Kissing stenting of aortic bifurcation for aorto-iliac obstructive disease: a comparison between bare metal stents and covered stents

INTRODUCTION Aim of this multicentric study:to compare the short-and mid-term results of bare metal stents(BMS)and covered stents(CS)in the Kissing Stent(KS)technique. METHODS Patients undertaking a KS with BMS or CS between January 2017-August 2021 included. Morphological features of plaques were classified as per the extension of calcifications and thrombosis. Every endpoint and outcome was compared in relation to BMS or CS. All patients included received dual anti-platelets DAPT)for at least one month. RESULTS Thirty-four patients enrolled,17 treated with BMS and 17 with CS. Average age 66 years. The 80% of patients were part of TASC C-D categories. DAPT was administered to 82.4%(28/34)of patients with a mean duration of 4.4±1.6 months. Mean follow-up 32.1±17.8 months. Technical Success was 100%. Immediate Clinical Success was reached in 29 cases(85.3%). Immediate and 30-day Clinical Success was higher in CS(64.7% vs 100%, p=.01). Overall Clinical Success at 1-year follow-up was 91.2%,and resulted significantly higher in CS(82.4% vs 100%,p .04). Overall Primary Patency,Assisted Patency,and Secondary Patency at 30 days were 97.1%,97.1%,and 100%,without differences between BMS and CS(94.1% vs 100%,94.1% vs 100%,and 100% vs 100%;p =.7). Two cases(5.9%)of thrombosis were registered,and both occurred within 3 months after the procedure and both in the BMS,without statistical differences with the CS group(11.8% vs 0%,p .48). Both cases of thrombosis occurred in patients who were not treated with dual antiplatelet therapy(33.3% vs 0%,p .027). Survival statistically differed only at the mean follow-up in favour of CS(70.6% and 100%,p .04). CONCLUSIONS The endovascular approach is currently safe and effective in the treatment of AIOD,and KS offers excellent results in particular if performed with CS; however,no statistically significant differences emerged between the two types of stents in terms of patency,reintervention,and complications. DAPT seems to warrant the best results in terms of patency,although there is still no consensus about the ideal duration of administration.

Algorithms for network design and routing problems

In this thesis we study three combinatorial optimization problems belonging to the classes of Network Design and Vehicle Routing problems that are strongly linked in the context of the design and management of transportation networks: the Non-Bifurcated Capacitated Network Design Problem (NBP), the Period Vehicle Routing Problem (PVRP) and the Pickup and Delivery Problem with Time Windows (PDPTW). These problems are NP-hard and contain as special cases some well known difficult problems such as the Traveling Salesman Problem and the Steiner Tree Problem. Moreover, they model the core structure of many practical problems arising in logistics and telecommunications. The NBP is the problem of designing the optimum network to satisfy a given set of traffic demands. Given a set of nodes, a set of potential links and a set of point-to-point demands called commodities, the objective is to select the links to install and dimension their capacities so that all the demands can be routed between their respective endpoints, and the sum of link fixed costs and commodity routing costs is minimized. The problem is called non- bifurcated because the solution network must allow each demand to follow a single path, i.e., the flow of each demand cannot be splitted. Although this is the case in many real applications, the NBP has received significantly less attention in the literature than other capacitated network design problems that allow bifurcation. We describe an exact algorithm for the NBP that is based on solving by an integer programming solver a formulation of the problem strengthened by simple valid inequalities and four new heuristic algorithms. One of these heuristics is an adaptive memory metaheuristic, based on partial enumeration, that could be applied to a wider class of structured combinatorial optimization problems. In the PVRP a fleet of vehicles of identical capacity must be used to service a set of customers over a planning period of several days. Each customer specifies a service frequency, a set of allowable day-combinations and a quantity of product that the customer must receive every time he is visited. For example, a customer may require to be visited twice during a 5-day period imposing that these visits take place on Monday-Thursday or Monday-Friday or Tuesday-Friday. The problem consists in simultaneously assigning a day- combination to each customer and in designing the vehicle routes for each day so that each customer is visited the required number of times, the number of routes on each day does not exceed the number of vehicles available, and the total cost of the routes over the period is minimized. We also consider a tactical variant of this problem, called Tactical Planning Vehicle Routing Problem, where customers require to be visited on a specific day of the period but a penalty cost, called service cost, can be paid to postpone the visit to a later day than that required. At our knowledge all the algorithms proposed in the literature for the PVRP are heuristics. In this thesis we present for the first time an exact algorithm for the PVRP that is based on different relaxations of a set partitioning-like formulation. The effectiveness of the proposed algorithm is tested on a set of instances from the literature and on a new set of instances. Finally, the PDPTW is to service a set of transportation requests using a fleet of identical vehicles of limited capacity located at a central depot. Each request specifies a pickup location and a delivery location and requires that a given quantity of load is transported from the pickup location to the delivery location. Moreover, each location can be visited only within an associated time window. Each vehicle can perform at most one route and the problem is to satisfy all the requests using the available vehicles so that each request is serviced by a single vehicle, the load on each vehicle does not exceed the capacity, and all locations are visited according to their time window. We formulate the PDPTW as a set partitioning-like problem with additional cuts and we propose an exact algorithm based on different relaxations of the mathematical formulation and a branch-and-cut-and-price algorithm. The new algorithm is tested on two classes of problems from the literature and compared with a recent branch-and-cut-and-price algorithm from the literature.

