Parameters and algorithms to evaluate cardiac mechanics by conductance catheter

This work is structured as follows: In Section 1 we discuss the clinical problem of heart failure. In particular, we present the phenomenon known as ventricular mechanical dyssynchrony: its impact on cardiac function, the therapy for its treatment and the methods for its quantification. Specifically, we describe the conductance catheter and its use for the measurement of dyssynchrony. At the end of the Section 1, we propose a new set of indexes to quantify the dyssynchrony that are studied and validated thereafter. In Section 2 we describe the studies carried out in this work: we report the experimental protocols, we present and discuss the results obtained. Finally, we report the overall conclusions drawn from this work and we try to envisage future works and possible clinical applications of our results. Ancillary studies that were carried out during this work mainly to investigate several aspects of cardiac resynchronization therapy (CRT) are mentioned in Appendix. -------- Ventricular mechanical dyssynchrony plays a regulating role already in normal physiology but is especially important in pathological conditions, such as hypertrophy, ischemia, infarction, or heart failure (Chapter 1,2.). Several prospective randomized controlled trials supported the clinical efficacy and safety of cardiac resynchronization therapy (CRT) in patients with moderate or severe heart failure and ventricular dyssynchrony. CRT resynchronizes ventricular contraction by simultaneous pacing of both left and right ventricle (biventricular pacing) (Chapter 1.). Currently, the conductance catheter method has been used extensively to assess global systolic and diastolic ventricular function and, more recently, the ability of this instrument to pick-up multiple segmental volume signals has been used to quantify mechanical ventricular dyssynchrony. Specifically, novel indexes based on volume signals acquired with the conductance catheter were introduced to quantify dyssynchrony (Chapter 3,4.). Present work was aimed to describe the characteristics of the conductancevolume signals, to investigate the performance of the indexes of ventricular dyssynchrony described in literature and to introduce and validate improved dyssynchrony indexes. Morevoer, using the conductance catheter method and the new indexes, the clinical problem of the ventricular pacing site optimization was addressed and the measurement protocol to adopt for hemodynamic tests on cardiac pacing was investigated. In accordance to the aims of the work, in addition to the classical time-domain parameters, a new set of indexes has been extracted, based on coherent averaging procedure and on spectral and cross-spectral analysis (Chapter 4.). Our analyses were carried out on patients with indications for electrophysiologic study or device implantation (Chapter 5.). For the first time, besides patients with heart failure, indexes of mechanical dyssynchrony based on conductance catheter were extracted and studied in a population of patients with preserved ventricular function, providing information on the normal range of such a kind of values. By performing a frequency domain analysis and by applying an optimized coherent averaging procedure (Chapter 6.a.), we were able to describe some characteristics of the conductance-volume signals (Chapter 6.b.). We unmasked the presence of considerable beat-to-beat variations in dyssynchrony that seemed more frequent in patients with ventricular dysfunction and to play a role in discriminating patients. These non-recurrent mechanical ventricular non-uniformities are probably the expression of the substantial beat-to-beat hemodynamic variations, often associated with heart failure and due to cardiopulmonary interaction and conduction disturbances. We investigated how the coherent averaging procedure may affect or refine the conductance based indexes; in addition, we proposed and tested a new set of indexes which quantify the non-periodic components of the volume signals. Using the new set of indexes we studied the acute effects of the CRT and the right ventricular pacing, in patients with heart failure and patients with preserved ventricular function. In the overall population we observed a correlation between the hemodynamic changes induced by the pacing and the indexes of dyssynchrony, and this may have practical implications for hemodynamic-guided device implantation. The optimal ventricular pacing site for patients with conventional indications for pacing remains controversial. The majority of them do not meet current clinical indications for CRT pacing. Thus, we carried out an analysis to compare the impact of several ventricular pacing sites on global and regional ventricular function and dyssynchrony (Chapter 6.c.). We observed that right ventricular pacing worsens cardiac function in patients with and without ventricular dysfunction unless the pacing site is optimized. CRT preserves left ventricular function in patients with normal ejection fraction and improves function in patients with poor ejection fraction despite no clinical indication for CRT. Moreover, the analysis of the results obtained using new indexes of regional dyssynchrony, suggests that pacing site may influence overall global ventricular function depending on its relative effects on regional function and synchrony. Another clinical problem that has been investigated in this work is the optimal right ventricular lead location for CRT (Chapter 6.d.). Similarly to the previous analysis, using novel parameters describing local synchrony and efficiency, we tested the hypothesis and we demonstrated that biventricular pacing with alternative right ventricular pacing sites produces acute improvement of ventricular systolic function and improves mechanical synchrony when compared to standard right ventricular pacing. Although no specific right ventricular location was shown to be superior during CRT, the right ventricular pacing site that produced the optimal acute hemodynamic response varied between patients. Acute hemodynamic effects of cardiac pacing are conventionally evaluated after stabilization episodes. The applied duration of stabilization periods in most cardiac pacing studies varied considerably. With an ad hoc protocol (Chapter 6.e.) and indexes of mechanical dyssynchrony derived by conductance catheter we demonstrated that the usage of stabilization periods during evaluation of cardiac pacing may mask early changes in systolic and diastolic intra-ventricular dyssynchrony. In fact, at the onset of ventricular pacing, the main dyssynchrony and ventricular performance changes occur within a 10s time span, initiated by the changes in ventricular mechanical dyssynchrony induced by aberrant conduction and followed by a partial or even complete recovery. It was already demonstrated in normal animals that ventricular mechanical dyssynchrony may act as a physiologic modulator of cardiac performance together with heart rate, contractile state, preload and afterload. The present observation, which shows the compensatory mechanism of mechanical dyssynchrony, suggests that ventricular dyssynchrony may be regarded as an intrinsic cardiac property, with baseline dyssynchrony at increased level in heart failure patients. To make available an independent system for cardiac output estimation, in order to confirm the results obtained with conductance volume method, we developed and validated a novel technique to apply the Modelflow method (a method that derives an aortic flow waveform from arterial pressure by simulation of a non-linear three-element aortic input impedance model, Wesseling et al. 1993) to the left ventricular pressure signal, instead of the arterial pressure used in the classical approach (Chapter 7.). The results confirmed that in patients without valve abnormalities, undergoing conductance catheter evaluations, the continuous monitoring of cardiac output using the intra-ventricular pressure signal is reliable. Thus, cardiac output can be monitored quantitatively and continuously with a simple and low-cost method. During this work, additional studies were carried out to investigate several areas of uncertainty of CRT. The results of these studies are briefly presented in Appendix: the long-term survival in patients treated with CRT in clinical practice, the effects of CRT in patients with mild symptoms of heart failure and in very old patients, the limited thoracotomy as a second choice alternative to transvenous implant for CRT delivery, the evolution and prognostic significance of diastolic filling pattern in CRT, the selection of candidates to CRT with echocardiographic criteria and the prediction of response to the therapy.

