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.

Biofilm formation by the anaerobic pathogen Clostridium difficile

Clostridium difficile is an obligate anaerobic, Gram-positive, endospore-forming bacterium. Although an opportunistic pathogen, it is one of the important causes of healthcare-associated infections. While toxins TcdA and TcdB are the main virulence factors of C. difficile, the factors or processes involved in gut colonization during infection remain unclear. The biofilm-forming ability of bacterial pathogens has been associated with increased antibiotic resistance and chronic recurrent infections. Little is known about biofilm formation by anaerobic gut species. Biofilm formation by C. difficile could play a role in virulence and persistence of C. difficile, as seen for other intestinal pathogens. We demonstrate that C. difficile clinical strains, 630, and the strain isolated in the outbreak, R20291, form structured biofilms in vitro. Biofilm matrix is made of proteins, DNA and polysaccharide. Strain R20291 accumulates substantially more biofilm. Employing isogenic mutants, we show that virulence-associated proteins, Cwp84, flagella and a putative quorum sensing regulator, LuxS, Spo0A, are required for maximal biofilm formation by C. difficile. Moreover we demonstrate that bacteria in C. difficile biofilms are more resistant to high concentrations of vancomycin, a drug commonly used for treatment of CDI, and that inhibitory and sub-inhibitory concentrations of the same antibiotic induce biofilm formation. Surprisingly, clinical C. difficile strains from the same out-break, but from different origin, show differences in biofilm formation. Genome sequence analysis of these strains showed presence of a single nucleoide polymorphism (SNP) in the anti-σ factor RsbW, which regulates the stress-induced alternative sigma factor B (σB). We further demonstrate that RsbW, a negative regulator of alternative sigma factor B, has a role in biofilm formation and sporulation of C. difficile. Our data suggest that biofilm formation by C. difficile is a complex multifactorial process and may be a crucial mechanism for clostridial persistence in the host.

Analysis of Two Component Systems in Group B Streptococcus Shows that RgfAC and the Novel FspSR Modulate Virulence and Bacterial Fitness

Group B Streptococcus (GBS), in its transition from commensal to pathogen, will encounter diverse host environments and thus require coordinately controlling its transcriptional responses to these changes. This work was aimed at better understanding the role of two component signal transduction systems (TCS) in GBS pathophysiology through a systematic screening procedure. We first performed a complete inventory and sensory mechanism classification of all putative GBS TCS by genomic analysis. Five TCS were further investigated by the generation of knock-out strains, and in vitro transcriptome analysis identified genes regulated by these systems, ranging from 0.1-3% of the genome. Interestingly, two sugar phosphotransferase systems appeared differently regulated in the knock-out mutant of TCS-16, suggesting an involvement in monitoring carbon source availability. High throughput analysis of bacterial growth on different carbon sources showed that TCS-16 was necessary for growth of GBS on fructose-6-phosphate. Additional transcriptional analysis provided further evidence for a stimulus-response circuit where extracellular fructose-6-phosphate leads to autoinduction of TCS-16 with concomitant dramatic up-regulation of the adjacent operon encoding a phosphotransferase system. The TCS-16-deficient strain exhibited decreased persistence in a model of vaginal colonization and impaired growth/survival in the presence of vaginal mucoid components. All mutant strains were also characterized in a murine model of systemic infection, and inactivation of TCS-17 (also known as RgfAC) resulted in hypervirulence. Our data suggest a role for the previously unknown TCS-16, here named FspSR, in bacterial fitness and carbon metabolism during host colonization, and also provide experimental evidence for TCS-17/RgfAC involvement in virulence.

