New functional and biomechanical assessments for the improvement of the surgical navigation systems for joint replacement in the human lower limb

In case of severe osteoarthritis at the knee causing pain, deformity, and loss of stability and mobility, the clinicians consider that the substitution of these surfaces by means of joint prostheses. The objectives to be pursued by this surgery are: complete pain elimination, restoration of the normal physiological mobility and joint stability, correction of all deformities and, thus, of limping. The knee surgical navigation systems have bee developed in computer-aided surgery in order to improve the surgical final outcome in total knee arthroplasty. These systems provide the surgeon with quantitative and real-time information about each surgical action, like bone cut executions and prosthesis component alignment, by mean of tracking tools rigidly fixed onto the femur and the tibia. Nevertheless, there is still a margin of error due to the incorrect surgical procedures and to the still limited number of kinematic information provided by the current systems. Particularly, patello-femoral joint kinematics is not considered in knee surgical navigation. It is also unclear and, thus, a source of misunderstanding, what the most appropriate methodology is to study the patellar motion. In addition, also the knee ligamentous apparatus is superficially considered in navigated total knee arthroplasty, without taking into account how their physiological behavior is altered by this surgery. The aim of the present research work was to provide new functional and biomechanical assessments for the improvement of the surgical navigation systems for joint replacement in the human lower limb. This was mainly realized by means of the identification and development of new techniques that allow a thorough comprehension of the functioning of the knee joint, with particular attention to the patello-femoral joint and to the main knee soft tissues. A knee surgical navigation system with active markers was used in all research activities presented in this research work. Particularly, preliminary test were performed in order to assess the system accuracy and the robustness of a number of navigation procedures. Four studies were performed in-vivo on patients requiring total knee arthroplasty and randomly implanted by means of traditional and navigated procedures in order to check for the real efficacy of the latter with respect to the former. In order to cope with assessment of patello-femoral joint kinematics in the intact and replaced knees, twenty in-vitro tests were performed by using a prototypal tracking tool also for the patella. In addition to standard anatomical and articular recommendations, original proposals for defining the patellar anatomical-based reference frame and for studying the patello-femoral joint kinematics were reported and used in these tests. These definitions were applied to two further in-vitro tests in which, for the first time, also the implant of patellar component insert was fully navigated. In addition, an original technique to analyze the main knee soft tissues by means of anatomical-based fiber mappings was also reported and used in the same tests. The preliminary instrumental tests revealed a system accuracy within the millimeter and a good inter- and intra-observer repeatability in defining all anatomical reference frames. In in-vivo studies, the general alignments of femoral and tibial prosthesis components and of the lower limb mechanical axis, as measured on radiographs, was more satisfactory, i.e. within ±3°, in those patient in which total knee arthroplasty was performed by navigated procedures. As for in-vitro tests, consistent patello-femoral joint kinematic patterns were observed over specimens throughout the knee flexion arc. Generally, the physiological intact knee patellar motion was not restored after the implant. This restoration was successfully achieved in the two further tests where all component implants, included the patellar insert, were fully navigated, i.e. by means of intra-operative assessment of also patellar component positioning and general tibio-femoral and patello-femoral joint assessment. The tests for assessing the behavior of the main knee ligaments revealed the complexity of the latter and the different functional roles played by the several sub-bundles compounding each ligament. Also in this case, total knee arthroplasty altered the physiological behavior of these knee soft tissues. These results reveal in-vitro the relevance and the feasibility of the applications of new techniques for accurate knee soft tissues monitoring, patellar tracking assessment and navigated patellar resurfacing intra-operatively in the contest of the most modern operative techniques. This present research work gives a contribution to the much controversial knowledge on the normal and replaced of knee kinematics by testing the reported new methodologies. The consistence of these results provides fundamental information for the comprehension and improvements of knee orthopedic treatments. In the future, the reported new techniques can be safely applied in-vivo and also adopted in other joint replacements.

