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.

Investigating strategies and indicators for sustainable campus: Comparison and synergies between University of Bologna and Delft University of Technology

Sustainable development is one of the biggest challenges of the twenty fist-century. Various university has begun the debate about the content of this concept and the ways in which to integrate it into their policy, organization and activities. Universities have a special responsibility to take over a leading position by demonstrating best practices that sustain and educate a sustainable society. For that reason universities have the opportunity to create the culture of sustainability for today’s student, and to set their expectations for how the world should be. This thesis aim at analyzing how Delft University of Technology and University of Bologna face the challenge of becoming a sustainable campus. In this context, both universities have been studied and analyzed following the International Sustainable Campus Network (ISCN) methodology that provides a common framework to formalize commitments and goals at campus level. In particular this work has been aimed to highlight which key performance indicators are essential to reach sustainability as a consequence the following aspects has been taken into consideration: energy use, water use, solid waste and recycling, carbon emission. Subsequently, in order to provide a better understanding of the current state of sustainability on University of Bologna and Delft University of Technology, and potential strategies to achieve the stated objective, a SWOT Analysis has been undertaken. Strengths, weaknesses, opportunities and threats have been shown to understand how the two universities can implement a synergy to improve each other. In the direction of framing a “Sustainable SWOT” has been considered the model proposed by People and Planet, so it has been necessary to evaluate important matters as for instance policy, investment, management, education and engagement. Regarding this, it has been fundamental to involve the main sustainability coordinators of the two universities, this has been achieved through a brainstorming session. Partnerships are key to the achievement of sustainability. The creation of a bridge between two universities aims to join forces and to create a new generation of talent. As a result, people can become able to support universities in the exchange of information, ideas, and best practices for achieving sustainable campus operations and integrating sustainability in research and teaching. For this purpose the project "SUCCESS" has been presented, the project aims to create an interactive European campus network that can be considered a strategic key player for sustainable campus innovation in Europe. Specifically, the main key performance indicators have been analyzed and the importance they have for the two universities and their strategic impact have been highlighted. For this reason, a survey was conducted with people who play crucial roles for sustainability within the two universities and they were asked to evaluate the KPIs of the project. This assessment has been relevant because has represented the foundation to develop a strategy to create a true collaboration.

Catheter ablation of recurrent scar-related ventricular tachycardia using electroanatomical mapping and irrigated ablation technology: results of the prospective multicenter Euro-VT-study

Ventricular tachycardia (VT) late after myocardial infarction is an important contributor to morbidity and mortality. This prospective multicenter study assessed the efficacy and safety of electroanatomical mapping in combination with open-saline irrigated ablation technology for ablation of chronic recurrent mappable and unmappable VT in remote myocardial infarction.

Comparison of real-time polymerase chain reaction and DNA-strip technology in microbiological evaluation of periodontitis treatment

The impact of a semiquantitative commercially available test based on DNA-strip technology (microIDent®, Hain Lifescience, Nehren, Germany) on diagnosis and treatment of severe chronic periodontitis of 25 periodontitis patients was evaluated in comparison with a quantitative in-house real-time PCR. Subgingival plaque samples were collected at baseline as well as at 3, 6, and 12 months later. After extracting DNA, Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, and several other periodontopathogens were determined by both methods. The results obtained by DNA-strip technology were analyzed semiquantitatively and additionally quantitatively by densitometry. The results for the 4 major periodontopathogenic bacterial species correlated significantly between the 2 methods. Samples detecting a high bacterial load by one method and negative by the other were always found in less than 2% of the total samples. Both technologies showed the impact of treatment on microflora. Especially the semiquantitative DNA-strip technology clearly analyzed the different loads of periodontopathogens after therapy and is useful in microbial diagnostics for patients in dental practices.

Development and improvement of warm-mix asphalt technology

Traditionally, asphalt mixtures were produced at high temperatures (between 150°C to 180°C) and therefore often referred to as Hot Mix Asphalt (HMA). Recently, a new technology named Warm Mix Asphalt (WMA) was developed in Europe that allows HMA to be produced at a lower temperature. Over years of research efforts, a few WMA technologies were introduced including the foaming method using Aspha-min® and Advera® WMA; organic additives such as Sasobit® and Asphaltan B®; and chemical packages such as Evotherm® and Cecabase RT®. Benefits were found when lower temperatures were used to produce asphalt mixtures, especially when it comes to environmental and energy savings. Even though WMA has shown promising results in energy savings and emission reduction, however, only limited studies and laboratory tests have been conducted to date. The objectives of this project are to 1) develop a mix design framework for WMA by evaluating its mechanical properties; 2) evaluate performance of WMA containing high percentages of recycled asphalt material; and 3) evaluate the moisture sensitivity in WMA. The test results show that most of the WMA has higher fatigue life and TSR which indicated WMA has better fatigue cracking and moisture damage resistant; however, the rutting potential of most of the WMA tested were higher than the control HMA. A recommended WMA mix design framework was developed as well. The WMA design framework was presented in this study to provide contractors, and government agencies successfully design WMA. Mixtures containing high RAP and RAS were studied as well and the overall results show that WMA technology allows the mixture containing high RAP content and RAS to be produced at lower temperature (up to 35°C lower) without significantly affect the performance of asphalt mixture in terms of rutting, fatigue and moisture susceptibility. Lastly, the study also found that by introducing the hydrated lime in the WMA, all mixtures modified by the hydrated lime passed the minimum requirement of 0.80. This indicated that, the moisture susceptibility of the WMA can be improved by adding the hydrated lime.