MCAO for Extremely Large Telescopes: the cases of LBT and E-ELT

Several MCAO systems are under study to improve the angular resolution of the current and of the future generation large ground-based telescopes (diameters in the 8-40 m range). The subject of this PhD Thesis is embedded in this context. Two MCAO systems, in dierent realization phases, are addressed in this Thesis: NIRVANA, the 'double' MCAO system designed for one of the interferometric instruments of LBT, is in the integration and testing phase; MAORY, the future E-ELT MCAO module, is under preliminary study. These two systems takle the sky coverage problem in two dierent ways. The layer oriented approach of NIRVANA, coupled with multi-pyramids wavefront sensors, takes advantage of the optical co-addition of the signal coming from up to 12 NGS in a annular 2' to 6' technical FoV and up to 8 in the central 2' FoV. Summing the light coming from many natural sources permits to increase the limiting magnitude of the single NGS and to improve considerably the sky coverage. One of the two Wavefront Sensors for the mid- high altitude atmosphere analysis has been integrated and tested as a stand- alone unit in the laboratory at INAF-Osservatorio Astronomico di Bologna and afterwards delivered to the MPIA laboratories in Heidelberg, where was integrated and aligned to the post-focal optical relay of one LINC-NIRVANA arm. A number of tests were performed in order to characterize and optimize the system functionalities and performance. A report about this work is presented in Chapter 2. In the MAORY case, to ensure correction uniformity and sky coverage, the LGS-based approach is the current baseline. However, since the Sodium layer is approximately 10 km thick, the articial reference source looks elongated, especially when observed from the edge of a large aperture. On a 30-40 m class telescope, for instance, the maximum elongation varies between few arcsec and 10 arcsec, depending on the actual telescope diameter, on the Sodium layer properties and on the laser launcher position. The centroiding error in a Shack-Hartmann WFS increases proportionally to the elongation (in a photon noise dominated regime), strongly limiting the performance. To compensate for this effect a straightforward solution is to increase the laser power, i.e. to increase the number of detected photons per subaperture. The scope of Chapter 3 is twofold: an analysis of the performance of three dierent algorithms (Weighted Center of Gravity, Correlation and Quad-cell) for the instantaneous LGS image position measurement in presence of elongated spots and the determination of the required number of photons to achieve a certain average wavefront error over the telescope aperture. An alternative optical solution to the spot elongation problem is proposed in Section 3.4. Starting from the considerations presented in Chapter 3, a first order analysis of the LGS WFS for MAORY (number of subapertures, number of detected photons per subaperture, RON, focal plane sampling, subaperture FoV) is the subject of Chapter 4. An LGS WFS laboratory prototype was designed to reproduce the relevant aspects of an LGS SH WFS for the E-ELT and to evaluate the performance of different centroid algorithms in presence of elongated spots as investigated numerically and analytically in Chapter 3. This prototype permits to simulate realistic Sodium proles. A full testing plan for the prototype is set in Chapter 4.

