Liver transplantation for transthyretin amyloidosis: experience of a single center in Italy

Liver transplantation is the only definitive treatment for transthyretin amyloidosis, with an excellent 5-year survival in endemic countries where the Met30 mutation is predominant. We report our experience of liver transplantation for transthyretin amyloidosis. We reviewed the clinical records of 17 transplanted patients (11 males, 6 females; age at liver transplant: 45.7±11.7 years). We had a wide spectrum of non-Met30 mutations (52.9%), with a predominance of Gln89 (23.5%). Five-year survival after transplantation was 43.8%; at multivariate analysis, both non-Met30 mutations (HR 17.3, 95% CI 1.03-291.7) and modified BMI (HR 0.50, 95% CI 0.29-0.87) showed significant and independent prognostic roles (P=0.048 and P=0.015, respectively). Five out of the 9 non-Met30 carriers received combined heart transplantation because of severe cardiomyopathy; they showed a trend towards a better prognosis vs. the 4 patients who did not receive combined heart transplantation (although not statistically significant; P=0.095). At follow-up, no significant improvement of transthyretin amyloidosis manifestations was observed. The results of liver transplantation for transthyretin amyloidosis in our population are poorer than those reported in the literature probably because of the high prevalence of non-Met30 mutations.

Enzimi, acidi organici ed altri metaboliti coinvolti nella patogenesi di Penicillium spp

Blue mould caused by Penicillium expansum Link is one of the most destructive rot of pome fruit in all growing areas (Snowdon, 1990; Jones and Aldwinckle, 1991; Tonini,1996) In the past, Penicillium rot has been controlled by fungicide postharvest treatment mainly by thiabendazole (TBZ) and benomyl (Hardenburg and Spalding, 1972), but their intense use produced the appearance of resistant strains with a great reduction of their activity The aims of the present study were to characterize the isolates of Pencillium sp causing blue mold on pear in Italy by physiological and biochemical parameters. In particular differencing also the behavior of isolates to relationship with sensitivity or resistance to TBZ treatments. We have examined the early stage of infection in relation to enzyme activity, local modulation of pH, production of organic acids, and to secondary metabolism of pathogen. The results described here confirm that the majority of P. expansum isolates from pears packing houses are resistant to TBZ, Among the TBZ-resistant isolates scored in this work, different isolates (RR) showed higher percentage of conidial germination on TBZ-amended medium compared to non amended medium. This may indicate a stimulatory effect of TBZ on conidial germination. Therefore TBZ treatments are not only ineffective for controlling P. expansum, but they may also increase the severity of blue mould on fruits. In the absence of fungicide, isolates showed a significant difference for infection severity, R and RR isolates are characterized by higher pathogenic fitness on fruits, producing larger lesions than S isolates. These data are supported by the study with laboratory-induced resistant isolates, which shows the lack of correlation between TBZ resistance and osmotic sensitivity, and highlights the association between TBZ resistance and infection severity (Baraldi et al 2003). Enzymatic screening gave a positive reaction to esterase, urease, pectinase activity, in addition, the pathogen is able to synthesize a complex enzyme act to degrade the main components of the cell wall especially pectin and cellulose. Isolated sensitive and resistant are characterized by a good activity of pectinase, especially from poligactoronase, which, as already reported by several studies (D'hallewin et al, 2004; Prusky et al, 2004), are the basis of degradative process of cell wall. Also, although the measure was minor also highlighted some activities of cellulase, but even note in the production of this kind of cellulase and hemicellulase P. Expansum were not targeted, studies have found no other source of information in this regard. Twenty isolates of Penicillium expansum, were tested in vitro ad in vivo for acid production ability and pH drop. We have found that modulation of pH and the organic acids extrusion were influence to various parameter:  Initial pH: in general, the greatest reduction of pH was observed in isolates grown at pH 7, except for four isolates that maintained the pH of the medium close to 7, the others significantly decreased the pH, ranging from 5.5 to 4.1.. In extreme acid condition (pH 3,0) growth and modulation of pH is most lower respect optimal condition (pH 5,0). Also isolates R and RR have showed a greater adaptation to environmental condition more than isolates S.  Time: although the acidification continues for some days, PH modulation is strongest in early hours (48-72 hours)of inoculation process. Time also affects the quality of organic acids, for example in vitro results showed an initial abundant production of succinc acid, followed to important production of galacturoinc acid.  Substrates: there are many differences for the type of acids produced in vitro and in vivo. Results showed in vivo an abundant production of galacturonic, malic, and citric acids and some unknown organic acids in smaller concentrations. Secondary metabolite analysis revealed intra-specific differences, and patulin was found in all isolates, but most significant reduction was observed between in vitro and in vivo samples. There was no correlation between the concentration of patulin, and the percentage of infected fruits, but sample with a lower infection severity of rotten area than the others, showed a significantly lower mycotoxin concentration than samples with a higher lesion diameter of rotten area. Beyond of patulin was detected the presence of another secondary metabolite, penitrem A.

