Pachymetry-Guided Intrastromal Air Injection ("Pachy-Bubble") for Deep Anterior Lamellar Keratoplasty

To evaluate an innovative technique for intrastromal air injection to achieve deep anterior lamellar keratoplasty (DALK) with bare Descemet membrane (DM). Thirty-four eyes with anterior corneal pathology, including 27 with keratoconus, underwent DALK. After 400 mm trephination with a suction trephine, ultrasound pachymetry was performed 0.8 mm internally from the trephination groove in the 11 to 1 o'clock position. In this area, a 2-mm incision was created, parallel to the groove, with a micrometer diamond knife calibrated to 90% depth of the thinnest measurement. A cannula was inserted through the incision and 0.5 mL of air was injected to dissect the DM from the stroma. After peripheral paracentesis, anterior keratectomy was carried out to bare the DM. A 0.25-mm oversized graft was sutured in place. Overall, 94.1% of eyes achieved DALK. Bare DM was achieved in 30 eyes, and a pre-DM dissection was performed in 2 eyes. Air injection was successful in detaching the DM (achieving the big bubble) in 88.2% of the eyes. In keratoconus eyes, the rate was 88.9%. All cases but one required a single air injection to achieve DM detachment. Microperforations occurred in 5 cases: 3 during manual layer-by-layer dissection after air injection failed to detach the DM, 1 during removal of the residual stroma after big-bubble formation, and 1 during the diamond knife incision. Two cases (5.9%) were converted to penetrating keratoplasty because of macroperforations. The technique was reproducible, safe, and highly effective in promoting DALK with bare DM.

Parathyroid adenoma apoplexy as a temporary solution of primary hyperparathyroidism: a case report

Abstract Introduction The natural history of patients with spontaneous parathyroid necrosis is unknown. In this case report we describe the clinical course, laboratory, radiographic, bone densitometry tests, parathyroid ultrasonography and scintigraphy examinations of a patient performed over a period of eight years after she first presented with a sudden episode of spontaneous resolution of primary hyperparathyroidism (PHPT). Case presentation A 24-year-old woman with a clinical history and laboratory and radiographic tests compatible with PHPT suffered a sudden episode of cervical pain and presented with clinical evidence of hypocalcemia. Biopsy of a cervical nodule revealed necrotic material compatible with ischemia of the parathyroid. The follow-up of the patient presented four distinct phases: the first, which lasted two years, was compatible with a period of bone hunger during which it was necessary to introduce calcitriol and calcium carbonate. During this period, the patient showed bone mass gain. The second phase was characterized by normalization of calcium and parathyroid hormone levels and its end was difficult to define. During the third phase there was a recurrence of hypercalcemia associated with elevated parathyroid hormone (PTH) levels and loss of bone mass. The last phase corresponded to the interval after parathyroidectomy, which was characterized by normalization of serum levels of calcium and PTH, as well as bone mass gain. Conclusion This case report indicates that spontaneous resolution of PHPT by adenoma necrosis is potentially temporary. Thus, in cases in which a conservative approach is chosen, clinical and laboratory follow-up is indispensable. Bone mass measurement is a useful tool in the follow-up of these cases. However, this option exposes the patient to a potential roller-coaster ride of bone mass gain and loss, whose long term consequences are still unknown.

