International cooperation in endourology: percutaneous and flexible ureteroscopic treatment of lower pole kidney stones

Introduction Lower pole kidney stones represent at time a challenge for the urologist. The gold standard treatment for intrarenal stones <2 cm is Extracorporeal Shock Wave Lithotripsy (ESWL) while for those >2 cm is Percutaneous Nephrolithotomy (PCNL). The success rate of ESWL, however, decreases when it is employed for lower pole stones, and this is particularly true in the presence of narrow calices or acute infundibular angles. Studies have proved that ureteroscopy (URS) is an efficacious alternative to ESWL for lower pole stones <2 cm, but this is not reflected by either the European or the American guidelines. The aim of this study is to present the results of a large series of flexible ureteroscopies and PCNLs for lower pole kidney stones from high-volume centers, in order to provide more evidences on the potential indications of the flexible ureteroscopy for the treatment of kidney stones. Materials and Methods A database was created and the participating centres retrospectively entered their data relating to the percutaneous and flexible ureteroscopic management of lower pole kidney stones. Patients included were treated between January 2005 and January 2010. Variables analyzed included case load number, preoperative and postoperative imaging, stone burden, anaesthesia (general vs. spinal), type of lithotripter, access location and size, access dilation type, ureteral access sheath use, visual clarity, operative time, stone-free rate, complication rate, hospital stay, analgesic requirement and follow-up time. Stone-free rate was defined as absence of residual fragments or presence of a single fragment <2 mm in size at follow-up imaging. Primary end-point was to test the efficacy and safety of flexible URS for the treatment of lower pole stones; the same descriptive analysis was conducted for the PCNL approach, as considered the gold standard for the treatment of lower pole kidney stones. In this setting, no statistical analysis was conducted owing to the different selection criteria of the patients. Secondary end-point consisted in matching the results of stone-free rates, operative time and complications rate of flexible URS and PCNL in the subgroup of patients harbouring lower pole kidney stones between 1 and 2 cm in the higher diameter. Results A total 246 patients met the criteria for inclusion. There were 117 PCNLs (group 1) and 129 flexible URS (group 2). Ninety-six percent of cases were diagnosed by CT KUB scan. Mean stone burden was 175±160 and 50±62 mm2 for groups 1 and 2, respectively. General anaesthesia was induced in 100 % and 80% of groups 1 and 2, respectively. Pneumo-ultrasonic energy was used in 84% of cases in the PCNL group, and holmium laser in 95% of the cases in the flexible URS group. The mean operative time was 76.9±44 and 63±37 minutes for groups 1 and 2 respectively. There were 12 major complications (11%) in group 1 (mainly Grade II complications according to Clavidien classification) and no major complications in group 2. Mean hospital stay was 5.7 and 2.6 days for groups 1 and 2, respectively. Ninety-five percent of group 1 and 52% of group 2 required analgesia for a period longer than 24 hours. Intraoperative stone-free rate after a single treatment was 88.9% for group 1 and 79.1% for group 2. Overall, 6% of group 1 and 14.7% of group 2 required a second look procedure. At 3 months, stone-free rates were 90.6% and 92.2% for groups 1 and 2, respectively, as documented by follow-up CT KUB (22%) or combination of intra-venous pyelogram, regular KUB and/or kidney ultrasound (78%). In the subanalysis conducted comparing 82 vs 65 patients who underwent PCNL and flexible URS for lower pole stones between 1 and 2 cm, intreoperative stone-free rates were 88% vs 68% (p= 0.03), respectively; anyway, after an auxiliary procedure which was necessary in 6% of the cases in group 1 and 23% in group 2 (p=0.03), stone-free rates at 3 months were not statistically significant (91.5% vs 89.2%; p=0.6). Conversely, the patients undergoing PCNL maintained a higher risk of complications during the procedure, with 9 cases observed in this group versus 0 in the group of patients treated with URS (p=0.01) Conclusions These data highlight the value of flexible URS as a very effective and safe option for the treatment of kidney stones; thanks to the latest generation of flexible devices, this new technical approach seems to be a valid alternative in particular for the treatment of lower pole kidney stones less than 2 cm. In high-volume centres and in the hands of skilled surgeons, this technique can approach the stone-free rates achievable through PCNL in lower pole stones between 1 and 2 cm, with a very low risk of complications. Furthermore, the results confirm the high success rate and relatively low morbidity of modern PCNL for lower pole stones, with no difference detectable between the prone and supine position.