New insights into methodology and interpretation of osteoarthritis. The study of Frassetto identified skeletal collection.

Osteoarthritis (OA) or degenerative joint disease (DJD) is a pathology which affects the synovial joints and characterised by a focal loss of articular cartilage and subsequent bony reaction of the subcondral and marginal bone. Its etiology is best explained by a multifactorial model including: age, sex, genetic and systemic factors, other predisposing diseases and functional stress. In this study the results of the investigation of a modern identified skeletal collection will be presented. In particular, we will focus on the relationship between the presence of OA at various joints. The joint modifications have been analysed using a new methodology that allows the scoring of different degrees of expression of the features considered. Materials and Methods The sample examined comes from the Sassari identified skeletal collection (part of “Frassetto collections”). The individuals were born between 1828 and 1916 and died between 1918 and 1932. Information about sex and age is known for all the individuals. The occupation is known for 173 males and 125 females. Data concerning the occupation of the individuals indicate a preindustrial and rural society. OA has been diagnosed when eburnation (EB) or loss of morphology (LM) were present, or when at least two of the following: marginal lipping (ML), esostosis (EX) or erosion (ER), were present. For each articular surface affected a “mean score” was calculated, reflecting the “severity” of the alterations. A further “score” was calculated for each joint. In the analysis sexes and age classes were always kept separate. For the statistical analyses non parametric test were used. Results The results show there is an increase of OA with age in all the joints analyzed and in particular around 50 years and 60 years. The shoulder, the hip and the knee are the joints mainly affected with ageing while the ankle is the less affected; the correlation values confirm this result. The lesion which show the major correlation with age is the ML. In our sample males are more frequently and more severely affected by OA than females, particularly at the superior limbs, while hip and knee are similarly affected in the two sexes. Lateralization shows some positive results in particular in the right shoulder of males and in various articular surfaces especially of the superior limb of both males and females; articular surfaces and joints are quite always lateralized to the right. Occupational analyses did not show remarkable results probably because of the homogeneity of the sample; males although performing different activities are quite all employed in stressful works. No highest prevalence of knee and hip OA was found in farm-workers respect to the other males. Discussion and Conclusion In this work we propose a methodology to score the different features, necessary to diagnose OA, that allows the investigation of the severity of joint degeneration. This method is easier than the one proposed by Buikstra and Ubelaker (1994), but in the same time allows a quite detailed recording of the features. Epidemiological results can be interpreted quite simply and they are in accordance with other studies; more difficult is the interpretation of the occupational results because many questions concerning the activities performed by the individuals of the collection during their lifespan cannot be solved. Because of this, caution is suggested in the interpretation of bioarcheological specimens. With this work we hope to contribute to the discussion on the puzzling problem of the etiology of OA. The possibility of studying identified skeletons will add important data to the description of osseous features of OA, enriching the medical documentation, based on different criteria. Even if we are aware that the clinical diagnosis is different from the palaeopathological one we think our work will be useful in clarifying some epidemiological as well as pathological aspects of OA.