The "Orthoplastic" combined surgical approach to open tibia fractures: a multicentric prospective outcome study

Introduction: Open fractures of the leg represent a severe trauma. The combined approach, shared between plastic and orthopaedic surgeons, is considered to be important, although this multidisciplinary treatment is not routinely performed. Aim of this study was to verify whether the orthoplastic treatment is of any advantage over the traditional simply orthopedic treatment, through a multicentric inclusion of these unfrequent injuries into a prospective study. Material and methods: The following trauma centres were involved: Rizzoli Orthopaedic Institute/University of Bologna (leading centre) and Maggiore Hospital (Bologna, Italy), Frenchay Hospital (Bristol, United Kingdom), Jinnah Hospital (Lahore, Pakistan). All patients consecutively hospitalized in the mentioned centres between January 2012 and December 2013 due to tibial open fractures were included in the study and prospectively followed up to December 2014. Demographics and other clinical features were recorded, including the type of treatment (orthopaedic or orthoplastic). The considered outcome measures included duration of hospitalization, time for bone union and soft tissue closure, Enneking score at 3, 6 and 12 months, the incidence of osteomyelitis and other complications. Results: A total of 164 patients were included in the study. Out of them 68% were treated with an orthoplastic approach, whereas 32% received a purely orthopedic treatment. All considered outcome measures showed to be improved by the orthoplastic approach, compared to the orthopaedic one: time for soft tissue closure (2 versus 25 weeks), duration of hospital stay (22 versus 55 days), time for bone union (6 versus 8.5 months) , number of additional operations (0.6 versus 1.2) and functional recovery of the limb at 12 months (27 versus 19, Enneking’s score). All results were statistically significant. Conclusion: The combined orthoplastic approach to the treatment of open tibia fractures, in particular for high grade injuries (Gustilo 3B), is proven to improve the outcome of these severe injuries.

The effect of cross-linker on endogenous enzymatic activity within radicular dentin and bond strength between intraradicular post and radicular dentin

The primary aim was to evaluate the effect of 1-ethyl-3-(3-dimethylamino-propyl) carbodiimide (EDC) on endogenous enzymatic activity within radicular dentin and push-out bond strength of adhesively luted fiber posts, at baseline and after artificial aging. Additionally, the effect of different cementation strategies on endogenous enzymatic activity and fiber post retention was evaluated. The experiment was carried out on extracted human teeth, following endodontic treatment and fiber post cementation. Three cementation strategies were performed: resin cement in combination with etch-and-rinse (EAR) adhesive system, with self-etch (SE) system and self-adhesive (SE) cement. Each of the mentioned strategies had a control and experimental (EDC) group in which root canal was irrigated with 0.3M EDC for 1 minute. The push-out bond strength test was performed 24h after cementation and after 40.000 thermocycles. In order to investigate the effect of EDC and different cementation strategies, in situ zymography analyses of the resin-dentin interfaces were conducted. Statistical analyses were conducted with the software Stata 12.0 (Stata Corp, College Station, Texas, USA) and the significance was set for p<0.05. The results of statistical analysis (ANOVA) showed that the variables “EDC”, “root region” and “artificial aging” significantly influenced fiber posts’ retention to root canal (p<0.05). The highest values were observed in coronal third. The mean values observed after artificial aging were lower when compared to baseline, however EDC was effective in preserving bond strength. The level of enzymatic activity varied between the groups and EDC had a beneficial effect on silencing the enzymatic activity. Within the limitations of the study, it was concluded that the choice of cementation strategy did not influence posts’ retention, while EDC contributed to the preservation of bond strength after artificial aging and reduced enzymatic activity within radicular dentin. In vivo trials are necessary to confirm the results of this in vitro study.

Seismic vulnerability of buildings and non-structural elements: insights from the 2011 Lorca earthquake

This PhD dissertation presents a profound study of the vulnerability of buildings and non-structural elements stemming from the investigation of the Mw 5.2 Lorca 2011 earthquake; which constitutes one of the most significant earthquakes in Spain. It left nine fatalities due to falling debris from reinforced concrete buildings, 394 injured and material damage valued at 800 million euros. Within this framework, the most relevant initiatives concerning the vulnerability of buildings and the exposure of Lorca are studied. This work revealed two lines of research: the elaboration of a rational method to determine the adequacy of a specific fragility curve for the particular seismic risk study of a region; and the relevance of researching the seismic performance of non-structural elements. As a consequence, firstly, a method to assess and select fragility curves for seismic risk studies from the catalogue of those available in the literature is elaborated and calibrated by means of a case study. The said methodology is based on a multidimensional index and provides a ranking that classifies the curves in terms of adequacy. Its results for the case of Lorca led to the elaboration of new fragility curves for unreinforced masonry buildings. Moreover, a simplified method to account for the unpredictable directionality of the seism in the creation of fragility curves is contributed. Secondly, the characterisation of the seismic capacity and demand of the non-structural elements that caused most of the human losses is studied. Concerning the capacity, an analytical approach derived from theoretical considerations to characterise the complete out-of-plane seismic response curve of unreinforced masonry cantilever walls is provided; as well as a simplified and more practical trilinear version of it. Concerning the demand, several methods for characterising the Floor Response Spectra of reinforced concrete buildings are tested through case studies.