Monooxygenases involved in the n-alkanes metabolism by Rhodococcus sp. BCP1: molecular characterization and expression of alkB gene

Bioremediation implies the use of living organisms, primarily microorganisms, to convert environmental contaminants into less toxic forms. The impact of the consequences of hydrocarbon release in the environment maintain a high research interest in the study of microbial metabolisms associated with the biodegradation of aromatic and aliphatic hydrocarbons but also in the analysis of microbial enzymes that can convert petroleum substrates to value-added products. The studies described in this Thesis fall within the research field that directs the efforts into identifying gene/proteins involved in the catabolism of n-alkanes and into studying the regulatory mechanisms leading to their oxidation. In particular the studies were aimed at investigating the molecular aspects of the ability of Rhodococcus sp. BCP1 to grow on aliphatic hydrocarbons as sole carbon and energy sources. We studied the ability of Rhodococcus sp. BCP1 to grow on gaseous (C2-C4), liquid (C5-C16) and solid (C17-C28) n-alkanes that resulted to be biochemically correlated with the activity of one or more monooxygenases. In order to identify the alkane monooxygenase that is involved in the n-alkanes degradation pathway in Rhodococcus sp. BCP1, PCR-based methodology was applied by using degenerate primers targeting AlkB monooxygenase family members. As result, a chromosomal region, including the alkB gene cluster, was cloned from Rhodococcus sp. BCP1 genome. We characterized the products of this alkB gene cluster and the products of the orfs included in the flanking regions by comparative analysis with the homologues in the database. alkB gene expression studies were carried out by RT-PCR and by the construction of a promoter probe vector containing the lacZ gene downstream of the alkB promoter. B-galactosidase assays revealed the alkB promoter activity induced by n-alkanes and by n-alkanes metabolic products. Furthermore, the transcriptional start of alkB gene was determined by primer extension procedure. A proteomic approach was subsequently applied to compare the protein patterns expressed by BCP1 growing on n-butane, n-hexane, n-hexadecane or n-eicosane with the protein pattern expressed by BCP1 growing on succinate. The accumulation of enzymes specifically induced on n-alkanes was determined. These enzymes were identified by tandem mass spectrometry (LC/MS/MS). Finally, a prm gene, homologue to the gene family coding for soluble di-iron monooxygenases (SDIMOs), has been isolated from Rhodococcus sp. BCP1 genome. This gene product could be involved in the degradation of gaseous n-alkanes in this Rhodococcus strain. The versatility in utilizing hydrocarbons and the discovery of new remarkable metabolic activities outline the potential applications of this microorganism in environmental and industrial biotechnologies.

Resonances in the two centers Coulomb system

In this work we investigate the existence of resonances for two-centers Coulomb systems with arbitrary charges in two and three dimensions, defining them in terms of generalized complex eigenvalues of a non-selfadjoint deformation of the two-center Schrödinger operator. After giving a description of the bifurcation of the classical system for positive energies, we construct the resolvent kernel of the operators and we prove that they can be extended analytically to the second Riemann sheet. The resonances are then defined and studied with numerical methods and perturbation theory.