A communication and information technology infrastructure for real time monitoring and management of type 1 diabetes patients

This paper is focused on the integration of state-of-the-art technologies in the fields of telecommunications, simulation algorithms, and data mining in order to develop a Type 1 diabetes patient's semi to fully-automated monitoring and management system. The main components of the system are a glucose measurement device, an insulin delivery system (insulin injection or insulin pumps), a mobile phone for the GPRS network, and a PDA or laptop for the Internet. In the medical environment, appropriate infrastructure for storage, analysis and visualizing of patients' data has been implemented to facilitate treatment design by health care experts.

Using technology to teach technology: design and evaluation of bilingual online physician education about electronic medical records.

The "EMR Tutorial" is designed to be a bilingual online physician education environment about electronic medical records. After iterative assessment and redesign, the tutorial was tested in two groups: U.S. physicians and Mexican medical students. Split-plot ANOVA revealed significantly different pre-test scores in the two groups, significant cognitive gains for the two groups overall, and no significant difference in the gains made by the two groups. Users rated the module positively on a satisfaction questionnaire.

Knowledge and Perception of the Role of Targeted Ultrasound in Detecting Down Syndrome Among a High Risk Population

The purpose of this study was to determine the perception and knowledge of targeted ultrasound in women who screen positive for Down syndrome in the first or second trimester, and to assess the perceived detection rate of Down syndrome by targeted ultrasound in this population. While several studies have reported patient perceptions’ of routine ultrasound, no study has specifically examined knowledge regarding the targeted ultrasound and its role in detecting Down syndrome. A targeted ultrasound is a special ultrasound during the second trimester offered to women who may be at a higher-than-average risk of having a baby with some type of birth defect or complication. The purpose of the ultrasound is to evaluate the overall growth and development of the baby as well as screen for birth defects and genetic conditions. Women under the age of 35 referred for an abnormal first or second trimester maternal serum screen to several Houston area clinics were asked to complete a questionnaire to obtain demographic and ultrasound knowledge information as well as assess perceived detection rate of Down syndrome by ultrasound. Seventy-seven women completed the questionnaire and participated in the study. Our findings revealed that women have limited background knowledge about the targeted ultrasound and its role in detecting Down syndrome. These findings are consistent with other studies that have reported a lack of understanding about the purpose of ultrasound examinations. One factor that seems to increase background knowledge about the targeted ultrasound is individuals having a higher level of education. However, most participants regardless of race, education, income, and exposure to targeted ultrasound information did not know the capabilities of a targeted ultrasound. This study confirmed women lack background knowledge about the targeted ultrasound and do not know enough about the technology to form a perception regarding its ability to detect Down syndrome. Additional studies to identify appropriate education techniques are necessary to determine how to best inform our patient population about targeted ultrasound.

Diagnosis and Treatment of Venous Malformations Consensus Document of the International Union of Phlebology (IUP): updated 2013

Venous malformations (VMs) are the most common vascular developmental anomalies (birth defects) . These defects are caused by developmental arrest of the venous system during various stages of embryogenesis. VMs remain a difficult diagnostic and therapeutic challenge due to the wide range of clinical presentations, unpredictable clinical course, erratic response to the treatment with high recurrence/persistence rates, high morbidity following non-specific conventional treatment, and confusing terminology. The Consensus Panel reviewed the recent scientific literature up to the year 2013 to update a previous IUP Consensus (2009) on the same subject. ISSVA Classification with special merits for the differentiation between the congenital vascular malformation (CVM) and vascular tumors was reinforced with an additional review on syndrome-based classification. A "modified" Hamburg classification was adopted to emphasize the importance of extratruncular vs. truncular sub-types of VMs. This incorporated the embryological origin, morphological differences, unique characteristics, prognosis and recurrence rates of VMs based on this embryological classification. The definition and classification of VMs were strengthened with the addition of angiographic data that determines the hemodynamic characteristics, the anatomical pattern of draining veins and hence the risk of complication following sclerotherapy. The hemolymphatic malformations, a combined condition incorporating LMs and other CVMs, were illustrated as a separate topic to differentiate from isolated VMs and to rectify the existing confusion with name-based eponyms such as Klippel-Trenaunay syndrome. Contemporary concepts on VMs were updated with new data including genetic findings linked to the etiology of CVMs and chronic cerebrospinal venous insufficiency. Besides, newly established information on coagulopathy including the role of D-Dimer was thoroughly reviewed to provide guidelines on investigations and anticoagulation therapy in the management of VMs. Congenital vascular bone syndrome resulting in angio-osteo-hyper/hypotrophy and (lateral) marginal vein was separately reviewed. Background data on arterio-venous malformations was included to differentiate this anomaly from syndrome-based VMs. For the treatment, a new section on laser therapy and also a practical guideline for follow up assessment were added to strengthen the management principle of the multidisciplinary approach. All other therapeutic modalities were thoroughly updated to accommodate a changing concept through the years.