Role of new molecular approaches for the early diagnosis of bladder cancer in clinical practice

There is an urgent need to improve the performance of urine cytology for the diagnosis of bladder cancer. In preliminary studies, telomerase activity evaluated by telomeric repeat amplification protocol (TRAP) assay and chromosomal aneuploidy detected by fluorescence in situ hybridization (FISH) in the diagnosis of bladder cancer have produced important results. Urine cell-free (UCF) DNA has also been proposed as a potential marker for early bladder cancer diagnosis. In the first study the diagnostic performance of TRAP assay and FISH analysis was assessed, while the second study evaluated the potential role of UCF DNA integrity in early bladder cancer diagnosis. In the first cross-sectional study, 289 consecutive patients who presented with urinary symptoms underwent cystoscopy and cytology evaluation. In the second study, UCF DNA was isolated from 51 bladder cancer patients, 46 symptomatic patients, and 32 healthy volunteers. c-Myc, BCAS1 and HER2 gene sequences longer than 250 bp were quantified by real time PCR to verify UCF DNA integrity. In the first study, sensitivity and specificity were 0.39 and 0.83, respectively, for cytology; 0.66 and 0.72 for TRAP; 0.78 and 0.60 for the cytology and TRAP combination; 0.78 and 0.78 for the cytology, TRAP and FISH combination; and 0.65 and 0.93 for the TRAP and FISH combination. In the second study, at the best cutoff of 0.1 ng/µl, UCF DNA integrity analysis showed a sensitivity of 0.73 and a specificity of 0.84 in healthy individuals and 0.83 in symptomatic patients. The preliminary results suggest that these biomarkers could potentially be used for the early diagnosis of bladder cancer, especially in high-risk populations (e.g, symptomatic individuals exposed to occupational risk) who may benefit from the use of noninvasive diagnostic tests in terms of cost-benefit.

Expressiveness of Concurrent Languages

The aim of this thesis is to go through different approaches for proving expressiveness properties in several concurrent languages. We analyse four different calculi exploiting for each one a different technique. We begin with the analysis of a synchronous language, we explore the expressiveness of a fragment of CCS! (a variant of Milner's CCS where replication is considered instead of recursion) w.r.t. the existence of faithful encodings (i.e. encodings that respect the behaviour of the encoded model without introducing unnecessary computations) of models of computability strictly less expressive than Turing Machines. Namely, grammars of types 1,2 and 3 in the Chomsky Hierarchy. We then move to asynchronous languages and we study full abstraction for two Linda-like languages. Linda can be considered as the asynchronous version of CCS plus a shared memory (a multiset of elements) that is used for storing messages. After having defined a denotational semantics based on traces, we obtain fully abstract semantics for both languages by using suitable abstractions in order to identify different traces which do not correspond to different behaviours. Since the ability of one of the two variants considered of recognising multiple occurrences of messages in the store (which accounts for an increase of expressiveness) reflects in a less complex abstraction, we then study other languages where multiplicity plays a fundamental role. We consider the language CHR (Constraint Handling Rules) a language which uses multi-headed (guarded) rules. We prove that multiple heads augment the expressive power of the language. Indeed we show that if we restrict to rules where the head contains at most n atoms we could generate a hierarchy of languages with increasing expressiveness (i.e. the CHR language allowing at most n atoms in the heads is more expressive than the language allowing at most m atoms, with m

A core calculus for the analysis and implementation of biologically inspired languages

The application of Concurrency Theory to Systems Biology is in its earliest stage of progress. The metaphor of cells as computing systems by Regev and Shapiro opened the employment of concurrent languages for the modelling of biological systems. Their peculiar characteristics led to the design of many bio-inspired formalisms which achieve higher faithfulness and specificity. In this thesis we present pi@, an extremely simple and conservative extension of the pi-calculus representing a keystone in this respect, thanks to its expressiveness capabilities. The pi@ calculus is obtained by the addition of polyadic synchronisation and priority to the pi-calculus, in order to achieve compartment semantics and atomicity of complex operations respectively. In its direct application to biological modelling, the stochastic variant of the calculus, Spi@, is shown able to model consistently several phenomena such as formation of molecular complexes, hierarchical subdivision of the system into compartments, inter-compartment reactions, dynamic reorganisation of compartment structure consistent with volume variation. The pivotal role of pi@ is evidenced by its capability of encoding in a compositional way several bio-inspired formalisms, so that it represents the optimal core of a framework for the analysis and implementation of bio-inspired languages. In this respect, the encodings of BioAmbients, Brane Calculi and a variant of P Systems in pi@ are formalised. The conciseness of their translation in pi@ allows their indirect comparison by means of their encodings. Furthermore it provides a ready-to-run implementation of minimal effort whose correctness is granted by the correctness of the respective encoding functions. Further important results of general validity are stated on the expressive power of priority. Several impossibility results are described, which clearly state the superior expressiveness of prioritised languages and the problems arising in the attempt of providing their parallel implementation. To this aim, a new setting in distributed computing (the last man standing problem) is singled out and exploited to prove the impossibility of providing a purely parallel implementation of priority by means of point-to-point or broadcast communication.