Analysis of the pig genome for the identification of genomic regions affecting production traits

The aim of this work was to identify markers associated with production traits in the pig genome using different approaches. We focused the attention on Italian Large White pig breed using Genome Wide Association Studies (GWAS) and applying a selective genotyping approach to increase the power of the analyses. Furthermore, we searched the pig genome using Next Generation Sequencing (NSG) Ion Torrent Technology to combine selective genotyping approach and deep sequencing for SNP discovery. Other two studies were carried on with a different approach. Allele frequency changes for SNPs affecting candidate genes and at Genome Wide level were analysed to identify selection signatures driven by selection program during the last 20 years. This approach confirmed that a great number of markers may affect production traits and that they are captured by the classical selection programs. GWAS revealed 123 significant or suggestively significant SNP associated with Back Fat Thickenss and 229 associated with Average Daily Gain. 16 Copy Number Variant Regions resulted more frequent in lean or fat pigs and showed that different copies of those region could have a limited impact on fat. These often appear to be involved in food intake and behavior, beside affecting genes involved in metabolic pathways and their expression. By combining NGS sequencing with selective genotyping approach, new variants where discovered and at least 54 are worth to be analysed in association studies. The study of groups of pigs undergone to stringent selection showed that allele frequency of some loci can drastically change if they are close to traits that are interesting for selection schemes. These approaches could be, in future, integrated in genomic selection plans.

Infezione da virus dell'epatite E nel suino e nell'uomo: aggiornamento sulle metodiche diagnostiche di laboratorio

The first part of the thesis is a brief review on the most important aspects of HEV infection in human and swine, followed by an update on the laboratory techniques currently in use for the diagnosis of HEV infections in humans and animals. The second part refers on the results of two investigations carried out on the presence of HEV infection in swine farms in Toscana and Piemonte and on the presence of HEV infection in pigs and humans in some rural communities in Bolivia. HEV strains isolated from swine herds in Toscana and Piemonte were all included in the genotype 3, showing particular homology with Dutch porcine isolates, Spanish porcine and human isolates and British human isolates. The investigation carried out, with a random sampling, in the province of Cuneo, detected HEV infection with a prevalence of 46% on farms with a number of pigs greater than 500. HEV was detected in pigs and humans in rural communities in Bolivia and all the viral isolate were included in the genotype 3. Aminoacidic homology of human and swine isolates was estimated to be 92%. Results on the development of a Real Time RT-PCR to detect HEV are also reported. The used Real Time RT-PCR protocols, one step and two steps, exhibited good sensitivity to detect several Italian swine HEV strains with high rate of genetic variability.

Insolvenza transfrontaliera e giurisdizione: l'esperienza del regolamento (CE) n. 1346 del 2000

L’elaborato è strutturato in quattro parti: la prima è dedicata all’inquadramento del background normativo. L’autrice affronta, con un approccio ricostruttivo, i precedenti alla redazione del regolamento e le difficoltà incontrate a causa delle resistenze degli Stati membri. Si sofferma altresì sulle norme UNCITRAL, anch’esse oggetto nel recente periodo, di numerose implementazioni. La seconda parte fotografa il ruolo della Corte di Giustizia nell’interpretazione del regolamento n. 1346/2000 ed individua i concetti fondamentali del regolamento: l’universalità attenuata, il campo di applicazione soggettivo del regolamento, la legge applicabile, il principio dell’automatico riconoscimento delle decisioni e la correlata tematica dell’ordine pubblico, nonché la figura del curatore. Si approfondisce l’attività degli Stati membri nel dotarsi di norme di coordinamento ( esemplare il caso della Spagna e della Germania) sottolineando il silenzio del legislatore italiano che, nonostante le numerose riforme in materia, a tutt’oggi non ha ideato un sistema in grado di coordinare la normativa nazionale con la struttura del regolamento europeo. Nella terza parte l'autrice approfondisce la giurisdizione nel regolamento n. 1346/2000. Si individuano le parole chiave: Comi e dipendenza, i cui significati sono sfumati seguendo le posizioni della Corte di Giustizia, (Leading Case Eurofood sino a Interedil) e si mette in discussione, nel panorama attuale, la tenuta di tali criteri giurisdizionali. Sempre intorno al concetto di Comi, si analizzano: la giurisdizione verso gruppi di imprese disciplina assente nel regolamento, i rapporti tra procedura principale e secondaria , la giurisdizione in materia di azioni connesse e/o correlate (Gourdain vs Nadler/Seagon vs Deko Marty). Il capitolo conclusivo offre una panoramica delle proposte finalizzate ad un’implementazione della struttura del regolamento sull’insolvenza. Numerose, infatti, sono le proposte a livello dottrinale e da parte degli organi comunitari in vista della scadenza del Report della Commissione Europea sulla applicazione del regolamento 1346 del 2000 (art. 46).