Barn i missbrukarfamiljer – Överlevnadsstrategier

Barn till missbrukare sägs ha olika överlevnadsstrategier för att klara sin svåra situation. Det är viktigt att den roll som barnet utvecklat för att överleva inte permanentas och att barnet får hjälp att hitta andra vägar att lösa sin svåra situation på. Att ha förståelse och kunskap om hur det är att vara barn i en familj där någon av föräldrarna sitter fast i ett alkoholmissbruk är en nödvändig förutsättning för att arbeta professionellt med barn till alkoholister. Syftet med denna uppsats är att göra en kartläggning av barnens beteendemönster och de faktorer som kan påverka dessa i missbruksfamiljer. Denna studie är en kvantitativ enkätstudie där den huvudsakliga undersökningspopulationen bestått av föräldrar till barn som har missbruksproblem i sin närhet. Det finns gruppverksamheter för barn och ungdomar som har missbrukande föräldrar och genom kontakter med ett flertal av dessa verksamheter har enkäterna nått fram till undersökningspersonerna. De har frivilligt tagit emot enkäter och anonymt svarat på frågor om sina barn. De gruppansvariga samlade in de ifyllda enkäterna och återsände dem till Mittuniversitetet. Enkäterna sammanställdes sedan med tidigare forskning kring överlevnadsstrategier och roller som grund. Skalor konstruerades för att mäta beteendemönster. Med hjälp av dessa gjordes en uppdelning i grupperna hjälten, rebellen, tapetblomman, clownen och kelgrisen, efter hur barnen motsvarar de klassiskt beskrivna rollerna. Försök gjordes att förklara barnens beteenden utifrån familjens och barnets situation. Variansanalysen som gjordes visade att de beskrivna rollerna inte förklarades av några av de undersökta variablerna, alltså inte heller av missbruket eller andra stressfaktorer såsom negativt familjeklimat eller externa konflikter. Analysen ger alltså dåligt stöd för att rollerna till påtaglig del kan förklaras utifrån familjeproblemen.

Famijens upplevelse av palliativ vård av barn med cancer : - en litteraturstudie

Abstrakt Syfte: Syftet med litteraturstudien är att belysa familjens upplevelser av palliativ omvårdnad av barn med cancer. Bakgrund: Varje år får cirka 300 svenska barn och ungdomar en cancerdiagnos. En fjärdedel dör av sin sjukdom. Barnets sjukdom påverkar föräldrarnas roller, inbördes och mot barnen och även syskon blir åsidosatta. Vetskapen om att det inte går att bota barnet upplevs för föräldrarna som oerhört stressande, samtidigt som de vill leva ett så normalt liv som möjligt. Metod: Metoden som användes var en systematisk litteraturstudie. Arton vetenskapliga artiklar inkluderades, vilka var publicerade mellan åren 1997-2007. Resultat: Resultatet visar att informationen kring barnets behandling och kommande död ansåg föräldrarna vara viktig för att vården skulle vara av god kvalitet. Psykosociala problemen som föräldrar upplevde var rädslan inför deras barns död samt stressen över att inte kunna hjälpa sitt sjuka barn. Många föräldrar ville vårda barnet själva hemma så att det vanliga livet kunde fortsätta. Diskussion: Det är viktigt att vårdpersonal visar att de bryr sig, ger information som kan förstås samt ge informationen med medkänsla. För att familjen lättare ska klara av situationen behöver de mycket stöd från familj, vänner och personal. Stödet är viktigt när föräldrarna valt att vårda sitt barn i hemmet, trots att det är stressande och skrämmande.

Maximal muscular vascular conductances during whole body upright exercise in humans

