Valutazione dell'impatto della farmacogenetica in ambito di Sanità Pubblica. Analisi del polimorfismo genetico dell'enzima CYP2D6 metabolizzante xenobiotici.

Pharmacogenetic testing provides an outstanding opportunity to improve prescribing safety and efficacy. In Public health policy pharmacogenetics is relevant for personalized therapy and to maximize therapeutic benefit minimizing adverse events. CYP2D6 is known to be a key enzyme responsible for the biotransformation of about 25-30% of extensively used drugs and genetic variations in genes coding for drug-metabolizing enzymes might lead to adverse drug reactions, toxicity or therapeutic failure of pharmacotherapy. Significant interethnic differences in CYP2D6 allele distribution are well established, but immigration is reshaping the genetic background due to interethnic admixture which introduces variations in individual ancestry resulting in distinct level of population structure. The present thesis deals with the genetic determination of the CYP2D6 alleles actually present in the Emilia-Romagna resident population providing insights into the admixture process. A random sample of 122 natives and 175 immigrants from Africa, Asia and South America where characterized considering the present scenario of migration and back migration events. The results are consistent with the known interethnic genetic variation, but introduction of ethnic specific variants by immigrants predicts a heterogeneous admixed population scenario requiring, for drugs prescription and pharmacogenetics studies, an interdisciplinary approach applied in a properly biogeographical and anthropological frame. To translate pharmacogenetics knowledge into clinical practice requires appropriated public health policies, possibly guiding clinicians to evaluate prospectively which patients have the greatest probability of expressing a variant genotype.

Die psychologische Kampfführung

Nach dem Ende des Zweiten Weltkriegs wurden auf dem Gebiet der Bundesrepublik Deutschland zahlreiche Organisationen gegründet, die es sich zur Aufgabe machten, auf die Meinungsbildung im Osten und Westen Einfluss zu nehmen. Dazu zählte von 1957 bis 1990 die Psychologische Kampfführung / Psychologische Verteidigung der Bundeswehr (PSK/PSV). Ihr primäres Ziel war es, das Staats- und Gesellschaftssystem der Bundesrepublik nach innen und außen zu konsolidieren. Der Dissertationsschrift liegt ein interdisziplinärer Ansatz zugrunde: Zum einen wird die PSK/PSV im Kontext der Propagandageschichte und -theorie dargestellt und untersucht – von diesem Standpunkt aus betrachtet handelt es sich um eine publizistikwissenschaftliche Untersuchung. Zum anderen wird die Wirklichkeit der PSK/PSV mit erziehungswissenschaftlichen Begriffen beschrieben, analysiert und unter pädagogischen Gesichtspunkten diskutiert – aus dieser Sichtweise liegt hier eine erziehungswissenschaftliche Untersuchung vor. Die PSK/PSV stand historisch betrachtet keineswegs im wertfreien Raum. Vor allem die Ausprägungen von Propaganda im Dritten Reich – aber auch in der Deutschen Demokratischen Republik – spielten für die PSK/PSV eine bedeutende Rolle. Sie waren gewissermaßen stets zu meidende (politische) rechte und linke Grenze in dem Unterfangen, eine eigene Form von Propaganda zu entwickeln und zu betreiben. Die PSK/PSV wirkte unter politischer Zielsetzung auf Einstellungen und Verhalten von Personen beiderseits des Eisernen Vorhangs ein. Ihre Aktivitäten weisen in auffälliger Weise Schnittmengen zu Feldern der Erziehung auf. Die unterschiedlichen pädagogischen Programme und Strategien der vier PSK/PSV-Bereiche – (1) Lehr- und Forschungsstätten, (2) PSK/PSV-Truppe, (3) Deutsche Gesellschaft für Sozialbeziehungen e.V. und (4) Studiengesellschaft für Zeitprobleme e.V. – werden in der Dissertationsschrift dargestellt, analysiert und bewertet. In den Schlussbetrachtungen wird unter pädagogischen Gesichtspunkten diskutiert, ob der in Presse und Politik geäußerte Vorwurf einer Nähe der PSK/PSV zur Propaganda und Erziehung im Dritten Reich haltbar ist.