Essays in Applied Health Economics: Evidence on Health and Health Care in Italy and UK

This thesis is the result of my experience as a PhD student taking part in the Joint Doctoral Programme at the University of York and the University of Bologna. In my thesis I deal with topics that are of particular interest in Italy and in Great Britain. Chapter 2 focuses on the empirical test of the existence of the relationship between technological profiles and market structure claimed by Sutton’s theory (1991, 1998) in the specific economic framework of hospital care services provided by the Italian National Health Service (NHS). In order to test the empirical predictions by Sutton, we identify the relevant markets for hospital care services in Italy in terms of both product and geographic dimensions. In particular, the Elzinga and Hogarty (1978) approach has been applied to data on patients’ flows across Italian Provinces in order to derive the geographic dimension of each market. Our results provide evidence in favour of the empirical predictions of Sutton. Chapter 3 deals with the patient mobility in the Italian NHS. To analyse the determinants of patient mobility across Local Health Authorities, we estimate gravity equations in multiplicative form using a Poisson pseudo maximum likelihood method, as proposed by Santos-Silva and Tenreyro (2006). In particular, we focus on the scale effect played by the size of the pool of enrolees. In most of the cases our results are consistent with the predictions of the gravity model. Chapter 4 considers the effects of contractual and working conditions on selfassessed health and psychological well-being (derived from the General Health Questionnaire) using the British Household Panel Survey (BHPS). We consider two branches of the literature. One suggests that “atypical” contractual conditions have a significant impact on health while the other suggests that health is damaged by adverse working conditions. The main objective of our paper is to combine the two branches of the literature to assess the distinct effects of contractual and working conditions on health. The results suggest that both sets of conditions have some influence on health and psychological well-being of employees.

Teorie e immagini del governo "misto" nel Cinquecento: i casi di Gasparo Contarini, Donato Giannotti, Paolo Paruta e Traiano Boccalini

This doctoral dissertation faces the debated topic of the traditions of Republicanism in the Modern Age assuming, as a point of view, the problem of the "mixed" government. The research therefore dwells upon the use of this model in Sixteenth-Century Italy, also in connection with the historical events of two standard Republics such as Florence and Venice. The work focuses on Donato Giannotti (1492-1573), Gasparo Contarini (1483-1542) and Paolo Paruta (1540-1598), as the main figures in order to reconstruct the debate on "mixed" constitution: in them, decisive in the attention paid to the peculiar structure of the Venetian Republic, the only of a certain dimension and power to survive after 1530. The research takes into account also the writings of Traiano Boccalini (1556-1613): he himself, though being involved in the same topics of debate, sets for some aspects his considerations in the framework of a new theme, that of Reason of State.

Identificazione di un QTL principale per resistenza a ruggine bruna sul cromosoma 7B di frumento duro

Leaf rust caused by Puccinia triticina is a serious disease of durum wheat (Triticum durum) worldwide. However, genetic and molecular mapping studies aimed at characterizing leaf rust resistance genes in durum wheat have been only recently undertaken. The Italian durum wheat cv. Creso shows a high level of resistance to P. triticina that has been considered durable and that appears to be due to a combination of a single dominant gene and one or more additional factors conferring partial resistance. In this study, the genetic basis of leaf rust resistance carried by Creso was investigated using 176 recombinant inbred lines (RILs) from the cross between the cv. Colosseo (C, leaf rust resistance donor) and Lloyd (L, susceptible parent). Colosseo is a cv. directly related to Creso with the leaf rust resistance phenotype inherited from Creso, and was considered as resistance donor because of its better adaptation to local (Emilia Romagna, Italy) cultivation environment. RILs have been artificially inoculated with a mixture of 16 Italian P. triticina isolates that were characterized for virulence to seedlings of 22 common wheat cv. Thatcher isolines each carrying a different leaf rust resistance gene, and for molecular genotypes at 15 simple sequence repeat (SSR) loci, in order to determine their specialization with regard to the host species. The characterization of the leaf rust isolates was conducted at the Cereal Disease Laboratory of the University of Minnesota (St. Paul, USA) (Chapter 2). A genetic linkage map was constructed using segregation data from the population of 176 RILs from the cross CL. A total of 662 loci, including 162 simple sequence repeats (SSRs) and 500 Diversity Arrays Technology markers (DArTs), were analyzed by means of the package EasyMap 0.1. The integrated SSR-DArT linkage map consisted of 554 loci (162 SSR and 392 DArT markers) grouped into 19 linkage blocks with an average marker density of 5.7 cM/marker. The final map spanned a total of 2022 cM, which correspond to a tetraploid genome (AABB) coverage of ca. 77% (Chapter 3). The RIL population was phenotyped for their resistance to leaf rust under artificial inoculation in 2006; the percentage of infected leaf area (LRS, leaf rust susceptibility) was evaluated at three stages through the disease developmental cycle and the area under disease progress curve (AUDPC) was then calculated. The response at the seedling stage (infection type, IT) was also investigated. QTL analysis was carried out by means of the Composite Interval Mapping method based on a selection of markers from the CL map. A major QTL (QLr.ubo-7B.2) for leaf rust resistance controlling both the seedling and the adult plant response, was mapped on the distal region of chromosome arm 7BL (deletion bin 7BL10-0.78-1.00), in a gene-dense region known to carry several genes/QTLs for resistance to rusts and other major cereal fungal diseases in wheat and barley. QLr.ubo-7B.2 was identified within a supporting interval of ca. 5 cM tightly associated with three SSR markers (Xbarc340.2, Xgwm146 e Xgwm344.2), and showed an R2 and an LOD peak value for the AUDPC equal to 72.9% an 44.5, respectively. Three additional minor QTLs were also detected (QLr.ubo-7B.1 on chr. 7BS; QLr.ubo-2A on chr. 2AL and QLr.ubo-3A on chr. 3AS) (Chapter 4). The presence of the major QTL (QLr.ubo-7B.2) was validated by a linkage disequilibrium (LD)-based test using field data from two different plant materials: i) a set of 62 advanced lines from multiple crosses involving Creso and his directly related resistance derivates Colosseo and Plinio, and ii) a panel of 164 elite durum wheat accessions representative of the major durum breeding program of the Mediterranean basin. Lines and accessions were phenotyped for leaf rust resistance under artificial inoculation in two different field trials carried out at Argelato (BO, Italy) in 2006 and 2007; the durum elite accessions were also evaluated in two additional field experiments in Obregon (Messico; 2007 and 2008) and in a green-house experiment (seedling resistance) at the Cereal Disease Laboratory (St. Paul, USA, 2008). The molecular characterization involved 14 SSR markers mapping on the 7BL chromosome region found to harbour the major QTL. Association analysis was then performed with a mixed-linear-model approach. Results confirmed the presence of a major QTL for leaf rust resistance, both at adult plant and at seedling stage, located between markers Xbarc340.2, Xgwm146 and Xgwm344.2, in an interval that coincides with the supporting interval (LOD-2) of QLr.ubo-7B.2 as resulted from the RIL QTL analysis. (Chapter 5). The identification and mapping of the major QTL associated to the durable leaf rust resistance carried by Creso, together with the identification of the associated SSR markers, will enhance the selection efficiency in durum wheat breeding programs (MAS, Marker Assisted Selection) and will accelerate the release of cvs. with durable resistance through marker-assisted pyramiding of the tagged resistance genes/QTLs most effective against wheat fungal pathogens.