Studio di ausili tecnologici compensativi di supporto all'iter di apprendimento matematico secondario e universitario degli studenti con dislessia

Data coming out from various researches carried out over the last years in Italy on the problem of school dispersion in secondary school show that difficulty in studying mathematics is one of the most frequent reasons of discomfort reported by students. Nevertheless, it is definitely unrealistic to think we can do without such knowledge in today society: mathematics is largely taught in secondary school and it is not confined within technical-scientific courses only. It is reasonable to say that, although students may choose academic courses that are, apparently, far away from mathematics, all students will have to come to terms, sooner or later in their life, with this subject. Among the reasons of discomfort given by the study of mathematics, some mention the very nature of this subject and in particular the complex symbolic language through which it is expressed. In fact, mathematics is a multimodal system composed by oral and written verbal texts, symbol expressions, such as formulae and equations, figures and graphs. For this, the study of mathematics represents a real challenge to those who suffer from dyslexia: this is a constitutional condition limiting people performances in relation to the activities of reading and writing and, in particular, to the study of mathematical contents. Here the difficulties in working with verbal and symbolic codes entail, in turn, difficulties in the comprehension of texts from which to deduce operations that, once combined together, would lead to the problem final solution. Information technologies may support this learning disorder effectively. However, these tools have some implementation limits, restricting their use in the study of scientific subjects. Vocal synthesis word processors are currently used to compensate difficulties in reading within the area of classical studies, but they are not used within the area of mathematics. This is because the vocal synthesis (or we should say the screen reader supporting it) is not able to interpret all that is not textual, such as symbols, images and graphs. The DISMATH software, which is the subject of this project, would allow dyslexic users to read technical-scientific documents with the help of a vocal synthesis, to understand the spatial structure of formulae and matrixes, to write documents with a technical-scientific content in a format that is compatible with main scientific editors. The system uses LaTex, a text mathematic language, as mediation system. It is set up as LaTex editor, whose graphic interface, in line with main commercial products, offers some additional specific functions with the capability to support the needs of users who are not able to manage verbal and symbolic codes on their own. LaTex is translated in real time into a standard symbolic language and it is read by vocal synthesis in natural language, in order to increase, through the bimodal representation, the ability to process information. The understanding of the mathematic formula through its reading is made possible by the deconstruction of the formula itself and its “tree” representation, so allowing to identify the logical elements composing it. Users, even without knowing LaTex language, are able to write whatever scientific document they need: in fact the symbolic elements are recalled by proper menus and automatically translated by the software managing the correct syntax. The final aim of the project, therefore, is to implement an editor enabling dyslexic people (but not only them) to manage mathematic formulae effectively, through the integration of different software tools, so allowing a better teacher/learner interaction too.

Advances in methods to detect, isolate and quantify foodborne pathogens

Foodborne diseases impact human health and economies worldwide in terms of health care and productivity loss. Prevention is necessary and methods to detect, isolate and quantify foodborne pathogens play a fundamental role, changing continuously to face microorganisms and food production evolution. Official methods are mainly based on microorganisms growth in different media and their isolation on selective agars followed by confirmation of presumptive colonies through biochemical and serological test. A complete identification requires form 7 to 10 days. Over the last decades, new molecular techniques based on antibodies and nucleic acids allow a more accurate typing and a faster detection and quantification. The present thesis aims to apply molecular techniques to improve official methods performances regarding two pathogens: Shiga-like Toxin-producing Escherichia coli (STEC) and Listeria monocytogenes. In 2011, a new strain of STEC belonging to the serogroup O104 provoked a large outbreak. Therefore, the development of a method to detect and isolate STEC O104 is demanded. The first objective of this work is the detection, isolation and identification of STEC O104 in sprouts artificially contaminated. Multiplex PCR assays and antibodies anti-O104 incorporated in reagents for immunomagnetic separation and latex agglutination were employed. Contamination levels of less than 1 CFU/g were detected. Multiplex PCR assays permitted a rapid screening of enriched food samples and identification of isolated colonies. Immunomagnetic separation and latex agglutination allowed a high sensitivity and rapid identification of O104 antigen, respectively. The development of a rapid method to detect and quantify Listeria monocytogenes, a high-risk pathogen, is the second objective. Detection of 1 CFU/ml and quantification of 10–1,000 CFU/ml in raw milk were achieved by a sample pretreatment step and quantitative PCR in about 3h. L. monocytogenes growth in raw milk was also evaluated.