Higher-Order Concurrency: Expressiveness and Decidability Results

Higher-order process calculi are formalisms for concurrency in which processes can be passed around in communications. Higher-order (or process-passing) concurrency is often presented as an alternative paradigm to the first order (or name-passing) concurrency of the pi-calculus for the description of mobile systems. These calculi are inspired by, and formally close to, the lambda-calculus, whose basic computational step ---beta-reduction--- involves term instantiation. The theory of higher-order process calculi is more complex than that of first-order process calculi. This shows up in, for instance, the definition of behavioral equivalences. A long-standing approach to overcome this burden is to define encodings of higher-order processes into a first-order setting, so as to transfer the theory of the first-order paradigm to the higher-order one. While satisfactory in the case of calculi with basic (higher-order) primitives, this indirect approach falls short in the case of higher-order process calculi featuring constructs for phenomena such as, e.g., localities and dynamic system reconfiguration, which are frequent in modern distributed systems. Indeed, for higher-order process calculi involving little more than traditional process communication, encodings into some first-order language are difficult to handle or do not exist. We then observe that foundational studies for higher-order process calculi must be carried out directly on them and exploit their peculiarities. This dissertation contributes to such foundational studies for higher-order process calculi. We concentrate on two closely interwoven issues in process calculi: expressiveness and decidability. Surprisingly, these issues have been little explored in the higher-order setting. Our research is centered around a core calculus for higher-order concurrency in which only the operators strictly necessary to obtain higher-order communication are retained. We develop the basic theory of this core calculus and rely on it to study the expressive power of issues universally accepted as basic in process calculi, namely synchrony, forwarding, and polyadic communication.

Expressiveness in biologically inspired languages

A very recent and exciting new area of research is the application of Concurrency Theory tools to formalize and analyze biological systems and one of the most promising approach comes from the process algebras (process calculi). A process calculus is a formal language that allows to describe concurrent systems and comes with well-established techniques for quantitative and qualitative analysis. Biological systems can be regarded as concurrent systems and therefore modeled by means of process calculi. In this thesis we focus on the process calculi approach to the modeling of biological systems and investigate, mostly from a theoretical point of view, several promising bio-inspired formalisms: Brane Calculi and k-calculus family. We provide several expressiveness results mostly by means of comparisons between calculi. We provide a lower bound to the computational power of the non Turing complete MDB Brane Calculi by showing an encoding of a simple P-System into MDB. We address the issue of local implementation within the k-calculus family: whether n-way rewrites can be simulated by binary interactions only. A solution introducing divergence is provided and we prove a deterministic solution preserving the termination property is not possible. We use the symmetric leader election problem to test synchronization capabilities within the k-calculus family. Several fragments of the original k-calculus are considered and we prove an impossibility result about encoding n-way synchronization into (n-1)-way synchronization. A similar impossibility result is obtained in a pure computer science context. We introduce CCSn, an extension of CCS with multiple input prefixes and show, using the dining philosophers problem, that there is no reasonable encoding of CCS(n+1) into CCSn.

Immunohistochemical and Molecular Prognostic/Predictive Markers in Neoplastic Diseases

Traditional morphological examinations are not anymore sufficient for a complete evaluation of tumoral tissue and the use of neoplastic markers is of utmost importance. Neoplastic markers can be classified in: diagnostic, prognostic and predictive markers. Three markers were analyzed. 1) Insulin-like growth factor binding protein 2 (IGFBP2) was immunohistochemically examined in prostatic tissues: 40 radical prostatectomies from hormonally untreated patients with their preoperative biopsies, 10 radical prostatectomies from patients under complete androgen ablation before surgery and 10 simple prostatectomies from patients with bladder outlet obstruction. Results were compared with α-methylacyl-CoA racemase (AMACR). IGFBP2 was expressed in the cytoplasm of untreated adenocarcinomas and, to a lesser extent, in HG-PIN; the expression was markedly lower in patients after complete androgen ablation. AMACR was similarly expressed in both adenocarcinoma and HG-PIN, the level being similar in both lesions; the expression was slightly lower in patients after complete androgen ablation. IGFBP2 may be used a diagnostic marker of prostatic adenocarcinomas. 2) Heparan surface proteoglycan immunohistochemical expression was examined in 150 oral squamous cell carcinomas. Follow up information was available in 93 patients (range: 6-34 months, mean: 19±7). After surgery, chemotherapy was performed in 8 patients and radiotherapy in 61 patients. Multivariate and univariate overall survival analyses showed that high expression of syndecan-1 (SYN-1) was associated with a poor prognosis. In patients treated with radiotherapy, such association was higher. SYN-1 is a prognostic marker in oral squamous cell carcinomas; it may also represent a predictive factor for responsiveness to radiotherapy. 3) EGFR was studied in 33 pulmonary adenocarcinomas with traditional DNA sequencing methods and with two mutation-specific antibodies. Overall, the two antibodies had 61.1% sensitivity and 100% specificity in detecting EGFR mutations. EGFR mutation-specific antibodies may represent a predictive marker to identify patients candidate to tyrosine kinase inhibitors therapy.