Tectonic geomorphology and active strain of the Northern Apennines mountain front

The Northern Apennines (NA) chain is the expression of the active plate margin between Europe and Adria. Given the low convergence rates and the moderate seismic activity, ambiguities still occur in defining a seismotectonic framework and many different scenarios have been proposed for the mountain front evolution. Differently from older models that indicate the mountain front as an active thrust at the surface, a recently proposed scenario describes the latter as the frontal limb of a long-wavelength fold (> 150 km) formed by a thrust fault tipped around 17 km at depth, and considered as the active subduction boundary. East of Bologna, this frontal limb is remarkably very straight and its surface is riddled with small, but pervasive high- angle normal faults. However, west of Bologna, some recesses are visible along strike of the mountain front: these perturbations seem due to the presence of shorter wavelength (15 to 25 km along strike) structures showing both NE and NW-vergence. The Pleistocene activity of these structures was already suggested, but not quantitative reconstructions are available in literature. This research investigates the tectonic geomorphology of the NA mountain front with the specific aim to quantify active deformations and infer possible deep causes of both short- and long-wavelength structures. This study documents the presence of a network of active extensional faults, in the foothills south and east of Bologna. For these structures, the strain rate has been measured to find a constant throw-to-length relationship and the slip rates have been compared with measured rates of erosion. Fluvial geomorphology and quantitative analysis of the topography document in detail the active tectonics of two growing domal structures (Castelvetro - Vignola foothills and the Ghiardo plateau) embedded in the mountain front west of Bologna. Here, tilting and river incision rates (interpreted as that long-term uplift rates) have been measured respectively at the mountain front and in the Enza and Panaro valleys, using a well defined stratigraphy of Pleistocene to Holocene river terraces and alluvial fan deposits as growth strata, and seismic reflection profiles relationships. The geometry and uplift rates of the anticlines constrain a simple trishear fault propagation folding model that inverts for blind thrust ramp depth, dip, and slip. Topographic swath profiles and the steepness index of river longitudinal profiles that traverse the anti- clines are consistent with stratigraphy, structures, aquifer geometry, and seismic reflection profiles. Available focal mechanisms of earthquakes with magnitude between Mw 4.1 to 5.4, obtained from a dataset of the instrumental seismicity for the last 30 years, evidence a clear vertical separation at around 15 km between shallow extensional and deeper compressional hypocenters along the mountain front and adjacent foothills. In summary, the studied anticlines appear to grow at rates slower than the growing rate of the longer- wavelength structure that defines the mountain front of the NA. The domal structures show evidences of NW-verging deformation and reactivations of older (late Neogene) thrusts. The reconstructed river incision rates together with rates coming from several other rivers along a 250 km wide stretch of the NA mountain front and recently available in the literature, all indicate a general increase from Middle to Late Pleistocene. This suggests focusing of deformation along a deep structure, as confirmed by the deep compressional seismicity. The maximum rate is however not constant along the mountain front, but varies from 0.2 mm/yr in the west to more than 2.2 mm/yr in the eastern sector, suggesting a similar (eastward-increasing) trend of the apenninic subduction.

Hepatobiliary diseases in small animals: a comparison of ultrasonography and multidetector-row computed tomography

Ultrasonography (US) is an essential imaging tool for identifying abnormalities of the liver parenchyma, biliary tract and vascular system. US has replaced radiography as the initial imaging procedure in screening for liver disease in small animals. There are few reports of the use of conventional and helical computed tomography (CT) to assess canine or feline parenchymal and neoplastic liver disease and biliary disorders. In human medicine the development of multidetector- row helical computed tomography (MDCT), with its superior spatial and temporal resolution, has resulted in improved detection and characterization of diffuse and focal liver lesions. The increased availability of MDCT in veterinary practice provides incentive to develop MDCT protocols for liver imaging in small animals. The purpose of this study is to assess the rule of MDCT in the characterization of hepatobiliary diseases in small animals; and to compare this method with conventional US. Candidates for this prospective study were 175 consecutive patients (dogs and cats) referred for evaluation of hepatobiliary disease. The patients underwent liver US and MDCT. Percutaneous needle biopsy was performed on all liver lesions or alterations encountered. As for gallbladder, histopatological evaluation was obtained from cholecystectomy specimens. Ultrasonographic findings in this study agreed well with those of previous reports. A protocol for dual-phase liver MDCT in small animals has been described. MDCT findings in parenchymal disorders of the liver, hepatic neoplasia and biliary disorders are here first described in dogs and cats and compared with the corresponding features in human medicine. The ability of MDCT in detection and characterization of hepatobiliary diseases in small animals is overall superior to conventional US. Ultrasonography and MDCT scanning, however, play complementary rules in the evaluation of these diseases. Many conditions have distinctive imaging features that may permit diagnosis. In most instances biopsy is required for definitive diagnosis.