Dalla "postmémoire" alla scrittura dell'oblio nell'opera di Sylvie Germain

La tesi intitolata "Dalla «postmémoire» alla scrittura dell’oblio nell’opera di Sylvie Germain" si pone l’obbiettivo di analizzare l’opera della scrittrice francese contemporanea Sylvie Germain alla luce di alcune elaborazioni teoriche sulla dialettica memoria/oblio. Basandoci sulle principali teorie-guida relative alla «memoria culturale» teorizzate da Maurice Halbwachs,Pierre Nora,Tzvetan Todorov,Paul Ricoeur e Aleida Assmann,la nostra analisi si è successivamente concentrata sugli studi condotti attorno al concetto di «postmemory» elaborato dalla studiosa americana Marianne Hirsch. Scopo di questa prospettiva critica è quello di leggere l'opera germainiana come espressione di una «affiliative postmemory», risultato della connessione generazionale di coloro che non hanno vissuto direttamente un trauma con la «literal second generation». Attraverso un approccio interdisciplinare che ha coinvolto gli studi sulla memoria culturale in rapporto alla questione del gender, si è inoltre evidenziata la specificità del ruolo rivestito dai personaggi femminili nei romanzi di Germain che assumono un peso determinante nella trasmissione della memoria individuale e collettiva, studio che ci ha permesso di sottolineare la funzione attiva svolta dalle protagoniste delle opere della scrittrice. Nella fase conclusiva sono state esaminate le opere più recenti di Sylvie Germain pubblicate tra il 2008 e il 2011 in cui l’autrice sembra avvertire la necessità di controbilanciare il peso della «troppa memoria» con una giusta dose di oblio. Sono state inoltre affrontate la questione della responsabilità etica e l’idea di debito nei confronti della memoria familiare e collettiva: la scrittura stessa diventa così per Germain lo strumento attraverso il quale l’autrice assume il ruolo di passeuse de mémoire per le generazioni future.

Oltre Oceano: Altri orizzonti del possibile. Epistemiologie di Abya Yala e progettualità esistenziale “Lekil Kuxlejal,Sumak Kawsay, Kajkrasa Ruyina”. Filosofie della Terra per una Pedagogia del Buen Vivir

Questo elaborato propone alcune riflessioni sulla necessità urgente di un nuovo paradigma educativo, mediante la re-organizzazione delle scienze della conoscenza, scienze in parole di Morin, “disgiunte e frazionate, inadeguate ad affrontare problemi che richiedono oggi approcci multidisciplinari”. La sfida: affrontare i nuovi problemi di una convivenza planetaria, attraverso le connessioni del pensiero ecologico, in questo studio asse centrale delle cosmovisioni e della Sapienza ancestrale dei Popoli di AbyaYala (America Latina). Popoli in cui la Vita come orizzonte di Armonia ed Equilibrio si concretizza in pratiche di Vita Quotidiana grazie ad una Pedagogia del BuenVivir, inclusiva e partecipativa, rispettosa della diversità biologica e delle differenze culturali, nonché della Sacralità della Terra e della Vita in tutte le sue manifestazioni. La cornice teorica considerata fa riferimento in modo particolare a: L’Ecologia della Mente (Bateson); Il problematicismo Pedagogico e l’Educazione alla Progettualità Esistenziale (G.M.Bertin, Contini); l’Ecologia dei Saperi e le Epistemologie del Sud (Boaventura di Sousa Santos, sociologo portoghese), in modo da tessere ponti di dialogo fra le diverse discipline, in particolare fra la pedagogia, la geografia, l’antropologia, la filosofia, la sociologia, la letteratura, il diritto e anche con le neuroscienze.

Il ruolo della metafora nella comunicazione della fisica contemporanea

Il presente lavoro si rivolge all’analisi del ruolo delle forme metaforiche nella divulgazione della fisica contemporanea. Il focus è sugli aspetti cognitivi: come possiamo spiegare concetti fisici formalmente complessi ad un audience di non-esperti senza ‘snaturarne’ i significati disciplinari (comunicazione di ‘buona fisica’)? L’attenzione è sulla natura stessa della spiegazione e il problema riguarda la valutazione dell’efficacia della spiegazione scientifica a non-professionisti. Per affrontare tale questione, ci siamo orientati alla ricerca di strumenti formali che potessero supportarci nell’analisi linguistica dei testi. La nostra attenzione si è rivolta al possibile ruolo svolto dalle forme metaforiche nella costruzione di significati disciplinarmente validi. Si fa in particolare riferimento al ruolo svolto dalla metafora nella comprensione di nuovi significati a partire da quelli noti, aspetto fondamentale nel caso dei fenomeni di fisica contemporanea che sono lontani dalla sfera percettiva ordinaria. In particolare, è apparsa particolarmente promettente come strumento di analisi la prospettiva della teoria della metafora concettuale. Abbiamo allora affrontato il problema di ricerca analizzando diverse forme metaforiche di particolare rilievo prese da testi di divulgazione di fisica contemporanea. Nella tesi viene in particolare discussa l’analisi di un case-study dal punto di vista della metafora concettuale: una analogia di Schrödinger per la particella elementare. I risultati dell’analisi suggeriscono che la metafora concettuale possa rappresentare uno strumento promettente sia per la valutazione della qualità delle forme analogiche e metaforiche utilizzate nella spiegazione di argomenti di fisica contemporanea che per la creazione di nuove e più efficaci metafore. Inoltre questa prospettiva di analisi sembra fornirci uno strumento per caratterizzare il concetto stesso di ‘buona fisica’. Riteniamo infine che possano emergere altri risultati di ricerca interessanti approfondendo l’approccio interdisciplinare tra la linguistica e la fisica.