I sensi spirituali nel Liber di Angela da Foligno. La metafora del "gusto" nel Liber di Angela da Foligno e nella mistica femminile francescana tra XIII e XIV secolo.

Angela da Foligno’s Liber is a fundamental text for the scholar of Women Mystics between the XIIIth and the XIVth century in Italy and all over Europe, and it has been chosen in my research because of its originality, with refer of its feminine and franciscan essence. Angela teaches to the italian hagiographic tradition the internal point of view of the holy woman, who becomes the teller of her both ordinary and extraordinary experiences. After giving references about the religious and social historical universe in evolution during the XIIth century, my research proceeds with a linguistic and rhetorical analysis based upon the Liber. I have been searching in Angela’s text and in contemporary italian feminine hagiography the sensory metaphor of “tasting”. That kind of metaphor has an ancient memory and, thanks to the Origene’s studies - the Christian Father of the IIIrd century - we can easily recognize it already in the Bible; Origene identifies the sensory metaphor as a rhetoric system, able to exemplify the God learning process of soul. Theory of “spiritual senses”, theory of vision and rhetoric, evolving from the IIIrd to the XIIIth century, are the theological and linguistic heritage of our feminine and franciscan literature. Inside of that, the metaphor of “tasting” moves and changes, therefore becoming the favourite way of mystics to represent the contact of their souls with God.

Gli assetti proprietari e di controllo nell'agroalimentare italiano

The recent default of important Italian agri-business companies provides a challenging issue to be investigated through an appropriate scientific approach. The events involving CIRIO, FERRUZZI or PARMALAT rise an important research question: what are the determinants of performance for Italian companies in the Italian agri – food sector? My aim is not to investigate all the factors that are relevant in explaining performance. Performance depends on a wide set of political, social, economic variables that are strongly interconnected and that are often very difficult to express by formal or mathematical tools. Rather, in my thesis I mainly focus on those aspects that are strictly related to the governance and ownership structure of agri – food companies representing a strand of research that has been quite neglected by previous scholars. The conceptual framework from which I move to justify the existence of a relationship between the ownership structure of a company, governance and performance is the model set up by Airoldi and Zattoni (2005). In particular the authors investigate the existence of complex relationships arising within the company and between the company and the environment that can bring different strategies and performances. They do not try to find the “best” ownership structure, rather they outline what variables are connected and how they could vary endogenously within the whole economic system. In spite of the fact that the Airoldi and Zattoni’s model highlights the existence of a relationship between ownership and structure that is crucial for the set up of the thesis the authors fail to apply quantitative analyses in order to verify the magnitude, sign and the causal direction of the impact. In order to fill this gap we start from the literature trying to investigate the determinants of performance. Even in this strand of research studies analysing the relationship between different forms of ownership and performance are still lacking. In this thesis, after a brief description of the Italian agri – food sector and after an introduction including a short explanation of the definitions of performance and ownership structure, I implement a model in which the performance level (interpreted here as Return on Investments and Return on Sales) is related to variables that have been previously identified by the literature as important such as the financial variables (cash and leverage indices), the firm location (North Italy, Centre Italy, South Italy), the power concentration (lower than 25%, between 25% and 50% and between 50% and 100% of ownership control) and the specific agri – food sector (agriculture, food and beverage). Moreover we add a categorical variable representing different forms of ownership structure (public limited company, limited liability company, cooperative) that is the core of our study. All those variables are fully analysed by a preliminary descriptive analysis. As in many previous contributions we apply a panel least squares analysis for 199 Italian firms in the period 1998 – 2007 with data taken from the Bureau Van Dijck Dataset. We apply two different models in which the dependant variables are respectively the Return on Investments (ROI) and the Return on Sales (ROS) indicators. Not surprisingly we find that companies located in the North Italy representing the richest area in Italy perform better than the ones located in the Centre and South of Italy. In contrast with the Modigliani - Miller theorem financial variables could be significant and the specific sector within the agri – food market could play a relevant role. As the power concentration, we find that a strong property control (higher than 50%) or a fragmented concentration (lower than 25%) perform better. This result apparently could suggest that “hybrid” forms of concentrations could create bad functioning in the decision process. As our key variables representing the ownership structure we find that public limited companies and limited liability companies perform better than cooperatives. This is easily explainable by the fact that law establishes that cooperatives are less profit – oriented. Beyond cooperatives public limited companies perform better than limited liability companies and show a more stable path over time. Results are quite consistent when we consider both ROI and ROS as dependant variables. These results should not lead us to claim that public limited company is the “best” among all possible governance structures. First, every governance solution should be considered according to specific situations. Second more robustness analyses are needed to confirm our results. At this stage we deem these findings, the model set up and our approach represent original contributions that could stimulate fruitful future studies aimed at investigating the intriguing issue concerning the effect of ownership structure on the performance levels.