Detailed study of the seismotectonic setting in the Lucanian Apennines and surrounding areas (Southern Italy)

In this research work I analyzed the instrumental seismicity of Southern Italy in the area including the Lucanian Apennines and Bradano foredeep, making use of the most recent seismological database available so far. I examined the seismicity occurred during the period between 2001 and 2006, considering 514 events with magnitudes M ≥ 2.0. In the first part of the work, P- and S-wave arrival times, recorded by the Italian National Seismic Network (RSNC) operated by the Istituto Nazionale di Geofisica e Vulcanologia (INGV), were re-picked along with those of the SAPTEX temporary array (2001–2004). For some events located in the Upper Val d'Agri, I also used data from the Eni-Agip oil company seismic network. I computed the VP/VS ratio obtaining a value of 1.83 and I carried out an analysis for the one-dimensional (1D) velocity model that approximates the seismic structure of the study area. After this preliminary analysis, making use of the records obtained in the SeSCAL experiment, I incremented the database by handpicking new arrival times. My final dataset consists of 15,666 P- and 9228 S-arrival times associated to 1047 earthquakes with magnitude ML ≥ 1.5. I computed 162 fault-plane solutions and composite focal mechanisms for closely located events. I investigated stress field orientation inverting focal mechanism belonging to the Lucanian Apennine and the Pollino Range, both areas characterized by more concentrated background seismicity. Moreover, I applied the double difference technique (DD) to improve the earthquake locations. Considering these results and different datasets available in the literature, I carried out a detailed analysis of single sub-areas and of a swarm (November 2008) recorded by SeSCAL array. The relocated seismicity appears more concentrated within the upper crust and it is mostly clustered along the Lucanian Apennine chain. In particular, two well-defined clusters were located in the Potentino and in the Abriola-Pietrapertosa sector (central Lucanian region). Their hypocentral depths are slightly deeper than those observed beneath the chain. I suggest that these two seismic features are representative of the transition from the inner portion of the chain with NE-SW extension to the external margin characterized by dextral strike-slip kinematics. In the easternmost part of the study area, below the Bradano foredeep and the Apulia foreland, the seismicity is generally deeper and more scattered and is associated to the Murge uplift and to the small structures present in the area. I also observed a small structure NE-SW oriented in the Abriola-Pietrapertosa area (activated with a swarm in November 2008) that could be considered to act as a barrier to the propagation of a potential rupture of an active NW-SE striking faults system. Focal mechanisms computed in this study are in large part normal and strike-slip solutions and their tensional axes (T-axes) have a generalized NE-SW orientation. Thanks to denser coverage of seismic stations and the detailed analysis, this study is a further contribution to the comprehension of the seismogenesis and state of stress of the Southern Apennines region, giving important contributions to seismotectonic zoning and seismic hazard assessment.

Analysis of human body kinematics using a hybrid markerless video acquisition and processing