Teos-based consolidants for stone conservation: evaluation of the effects and testing by x-ray imaging

Natural stones have been widely used in the construction field since antiquity. Building materials undergo decay processes due to mechanical,chemical, physical and biological causes that can act together. Therefore an interdisciplinary approach is required in order to understand the interaction between the stone and the surrounding environment. Utilization of buildings, inadequate restoration activities and in general anthropogenic weathering factors may contribute to this degradation process. For this reasons, in the last few decades new technologies and techniques have been developed and introduced in the restoration field. Consolidants are largely used in restoration and conservation of cultural heritage in order to improve the internal cohesion and to reduce the weathering rate of building materials. It is important to define the penetration depth of a consolidant for determining its efficacy. Impregnation mainly depends on the microstructure of the stone (i.e. porosity) and on the properties of the product itself. Throughout this study, tetraethoxysilane (TEOS) applied on globigerina limestone samples has been chosen as object of investigation. After hydrolysis and condensation, TEOS deposits silica gel inside the pores, improving the cohesion of the grains. X-ray computed tomography has been used to characterize the internal structure of the limestone samples,treated and untreated with a TEOS-based consolidant. The aim of this work is to investigate the penetration depth and the distribution of the TEOS inside the porosity, using both traditional approaches and advanced X-ray tomographic techniques, the latter allowing the internal visualization in three dimensions of the materials. Fluid transport properties and porosity have been studied both at macroscopic scale, by means of capillary uptake tests and radiography, and at microscopic scale,investigated with X-ray Tomographic Microscopy (XTM). This allows identifying changes in the porosity, by comparison of the images before and after the treatment, and locating the consolidant inside the stone. Tests were initially run at University of Bologna, where characterization of the stone was carried out. Then the research continued in Switzerland: X-ray tomography and radiography were performed at Empa, Swiss Federal Laboratories for Materials Science and Technology, while XTM measurements with synchrotron radiation were run at Paul Scherrer Institute in Villigen.

La resistenza dei legami. Narrazioni e rappresentazioni della famiglia nella trilogia di romanzi “Past Imperfect” (2004-2011) di Nuruddin Farah

Il presente progetto di ricerca riguarda la terza trilogia di romanzi di Nuruddin Farah, “Past Imperfect” (2004-2011). L’analisi dei tre testi che compongono la trilogia – “Links” (2004), “Knots” (2007) e “Crossbones” (2011) – evidenzia la persistente rilevanza delle narrazioni e delle rappresentazioni della famiglia all’interno di tutta la produzione letteraria dell’autore. Questa prospettiva critica richiede l’impiego di una metodologia che riunisce vari aspetti della critica letteraria di matrice post-strutturalista e, per altri versi, di stampo materialista, assecondando così le due principali tendenze critiche presenti all’interno degli studi postcoloniali. Lo stesso approccio teorico-metodologico può essere applicato anche in altri due ambiti critici chiamati in causa dalla trilogia di Nuruddin Farah: la cosiddetta “world literature” e la cosiddetta “failed-state fiction”. L’analisi delle narrazioni e delle rappresentazioni della famiglia richiede, inoltre, un approccio interdisciplinare molto esteso, stimolando ricerche negli ambiti della semiotica, dell’antropologia, della psicanalisi, dei Gender Studies e dei Trauma Studies.