[EN] That muscular blood flow may reach 2.5 l kg(-1) min(-1) in the quadriceps muscle has led to the suggestion that muscular vascular conductance must be restrained during whole body exercise to avoid hypotension. The main aim of this study was to determine the maximal arm and leg muscle vascular conductances (VC) during leg and arm exercise, to find out if the maximal muscular vasodilatory response is restrained during maximal combined arm and leg exercise. Six Swedish elite cross-country skiers, age (mean +/-s.e.m.) 24 +/- 2 years, height 180 +/- 2 cm, weight 74 +/- 2 kg, and maximal oxygen uptake (VO(2,max)) 5.1 +/- 0.1 l min(-1) participated in the study. Femoral and subclavian vein blood flows, intra-arterial blood pressure, cardiac output, as well as blood gases in the femoral and subclavian vein, right atrium and femoral artery were determined during skiing (roller skis) at approximately 76% of VO(2,max) and at VO(2,max) with different techniques: diagonal stride (combined arm and leg exercise), double poling (predominantly arm exercise) and leg skiing (predominantly leg exercise). During submaximal exercise cardiac output (26-27 l min(-1)), mean blood pressure (MAP) (approximately 87 mmHg), systemic VC, systemic oxygen delivery and pulmonary VO2(approximately 4 l min(-1)) attained similar values regardless of exercise mode. The distribution of cardiac output was modified depending on the musculature engaged in the exercise. There was a close relationship between VC and VO2 in arms (r= 0.99, P < 0.001) and legs (r= 0.98, P < 0.05). Peak arm VC (63.7 +/- 5.6 ml min(-1) mmHg(-1)) was attained during double poling, while peak leg VC was reached at maximal exercise with the diagonal technique (109.8 +/- 11.5 ml min(-1) mmHg(-1)) when arm VC was 38.8 +/- 5.7 ml min(-1) mmHg(-1). If during maximal exercise arms and legs had been vasodilated to the observed maximal levels then mean arterial pressure would have dropped at least to 75-77 mmHg in our experimental conditions. It is concluded that skeletal muscle vascular conductance is restrained during whole body exercise in the upright position to avoid hypotension.

Leg and arm lactate and substrate kinetics during exercise

[EN] To study the role of muscle mass and muscle activity on lactate and energy kinetics during exercise, whole body and limb lactate, glucose, and fatty acid fluxes were determined in six elite cross-country skiers during roller-skiing for 40 min with the diagonal stride (Continuous Arm + Leg) followed by 10 min of double poling and diagonal stride at 72-76% maximal O(2) uptake. A high lactate appearance rate (R(a), 184 +/- 17 micromol x kg(-1) x min(-1)) but a low arterial lactate concentration ( approximately 2.5 mmol/l) were observed during Continuous Arm + Leg despite a substantial net lactate release by the arm of approximately 2.1 mmol/min, which was balanced by a similar net lactate uptake by the leg. Whole body and limb lactate oxidation during Continuous Arm + Leg was approximately 45% at rest and approximately 95% of disappearance rate and limb lactate uptake, respectively. Limb lactate kinetics changed multiple times when exercise mode was changed. Whole body glucose and glycerol turnover was unchanged during the different skiing modes; however, limb net glucose uptake changed severalfold. In conclusion, the arterial lactate concentration can be maintained at a relatively low level despite high lactate R(a) during exercise with a large muscle mass because of the large capacity of active skeletal muscle to take up lactate, which is tightly correlated with lactate delivery. The limb lactate uptake during exercise is oxidized at rates far above resting oxygen consumption, implying that lactate uptake and subsequent oxidation are also dependent on an elevated metabolic rate. The relative contribution of whole body and limb lactate oxidation is between 20 and 30% of total carbohydrate oxidation at rest and during exercise under the various conditions. Skeletal muscle can change its limb net glucose uptake severalfold within minutes, causing a redistribution of the available glucose because whole body glucose turnover was unchanged.

Riabilitazione protesica ed implanto-protesica di pazienti in età evolutiva affetti da Displasia Ectodermica