Ship performance modelling for least-CO2 emission routes

Decarbonization of maritime transport requires immediate action. In the short term, ship weather routing can provide greenhouse gas emission reductions, even for existing ships and without retrofitting them. Weather routing is based on making optimal use of both envi- ronmental information and knowledge about vessel seakeeping and performance. Combining them at a state-of-the-art level and making use of path planning in realistic conditions can be challenging. To address these topics in an open-source framework, this thesis led to the development of a new module called bateau , and to its combination with the ship routing model VISIR. bateau includes both hull geometry and propulsion modelling for various vessel types. It has two objectives: to predict the sustained speed in a seaway and to estimate the CO2 emission rate during the voyage. Various semi-empirical approaches were used in bateau to predict the ship hydro- and aerodynamical resistance in both head and oblique seas. Assuming that the ship sails at a constant engine load, the involuntary speed loss due to waves was estimated. This thesis also attempted to clarify the role played by the actual representation of the sea state. In particular, the influence of the wave steepness parameter was assessed. For dealing with ships with a greater superstructure, the wind added resistance was also estimated. Numerical experiments via bateau were conducted for both a medium and a large-size container ships, a bulk-carrier, and a tanker. The simulations of optimal routes were carried out for a feeder containership during voyages in the North Indian Ocean and in the South China Sea. Least-CO2 routes were compared to the least-distance ones, assessing the relative CO2 savings. Analysis fields from the Copernicus Marine Service were used in the numerical experiments.

Ruolo dell'Infliximab nella terapia della colite ulcerosa moderato-severa

Background: Almost 10-15% of patients with active Ulcerative Colitis are refractory to conventional therapy. Infliximab is a treatment of proven efficacy in this group of patients. Aims: To evaluate the role of Inliximab in inducing and maintaining remission in patients with chronically active moderate-severe Ulcerative Colitis. Materials and methods: 53 patients were enrolled, 47 patients entered the study and were treated with a dose of 5 mg/kg. The remission was evaluated through endoscopy and clinical criteria. (Mayo Score). The primary endpoint were clinical and endoscopic remission in moderate-severe Ulcerative Colitis refractory to standard therapy, the secondary out point was the maintenance of remission in the long period. Results: 47 patients started the study, 43 completed the study, 4 dropped out for worsening disease or adverse events; 27 patients were treated with 3 infusions, 9 patients with 4 infusions, 7 patients with > o = 5 infusions. 34 /47 patients (72.3%) were responders 12 (25.5%) improved their symptoms, 22 ( 46.8%) were in remission after the treatment. Among the responders, 21/34 (61.8%) stopped the steroid therapy after 3 infusions, the others reduced the dose or maintained just topic therapy. 13/47 patients (27.7%) were non responders (p <0.001). After 3 months all 22 patients which had reached remission maintained low Mayo Score; 10/12 (83.3%) patients with clinical response maintained their low score, 2 relapsed . Conclusions: Infliximab is a valid therapy for the treatment of Ulcerative Colitis and can avoid surgery in selected patients.