Spinal cord injury: assessment of autonomic state-dependent control of cardiovascular system and body core temperature

Spinal cord injury (SCI) results not only in paralysis; but it is also associated with a range of autonomic dysregulation that can interfere with cardiovascular, bladder, bowel, temperature, and sexual function. The entity of the autonomic dysfunction is related to the level and severity of injury to descending autonomic (sympathetic) pathways. For many years there was limited awareness of these issues and the attention given to them by the scientific and medical community was scarce. Yet, even if a new system to document the impact of SCI on autonomic function has recently been proposed, the current standard of assessment of SCI (American Spinal Injury Association (ASIA) examination) evaluates motor and sensory pathways, but not severity of injury to autonomic pathways. Beside the severe impact on quality of life, autonomic dysfunction in persons with SCI is associated with increased risk of cardiovascular disease and mortality. Therefore, obtaining information regarding autonomic function in persons with SCI is pivotal and clinical examinations and laboratory evaluations to detect the presence of autonomic dysfunction and quantitate its severity are mandatory. Furthermore, previous studies demonstrated that there is an intimate relationship between the autonomic nervous system and sleep from anatomical, physiological, and neurochemical points of view. Although, even if previous epidemiological studies demonstrated that sleep problems are common in spinal cord injury (SCI), so far only limited polysomnographic (PSG) data are available. Finally, until now, circadian and state dependent autonomic regulation of blood pressure (BP), heart rate (HR) and body core temperature (BcT) were never assessed in SCI patients. Aim of the current study was to establish the association between the autonomic control of the cardiovascular function and thermoregulation, sleep parameters and increased cardiovascular risk in SCI patients.

Protonterapia nel trattamento del tumore prostatico

Obiettivo: Il nostro obiettivo è stato quello di confrontare la tomoterapia (HT) e la protonterapia ad intensità modulata (IMPT) nel trattamento del tumore prostatico, seguendo un protocollo di boost simultaneo (SIB) e moderatamente ipofrazionato. Materiali e metodi: Abbiamo selezionato 8 pazienti, trattati con HT e abbiamo rielaborato i piani con 2 campi IMPT. La dose prescritta è stata di 74 Gy sul PTV1 (prostata e vescicole seminali prossimali), 65.8 Gy sul PTV2 (vescicole seminali distali) e 54 Gy sul PTV3 (linfonodi pelvici). Risultati: Sia con IMPT che con HT abbiamo ottenuto una copertura e una omogeneità di dose del target sovrapponibile. Oltre i 65 Gy, HT e IMPT erano equivalenti per il retto, mentre con l’IMPT c’era maggior risparmio della vescica e del bulbo penieno da 0 a 70 Gy. Da 0 fino a 60 Gy, i valori dosimetrici dell’IMPT erano molto più bassi per tutti gli organi a rischio (OARs), eccetto che per le teste femorali, dove la HT aveva un vantaggio dosimetrico rispetto all’IMPT nel range di dose 25-35 Gy. La dose media agli OARs era ridotta del 30-50% con l’IMPT. Conclusioni: Con le due tecniche di trattamento (HT e IMPT) si ottiene una simile distribuzione di dose nel target. Un chiaro vantaggio dosimetrico dell’IMPT sul HT è ottenuto dalle medie e basse dosi. Le attuali conoscenze sulle relazioni dose-effetto e sul risparmio delle madie e basse dosi con l’IMPT non sono ancora state quantificate dal punto di vista clinico.

La navigazione nella chirurgia oncologica ortopedica: Applicazione ed implementazione di nuove tecnologie per il trattamento chirurgico dei tumori dell'apparato muscolo-scheletrico, studio pilota