Harnack inequalities in sub-Riemannian settings

In the present thesis, we discuss the main notions of an axiomatic approach for an invariant Harnack inequality. This procedure, originated from techniques for fully nonlinear elliptic operators, has been developed by Di Fazio, Gutiérrez, and Lanconelli in the general settings of doubling Hölder quasi-metric spaces. The main tools of the approach are the so-called double ball property and critical density property: the validity of these properties implies an invariant Harnack inequality. We are mainly interested in the horizontally elliptic operators, i.e. some second order linear degenerate-elliptic operators which are elliptic with respect to the horizontal directions of a Carnot group. An invariant Harnack inequality of Krylov-Safonov type is still an open problem in this context. In the thesis we show how the double ball property is related to the solvability of a kind of exterior Dirichlet problem for these operators. More precisely, it is a consequence of the existence of some suitable interior barrier functions of Bouligand-type. By following these ideas, we prove the double ball property for a generic step two Carnot group. Regarding the critical density, we generalize to the setting of H-type groups some arguments by Gutiérrez and Tournier for the Heisenberg group. We recognize that the critical density holds true in these peculiar contexts by assuming a Cordes-Landis type condition for the coefficient matrix of the operator. By the axiomatic approach, we thus prove an invariant Harnack inequality in H-type groups which is uniform in the class of the coefficient matrices with prescribed bounds for the eigenvalues and satisfying such a Cordes-Landis condition.

Il museo Wilhelm Lehmbruck: paradigma della nuova modernità nella Germania del secondo dopoguerra

Oggetto della ricerca è il museo Wilhelm Lehmbruck di Duisburg, un'opera dell'architetto Manfred Lehmbruck, progettata e realizzata tra il 1957 e il 1964. Questa architettura, che ospita la produzione artistica del noto scultore Wilhelm Lehmbruck, padre di Manfred, è tra i primi musei edificati ex novo nella Repubblica Federale Tedesca dopo la seconda guerra mondiale. Il mito di Wilhelm Lehmbruck, costruito negli anni per donare una identità culturale alla città industriale di Duisburg, si rinvigorì nel secondo dopoguerra in seno ad una più generale tendenza sorta nella Repubblica di Bonn verso la rivalutazione dell'arte moderna, dichiarata “degenerata” dal nazionalsocialismo. Ricollegarsi all'arte e all'architettura moderna degli anni venti era in quel momento funzionale al ridisegno di un volto nuovo e democratico del giovane stato tedesco, che cercava legittimazione proclamandosi erede della mitica e gloriosa Repubblica di Weimar. Dopo anni di dibattiti sulla ricostruzione, l'architettura del neues Bauen sembrava l'unico modo in cui la Repubblica Federale potesse presentarsi al mondo, anche se la realtà del paese era assai più complessa e svelava il “doppio volto” che connotò questo stato a partire dal 1945. Le numerose dicotomie che popolarono presto la tabula rasa nata dalle ceneri del conflitto (memoria/oblio, tradizione/modernità, continuità/discontinuità con il recente e infausto passato) trovano espressione nella storia e nella particolare architettura del museo di Duisburg, che può essere quindi interpretato come un'opera paradigmatica per comprendere la nuova identità della Repubblica Federale, un'identità che la rese capace di risorgere dopo l' “anno zero”, ricercando nel miracolo economico uno strumento di redenzione da un passato vergognoso, che doveva essere taciuto, dimenticato, lasciato alle spalle.

Cosmic-Lab: Optical companions to binary Millisecond Pulsars

Millisecond Pulsars (MSPs) are fast rotating, highly magnetized neutron stars. According to the "canonical recycling scenario", MSPs form in binary systems containing a neutron star which is spun up through mass accretion from the evolving companion. Therefore, the final stage consists of a binary made of a MSP and the core of the deeply peeled companion. In the last years, however an increasing number of systems deviating from these expectations has been discovered, thus strongly indicating that our understanding of MSPs is far to be complete. The identification of the optical companions to binary MSPs is crucial to constrain the formation and evolution of these objects. In dense environments such as Globular Clusters (GCs), it also allows us to get insights on the cluster internal dynamics. By using deep photometric data, acquired both from space and ground-based telescopes, we identified 5 new companions to MSPs. Three of them being located in GCs and two in the Galactic Field. The three new identifications in GCs increased by 50% the number of such objects known before this Thesis. They all are non-degenerate stars, at odds with the expectations of the "canonical recycling scenario". These results therefore suggest either that transitory phases should also be taken into account, or that dynamical processes, as exchange interactions, play a crucial role in the evolution of MSPs. We also performed a spectroscopic follow-up of the companion to PSRJ1740-5340A in the GC NGC 6397, confirming that it is a deeply peeled star descending from a ~0.8Msun progenitor. This nicely confirms the theoretical expectations about the formation and evolution of MSPs.