Atmospheric corrosion of quaternary bronzes (Cu-Sn-Zn-Pb): laboratory tests (accelerated ageing in wet & dry conditions)and field studies (the Bottego monument in Parma, Italy).

The interactions between outdoor bronzes and the environment, which lead to bronze corrosion, require a better understanding in order to design effective conservation strategies in the Cultural Heritage field. In the present work, investigations on real patinas of the outdoor monument to Vittorio Bottego (Parma, Italy) and laboratory studies on accelerated corrosion testing of inhibited (by silane-based films, with and without ceria nanoparticles) and non-inhibited quaternary bronzes are reported and discussed. In particular, a wet&dry ageing method was used both for testing the efficiency of the inhibitor and for patinating bronze coupons before applying the inhibitor. A wide range of spectroscopic techniques has been used, for characterizing the core metal (SEM+EDS, XRF, AAS), the corroded surfaces (SEM+EDS, portable XRF, micro-Raman, ATR-IR, Py-GC-MS) and the ageing solutions (AAS). The main conclusions were: 1. The investigations on the Bottego monument confirmed the differentiation of the corrosion products as a function of the exposure geometry, already observed in previous works, further highlighting the need to take into account the different surface features when selecting conservation procedures such as the application of inhibitors (i.e. the relative Sn enrichment in unsheltered areas requires inhibitors which effectively interact not only with Cu but also with Sn). 2. The ageing (pre-patination) cycle on coupons was able to reproduce the relative Sn enrichment that actually happens in real patinated surfaces, making the bronze specimens representative of the real support for bronze inhibitors. 3. The non-toxic silane-based inhibitors display a good protective efficiency towards pre-patinated surfaces, differently from other widely used inhibitors such as benzotriazole (BTA) and its derivatives. 4. The 3-mercapto-propyl-trimethoxy-silane (PropS-SH) additivated with CeO2 nanoparticles generally offered a better corrosion protection than PropS-SH.

Studio di fenomeni d'instabilità gravitativa sui fondali marini, con particolare riferimento all'isola di Stromboli

In the last decade the interest for submarine instability grew up, driven by the increasing exploitation of natural resources (primary hydrocarbons), the emplacement of bottom-lying structures (cables and pipelines) and by the development of coastal areas, whose infrastructures increasingly protrude to the sea. The great interest for this topic promoted a number of international projects such as: STEAM (Sediment Transport on European Atlantic Margins, 93-96), ENAM II (European North Atlantic Margin, 96-99), GITEC (Genesis and Impact of Tsunamis on the European Coast 92-95), STRATAFORM (STRATA FORmation on Margins, 95-01), Seabed Slope Process in Deep Water Continental Margin (Northwest Gulf of Mexico, 96-04), COSTA (Continental slope Stability, 00-05), EUROMARGINS (Slope Stability on Europe’s Passive Continental Margin), SPACOMA (04-07), EUROSTRATAFORM (European Margin Strata Formation), NGI's internal project SIP-8 (Offshore Geohazards), IGCP-511: Submarine Mass Movements and Their Consequences (05-09) and projects indirectly related to instability processes, such as TRANSFER (Tsunami Risk ANd Strategies For the European region, 06-09) or NEAREST (integrated observations from NEAR shore sourcES of Tsunamis: towards an early warning system, 06-09). In Italy, apart from a national project realized within the activities of the National Group of Volcanology during the framework 2000-2003 “Conoscenza delle parti sommerse dei vulcani italiani e valutazione del potenziale rischio vulcanico”, the study of submarine mass-movement has been underestimated until the occurrence of the landslide-tsunami events that affected Stromboli on December 30, 2002. This event made the Italian Institutions and the scientific community more aware of the hazard related to submarine landslides, mainly in light of the growing anthropization of coastal sectors, that increases the vulnerability of these areas to the consequences of such processes. In this regard, two important national projects have been recently funded in order to study coastal instabilities (PRIN 24, 06-08) and to map the main submarine hazard features on continental shelves and upper slopes around the most part of Italian coast (MaGIC Project). The study realized in this Thesis is addressed to the understanding of these processes, with particular reference to Stromboli submerged flanks. These latter represent a natural laboratory in this regard, as several kind of instability phenomena are present on the submerged flanks, affecting about 90% of the entire submerged areal and often (strongly) influencing the morphological evolution of subaerial slopes, as witnessed by the event occurred on 30 December 2002. Furthermore, each phenomenon is characterized by different pre-failure, failure and post-failure mechanisms, ranging from rock-falls, to turbidity currents up to catastrophic sector collapses. The Thesis is divided into three introductive chapters, regarding a brief review of submarine instability phenomena and related hazard (cap. 1), a “bird’s-eye” view on methodologies and available dataset (cap. 2) and a short introduction on the evolution and the morpho-structural setting of the Stromboli edifice (cap. 3). This latter seems to play a major role in the development of largescale sector collapses at Stromboli, as they occurred perpendicular to the orientation of the main volcanic rift axis (oriented in NE-SW direction). The characterization of these events and their relationships with successive erosive-depositional processes represents the main focus of cap.4 (Offshore evidence of large-scale lateral collapses on the eastern flank of Stromboli, Italy, due to structurally-controlled, bilateral flank instability) and cap. 5 (Lateral collapses and active sedimentary processes on the North-western flank of Stromboli Volcano), represented by articles accepted for publication on international papers (Marine Geology). Moreover, these studies highlight the hazard related to these catastrophic events; several calamities (with more than 40000 casualties only in the last two century) have been, in fact, the direct or indirect result of landslides affecting volcanic flanks, as observed at Oshima-Oshima (1741) and Unzen Volcano (1792) in Japan (Satake&Kato, 2001; Brantley&Scott, 1993), Krakatau (1883) in Indonesia (Self&Rampino, 1981), Ritter Island (1888), Sissano in Papua New Guinea (Ward& Day, 2003; Johnson, 1987; Tappin et al., 2001) and Mt St. Augustine (1883) in Alaska (Beget& Kienle, 1992). Flank landslide are also recognized as the most important and efficient mass-wasting process on volcanoes, contributing to the development of the edifices by widening their base and to the growth of a volcaniclastic apron at the foot of a volcano; a number of small and medium-scale erosive processes are also responsible for the carving of Stromboli submarine flanks and the transport of debris towards the deeper areas. The characterization of features associated to these processes is the main focus of cap. 6; it is also important to highlight that some small-scale events are able to create damage to coastal areas, as also witnessed by recent events of Gioia Tauro 1978, Nizza, 1979 and Stromboli 2002. The hazard potential related to these phenomena is, in fact, very high, as they commonly occur at higher frequency with respect to large-scale collapses, therefore being more significant in terms of human timescales. In the last chapter (cap. 7), a brief review and discussion of instability processes identified on Stromboli submerged flanks is presented; they are also compared with respect to analogous processes recognized in other submerged areas in order to shed lights on the main factors involved in their development. Finally, some applications of multibeam data to assess the hazard related to these phenomena are also discussed.

