radionuclide migration in the subsurface environment, and (iii) development of a novel sensitivity-based strategy for parameter calibration and experiment design in laboratory scale tracer transport.

Musculoskeletal tissue regeneration by human non-embryonic stem cells

The aim of this thesis was to investigate the regenerative potential of alternative sources of stem cells, derived from human dental pulp (hDPSCs) and amniotic fluid (hAFSCs) and, specifically, to evaluate their capability to be committed towards osteogenic and myogenic lineages, for the eventual applicability of these stem cells to translational strategies in regenerative medicine of bone and skeletal muscle tissues. The in vitro bone production by stem cells may represent a radical breakthrough in the treatment of pathologies and traumas characterized by critical bone mass defects, with no medical or surgical solution. Human DPSCs and AFSCs were seeded and pre-differentiated on different scaffolds to test their capability to subsequently reach the osteogenic differentiation in vivo, in order to recover critical size bone defects. Fibroin scaffold resulted to be the best scaffold promoting mature bone formation and defect correction when combined to both hDPSCs and hAFSCs. This study also described a culture condition that might allow human DPSCs to be used for human cell therapy in compliance with good manufacturing practices (GMPs): the use of human serum (HS) promoted the expansion and the osteogenic differentiation of hDPSCs in vitro and, furthermore, allowed pre-differentiated hDPSCs to regenerate critical size bone defects in vivo. This thesis also showed that hDPSCs and hAFSCs can be differentiated towards the myogenic lineage in vitro, either when co-cultured with murine myoblasts and when differentiated alone after DNA demethylation treatment. Interestingly, when injected into dystrophic muscles of SCID/mdx mice - animal model of Duchenne Muscular Dystrophy (DMD) - hDPSCs and hAFSCs pre-differentiated after demethylating treatment were able to regenerate the skeletal muscle tissue and, particularly, to restore dystrophin expression. These observations suggest that human DPSCs and AFSCs might be eventually applied to translational strategies, in order to enhance the repair of injured skeletal muscles in DMD patients.

Potential Analysis for Hypoelliptic Second Order PDEs with Nonnegative Characteristic Form

In this Thesis we consider a class of second order partial differential operators with non-negative characteristic form and with smooth coefficients. Main assumptions on the relevant operators are hypoellipticity and existence of a well-behaved global fundamental solution. We first make a deep analysis of the L-Green function for arbitrary open sets and of its applications to the Representation Theorems of Riesz-type for L-subharmonic and L-superharmonic functions. Then, we prove an Inverse Mean value Theorem characterizing the superlevel sets of the fundamental solution by means of L-harmonic functions. Furthermore, we establish a Lebesgue-type result showing the role of the mean-integal operator in solving the homogeneus Dirichlet problem related to L in the Perron-Wiener sense. Finally, we compare Perron-Wiener and weak variational solutions of the homogeneous Dirichlet problem, under specific hypothesis on the boundary datum.

Ultra-Low Power and Non-intrusive Wireless Monitoring for Smart Buildings

Wireless Sensor Networks (WSNs) offer a new solution for distributed monitoring, processing and communication. First of all, the stringent energy constraints to which sensing nodes are typically subjected. WSNs are often battery powered and placed where it is not possible to recharge or replace batteries. Energy can be harvested from the external environment but it is a limited resource that must be used efficiently. Energy efficiency is a key requirement for a credible WSNs design. From the power source's perspective, aggressive energy management techniques remain the most effective way to prolong the lifetime of a WSN. A new adaptive algorithm will be presented, which minimizes the consumption of wireless sensor nodes in sleep mode, when the power source has to be regulated using DC-DC converters. Another important aspect addressed is the time synchronisation in WSNs. WSNs are used for real-world applications where physical time plays an important role. An innovative low-overhead synchronisation approach will be presented, based on a Temperature Compensation Algorithm (TCA). The last aspect addressed is related to self-powered WSNs with Energy Harvesting (EH) solutions. Wireless sensor nodes with EH require some form of energy storage, which enables systems to continue operating during periods of insufficient environmental energy. However, the size of the energy storage strongly restricts the use of WSNs with EH in real-world applications. A new approach will be presented, which enables computation to be sustained during intermittent power supply. The discussed approaches will be used for real-world WSN applications. The first presented scenario is related to the experience gathered during an European Project (3ENCULT Project), regarding the design and implementation of an innovative network for monitoring heritage buildings. The second scenario is related to the experience with Telecom Italia, regarding the design of smart energy meters for monitoring the usage of household's appliances.

Biomedical and industrial applications of atmospheric pressure non-equilibrium plasmas

This dissertation will be focused on the characterization of an atmospheric pressure plasma jet source with an application oriented diagnostic approach and the description of processes supported by this plasma source. The plasma source investigated is a single electrode plasma jet. Schlieren images, optical emission spectra, temperature and heat flux profiles are analyzed to deeply investigate the fluid dynamic, the chemical composition and the thermal output of the plasma generated with a nanosecond-pulsed high voltage generator. The maximum temperature measured is about 45 °C and values close to the room temperature are reached 10 mm down the source outlet, ensuring the possibility to use the plasma jet for the treatment of thermosensitive materials, such as, for example, biological substrate or polymers. Electrospinning of polymeric solution allows the production of nanofibrous non-woven mats and the plasma pre-treatment of the solutions leads to the realization of defect free nanofibers. The use of the plasma jet allows the electrospinnability of a non-spinnable poly(L-lactic acid) (PLLA) solution, suitable for the production of biological scaffold for the wound dressing.

Patent nonnuse: are patent pools as possible solution?

Studies have depicted that the rate of unused patents comprises a high portion of patents in North America, Europe and Japan. Particularly, studies have identified a considerable share of strategic patents which are left unused due to pure strategic reasons. While such patents might generate strategic rents to their owner, they may have harmful consequences for the society if by blocking alternative solutions that other inventions provide they hamper the possibility of better solutions. Accordingly, the importance of the issue of nonuse is highlighted within the literature on strategic patenting, IPR policy and innovation economics. Moreover, the current literature has emphasized on the role of patent pools in dealing with potential issues such as excessive transaction cost caused by patent thickets and blocking patents. In fact, patent pools have emerged as policy tools facilitating technology commercialization and alleviating patent litigation among rivals holding overlapping IPRs. In this dissertation I provide a critical literature review on strategic patenting, identify present gaps and discuss some future research paths. Moreover, I investigate the drivers of strategic non-use of patents with particular focus on unused strategic play patents. Finally, I examine if participation intensity in patent pools by pool members explains their willingness to use their non-pooled patents. I also investigate which characteristics of the patent pools are associated to the willingness to use non-pooled patents through pool participation. I show that technological uncertainty and technological complexity are two technology environment factors that drive unused play patents. I also show that pool members participating more intensively in patent pools are more likely to be willing to use their non-pooled patents through pool participation. I further depict that pool licensors are more likely to be willing to use their non-pooled patents by participating in pools with higher level of technological complementarity to their own technology.