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.

Metodi biochimici e biomolecolari applicati alla medicina clinica: rendimento della real-time TaqMan PCR per la valutazione della resistenza alla claritromicina in H.pylori e tests fecali nella diagnorstica del carcinoma colo-rettale: M2PK, calprotectina e FOBT

1) Background: The most common methods to evaluate clarithromycin resistance is the E-Test, but is time consuming. Resistance of Hp to clarithromycin is due to point mutations in the 23S rRNA. Eight different point mutations have been related to CH resistance, but the large majority of the clarithromycin resistance depends on three point mutations (A2142C, A2142G and A2143G). A novel PCR-based clarithromycin resistance assays, even on paraffin-embedded biopsy specimens, have been proposed. Aims: to assess clarithromycin resistance detecting these point mutation (E-Test as a reference method);secondly, to investigate relation with MIC values. Methods: Paraffin-embedded biopsies of patients Hp-positive were retrieved. The A2142C, A2142G and A2143G point mutations were detected by molecular analysis after DNA extraction by using a TaqMan real-time PCR. Results: The study enrolled 86 patients: 46 resistant and 40 sensible to CH. The Hp status was evaluated at endoscopy, by rapid urease test (RUT), histology and hp culture. According to real-time PCR, 37 specimens were susceptible to clarithromycin (wild type dna) whilst the remaining 49 specimens (57%) were resistant. A2143G is the most frequent mutation. A2142C always express a resistant phenotype and A2142G leads to a resitant phenotype only if homozigous. 2) Background: Colonoscopy work-load for endoscopy services is increasing due to colorectal cancer prevention. We tested a combination of faecal tests to improve accuracy and prioritize the access to colonoscopy. Methods: we tested a combination of fecal tests (FOBT, M2-PK and calprotectin) in a group of 280 patients requiring colonoscopy. Results: 47 patients had CRC and 85 had advanced adenoma/s at colonoscopy/histology. In case of single test, for CRC detection FOBT was the test with the highest specificity and PPV, M2-PK had the highest sensitivity and higher NPV. Combination was more interesting in term of PPV. And the best combination of tests was i-FOBT + M2-PK.

Progetto e valutazione di una piattaforma sperimentale di Internet of Energy per veicoli elettrici

This dissertation deals with the development of a project concerning a demonstration in the scope of the Supply Chain 6 of the Internet of Energy (IoE) project: the Remote Monitoring Emulator, which bears my personal contribution in several sections. IoE is a project of international relevance, that means to establish an interoperability standard as regards the electric power production and utilization infrastructure, using Smart Space platforms. The future perspectives of IoE have to do with a platform for electrical power trade-of, the Smart Grid, whose energy is produced by decentralized renewable sources and whose services are exploited primarily according to the Internet of Things philosophy. The main consumers of this kind of smart technology will be Smart Houses (that is to say, buildings controlled by an autonomous system for electrical energy management that is interoperable with the Smart Grid) and Electric Mobility, that is a smart and automated management regarding movement and, overall, recharging of electrical vehicles. It is precisely in the latter case study that the project Remote Monitoring Emulator takes place. It consists in the development of a simulated platform for the management of an electrical vehicle recharging in a city. My personal contribution to this project lies in development and modeling of the simulation platform, of its counterpart in a mobile application and implementation of a city service prototype. This platform shall, ultimately, make up a demonstrator system exploiting the same device which a real user, inside his vehicle, would use. The main requirements that this platform shall satisfy will be interoperability, expandability and relevance to standards, as it needs to communicate with other development groups and to effectively respond to internal changes that can affect IoE.

La Restless Legs Syndrome aumenta il rischio cardiovascolare e la mortalità a breve termine nei pazienti emodializzati

Abstract Restless legs syndrome (RLS) is a sensori-motor neurological disorder characterzed by paraesthesia, dysaesthesia and irresistibile urge to move the legs especially at night. Its prevalence is much higher among dialysis patients at 12 to 62% compared to 3 to 9% in the general population. In our study we investigated the association between RLS and cardiovascular events risk and laboratory parameters in End-stage kidney disease (ESKD) patients on dialysis. We studied 100 ESKD patients undergoing hemodialysis that were enrolled in an 18-months prospective observational study. The main outcomes were the association of RLS with new cardiovascular events and cardiovascular mortality. RLS affected 31% of the study population. It was associated with female gender, gradual reduction in residual dieresis, lower albumin (P=0.039) and inflammation, but not the dialysis parameters spKt/V and URR. During observation, 47% of patients experienced new cardiovascular events (64.5% with and 39.1% without RLS; P=0.019). Mortality was 20.0% in all patients, 32.3% in those with and 14.5% in patients without RLS (P=0.04). This study confirmed the high prevalence of RLS among dialysis patients and the associations between the severity of RLS and the risk of new cardiovascular events and higher short-term mortality. Abstract Restless legs syndrome (RLS) is a sensori-motor neurological disorder characterzed by paraesthesia, dysaesthesia and irresistibile urge to move the legs especially at night. Its prevalence is much higher among dialysis patients at 12 to 62% compared to 3 to 9% in the general population. In our study we investigated the association between RLS and cardiovascular events risk and laboratory parameters in End-stage kidney disease (ESKD) patients on dialysis. We studied 100 ESKD patients undergoing hemodialysis that were enrolled in an 18-months prospective observational study. The main outcomes were the association of RLS with new cardiovascular events and cardiovascular mortality. RLS affected 31% of the study population. It was associated with female gender, gradual reduction in residual dieresis, lower albumin (P=0.039) and inflammation, but not the dialysis parameters spKt/V and URR. During observation, 47% of patients experienced new cardiovascular events (64.5% with and 39.1% without RLS; P=0.019). Mortality was 20.0% in all patients, 32.3% in those with and 14.5% in patients without RLS (P=0.04). This study confirmed the high prevalence of RLS among dialysis patients and the associations between the severity of RLS and the risk of new cardiovascular events and higher short-term mortality.