La carriera degli attori italiani di prosa dalla scena allo schermo (1909-1916)

Most actors of the Italian silent cinema in the early 1910s have a theatrical training. Some of them are already asserted or famous actors (like Cesare Dondini, Ermete Novelli, Ermete Zacconi, Giovanni Grasso) who are invited “to pose” for the cinema following their reputation, according to a strategy of an aesthetic and cultural legitimacy launched in 1909 by film d'art of the Pathé Consortium. I think it is the proverbial readiness and strength of the stage Italian actors that create a decisive contribution to the rapid development of the national cinema industry, despite its serious structural deficiencies, from the protoindustrialized phase (1909) to the golden age of divismo (starting in 1913), until the first signs of decadence (1919), and the so-called “fall” of the UCI production and distribution system. This is the main topic of the thesis: an investigation on the Italian stage actors engaged in the film industry (“from stage to screen” as the Italian title says, but in a “post-Vardac” approach) through many different sources: periodicals, memories, personal and business letters, and also contracts, found in several archive funds. A specific chapter is dedicated to the artistic career of Febo Mari (1881-1939), real name Alfredo Rodriguez, witch is a time-sample symptomatic of deep ties established between the growing film publishing and the Italian theatrical production system in the 1910s. The Mari debut in cinema and his ascent toward screen “divo” status coincides with the parable that leads from emergence to decadence of divismo in Italy.

Contributo di un software di quantificazione del segnale contrastografico(SonoLiver®) nella diagnosi ecografica di Epatocarcinoma su Cirrosi.

Introduzione La diagnosi di HCC con le tecniche di immagine ed in particolare con CEUS su fegato cirrotico secondo le ultime linee guida prevede un comportamento contrastografico di ipervascolarizzazione nella fase arteriosa e wash-out nella fase tardiva. CEUS è ormai una metodica accettata per la diagnosi ma il wash out nella fase tardiva presenta notevoli difficoltà nel determinare il comportamento contrastografico in quanto valutato soggettivamente su display, infatti il giudizio di tale fase dipende molto dall’operatore e non è rarissimo che nascono discordanza tra operatori anche per piccole differenze. Recentemente è stato proposto un nuovo software(SonoLiver, Bracco, Italy) in grado di quantificare la perfusione delle lesione durante CEUS. Pertanto lo scopo di questo studio pilota è quello di valutare l’impatto di SonoLiver nel rilevare caratteristiche contrastografiche tipiche dell’HCC e valutare la riproducibilità tra due operatori. Pazienti e metodi: Sono stati presi in considerazione 20 noduli (di dimensioni tra 12-95 mm) con diagnosi di HCC in 20 pazienti con cirrosi . La CEUS è stata valutata dapprima ad occhio nudo su display e successivamente con le curve ottenute con DVP da parte di due operatori diversi in cieco, dopo un periodo di formazione adeguata. Sono state quindi analizzate le performance di ciascuna metodica sia in termini di variabilità tra i due operatori che la variabilità tra CEUS ad occhio nudo e CEUS con SonoLiver dello stesso operatore. Risultati:Operatore 1 ha rilevato ipervascolarizzazione in fase arteriosa in 17 su 20 pazienti con valutazione ad occhio nudo su schermo e su 19/20 con le curve ottenute con DVP (+10% sensibilità) mentre operatore 2 ha rilevato ipervascolarizzazione in fase arteriosa19/20 pazienti sia con valutazione ad occhio nudo che con le curve DVP. Nella fase tardiva il wash-out è stato rilevato in 7/20 ad occhio nudo e 10/20 pazienti con le curve DVP (sensibilità aumenta da 35% a 50%) mentre operatore 2 ha rilevato rispettivamente 8/20 e 11/20 (sensibilità aumenta da 40% a 55%). La riproducibilità tra i due operatori rimane invariata con la valutazione di Sonoliver sia nella fase arteriosa che nella fase tardiva. Conclusione:La quantificazione perfusionale con SonoLiver sembra essere uno strumento promettente nella diagnosi di HCC su fegato cirrotico, aumentando aspetti tipici contrastografici.

