Alterazioni del metabolismo osseo e fratture vertebrali dopo trapianto di rene

Introduction:Persistent Hyperparathyroidism after transplantation (HPT),bone disease and vertebral fractures are an important clinical problem in renal transplant patients. Several factors such as renal osteodystrophy, immunosuppressive therapy, deficit/insufficiency Vitamin D may contribute to that.In literature are described different percentages of HPT, vertebral fractures and Osteoporosis/Osteopenia that may be due to the different therapy and to the different employ of steroid. We analyzed 90 patients who received a renal graft between 2005 e 2010. Patients and Methods: 44 male and 46 female. Average age 52,2± 10,1 years, follow-up 31,3±16,6 months, time on dialysis 37±29,6 months. Patients who had creatinine level greater than 2,5 mg/dl were excluded. Immunosuppressive therapy was based on basiliximab, steroids (1.6 to 2 mg/kg/day progressively reduced to 5 mg/day after 45 days from the transplantation) in all patients + calcineurin inhibitor+ mycophenolate mophetil/mycophenolic acid in 88,8% of patients or Everolimus± calcineurin inhibitor in the others. Patients were studied with X-ray of the spine, dual-energy-X-ray, PTH, 25(OH)VitD. Results: 41,1% had HPT; 41,1% had osteopenia at femoral neck and 36,7% at vertebral column; 16,7% had osteoporosis at femoral neck and 15,6% at vertebral column. 10 patients (11%) had vertebral fractures. Patients with normal bone mineral density, compared to those with osteoporosis/osteopenia, are more younger (average age 46,4±11,7 years vs 54.3±8,6); they have spent less time on dialysis (26,5±14,8 months vs 40,7±32,6) and they have values of 25(OH)VitD higher (22,1±7,6 ng/ml vs 17,8±8,5). Patients with vertebral fractures have values of 25(OH)VitD lowest (14,1±6,4 ng/ml vs 19,7±8,5) and they had transplant since more time (29,1±16,2 vs 48,1±8,7 months). There is a significant correlation between HPT and PTH pre transplantation; HPT and levels of VitD (p<0,05) Conclusion: Prevention of Bone disease and vertebral fractures after renal transplant includes: a)treatment before transplantation b)supplementation of vitamin D with cholecalciferol or calcidiol c)shorten the dialysis time.

X-Ray studies of the physics of matter around super-massive black-holes in nearby Seyfert galaxies

Seyfert galaxies are the closest active galactic nuclei. As such, we can use them to test the physical properties of the entire class of objects. To investigate their general properties, I took advantage of different methods of data analysis. In particular I used three different samples of objects, that, despite frequent overlaps, have been chosen to best tackle different topics: the heterogeneous BeppoS AX sample was thought to be optimized to test the average hard X-ray (E above 10 keV) properties of nearby Seyfert galaxies; the X-CfA was thought the be optimized to compare the properties of low-luminosity sources to the ones of higher luminosity and, thus, it was also used to test the emission mechanism models; finally, the XMM–Newton sample was extracted from the X-CfA sample so as to ensure a truly unbiased and well defined sample of objects to define the average properties of Seyfert galaxies. Taking advantage of the broad-band coverage of the BeppoS AX MECS and PDS instruments (between ~2-100 keV), I infer the average X-ray spectral propertiesof nearby Seyfert galaxies and in particular the photon index (~1.8), the high-energy cut-off (~290 keV), and the relative amount of cold reflection (~1.0). Moreover the unified scheme for active galactic nuclei was positively tested. The distribution of isotropic indicators used here (photon index, relative amount of reflection, high-energy cut-off and narrow FeK energy centroid) are similar in type I and type II objects while the absorbing column and the iron line equivalent width significantly differ between the two classes of sources with type II objects displaying larger absorbing columns. Taking advantage of the XMM–Newton and X–CfA samples I also deduced from measurements that 30 to 50% of type II Seyfert galaxies are Compton thick. Confirming previous results, the narrow FeK line is consistent, in Seyfert 2 galaxies, with being produced in the same matter responsible for the observed obscuration. These results support the basic picture of the unified model. Moreover, the presence of a X-ray Baldwin effect in type I sources has been measured using for the first time the 20-100 keV luminosity (EW proportional to L(20-100)^(−0.22±0.05)). This finding suggests that the torus covering factor may be a function of source luminosity, thereby suggesting a refinement of the baseline version of the unifed model itself. Using the BeppoSAX sample, it has been also recorded a possible correlation between the photon index and the amount of cold reflection in both type I and II sources. At a first glance this confirms the thermal Comptonization as the most likely origin of the high energy emission for the active galactic nuclei. This relation, in fact, naturally emerges supposing that the accretion disk penetrates, depending to the accretion rate, the central corona at different depths (Merloni et al. 2006): the higher accreting systems hosting disks down to the last stable orbit while the lower accreting systems hosting truncated disks. On the contrary, the study of the well defined X–C f A sample of Seyfert galaxies has proved that the intrinsic X-ray luminosity of nearby Seyfert galaxies can span values between 10^(38−43) erg s^−1, i.e. covering a huge range of accretion rates. The less efficient systems have been supposed to host ADAF systems without accretion disk. However, the study of the X–CfA sample has also proved the existence of correlations between optical emission lines and X-ray luminosity in the entire range of L_(X) covered by the sample. These relations are similar to the ones obtained if high-L objects are considered. Thus the emission mechanism must be similar in luminous and weak systems. A possible scenario to reconcile these somehow opposite indications is assuming that the ADAF and the two phase mechanism co-exist with different relative importance moving from low-to-high accretion systems (as suggested by the Gamma vs. R relation). The present data require that no abrupt transition between the two regimes is present. As mentioned above, the possible presence of an accretion disk has been tested using samples of nearby Seyfert galaxies. Here, to deeply investigate the flow patterns close to super-massive black-holes, three case study objects for which enough counts statistics is available have been analysed using deep X-ray observations taken with XMM–Newton. The obtained results have shown that the accretion flow can significantly differ between the objects when it is analyzed with the appropriate detail. For instance the accretion disk is well established down to the last stable orbit in a Kerr system for IRAS 13197-1627 where strong light bending effect have been measured. The accretion disk seems to be formed spiraling in the inner ~10-30 gravitational radii in NGC 3783 where time dependent and recursive modulation have been measured both in the continuum emission and in the broad emission line component. Finally, the accretion disk seems to be only weakly detectable in rk 509, with its weak broad emission line component. Finally, blueshifted resonant absorption lines have been detected in all three objects. This seems to demonstrate that, around super-massive black-holes, there is matter which is not confined in the accretion disk and moves along the line of sight with velocities as large as v~0.01-0.4c (whre c is the speed of light). Wether this matter forms winds or blobs is still matter of debate together with the assessment of the real statistical significance of the measured absorption lines. Nonetheless, if confirmed, these phenomena are of outstanding interest because they offer new potential probes for the dynamics of the innermost regions of accretion flows, to tackle the formation of ejecta/jets and to place constraints on the rate of kinetic energy injected by AGNs into the ISM and IGM. Future high energy missions (such as the planned Simbol-X and IXO) will likely allow an exciting step forward in our understanding of the flow dynamics around black holes and the formation of the highest velocity outflows.