Introduction. Ectodermal Dysplasias are a heterogeneous group of inherited disorders characterized by dysplasia of tissues of ectodermal origin (hair, nails, teeth, skins and glands). Clinically, it may be divided into two broad categories: the X-linked hypoidrotic form and the hidrotic form. Hypohidrotic Ectodermal Dysplasia (H.E.D) is characterized by the triad oligo-anodontia, hypotricosis, hypo-anhydrosis (Christ-Siemens-Tourane syndrome). The incidence of HED is about 1/100,000. Mutation in the actodysplasin-A (EDA) and ectodysplasin-A receptor (EDAR) genes are responsible for X-linked and autosomal HED. The clinical features include sparse, fine hair, missing or conical-shaped teeth, decreased sweat and mucous glands, hypoplastic skin, and heat intolerance with exercise or increased ambient temperature. Complete or partial anodontia and malformation of teeth are the most frequent dental findings. Incisors and canines are often conical-shaped while primarily second molars, if present, are mostly affected by taurodontism. Treatment is supportive and includes protection from heat exposure, early prosthetic rehabilitation, skin, hair ear, nose and nail care, and genetic counseling for family planning. The diagnosis of HED in the neonatal and early infancy period may be difficult since sparse hair and absent teeth are normal finding at this age. In childhood the diagnosis is more easily made on the basis of history and clinical examination. Dental abnormalities are the most common complaint. Prosthetic rehabilitation has been recommended as an essential part of the management of HED because is important from functional, esthetic, and psychological standpoint. A team approach that includes input from a pediatric dentist, an orthodontist, a prosthodontist, and an oral and maxillofacial surgeon is necessary for a successful outcome. Conventional prosthodontic rehabilitation in young patient is often difficult because of the anatomical abnormalities of existing teeth and alveolar ridges. The conical shaped teeth and “knife-edge” alveolar ridges result in poor retention and instability of dentures. Moreover, denture must permit jaws expansion and a correct pattern of growth. Materials and Methods. Complete removable dentures were provided to allow for normal physiological development and a corrected masticatory function. Initial maxillary and mandibular impressions were made with smallest stock trays and irreversible hydrocolloid and then final impressions ware made with light-bodied polysulfide rubber base impression material. A base of autopolymerizing resin was constructed and a wax rim was added to the base. The patient’s vertical dimension of occlusion was established by assessing phonetic and esthetic criteria. Preliminary occlusal relations were recorded, and the mandibular cast was mounted on the articulator. Acrylic resin teeth specific for children dentures were selected and mounted. The dentures were tried in and, after proper adjustments, were inserted. The patients were monitored clinically every month to fit prostheses. Cephalometric radiographs were taken every 6 month with the prostheses in place in order to evaluate correct pattern of growth. Cephalometric measurements were realized and used to evaluate the effect of rehabilitation on craniofacial growth. Cephalometric measurements of sound patients were compared with ED patients. After two month expander screws (three-way screw in the upper denture and two-way the lower one)were inserted in each denture in order to permit the expansion of the denture and the jaws growth. Where conical teeth were present, composite crown were realized and luted to improve the esthetic and phonesis. In order to improve retention the placement of endosseous implants was carried out. TC 3D Accuitomo was performed and a resin model of mandibular bone of the patient was realized. At the age of 11 years two implants were inserted into anterior mandible in a child with anodontia. Despite a remarkable multi-dimensional atrophy of the mandibular alveolar process, the insertion of two tapered screw implants (SAMO Smiler, diameter 3.8, length 10 mm). After a submerged healing period of two-three month, the implants were exposed. Implants were connected with an expansion guide that permits mandibular growth and prosthetic retention. The amount of mandibular growth was also evaluate dusing the expansion guide. Results. Early oral rehabilitation improve oral function, phonesis and esthetic, reducing social impairment. Treated patients showed normal cephalometric measurement. Early rehabilitation is able to prevent the prognatissm of the mandibula . The number of teeth was significantly related to several changes in craniofacial morphology. Discussion. In the present study the 5,3% of ED patients showed hypodontia, the l’89,4% di oligodontia, and the 5,3% di anodontia. The cephalometric analysis supports that ED patients showed midface hypoplasia. ED groups showed an increased pogonion to nasion measurement than sound patients, indicative of class III tendency. The present study demonstrated that number of teeth was significantly correlated with deviation of cephalometric measurements from normality. Oligoanodontia is responsible for changing of cephalometric measuraments also on sagittal plane with a class III tendency. Maxillary jaw showed a retrused position related to the presence of hypodontia.

Laboratory verification of predicted permanent deformation in asphalt materials following climate change.