A main objective of the human movement analysis is the quantitative description of joint kinematics and kinetics. This information may have great possibility to address clinical problems both in orthopaedics and motor rehabilitation. Previous studies have shown that the assessment of kinematics and kinetics from stereophotogrammetric data necessitates a setup phase, special equipment and expertise to operate. Besides, this procedure may cause feeling of uneasiness on the subjects and may hinder with their walking. The general aim of this thesis is the implementation and evaluation of new 2D markerless techniques, in order to contribute to the development of an alternative technique to the traditional stereophotogrammetric techniques. At first, the focus of the study has been the estimation of the ankle-foot complex kinematics during stance phase of the gait. Two particular cases were considered: subjects barefoot and subjects wearing ankle socks. The use of socks was investigated in view of the development of the hybrid method proposed in this work. Different algorithms were analyzed, evaluated and implemented in order to have a 2D markerless solution to estimate the kinematics for both cases. The validation of the proposed technique was done with a traditional stereophotogrammetric system. The implementation of the technique leads towards an easy to configure (and more comfortable for the subject) alternative to the traditional stereophotogrammetric system. Then, the abovementioned technique has been improved so that the measurement of knee flexion/extension could be done with a 2D markerless technique. The main changes on the implementation were on occlusion handling and background segmentation. With the additional constraints, the proposed technique was applied to the estimation of knee flexion/extension and compared with a traditional stereophotogrammetric system. Results showed that the knee flexion/extension estimation from traditional stereophotogrammetric system and the proposed markerless system were highly comparable, making the latter a potential alternative for clinical use. A contribution has also been given in the estimation of lower limb kinematics of the children with cerebral palsy (CP). For this purpose, a hybrid technique, which uses high-cut underwear and ankle socks as “segmental markers” in combination with a markerless methodology, was proposed. The proposed hybrid technique is different than the abovementioned markerless technique in terms of the algorithm chosen. Results showed that the proposed hybrid technique can become a simple and low-cost alternative to the traditional stereophotogrammetric systems.

Fault delineation and stress orientations from the analysis of background, low magnitude seismicity in Southern Apennines (Italy)

The aim of this work was to show that refined analyses of background, low magnitude seismicity allow to delineate the main active faults and to accurately estimate the directions of the regional tectonic stress that characterize the Southern Apennines (Italy), a structurally complex area with high seismic potential. Thanks the presence in the area of an integrated dense and wide dynamic network, was possible to analyzed an high quality microearthquake data-set consisting of 1312 events that occurred from August 2005 to April 2011 by integrating the data recorded at 42 seismic stations of various networks. The refined seismicity location and focal mechanisms well delineate a system of NW-SE striking normal faults along the Apenninic chain and an approximately E-W oriented, strike-slip fault, transversely cutting the belt. The seismicity along the chain does not occur on a single fault but in a volume, delimited by the faults activated during the 1980 Irpinia M 6.9 earthquake, on sub-parallel predominant normal faults. Results show that the recent low magnitude earthquakes belongs to the background seismicity and they are likely generated along the major fault segments activated during the most recent earthquakes, suggesting that they are still active today thirty years after the mainshock occurrences. In this sense, this study gives a new perspective to the application of the high quality records of low magnitude background seismicity for the identification and characterization of active fault systems. The analysis of the stress tensor inversion provides two equivalent models to explain the microearthquake generation along both the NW-SE striking normal faults and the E- W oriented fault with a dominant dextral strike-slip motion, but having different geological interpretations. We suggest that the NW-SE-striking Africa-Eurasia convergence acts in the background of all these structures, playing a primary and unifying role in the seismotectonics of the whole region.

Anatomic study of the feline bronchial and vascular structures with a 64 detector-row computed tomography

Multidetector row computed tomography over the last decade is commonly used in veterinary medicine. This new technology has an increased spatial and temporal resolution, could evaluate wider scanning range in shorter scanning time, providing an advanced imaging modality. Computed tomography angiographic studies are commonly used in veterinary medicine in order to evaluate vascular structures of the abdomen and the thorax. Pulmonary pathology in feline patients is a very common condition and usually is further evaluating with computed tomography. Up to date few references of the normal computed tomographic aspects of the feline thorax are reported. In this study a computed tomographic pulmonary angiography (CTPA) protocol is reported in normal cats and is compared with the up to date anatomical references. A CTPA protocol using a 64 MDCT in our study achieved high resolution images of the pulmonary arteries, pulmonary veins and bronchial lumen till the level of minor segmental branches. Feline pulmonary bronchial parenchyma demonstrates an architecture of mixed type with a monopedial model observed in the most anatomical parts and the dichotomic aspect is seen at the accessory lobe. The arterial and venous architecture is similar to the bronchial. Statistical analysis demonstrates the linear correlation of tracheal diameter to the felines weight. Vascular variations were noticed. The pulmonary venous system enters into the left atrium through three ostia (left cranial ostia: consisted of the anastomosis of the cranial and caudal portion of the left cranial pulmonary vein; right ostia: consisted of the anastomosis of the right cranial and middle pulmonary vein; and the caudal ostia: consisted of the anastomosis of the right and left caudal pulmonary vein). In conclusion CTPA is applicable in feline patients and provides an excellent imaging of the pulmonary arterial, venous and bronchial system till the level of minor segmental branches.