Campionamento e determinazione di sostanze rilevanti per la valutazione della capacità ossidante dell’atmosfera e studio del loro effetto sui materiali ceramici

Carbonyl compounds are very important volatil organic compounds receiving increasing attention due to their critical role in tropospheric organic chemistry and to their effects on human health. They are first photo-oxidation stage of almost all organic compounds and originators of free radicals (OH, O3...). Therfore, continuous determination of their atmospheric concentrations is essential. Currently, field measurements are very limited mainly because of the analytical challenges posed by trace concentrations and interferences arising from atmospheric co-pollutants. Additionally, hydroxyl radical (OH) plays a central role in atmospheric chemistry processes. The measurement of atmospheric OH concentrations is essential for the comprehension of atmospheric chemical and photochemical processes. In this context, objectives of this work were: To perform a continuous survey of atmospheric concentrations of carbonyl compounds on different sites around the area of Bologna. For this purpose, an automatic instrument for the continuous measurement (one hour of time resolution) was developed and used. Additionally, the development of a complete and original analytical method was realised. To develop an original OH generation system in order to evaluate the effect of OH and the reactivity of solid and/or liquid materials of interest. This included the validation of an analytical method for the quantification of OH concentrations generated. Effect of OH on ceramic materials and reactivity of snow surface samples, involved as sink of OH in atmospheric chemistry, were evaluated.

Sviluppo cognitivo, motorio e comunicativo-linguistico: traiettorie evolutive nei primi 18 mesi di vita in bambini nati pretermine e a termine

Nella presente ricerca si ipotizza che la nascita pretemine con elevata immaturità, in assenza di danni neurologici permanenti, comporti un differente sviluppo neuro-evolutivo e diverse traiettorie nei primi 18 mesi di vita con una più alta frequenza di ritardi rispetto ai bambini nati a termine. Metodo. E’ stato esaminato lo sviluppo psicomotorio di 17 bambini pretermine con età gestazionale estremamente bassa (ELGA) e di 51 bambini pretermine con età gestazionale molto bassa (VLGA, 29-31) confrontati con 11 bambini nati a termine (FT), comparabili per caratteristiche socio-culturali, mediante le Scale Griffiths a 3, 6, 9, 12 e 18 mesi di vita (età corretta per ELGA e VLGA). E’ stato inoltre esaminato lo sviluppo cognitivo, motorio e linguistico dei 17 pretermine ELGA e degli 11 bambini FT mediante le Scale Bayely-III a 12 e 18 mesi di vita. Infine per la valutazione delle competenze comunicative-linguistiche, è stato somministrato il questionario “Primo Vocabolario del Bambino” -PVB somministrato ai genitori dei bambini ELGA e FT dagli 8 ai 18 mesi. Risultati. L’analisi multilivello ha mostrato che i nati ELGA e VLGA hanno traiettorie evolutive differenti rispetto ai nati FT nello sviluppo psicomotorio e in quello comunicativo-linguistico con punteggi significativamente più bassi e con una percentuale più elevata di ritardi lievi e moderati che si evidenziano già a partire dal primo anno di vita e aumentano tra i 12 e i 18 mesi. Conclusioni. La nascita pretermine con elevata immaturità comporta un rischio per lo sviluppo delle funzioni di base nei primi 18 mesi di vita anche in assenza di danno neurologico. Le ripetute valutazioni e l’uso di strumenti diretti e indiretti hanno permesso di effettuare un’accurata valutazione delle specifiche competenze esaminate. Questi risultati dimostrano l’importanza di condurre follow-up continuativi per monitorare lo sviluppo delle funzioni di base, individuare precocemente i bambini con ritardo e avviare interventi abilitativi precoci.

Valutazione del comportamento a fatica di piatti forati in acciaio in presenza ed assenza di interferenza

Descrizione dell'effetto favorevole sulla resistenza a fatica di un piatto forato della presenza di un accoppiamento per interferenza, rilevato mediante prove sperimentali e simulazioni agli elementi finiti.

Applicazioni industriali e di ricerca della spettroscopia NIR per la valutazione di indici qualitativi di prodotti alimentari

In the present work qualitative aspects of products that fall outside the classic Italian of food production view will be investigated, except for the apricot, a fruit, however, less studied by the methods considered here. The development of computer systems and the advanced software systems dedicated for statistical processing of data, has permitted the application of advanced technologies including the analysis of niche products. The near-infrared spectroscopic analysis was applied to the chemical industry for over twenty years and, subsequently, was applied in food industry with great success for non-destructive in line and off-line analysis. The work that will be presented below range from the use of spectroscopy for the determination of some rheological indices of ice cream applications to the characterization of the main quality indices of apricots, fresh dates, determination of the production areas of pistachio. Next to the spectroscopy will be illustrated different methods of multivariate analysis for spectra interpretation or for the construction of qualitative models of estimation. The thesis is divided into four separate studies that consider the same number of products. Each one of it is introduced by its own premise and ended with its own bibliography. This studies are preceded by a general discussion on the state of art and the basics of NIR spectroscopy.