In the past a change in temperature of 5°C most often occurred over intervals of thousands of years. According to estimates by the IPCC, in the XXI century is expected an increase in average temperatures in Europe between 1.8 and 4.0°C in the best case caused by emissions of carbon dioxide and other GHG from human activities. As well as on the environment and economic context, global warming will have effects even on road safety. Several studies have already shown how increasing temperature may cause a worsening of some types of road surface damages, especially rutting, a permanent deformation of the road structures consisting in the formation of a longitudinal depression in the wheelpath, mostly due to the rheological behavior of bitumen. This deformation evolves during the hot season because of the heating capacity of the asphalt layers, in fact, the road surface temperature is up to 24°C higher than air. In this thesis, through the use of Wheeltrack test, it was studied the behavior of some types of asphalt concrete mixtures subjected to fatigue testing at different temperatures. The objectives of this study are: to determine the strain variation of different bituminous mixture subjected to fatigue testing at different temperature conditions; to investigate the effect of aggregates, bitumen and mixtures’ characteristics on rutting. Samples were made in the laboratory mostly using an already prepared mixtures, the others preparing the asphalt concrete from the grading curve and bitumen content. The same procedure was performed for each specimen: preparation, compaction using the roller compactor, cooling and heating before the test. The tests were carried out at 40 - 50 - 60°C in order to obtain the evolution of deformation with temperature variation, except some mixtures for which the tests were carried out only at 50°C. In the elaboration of the results were considered testing parameters, component properties and the characteristics of the mixture. Among the testing parameters, temperature was varied for each sample. The mixtures responded to this variation with a different behavior (linear logarithmic and exponential) not directly correlated with the asphalt characteristics; the others parameters as load, passage frequency and test condition were kept constant. According to the results obtained, the main contribution to deformation is due to the type of binder used, it was found that the modified bitumen have a better response than the same mixtures containing traditional bitumen; to the porosity which affects negatively the behavior of the samples and to the homogeneity ceteris paribus. The granulometric composition did not seem to have interfered with the results. Overall has emerged at working temperature, a decisive importance of bitumen composition, than the other characteristics of the mixture, that tends to disappear with heating in favor of increased dependence of rutting resistance from the granulometric composition of the sample considered. In particular it is essential, rather than the mechanical characteristics of the binder, its chemical properties given by the polymeric modification. To confirm some considered results, the maximum bulk density and the air voids content were determined. Tests have been conducted in the laboratories of the Civil Engineering Department at NTNU in Trondheim according to European Standards.

Chemie an funktionalen Polymer-Opalen

In dieser Arbeit wird die Herstellung und Anwendung von funktionalen Polymer-Opalen beschrieben. Für die Synthese von funktionalen monodipsersen Kolloiden, den Bausteinen der Opale, wird die emulgatorfreie Emulsionspolymerisation (SFEP) verwendet. Je nach einzubauendem funktionalem Molekül werden verschiedene Varianten der SFEP verwendet, wie z. B. Homopolymerisation, Copolymerisation, Polymerisation mit Fremdstoffen und die Herstellung von Kern-Schale-Kolloiden. Die so hergestellten monodispersen Kolloide formen durch Selbstorganisation über horizontale (Aufpipettieren, Rakeln, Sprühen) oder vertikale Kristallisation (Ziehmaschine)hochqualitative künstliche Opale. Die eingebauten Funktionalitäten öffnen den Weg zu einer Vielzahl von Anwendungen. Über die Spaltung von funktionalen Estergruppen kann eine lichtinduzierte Strukturierung durchgeführt werden. Der Einbau von Epoxidgruppen ermöglicht eine makroskopische Vernetzung wodurch die mechanische Stabilität der Struktur erhöht wird. Der Einsatz von Reaktivestern kann zur Oberflächen- funktionalisierung verwendet werden. Durch Replizierung der Struktur zum inversen Opal können weitere funktionale Materialien eingeführt werden, was die Einsatzmöglichkeiten noch erweitert.