From inverted pendulum to N-link chain: inertial sensors-based assessment of movement kinematics and dynamics for functional evaluation and rehabilitation

Despite several clinical tests that have been developed to qualitatively describe complex motor tasks by functional testing, these methods often depend on clinicians' interpretation, experience and training, which make the assessment results inconsistent, without the precision required to objectively assess the effect of the rehabilitative intervention. A more detailed characterization is required to fully capture the various aspects of motor control and performance during complex movements of lower and upper limbs. The need for cost-effective and clinically applicable instrumented tests would enable quantitative assessment of performance on a subject-specific basis, overcoming the limitations due to the lack of objectiveness related to individual judgment, and possibly disclosing subtle alterations that are not clearly visible to the observer. Postural motion measurements at additional locations, such as lower and upper limbs and trunk, may be necessary in order to obtain information about the inter-segmental coordination during different functional tests involved in clinical practice. With these considerations in mind, this Thesis aims: i) to suggest a novel quantitative assessment tool for the kinematics and dynamics evaluation of a multi-link kinematic chain during several functional motor tasks (i.e. squat, sit-to-stand, postural sway), using one single-axis accelerometer per segment, ii) to present a novel quantitative technique for the upper limb joint kinematics estimation, considering a 3-link kinematic chain during the Fugl-Meyer Motor Assessment and using one inertial measurement unit per segment. The suggested methods could have several positive feedbacks from clinical practice. The use of objective biomechanical measurements, provided by inertial sensor-based technique, may help clinicians to: i) objectively track changes in motor ability, ii) provide timely feedback about the effectiveness of administered rehabilitation interventions, iii) enable intervention strategies to be modified or changed if found to be ineffective, and iv) speed up the experimental sessions when several subjects are asked to perform different functional tests.

Treatment of knee articular cartilage defects: surgical strategies, results and analysis of factors determining the clinical outcome

Articular cartilage lesions, with their inherent limited healing potential, are hard to treat and remain a challenging problem for orthopedic surgeons. Despite the development of several treatment strategies, the real potential of each procedure in terms of clinical benefit and effects on the joint degeneration processes is not clear. Aim of this PhD project was to evaluate the results, both in terms of clinical and imaging improvement, of new promising procedures developed to address the challenging cartilage pathology. Several studies have been followed in parallel and completed over the 3-year PhD, and are reported in detail in the following pages. In particular, the studies have been focused on the evaluation of the treatment indications of a scaffold based autologous chondrocyte implantation procedure, documenting its results for the classic indication of focal traumatic lesions, as well as its use for the treatment of more challenging patients, older, with degenerative lesions, or even as salvage procedure for more advanced stages of articular degeneration. The second field of study involved the analysis of the results obtained treating lesions of the articular surface with a new biomimetic osteochondral scaffold, which showed promise for the treatment of defects where the entire osteochondral unit is involved. Finally, a new minimally invasive procedure based on the use of growth factors derived from autologous platelets has been explored, showing results and underlining indicatios for the treatment of cartilage lesions and different stages of joint degeneration. These studies shed some light on the potential of the evaluated procedures, underlining good results as well as limits, they give some indications on the most appropriate candidates for their application, and document the current knowledge on cartilage treatment procedures suggesting the limitations that need to be addressed by future studies to improve the management of cartilage lesions.