Development of motion analysis protocols based on inertial sensors

The aim of this thesis was to describe the development of motion analysis protocols for applications on upper and lower limb extremities, by using inertial sensors-based systems. Inertial sensors-based systems are relatively recent. Knowledge and development of methods and algorithms for the use of such systems for clinical purposes is therefore limited if compared with stereophotogrammetry. However, their advantages in terms of low cost, portability, small size, are a valid reason to follow this direction. When developing motion analysis protocols based on inertial sensors, attention must be given to several aspects, like the accuracy of inertial sensors-based systems and their reliability. The need to develop specific algorithms/methods and software for using these systems for specific applications, is as much important as the development of motion analysis protocols based on them. For this reason, the goal of the 3-years research project described in this thesis was achieved first of all trying to correctly design the protocols based on inertial sensors, in terms of exploring and developing which features were suitable for the specific application of the protocols. The use of optoelectronic systems was necessary because they provided a gold standard and accurate measurement, which was used as a reference for the validation of the protocols based on inertial sensors. The protocols described in this thesis can be particularly helpful for rehabilitation centers in which the high cost of instrumentation or the limited working areas do not allow the use of stereophotogrammetry. Moreover, many applications requiring upper and lower limb motion analysis to be performed outside the laboratories will benefit from these protocols, for example performing gait analysis along the corridors. Out of the buildings, the condition of steady-state walking or the behavior of the prosthetic devices when encountering slopes or obstacles during walking can also be assessed. The application of inertial sensors on lower limb amputees presents conditions which are challenging for magnetometer-based systems, due to ferromagnetic material commonly adopted for the construction of idraulic components or motors. INAIL Prostheses Centre stimulated and, together with Xsens Technologies B.V. supported the development of additional methods for improving the accuracy of MTx in measuring the 3D kinematics for lower limb prostheses, with the results provided in this thesis. In the author’s opinion, this thesis and the motion analysis protocols based on inertial sensors here described, are a demonstration of how a strict collaboration between the industry, the clinical centers, the research laboratories, can improve the knowledge, exchange know-how, with the common goal to develop new application-oriented systems.

Advanced Waste-To-Energy Cycles

The increase in environmental and healthy concerns, combined with the possibility to exploit waste as a valuable energy resource, has led to explore alternative methods for waste final disposal. In this context, the energy conversion of Municipal Solid Waste (MSW) in Waste-To-Energy (WTE) power plant is increasing throughout Europe, both in terms of plants number and capacity, furthered by legislative directives. Due to the heterogeneous nature of waste, some differences with respect to a conventional fossil fuel power plant have to be considered in the energy conversion process. In fact, as a consequence of the well-known corrosion problems, the thermodynamic efficiency of WTE power plants typically ranging in the interval 25% ÷ 30%. The new Waste Framework Directive 2008/98/EC promotes production of energy from waste introducing an energy efficiency criteria (the so-called “R1 formula”) to evaluate plant recovery status. The aim of the Directive is to drive WTE facilities to maximize energy recovery and utilization of waste heat, in order to substitute energy produced with conventional fossil fuels fired power plants. This calls for novel approaches and possibilities to maximize the conversion of MSW into energy. In particular, the idea of an integrated configuration made up of a WTE and a Gas Turbine (GT) originates, driven by the desire to eliminate or, at least, mitigate limitations affecting the WTE conversion process bounding the thermodynamic efficiency of the cycle. The aim of this Ph.D thesis is to investigate, from a thermodynamic point of view, the integrated WTE-GT system sharing the steam cycle, sharing the flue gas paths or combining both ways. The carried out analysis investigates and defines the logic governing plants match in terms of steam production and steam turbine power output as function of the thermal powers introduced.

Teoria e pratica dell'architettura solare - Morfologia, rendimento, strategia progettuale