Social inclusion of vulnerable groups through participatory and emancipatory approaches. Implementing active citizenship and socially innovative actions in the framework of civil & human rights model of disability

The research hypothesis of the thesis is that “an open participation in the co-creation of the services and environments, makes life easier for vulnerable groups”; assuming that the participatory and emancipatory approaches are processes of possible actions and changes aimed at facilitating people’s lives. The adoption of these approaches is put forward as the common denominator of social innovative practices that supporting inclusive processes allow a shift from a medical model to a civil and human rights approach to disability. The theoretical basis of this assumption finds support in many principles of Inclusive Education and the main focus of the hypothesis of research is on participation and emancipation as approaches aimed at facing emerging and existing problems related to inclusion. The framework of reference for the research is represented by the perspectives adopted by several international documents concerning policies and interventions to promote and support the leadership and participation of vulnerable groups. In the first part an in-depth analysis of the main academic publications on the central themes of the thesis has been carried out. After investigating the framework of reference, the analysis focuses on the main tools of participatory and emancipatory approaches, which are able to connect with the concepts of active citizenship and social innovation. In the second part two case studies concerning participatory and emancipatory approaches in the areas of concern are presented and analyzed as example of the improvement of inclusion, through the involvement and participation of persons with disability. The research has been developed using a holistic and interdisciplinary approach, aimed at providing a knowledge-base that fosters a shift from a situation of passivity and care towards a new scenario based on the person’s commitment in the elaboration of his/her own project of life.

[How to assess the nutritional status of my patient]

Protein-energy-malnutrition is a growing problem in industrialised countries. Many studies have found malnourishment in 20-60% of hospitalized medical or surgical patients, as well as out-patients. Malnutrition negatively influences patients' prognosis, immune system, muscle strength, and quality of life. As it is a largely treatable co-morbidity, systematic screening for malnutrition and effective management will improve patient outcomes and reduce healthcare costs. Early diagnosis and assessment depends on a simple and standardised screening tool that identifies at-risk patients, allowing the medical team in charge to solve patients' nutritional problems with an interdisciplinary approach.

Clinical assessment of deficits after SAH: hasty neurosurgeons and accurate neurologists

For survivors of aneurysmal subarachnoid hemorrhage (SAH), somatic and cognitive deficits can affect long-term outcomes. We were interested in comparing the deficits identified in SAH patients, including cognitive deficits, at discharge by neurosurgeons and deficits identified by neurologists upon admission to the rehabilitation unit on the same day. The assessment of deficits might have an impact on referring patients to rehabilitation. This retrospective study included 494 SAH patients treated between 2005 and 2010. Of these, 50 patients were discharged to an affiliated rehabilitation unit. Deficits were grouped into 18 categories and summarized into three groups: major somatic, minor somatic, and cognitive deficits. Major somatic deficits were identified in 16 and 20 patients (p = 0.53), minor somatic deficits in 16 and 44 (p < 0.0001) patients, and cognitive deficits in 36 and 45 (p < 0.04) patients by neurosurgeons and neurologists, respectively. The absolute number of deficits in daily activities identified by the neurosurgeon and neurologist were 21 and 31 major somatic deficits (p = 0.2), 18 and 97 minor somatic deficits (p < 0.0001), and 61 and 147 cognitive deficits (p < 0.0001), respectively. Significant differences in assessment of cognitive and minor somatic deficits between neurosurgeons and neurologists exist. Based on these findings, it is evident that for the neurosurgeon, there needs to be an increased awareness of the assessment of cognitive deficits and a more routine interdisciplinary approach, including the use of neuropsychological evaluations, to ensure a better triage of patients to rehabilitation or for discharge home.

Injuries to permanent teeth. Part 3: Therapy of root fractures

Diagnostic and therapeutic interventions following dental injuries are not part of the routine practice in the dental office. Quite often, these patients are emergency cases who seek treatment after normal office hours. The objective of this and the future papers is to present the current treatment concepts in dental traumatology at the School of Dental Medicine, University of Berne. The fruitful cooperation in the field of dental traumatology between the Department of Oral Surgery and Stomatology, and the Department of Conservative Dentistry (including pediatric dentistry and endodontology), is based on the interdisciplinary approach that has been established four years ago. Following discussion and evaluation of such treated cases, and considering current clinical and experimental studies, the said concepts have been worked out. The present paper describes the therapeutic approach for root fractures.