Farm tourism: a cross-country empirical study in Germany and Italy

PROBLEM In the last few years farm tourism or agritourism as it is also referred to has enjoyed increasing success because of its generally acknowledged role as a promoter of economic and social development of rural areas. As a consequence, a plethora of studies have been dedicated to this tourist sector, focusing on a variety of issues. Nevertheless, despite the difficulties of many farmers to orient their business towards potential customers, the contribution of the marketing literature has been moderate. PURPOSE This dissertation builds upon studies which advocate the necessity of farm tourism to innovate itself according to the increasingly demanding needs of customers. Henceforth, the purpose of this dissertation is to critically evaluate the level of professionalism reached in the farm tourism market within a marketing approach. METHODOLOGY This dissertation is a cross-country perspective incorporating the marketing of farm tourism studied in Germany and Italy. Hence, the marketing channels of this tourist sector are examined both from the supply and the demand side by means of five exploratory studies. The data collection has been conducted in the timeframe of 2006 to 2009 in manifold ways (online survey, catalogues of industry associations, face-to-face interviews, etc.) according to the purpose of the research of each study project. The data have been analyzed using multivariate statistical analysis. FINDINGS A comprehensive literature review provides the state of the art of the main differences and similarities of farm tourism in the two countries of study. The main findings contained in the empirical chapters provide insights on many aspects of agritourism including how the expectations of farm operators and customers differ, which development scenarios of farm tourism are more likely to meet individuals’ needs, how new technologies can impact the demand for farm tourism, etc. ORIGINALITY/VALUE The value of this study is in the investigation of the process by which farmers’ participation in the development of this sector intersects with consumer consumption patterns. Focusing on this process should allow farm operators and others including related businesses to more efficiently allocate resources.

Studio e modellazione numerica della propagazione di colate detritiche in ambiente appenninico