La recente Direttiva 31/2010 dell’Unione Europea impone agli stati membri di riorganizzare il quadro legislativo nazionale in materia di prestazione energetica degli edifici, affinchè tutte le nuove costruzioni presentino dal 1° gennaio 2021 un bilancio energetico tendente allo zero; termine peraltro anticipato al 1° gennaio 2019 per gli edifici pubblici. La concezione di edifici a energia “quasi” zero (nZEB) parte dal presupposto di un involucro energeticamente di standard passivo per arrivare a compensare, attraverso la produzione preferibilmente in sito di energia da fonti rinnovabili, gli esigui consumi richiesti su base annuale. In quest’ottica la riconsiderazione delle potenzialità dell’architettura solare individua degli strumenti concreti e delle valide metodologie per supportare la progettazione di involucri sempre più performanti che sfruttino pienamente una risorsa inesauribile, diffusa e alla portata di tutti come quella solare. Tutto ciò in considerazione anche della non più procrastinabile necessità di ridurre il carico energetico imputabile agli edifici, responsabili come noto di oltre il 40% dei consumi mondiali e del 24% delle emissioni di gas climalteranti. Secondo queste premesse la ricerca pone come centrale il tema dell’integrazione dei sistemi di guadagno termico, cosiddetti passivi, e di produzione energetica, cosiddetti attivi, da fonte solare nell’involucro architettonico. Il percorso sia analitico che operativo effettuato si è posto la finalità di fornire degli strumenti metodologici e pratici al progetto dell’architettura, bisognoso di un nuovo approccio integrato mirato al raggiungimento degli obiettivi di risparmio energetico. Attraverso una ricognizione generale del concetto di architettura solare e dei presupposti teorici e terminologici che stanno alla base della stessa, la ricerca ha prefigurato tre tipologie di esito finale: una codificazione delle morfologie ricorrenti nelle realizzazioni solari, un’analisi comparata del rendimento solare nelle principali aggregazioni tipologiche edilizie e una parte importante di verifica progettuale dove sono stati applicati gli assunti delle categorie precedenti

Iva e Pubblica Autorità: coerenza del sistema e dimensioni nazionali

Il sistema comune europeo dell’imposta sul valore aggiunto privilegia caratteri e finalità economiche nel definire chi siano gli operatori economici soggetti all’IVA. Una disciplina particolare è, tuttavia, prevista per i soggetti di diritto pubblico che, oltre alla principale attività istituzionale, esercitano un’attività di carattere economico. Ai sensi dell’articolo 13 della Direttiva del 28 novembre 2006, 2006/112/CE, gli Stati, le Regioni, le Province, i Comuni e gli altri enti di diritto pubblico, in relazione alle attività ed operazioni che essi effettuano in quanto pubbliche autorità, non sono considerati soggetti passivi IVA anche se in relazione ad esse percepiscono diritti, canoni, contributi o retribuzioni. La vigente disciplina europea delle attività economiche esercitate dagli enti pubblici, oltre che inadeguata al contesto economico attuale, rischia di diventare un fattore che influenza negativamente l’efficacia del modello impositivo dell’IVA e l’agire degli enti pubblici. La tesi propone un modello alternativo che prevede l’inversione dell’impostazione attuale della Direttiva IVA al fine di considerare, di regola, soggetti passivi IVA gli organismi pubblici che svolgono - ancorché nella veste di pubblica autorità - attività oggettivamente economiche.

All'origine dello squilibrio di potere negoziale della parte agricola nella food supply chain: il caso della suinicoltura in Emilia-Romagna

Il settore suinicolo ricopre un ruolo rilevante nel contesto nazionale, con ricadute economiche e sociali di primaria importanza in varie regioni. Tuttavia da alcuni anni il settore si trova in crisi a causa dell’instabilità dei mercati internazionali, dello scarso coordinamento tra gli attori della filiera, della progressiva riduzione della redditività dei prodotti trasformati a Denominazione di Origine, della mancata valorizzazione dei tagli di carne fresca, nonché della difficoltà di aggredire i mercati esteri. Altre criticità riguardano la distribuzione del valore lungo la filiera e la scarsa efficacia delle politiche di coordinamento finora adottate. L'obiettivo della ricerca è quello di identificare gli elementi che possono garantire maggiore equilibrio di potere negoziale tra allevatori suinicoli e macellatori rispetto alla situazione attuale: verificati gli elementi critici che caratterizzano la relazione commerciale tra allevatori e macellatori, si avanzano alcune proposte operative utili al superamento delle fratture tra la componente agricola e quella dei macelli in Emilia Romagna. La struttura della tesi è la seguente: (capitolo 1) si descrive il quadro economico del settore suinicolo a livello internazionale e nazionale. Successivamente (capitolo 2) si passano in rassegna le teorie economiche utili a comprendere le ragioni alla base del malfunzionamento dei rapporti tra gli attori della filiera agroalimentare, mentre nel terzo capitolo è richiamato il quadro normativo comunitario, nazionale e regionale all’interno del quale tali relazioni si configurano. Nel quarto capitolo si elabora un modello interpretativo al fine di spiegare le fratture che oggi contraddistinguono le relazioni in essere tra gli attori della filiera: il “modello delle fratture”. Alla luce di questa concettualizzazione è stata svolta un’indagine diretta svolta presso gli operatori aderenti all’Organizzazione Interprofessionale del Gran Suino Italiano, i cui risultati hanno consentito di valutare l’efficacia del modello interpretativo e di fornire indicazioni migliorative della strategia di governance delle relazioni tra allevatori e macellatori.