The gaseous environment of radio galaxies: a new perspective from high-resolution x-ray spectroscopy

It is known that massive black holes have a profound effect on the evolution of galaxies, and possibly on their formation by regulating the amount of gas available for the star formation. However, how black hole and galaxies communicate is still an open problem, depending on how much of the energy released interacts with the circumnuclear matter. In the last years, most studies of feedback have primarily focused on AGN jet/cavity systems in the most massive galaxy clusters. This thesis intends to investigate the feedback phenomena in radio--loud AGNs from a different perspective studying isolated radio galaxies, through high-resolution spectroscopy. In particular one NLRG and three BLRG are studied, searching for warm gas, both in emission and absorption, in the soft X-ray band. I show that the soft spectrum of 3C33 originates from gas photoionized by the central engine. I found for the first time WA in 3C382 and 3C390.3. I show that the observed warm emitter/absorbers is not uniform and probably located in the NLR. The detected WA is slow implying a mass outflow rate and kinetic luminosity always well below 1% the L(acc) as well as the P(jet). Finally the radio--loud properties are compared with those of type 1 RQ AGNs. A positive correlation is found between the mass outflow rate/kinetic luminosity, and the radio loudness. This seems to suggest that the presence of a radio source (the jet?) affects the distribution of the absorbing gas. Alternatively, if the gas distribution is similar in Seyferts and radio galaxies, the M(out) vs rl relation could simply indicate a major ejection of matter in the form of wind in powerful radio AGNs.

Background minimization issues for next generation hard X-ray focusing telescopes

The hard X-ray band (10 - 100 keV) has been only observed so far by collimated and coded aperture mask instruments, with a sensitivity and an angular resolution lower than two orders of magnitude as respects the current X-ray focusing telescopes operating below 10 - 15 keV. The technological advance in X-ray mirrors and detection systems is now able to extend the X-ray focusing technique to the hard X-ray domain, filling the gap in terms of observational performances and providing a totally new deep view on some of the most energetic phenomena of the Universe. In order to reach a sensitivity of 1 muCrab in the 10 - 40 keV energy range, a great care in the background minimization is required, a common issue for all the hard X-ray focusing telescopes. In the present PhD thesis, a comprehensive analysis of the space radiation environment, the payload design and the resulting prompt X-ray background level is presented, with the aim of driving the feasibility study of the shielding system and assessing the scientific requirements of the future hard X-ray missions. A Geant4 based multi-mission background simulator, BoGEMMS, is developed to be applied to any high energy mission for which the shielding and instruments performances are required. It allows to interactively create a virtual model of the telescope and expose it to the space radiation environment, tracking the particles along their path and filtering the simulated background counts as a real observation in space. Its flexibility is exploited to evaluate the background spectra of the Simbol-X and NHXM mission, as well as the soft proton scattering by the X-ray optics and the selection of the best shielding configuration. Altough the Simbol-X and NHXM missions are the case studies of the background analysis, the obtained results can be generalized to any future hard X-ray telescope. For this reason, a simplified, ideal payload model is also used to select the major sources of background in LEO. All the results are original contributions to the assessment studies of the cited missions, as part of the background groups activities.