Il presente studio ha come obiettivi l’analisi, la modellazione numerica e la caratterizzazione del rischio idrogeologico di due siti dell’Appennino bolognese interessati negli ultimi due anni da colate detritiche, Serraglio (Comune di Castiglione dei Pepoli) e Chiapporato (Comune di Camugnano). Lo studio è stato condotto in collaborazione con il Servizio Tecnico di Bacino Reno della Regione Emilia-Romagna, che ha reso disponibile la documentazione relativa ai due eventi analizzati. I predetti eventi possono esser definiti “anomali” in relazione sia alla loro collocazione – essendo il fenomeno delle colate detritiche diffuso principalmente in aree montuose caratterizzate da un’altitudine media rilevante, come l’arco alpino – sia al fatto che non sono né catalogati né ricordati a memoria d’uomo eventi, in tali località, precedenti a quelli in esame. Il rischio idrogeologico, indotto dalla possibilità non remota di nuovi eventi, è dato non dal volume o dall’area interessata dai fenomeni, ma piuttosto dall’estrema velocità caratterizzante le colate detritiche, appunto definite come manifestazioni parossistiche lungo la rete idrografica secondaria con trasporto in massa di sedimenti. L’analisi effettuata ha anche fornito l’occasione per effettuare un confronto tra due realtà, quella di Serraglio e quella di Chiapporato, accomunate dalla stessa tipologia di evento, ma differenti in relazione all’uso del suolo, alle caratteristiche geomorfologiche e alle modalità di propagazione nel corso dell’evento. L’abitato di Serraglio, sito nella frazione di Baragazza, è stato colpito da una colata detritica il 20 gennaio 2009. Da un punto di vista geologico e geomorfologico la località è sovrastata da un versante boscato notevolmente acclive, caratterizzato dall’affioramento della cosiddetta Formazione di Cervarola: tali rocce, appartenenti alla categoria delle arenarie e solitamente presenti in strati compatti, in seguito alla naturale degradazione dovuta agli agenti atmosferici hanno dato luogo ad un detrito composto da blocchi e ciottoli di varia dimensione immersi in una matrice sabbiosa. Il distacco è avvenuto proprio in questo materiale detritico, reso instabile dal notevole apporto pluviometrico verificatosi nei giorni precedenti. La colata, sviluppatasi in seguito alla fluidificazione del materiale coinvolto in uno scivolamento di detrito di ridotta volumetria, si è incanalata in uno dei rii effimeri che drenano il versante con traiettorie tra loro pseudo parallele. Il debris flow, accelerato da un dislivello complessivo di 125 m, ha poi raggiunto due abitazioni, fortunatamente non abitate al momento dell’evento, depositando uno spessore detritico di oltre 1,5 m nella zona di transito prima di proseguire verso valle nella sua frazione più fine, incanalandosi di fatto lungo lo stradello asfaltato di accesso alle abitazioni e interessando la strada provinciale che collega Castiglione dei Pepoli all’uscita autostradale di Roncobilaccio. Da un punto di vista meteo-climatico il mese di gennaio 2009 è stato caratterizzato da precipitazioni fortemente superiori alla media, accompagnate da una ridotta insolazione. La continua oscillazione dello zero termico tra 0 e 900 m ha dato luogo alla formazione di uno spessore nivale al suolo di circa 20 cm tre giorni prima dell’evento e poi al suo rapido scioglimento contestualmente all’aumento termico, dato dalla risalita di aria calda umida di origine africana, accompagnata da quella perturbazione che ha poi di fatto innescato il fenomeno. Nelle 48 ore precedenti l’evento sono stati registrati apporti nivo-pluviometrici corrispondenti ad oltre 130 mm, che hanno causato la completa saturazione del detrito superficiale, l’innesco dello scivolamento di detrito e la sua successiva fluidificazione. Il distacco del materiale detritico, la sua movimentazione e la notevole erosione che ha caratterizzato l’alveo del rio durante il fenomeno – quantificata mediamente in 20 cm – sono state favorite dalle mediocri condizioni di salute del castagneto che copre il versante interessato dall’evento: la totale assenza di manutenzione e l’abbandono della coltivazione “a pali” del bosco hanno inibito la naturale funzione stabilizzante del boscato, trasformatosi da fattore inibente a fattore predisponente il fenomeno. La seconda colata detritica analizzata ha invece interessato la strada comunale che collega la frazione di Stagno all’abitato di Chiapporato, splendida borgata cinquecentesca, frequentata soprattutto da turisti ed escursionisti durante la stagione estiva. Il versante sede della colata, occorsa in data 8 novembre 2010, è caratterizzato da numerosi affioramenti della cosiddetta Formazione di Stagno, arenarie intervallate da strati marnoso-pelitici. Tale litotipo, soggetto alla naturale degradazione indotta dagli agenti atmosferici, origina un detrito composto da massi e ciottoli, raccoltisi, nell’area in esame, in un canalone posto ai piedi di una scarpata pseudo verticale delimitante il pianoro di “Val di Sasso”. Tale materiale detritico è stato poi fluidificato dalle abbondanti piogge, depositando, dopo oltre 320 metri di dislivello, circa un metro di detrito sul piano stradale per poi proseguire la sua corsa verso il Torrente Limentra e il Bacino di Suviana. L’evento è stato innescato da precipitazioni intense e persistenti che hanno depositato al suolo oltre 69 mm di pioggia in 25 ore. Nel mese precedente il fenomeno sono stati misurati oltre 530 mm di pioggia, quantitativi superiori alla media climatologica, che hanno sicuramente accelerato anche la degradazione della scarpata e l’accumulo di detriti nell’area sorgente. Le colate sopra descritte sono state poi simulate utilizzando il modello DAN-W (Dynamic ANalysis) del prof. Oldrich Hungr della University of British Columbia (Canada). Tale modello si basa su una discretizzazione della massa movimentata tramite il metodo degli “elementi di contorno” e sulla soluzione alle differenze finite di tipo Lagrangiano dell’equazione di De Saint Venant. L’equazione del moto, integrata verticalmente, è applicata a colonne strette di flusso (elementi di contorno). L’equazione di continuità è invece risolta riferendosi agli elementi di massa delimitati dai predetti elementi di contorno. Il numero di incognite principali eguaglia il numero di equazioni disponibili ed il problema è quindi completamente determinato. Gli altri parametri caratterizzanti la colata sono determinati tramite interpolazioni basate sull’ipotesi che sia la superficie del flusso sia quella della traiettoria siano ragionevolmente lisce. La soluzione è esplicita ed avviene per step temporali successivi. Al fine della determinazione dei parametri l’utilizzatore ha la possibilità di scegliere tra vari modelli reologici, quantificanti il termine di resistenza caratterizzante il moto. Su indicazione dell’autore del modello sono stati utilizzati il modello frizionale e quello di Voellmy, che, in casi simili, forniscono risultati più realistici (in