Tracce di cinefilia su Facebook

La mia tesi approfondisce le dinamiche della cinefilia su Facebook: quali relazioni s'instaurano tra lo spettatore cinefilo, e dunque il suo particolare sguardo, e la moltitudine di frammenti di cinema dispersi nella rete; come si sono modificati i rapporti, gli atteggiamenti, i processi di negoziazione, le abitudini e soprattutto i discorsi dei cinefili al cospetto di tracce di cinema sui social network e in particolare su Facebook. Inoltreprovo a dimostrare che la cinefilia è un'esperienza costitutivamente autobiografica, cui il web permette il perpetuare potenzialmente infinito della (auto)narrazione di sé.

Permutation-based stochastic ordering using pairwise comparisons

The topic of this work concerns nonparametric permutation-based methods aiming to find a ranking (stochastic ordering) of a given set of groups (populations), gathering together information from multiple variables under more than one experimental designs. The problem of ranking populations arises in several fields of science from the need of comparing G>2 given groups or treatments when the main goal is to find an order while taking into account several aspects. As it can be imagined, this problem is not only of theoretical interest but it also has a recognised relevance in several fields, such as industrial experiments or behavioural sciences, and this is reflected by the vast literature on the topic, although sometimes the problem is associated with different keywords such as: "stochastic ordering", "ranking", "construction of composite indices" etc., or even "ranking probabilities" outside of the strictly-speaking statistical literature. The properties of the proposed method are empirically evaluated by means of an extensive simulation study, where several aspects of interest are let to vary within a reasonable practical range. These aspects comprise: sample size, number of variables, number of groups, and distribution of noise/error. The flexibility of the approach lies mainly in the several available choices for the test-statistic and in the different types of experimental design that can be analysed. This render the method able to be tailored to the specific problem and the to nature of the data at hand. To perform the analyses an R package called SOUP (Stochastic Ordering Using Permutations) has been written and it is available on CRAN.

q-Hook length formulas for colored labeled forests

The major index has been deeply studied from the early 1900s and recently has been generalized in different directions, such as the case of labeled forests and colored permutations. In this thesis we define new types of labelings for forests in which the labels are colored integers. We extend the definition of the flag-major index for these labelings and we present an analogue of well known major index hook length formulas. Finally, this study (which has just apparently a simple combinatoric nature) allows us to show a notion of duality for two particular families of groups obtained from the product G(r,n)×G(r,m).

Doveri e responsabilita' degli amministratori nella crisi dei gruppi di societa'

Il presente studio si propone di individuare i doveri e le responsabilità, di tipo risarcitorio, degli amministratori, in particolare degli amministratori della società che esercita attività di direzione e coordinamento, in una situazione di crisi o insolvenza nel gruppo, anche in un’ottica di “prevenzione”, e, più precisamente, il complesso di regole di corretta gestione societaria e imprenditoriale, con le quali il silenzio della legge fallimentare in tema di gruppi di società non può non confrontarsi. In particolare, si indagherà sulla possibilità di individuare nel nostro ordinamento giuridico, nel momento di emersione della crisi, doveri di comportamento in capo agli organi di governo della società o ente che esercita attività di direzione e coordinamento, al fine di fronteggiare la crisi, evitando il peggioramento della stessa, ovvero per un risanamento anticipato e, quindi, più suscettibile di esito positivo, nella prospettiva di tutela dei soci c.d. esterni e dei creditori delle società figlie e, nello stesso tempo, dei soci della capogruppo medesima e, quindi, in una prospettiva più ampia e articolata rispetto a una società individualmente considerata. L’oggetto dell’analisi viene introdotto mediante un inquadramento generale della disciplina in materia di gruppi di società presente nel nostro sistema normativo, con particolare riguardo alla disciplina dell’attività di direzione e coordinamento introdotta dal legislatore della riforma del diritto societario (d.lgs. 17 gennaio 2003, n. 6) con gli artt. 2497 ss. cod. civ.. Nella seconda parte verranno individuati e approfonditi i criteri e i principi dai quali ricavare le regole di governance nei gruppi di società e la relativa responsabilità degli amministratori nelle situazioni di crisi nel gruppo. Sulla scorta delle suddette argomentazioni, nell'ultima parte verranno individuate le regole di gestione nell'ambito del gruppo nel momento di “emersione” della crisi e, in particolare, i possibili “strumenti” che il nostro legislatore offre per fronteggiarla.