Nel presente progetto di ricerca, da novembre 2011 a novembre 2013 , sono stati trattati chirurgicamente, con l’assistenza del navigatore , pazienti con tumori ossei primitivi degli arti, del bacino e del sacro, analizzando i risultati degli esami istologici dei margini di resezione del tumore e i risultati clinici e radiografici. Materiali e metodi : Abbiamo analizzato 16 pazienti 9 maschi e 7 femmine , con un'età media di 31 anni (range 12-55 ). Di tutti i pazienti valutati 8 avevano una localizzazione agli arti inferiori , 4 al bacino e 4 all'osso sacro . Solo quelli con osteosarcoma parostale , Cordoma e Condrosarcoma non sono stati sottoposti a terapia antiblastica . Solo un paziente è stato sottoposto a radioterapia postoperatoria per una recidiva locale . Tutti gli altri pazienti non sono stati trattati con la radioterapia per l’ adeguatezza dei margini di resezione . Non ci sono state complicanze intraoperatorie . Nel periodo postoperatorio abbiamo osservato una vescica neurologica , una paresi sciatica, due casi di infezione di cui una superficiale e una profonda, tutti e quattro i pazienti con sarcoma sacrale sviluppati hanno avuto ritardato della guarigione della ferita e di questi tre hanno avuto incontinenza sfinterica. In tutti i casi si è ottenuta una eccellente risultato clinico e radiografico , con soddisfazione del paziente , corretto contatto tra l'osteotomia e l'impianto che apparivano stabili ai primi controlli ambulatoriali ( FU 19 mesi). Risultati: La chirurgia assistita da calcolatore ha permesso di migliorare l’esecuzione delle resezioni ossee prevista dal navigatore. Questa tecnologia è valida e utile per la cure dei tumori dell’apparato scheletrico, soprattutto nelle sedi anatomiche più complesse da trattare come la pelvi, il sacro e nelle resezioni intercalari difficoltose nell’ottenere un margine di resezione ampio e quindi di salvare l’articolazione e l’arto stesso.

Caratterizzazione morfologica e neurochimica dei neuroni sensitivi e motori del trigono vescicale e del muscolo uretrale di maiale

Il trigono della vescica urinaria (UBT) è un'area limitata attraverso la quale penetrano nella vescica la maggior parte dei vasi e fibre e in cui le fibre nervose e neuroni intramurali sono più concentrati. Mediante l’utilizzo combinato di un tracciante retrogrado(FB) e dell’immunoistochimica sono stati valutati il fenotipo e l’area del soma dei neuroni dei gangli spinali (DRG), dei neuroni post-gangliari, il fenotipo dei gangli della catena simpatica (STG) e i gangli mesenterici caudali (CMG) innervanti l’UBT. - Caratterizzazione dei neuroni dei DRG con: peptide correlato al gene della calcitonina (CGRP)(30±3%, 29±3%, rispettivamente), sostanza P(SP)(26±8%, 27±12%), ossido nitrico sintasi neuronale (nNOS)(21±4%; 26±7%), neurofilamento 200kDa (NF200)(75±14%, 81±7% ) , transient receptor potential vanilloid1 (TRPV1)(48±13%, 43±6%) e isolectina-B4-positivi (IB4) (56±6%;43±10%). I neuroni sensoriali, distribuiti da L2 a Ca1 (DRG), hanno presentato una localizzazione segmentale, mostrando maggior densità nei DRG L4-L5 e S2-S4. I neuroni sensoriali lombari sono risultati significativamente più grandi di quelle sacrali (1.112±624μm2 vs716±421μm2). Complessivamente, questi dati indicano che le vie lombari e sacrali probabilmente svolgono ruoli diversi nella trasmissione sensitiva del trigono della vescica urinaria. -I neuroni FB+ della STG e dei CMG sono risultati immunoreattivi per la tirosina idrossilasi (TH)(66±10,1%, 53±8,2%, rispettivamente), la dopamina beta-idrossilasi (DβH)(62±6,2%, 52±6,2%), neuropeptideY (NPY)(59±8%; 66±7%), CGRP(24±3%, 22±3%), SP(22±2%; 38±8%), polipeptide intestinale vasoattivo (VIP)(19±2%; 35±4%), nNOS(15±2%; 33±8%), trasportatore vescicolare dell'acetilcolina (VAChT)(15±2%; 35±5%), leu-encefalina (LENK)(14±7%; 26±9%), e somatostatina (SOM)(12±3%;32±7%).Il numero medio di neuroni FB+ (1845,1±259,3) era nella STG in L1-S3, con i pirenofori più piccoli (465,6±82.7μm2). Un gran numero (4287,5±1450,6) di neuroni FB+ di piccole dimensioni (476,1±103,9μm2) sono stati localizzati lungo il margine dei CMG. Il maggior numero (4793,3±1990,8) di neuroni FB + è stato osservato nel plesso pelvico, dove i neuroni marcati erano raggruppati in micro-gangli e con pirenoforo ancora più piccolo (374,9±85,4 μm2).

Proof theory of quantified modal logics

We introduce labelled sequent calculi for indexed modal logics. We prove that the structural rules of weakening and contraction are height-preserving admissible, that all rules are invertible, and that cut is admissible. Then we prove that each calculus introduced is sound and complete with respect to the appropriate class of transition frames.