Reconstruction of Skull Base and Fronto-orbital Defects following Tumor Resection

Reconstruction of the anterior skull base and fronto-orbital framework following extensive tumor resection is both challenging and controversial. Dural defects are covered with multiple sheets of fascia lata that provide sufficient support and avoid herniation. Plating along the skull base is contraindicated. After resection of orbital walls, grafting is necessary if the periosteum or parts of the periorbital tissue had to be removed, to avoid enophthalmus or strabism. Free bone grafts exposed to the sinonasal or pharyngeal cavity are vulnerable to infection or necrosis: therefore, covering the grafts with vascularized tissue, such as the Bichat fat-pad or pedicled temporalis flaps, should reduce these complications. Alloplastic materials are indispensable in cranial defects, whereas microsurgical free tissue transfer is indicated in cases of orbital exenteration and skin defects. The authors review their experience and follow-up of 122 skull base reconstructions following extensive subcranial tumor resection. Most significant complications were pneumocranium in 4.9%, CSF leaks in 3.2%, and partial bone resorption in 8.1%.

[Injuries to permanent teeth--Part 4: Therapy of crown fractures]

Diagnostic and therapeutic interventions following dental injuries are not part of the routine practice in the dental office. Quite often, these patients are emergency cases who seek treatment after normal office hours. The objective of this and the future papers is to present the current treatment concepts in dental traumatology at the School of Dental Medicine, University of Berne. The fruitful cooperation in the field of dental traumatology between the Department of Oral Surgery and Stomatology, and the Department of Conservative Dentistry (including pediatric dentistry and endodontology) is based on the interdisciplinary approach that has been established five years ago. Following discussion and evaluation of such treated cases, and considering current clinical and experimental references, the said concepts have been worked out. The present paper describes the therapeutic concepts of crown fractures.

Leukaemia and pregnancy

In summary, the management of women diagnosed with leukaemia in pregnancy needs an interdisciplinary approach, including a careful oncological work-up as well as close monitoring of the pregnancy until delivery and beyond. Patients with acute leukaemias normally must receive anti-leukaemic treatment at full dosage prior to delivery, except for selected women diagnosed very close to term. Treatment should be avoided in the first trimester. The prognosis of pregnant women with acute leukaemia corresponds to that of an age-matched and diagnosis-matched non-pregnant cohort of patients, provided appropriate treatment is given. If given as of the second trimester, the typical chemotherapy regimes used for acute leukaemias imply acceptable acute toxicities to the fetus, with a somewhat increased risk of premature birth or developmental retardation, but no clear evidence of late sequelae in children and adolescents who were exposed to cytostatic agents whilst in utero. In chronic leukaemias and MDS, treatment may often be delayed until after delivery. In CML targeted therapy with imatinib mesylate is safe as of the second trimester, and possibly even before. Obstetric care and monitoring of women with leukaemia are essential throughout the pregnancy to ensure the best possible outcome for mother and child.

Subarachnoid hemorrhage and intracerebral hematoma: incidence, prognostic factors, and outcome

OBJECTIVE: To analyze the incidence and impact of an intracerebral hematoma (ICH) on treatment and outcome in patients with aneurysmal subarachnoid hemorrhage. METHODS: Data of 585 consecutive patients with subarachnoid hemorrhage from June 1999 to December 2005 were prospectively entered in a database. ICH was diagnosed and size was measured by computed tomographic scan before aneurysm occlusion. Fifty patients (8.5%) presented with an ICH larger than 50 cm3. The treatment decision (coil, clip, or hematoma evacuation) was based on an interdisciplinary approach. Patients were stratified into good (Hunt and Hess Grades I-III) versus poor (Hunt and Hess Grades IV and V) grade, and outcome was assessed according to the modified Rankin Scale at 6 months. RESULTS: Overall, 358 patients presented in good grade, with 4 of them having ICH (1.1%); and 227 patients presented in poor grade, with 46 of them having ICH (20.3%, P < 0.01). In good-grade patients with an ICH (n = 4), a favorable outcome (modified Rankin Scale score of 0-2) was achieved in 1 patient (25%), and in 246 patients (75%) without an ICH (P = 0.053; odds ratio, 0.11). A favorable outcome was achieved in 5 poor-grade patients (12.8%) with an ICH and in 40 patients (23.7%) without an ICH (P = 0.19; odds ratio, 0.47). Time to treatment was significantly shorter in patients with an ICH than without an ICH (median, 7 versus 26 h; P < 0.001) and shortest in patients with favorable outcome (3.5 hours; P < 0.01). CONCLUSION: The current data confirm that the presence of an ICH is a predictor of unfavorable outcome. However, despite large ICHs, a significant number of patients have a good outcome. To achieve a favorable outcome, ultra-early treatment with hematoma evacuation and aneurysm obliteration seems to be mandatory.