Dynamic Modeling and Seasonal Performance Evaluation of Air-to-Water Heat Pump Systems

In this Thesis a series of numerical models for the evaluation of the seasonal performance of reversible air-to-water heat pump systems coupled to residential and non-residential buildings are presented. The exploitation of the energy saving potential linked to the adoption of heat pumps is a hard task for designers due to the influence on their energy performance of several factors, like the external climate variability, the heat pump modulation capacity, the system control strategy and the hydronic loop configuration. The aim of this work is to study in detail all these aspects. In the first part of this Thesis a series of models which use a temperature class approach for the prediction of the seasonal performance of reversible air source heat pumps are shown. An innovative methodology for the calculation of the seasonal performance of an air-to-water heat pump has been proposed as an extension of the procedure reported by the European standard EN 14825. This methodology can be applied not only to air-to-water single-stage heat pumps (On-off HPs) but also to multi-stage (MSHPs) and inverter-driven units (IDHPs). In the second part, dynamic simulation has been used with the aim to optimize the control systems of the heat pump and of the HVAC plant. A series of dynamic models, developed by means of TRNSYS, are presented to study the behavior of On-off HPs, MSHPs and IDHPs. The main goal of these dynamic simulations is to show the influence of the heat pump control strategies and of the lay-out of the hydronic loop used to couple the heat pump to the emitters on the seasonal performance of the system. A particular focus is given to the modeling of the energy losses linked to on-off cycling.

Ecografia con mezzo di contrasto dalla ricerca alla pratica clinica: diagnosi di carcinoma epatocellulare con sistema CEUS LI-RADS e con software di quantificazione della perfusione tissutale

Il carcinoma epatocellulare (HCC) rappresenta il tumore epatico primitivo più comune con una incidenza fino all’85%. È uno dei tumori più frequenti al mondo ed è noto per l’elevata letalità soprattutto in stadio avanzato. La diagnosi precoce attraverso la sorveglianza ecografica è necessaria per migliorare la sopravvivenza dei pazienti a rischio. Il mezzo di contrasto ecografico migliora la sensibilità e la specificità diagnostica dell’ecografia convenzionale. L’ecografia con mezzo di contrasto (contrast-enhanced ultrasound, CEUS) è pertanto considerata una metodica valida per la diagnosi di HCC a livello globale per la sua ottima specificità anche a fronte di una sensibilità subottimale. L’aspetto contrastografico delle lesioni focali epatiche ha portato un team di esperti allo sviluppo del sistema Liver Imaging Reporting and Data System (LI-RADS) con l’obiettivo di standardizzare la raccolta dati e la refertazione delle metodiche di imaging per la diagnosi di HCC. La CEUS è una metodica operatore-dipendente e le discordanze diagnostiche con gli imaging panoramici lasciano spazio a nuove tecniche (Dynamic Contrast Enhanced UltraSound, DCE-US) volte a migliorare l’accuratezza diagnostica della metodica e in particolare la sensibilità. Un software di quantificazione della perfusione tissutale potrebbe essere di aiuto nella pratica clinica per individuare il wash-out non visibile anche all’occhio dell’operatore più esperto. Il nostro studio ha due obiettivi: 1) validare il sistema CEUS LI-RADS nella diagnosi di carcinoma epatocellulare in pazienti ad alto rischio di HCC usando come gold-standard l’istologia quando disponibile oppure metodiche di imaging radiologico accettate da tutte le linee guida (tomografia computerizzata o risonanza magnetica con aspetto tipico) eseguite entro quattro settimane dalla CEUS; 2) valutare l’efficacia di un software di quantificazione della perfusione tissutale nel riscontro di wash-out per la diagnosi di HCC in CEUS.