Obsessed With Work: A multi-causal and multi-rater approach to workaholism

Workaholism is defined as the combination of two underlying dimensions: working excessively and working compulsively. The present thesis aims at achieving the following purposes: 1) to test whether the interaction between environmental and personal antecedents may enhance workaholism; 2) to develop a questionnaire aimed to assess overwork climate in the workplace; 3) to contrast focal employees’ and coworkers’ perceptions of employees’ workaholism and engagement. Concerning the first purpose, the interaction between overwork climate and person characteristics (achievement motivation, perfectionism, conscientiousness, self-efficacy) was explored on a sample of 333 Dutch employees. The results of moderated regression analyses showed that the interaction between overwork climate and person characteristics is related to workaholism. The second purpose was pursued with two interrelated studies. In Study 1 the Overwork Climate Scale (OWCS) was developed and tested using a principal component analysis (N = 395) and a confirmatory factor analysis (N = 396). Two overwork climate dimensions were distinguished, overwork endorsement and lacking overwork rewards. In Study 2 the total sample (N = 791) was used to explore the association of overwork climate with two types of working hard: work engagement and workaholism. Lacking overwork rewards was negatively associated with engagement, whereas overwork endorsement showed a positive association with workaholism. Concerning the third purpose, using a sample of 73 dyads composed by focal employees and their coworkers, a multitrait-multimethod matrix and a correlated trait-correlated method model, i.e. the CT-C(M–1) model, were examined. Our results showed a considerable agreement between raters on focal employees' engagement and workaholism. In contrast, we observed a significant difference concerning the cognitive dimension of workaholism, working compulsively. Moreover, we provided further evidence for the discriminant validity between engagement and workaholism. Overall, workaholism appears as a negative work-related state that could be better explained by assuming a multi-causal and multi-rater approach.

The vulnerable carotid plaque. Identification of endothelial markers predictive of plaque weakness, rupture predisposition and neoangiogenesis

Background. Neoangiogenesis is crucial in plaque progression and instability. Previous data from our group demonstrated that intra-plaque neovessels show both a Nestin+/WT+ and a Nestin+/WT1- phenotype, the latter being correlated with complications and plaque instability. Aims. The aims of the present thesis are: (i) to confirm our previous results on Nestin/WT1 phenotype in a larger series of carotid atheromatous plaques, (ii) to evaluate the relationship between the Nestin+/WT1- neoangiogenesis phenotype and plaque morphology, (iii) to evaluate the relationship between the immunohistochemical and histopathological characteristics and the clinical instability of the plaques. Materials and Methods. Seventy-three patients (53 males, 20 females, mean age 71 years) were consecutively enrolled. Symptoms, brain CT scan, 14 histological variables, including intraplaque hemorrhage and diffuse calcifications, were collected. Immunohistochemistry for CD34, Nestin and WT1 was performed. RT-PCR was performed to evaluate Nestin and WT1 mRNA (including 5 healthy arteries as controls). Results. Diffusely calcified plaques (13 out of 73) were found predominantly in females (P=0.017), with a significantly lower incidence of symptoms (TIA/stroke) and brain focal lesions (P=0.019 and P=0.013 respectively) than not-calcified plaques, but with the same incidence of intraplaque complications (P=0.156). Accordingly, both calcified and not calcified plaques showed similar mean densities of positivity for CD34, Nestin and WT1. The density of Nestin and WT1 correlated with the occurrence of intra-plaque hemorrhage in all cases, while the density of CD34 correlated only in not-calcified plaques. Conclusions. We confirmed that the Nestin+/WT1- phenotype characterizes the neovessels of instable plaques, regardless the real amount of CD34-positive neoangiogenesis. The calcified plaques show the same incidence of histological complications, albeit they do not influence symptomatology and plaque vulnerability. Female patients show a much higher incidence of not-complicated or calcified plaques, receiving de facto a sort of protection compared to male patients.

A Law and Economics Analysis of Trade Secrets: Optimal Scope of Law, Misappropriation and Alternative Damages Regimes

This thesis is primarily based on three core chapters, focused on the fundamental issues of trade secrets law. The goal of this thesis is to come up with policy recommendations to improve legal structure governing trade secrets. The focal points of this research are the following. What is the optimal scope of trade secrets law? How does it depend on the market characteristics such as degree of product differentiation between competing products? What factors need to be considered to balance the contradicting objectives of promoting innovation and knowledge diffusion? The second strand of this research focuses on the desirability of lost profits or unjust enrichment damage regimes in case of misappropriation of a trade secret. A comparison between these regimes is made and simple policy implications are extracted from the analysis. The last part of this research is an empirical analysis of a possible relationship between trade secrets sharing and misappropriation instances faced by firms.