Accuratezza diagnostica dell'ecografia con mezzo di contrasto nel predire l'evoluzione a breve termine in pazienti con morbo di Crohn

Obiettivi. L’ecografia con mezzo di contrasto (CEUS) può fornire informazioni sulla microvascolarizzazione della parete intestinale nella malattia di Crohn. L’infiammazione della parete intestinale non sembra essere correlata alla quantità di parete vascolarizzata (studi di pattern di vascolarizzazione, SVP) ma all’intensità del flusso di parete in un determinato periodo di tempo (studi di intensità-tempo, SIT). Scopo dello studio è valutare se gli studi SVP e/o SIT mediante CEUS siano in grado di mostrare il reale grado d’infiammazione della parete vascolare e se possano predire l’attività di malattia a 3 mesi. Materiali e metodi: 30 pazienti con malattia di Crohn venivano sottoposti a SVP e SIT mediante CEUS e venivano rivisti dopo 3 mesi. L’eCografia era eseguita con uno strumento dedicato con un software particolare per il calcolo delle curve intensità-tempo e con l’ausilio di un mezzo di contrasto (Sonovue). L’analisi quantitativa consisteva nella misura dell’area sotto la curva (AUC) (con cut-off tra malattia attiva e inattiva di 15) e di un intensità media (IM) con un cut-off di 10. Tutti gli esami venivano registrati e analizzati in modo digitale. Risultati: A T0: CDAI era inferiore a 150 in 22 pazienti e superiore a 150 in 8 pazienti; a T3: CDAI era inferiore a 150 in 19 pazienti e superiore a 150 in 11 pazienti. A T0 sia la CEUS SPV che la SIT evidenziavano bassa specificità, accuratezza diagnostica e valore predittivo negativo; a T3 la CEUS SVP mostrava bassa sensibilità e accuratezza diagnostica rispetto alla SIT che era in grado, in tutti i casi tranne uno, di predire l’attività clinica di malattia a tre mesi. Conclusioni: in questo studio, la CEUS-SIT ha mostrato buona accuratezza diagnostica nel predire l’attività clinica di malattia nel follow-up a breve termine di pazienti con malattia di Crohn.

Improved ground motion intensity measures for reliability-based demand analysis of structures

In Performance-Based Earthquake Engineering (PBEE), evaluating the seismic performance (or seismic risk) of a structure at a designed site has gained major attention, especially in the past decade. One of the objectives in PBEE is to quantify the seismic reliability of a structure (due to the future random earthquakes) at a site. For that purpose, Probabilistic Seismic Demand Analysis (PSDA) is utilized as a tool to estimate the Mean Annual Frequency (MAF) of exceeding a specified value of a structural Engineering Demand Parameter (EDP). This dissertation focuses mainly on applying an average of a certain number of spectral acceleration ordinates in a certain interval of periods, Sa,avg (T1,…,Tn), as scalar ground motion Intensity Measure (IM) when assessing the seismic performance of inelastic structures. Since the interval of periods where computing Sa,avg is related to the more or less influence of higher vibration modes on the inelastic response, it is appropriate to speak about improved IMs. The results using these improved IMs are compared with a conventional elastic-based scalar IMs (e.g., pseudo spectral acceleration, Sa ( T(¹)), or peak ground acceleration, PGA) and the advanced inelastic-based scalar IM (i.e., inelastic spectral displacement, Sdi). The advantages of applying improved IMs are: (i ) "computability" of the seismic hazard according to traditional Probabilistic Seismic Hazard Analysis (PSHA), because ground motion prediction models are already available for Sa (Ti), and hence it is possibile to employ existing models to assess hazard in terms of Sa,avg, and (ii ) "efficiency" or smaller variability of structural response, which was minimized to assess the optimal range to compute Sa,avg. More work is needed to assess also "sufficiency" and "scaling robustness" desirable properties, which are disregarded in this dissertation. However, for ordinary records (i.e., with no pulse like effects), using the improved IMs is found to be more accurate than using the elastic- and inelastic-based IMs. For structural demands that are dominated by the first mode of vibration, using Sa,avg can be negligible relative to the conventionally-used Sa (T(¹)) and the advanced Sdi. For structural demands with sign.cant higher-mode contribution, an improved scalar IM that incorporates higher modes needs to be utilized. In order to fully understand the influence of the IM on the seismis risk, a simplified closed-form expression for the probability of exceeding a limit state capacity was chosen as a reliability measure under seismic excitations and implemented for Reinforced Concrete (RC) frame structures. This closed-form expression is partuclarly useful for seismic assessment and design of structures, taking into account the uncertainty in the generic variables, structural "demand" and "capacity" as well as the uncertainty in seismic excitations. The assumed framework employs nonlinear Incremental Dynamic Analysis (IDA) procedures in order to estimate variability in the response of the structure (demand) to seismic excitations, conditioned to IM. The estimation of the seismic risk using the simplified closed-form expression is affected by IM, because the final seismic risk is not constant, but with the same order of magnitude. Possible reasons concern the non-linear model assumed, or the insufficiency of the selected IM. Since it is impossibile to state what is the "real" probability of exceeding a limit state looking the total risk, the only way is represented by the optimization of the desirable properties of an IM.