relazione alla modellizzazione di colate di detrito). I parametri utilizzati per la calibrazione sono lo spessore di detrito depositato sul piano stradale, nel caso di Chiapporato, e a tergo della prima abitazione investita dalla colata nel caso di Serraglio, unitamente alla massima distanza raggiunta dai detriti. I risultati ottenuti utilizzando il modello reologico frizionale mostrano profili di velocità scarsamente rappresentativi, con una costante sovrastima della stessa, a fronte di una migliore capacità descrittiva degli spessori accumulatisi. Il modello di Voellmy ha invece prodotto andamenti di velocità più realistici, confrontabili con i valori forniti dalla letteratura internazionale, riuscendo al contempo a quantificare con precisione l’accumulo di detrito rilevato a seguito degli eventi. I valori dei parametri utilizzati nella modellazione sono stati ricavati dalle indicazioni dell’autore del modello affiancate dai range resi disponibili dalla letteratura. Entrambe le caratterizzazioni reologiche sono poi state oggetto di un’analisi di sensitività ai fini di quantificare il peso dei parametri utilizzati. Il modello frizionale si è rivelato particolarmente sensibile all’andamento del coefficiente di attrito basale e al coefficiente di pressione dei pori, con un lieve preponderanza del primo, mentre il modello reologico di Voellmy si è mostrato fortemente influenzato dal coefficiente di turbolenza e dal coefficiente di attrito, pressoché paritari nell’effettivo condizionamento dei risultati. Gli output ottenuti simulando l’evento di Serraglio sono risultati generalmente meno realistici di quelli ricavati nel caso di Chiapporato: ciò è probabilmente dovuto alle caratteristiche reologiche proprie del fenomeno occorso a Serraglio, classificabile come un ibrido tra un mud flow e un debris flow. Sono state infine avanzate proposte di intervento e di monitoraggio dei siti indagati, al fine di una mitigazione del rischio idrogeologico gravante sulle aree esaminate. Il caso di Serraglio presenta, a parere dello scrivente, un rischio idrogeologico più elevato, se paragonato a quello presente a Chiapporato, dati la vicinanza ad un centro abitato e lo status quo caratterizzante il versante sede del dissesto. Nei circa 18 mesi trascorsi dopo l’evento è stato possibile rilevare un progressivo ampliamento della nicchia di distacco dello scivolamento, poi evolutosi in colata con andamento tipicamente retrogressivo. Lo stato della vegetazione permane in condizioni problematiche, con frequenti ribaltamenti e sradicamenti (processi noti in letteratura come chablis) dei castagni presenti, con un conseguente aumento dell’erosione superficiale del versante e l’apporto detritico all’interno del rio. Tale detrito è poi trattenuto all’interno dell’alveo da una serie di briglie naturali formatesi a seguito della caduta di varie piante all’interno del canale stesso a causa del passaggio del debris flow o a fenomeni di chablis. La forte sovraescavazione occorsa in occasione della colata ha poi favorito l’innesco di una serie di piccoli scivolamenti superficiali confluenti nel rio stesso, anch’essi apportatori di detrito, ingrediente principale per un nuovo debris flow. È inoltre da notare come la zona di runout è tuttora parzialmente occupata dal detrito depositatosi a seguito dell’evento: tale configurazione, causando di fatto una riduzione della potenziale area di “sfogo” di un nuovo debris flow, acuisce il rischio di un’estensione areale verso valle degli effetti di un nuovo fenomeno, con un conseguente possibile maggior coinvolgimento dell’abitato di Serraglio. È stato quindi proposto di attuare un’adeguata regimazione dell’area boschiva caratterizzante il versante, unitamente ad una regimazione fluviale del rio, tramite la realizzazione di briglie in legno e pietrame – essendo l’area non cantierabile – e la rimozione degli accumuli detritici in seno all’alveo stesso. La nicchia di distacco principale e le nicchie secondarie dovranno poi essere oggetto di opportuna stabilizzazione. Più a valle è stata suggerita la rimozione dell’accumulo detritico presente nell’area di runout e la realizzazione di un’adeguata opera di ricezione delle acque del rio e di eventuali nuove colate: a tal fine si è ipotizzato il ripristino dell’antico alveo, successivamente deviato e tombato per permettere l’edificazione dell’abitazione poi investita dalla colata. È stato inoltre proposto un monitoraggio attraverso l’installazione di un pluviometro, tarato con opportune soglie di allarme, dotato di datalogger e modem GPRS al fine di comunicare in tempo reale, ai tecnici incaricati e agli abitanti, un eventuale superamento della soglia di allarme. Il caso di Chiapporato è invece caratterizzato da problematiche connesse al rischio idrogeologico meno rilevanti di quelle presenti a Serraglio. Ciò è dovuto allo scarso traffico caratterizzante la strada comunale e all’assenza di altri edifici o infrastrutture potenzialmente coinvolgibili da un nuovo evento. La probabilità del verificarsi di una nuova colata è però concreta, considerata la forte erosione caratterizzante il versante: trascorsi sei mesi dall’evento, è stato possibile rilevare nell’area sorgente un accumulo medio di detrito di circa mezzo metro di spessore. Le cause del dissesto, a differenza di Serraglio, non sono in alcun modo imputabili all’azione antropica: si tratta infatti della naturale evoluzione del versante sovrastante il piano stradale. Si propone quindi la collocazione di cartelli stradali indicanti il pericolo di caduta massi e colate detritiche agli automobilisti e ai pedoni, unitamente all’installazione di un cavo a strappo posto lungo l’alveo torrentizio collegato ad un semaforo dislocato nei pressi del guado della strada comunale sul rio Casale. L’eventuale verificarsi di un nuovo evento comporterebbe la lacerazione del cavo installato e l’attivazione del semaforo – e di un eventuale allarme acustico – con conseguente inibizione del traffico stradale in occasione del transito del debris flow. Nel contesto geologico e geomorfologico dell’Appennino tosco-emiliano i debris flow rappresentano una tipologia di dissesto da frana poco diffusa, ma comunque potenzialmente presente nelle aree dove i processi di alterazione e degradazione degli ammassi rocciosi affioranti generino accumuli di detrito e in condizioni morfologiche caratterizzate da elevate pendenze dei versanti. Questo studio ha permesso di approfondire la conoscenza di questi fenomeni, che presentano una magnitudo notevolmente inferiore rispetto al contesto alpino, ma la cui interferenza con l’attività antropica acuisce notevolmente il rischio idrogeologico nelle zone interessate. Si sottolinea, inoltre, che nell’attuale contesto climatico caratterizzato da sempre più frequenti piogge brevi ed intense ed eventi cosiddetti di rain on snow, la frequenza sia temporale che spaziale di tali fenomeni di dissesto appare destinata ad aumentare, anche in aree in precedenza non interessate.