Tecniche regionali di stima della portata di progetto: Impatto della correlazione spaziale tra le serie di osservazioni

La stima degli indici idrometrici in bacini non strumentati rappresenta un problema che la ricerca internazionale ha affrontato attraverso il cosiddetto PUB (Predictions on Ungauged Basins – IAHS, 2002-2013). Attraverso l’analisi di un’area di studio che comprende 61 bacini del Sud-Est americano, si descrivono e applicano due tecniche di stima molto diverse fra loro: il metodo regressivo ai Minimi Quadrati Generalizzati (GLS) e il Topological kriging (TK). Il primo considera una serie di fattori geomorfoclimatici relativi ai bacini oggetto di studio, e ne estrae i pesi per un modello di regressione lineare dei quantili; il secondo è un metodo di tipo geostatistico che considera il quantile come una variabile regionalizzata su supporto areale (l’area del bacino), tenendo conto della dislocazione geografica e l’eventuale struttura annidata dei bacini d’interesse. L’applicazione di questi due metodi ha riguardato una serie di quantili empirici associati ai tempi di ritorno di 10, 50, 100 e 500 anni, con lo scopo di valutare le prestazioni di un loro possibile accoppiamento, attraverso l’interpolazione via TK dei residui GLS in cross-validazione jack-knife e con differenti vicinaggi. La procedura risulta essere performante, con un indice di efficienza di Nash-Sutcliffe pari a 0,9 per tempi di ritorno bassi ma stazionario su 0,8 per gli altri valori, con un trend peggiorativo all’aumentare di TR e prestazioni pressoché invariate al variare del vicinaggio. L’applicazione ha mostrato che i risultati possono migliorare le prestazioni del metodo GLS ed essere paragonabili ai risultati del TK puro, confermando l’affidabilità del metodo geostatistico ad applicazioni idrologiche.

Tecnologie innovative di Radioterapia Stereotassica

Dopo un'iniziale descrizione dei concetti fondamentali di dosimetria e degli effetti biologici delle radiazioni sul DNA, ho fatto una descrizione approfondita sulle diverse metodiche radioterapiche. Ho poi concentrato l'elaborato sull'approfondimento storico, tecnico-funzionale e degli aspetti positivi/negativi di due delle tecnologie di irradiazione mirata in ambito clinico più all'avanguardia e utilizzate nel loro ambito specifico: Gamma Knife modello PERFEXION e Cyberknife modello M6. Infine ho esposto gli aspetti principali dell'ultimo medello di Gamma Knife (ICON) presentato per la prima ad aprile 2015 e ad oggi presente solo in due strutture in Europa e cinque negli Stati Uniti.

Metodi per la stima spaziale della temperatura in territori ad orografia complessa e parametrizzazione di un modello idrologico semi-distribuito su alcuni bacini appenninici

I bacini idrografici appenninici romagnoli rappresentano una fonte idropotabile di essenziale importanza per la Romagna, grazie alla regolazione stagionale svolta dall’invaso artificiale di Ridracoli. Nel presente elaborato si è implementato un modello per lo studio e la valutazione del regime idrologico dei bacini idrografici allacciati all’invaso, affrontando sia gli aspetti relativi alla miglior spazializzazione dei dati metereologici in ingresso al modello (in particolare in relazione alla stima della temperatura, fondamentale per la rappresentazione dei processi di evapotraspirazione e dei fenomeni di accumulo e scioglimento nevoso), sia gli aspetti di calibrazione dei parametri, confrontando le simulazioni ottenute a partire da diverse configurazioni del modello in termini di rappresentazione spaziale e temporale dei fenomeni. Inoltre si è eseguita una regionalizzazione del modello su due sezioni fluviali che sono al momento oggetto di indagini idrologiche, fornendo supporto alla valutazione della possibilità di realizzazione di una nuova opera di presa. A partire dai dati puntuali dei sensori termometrici disponibili si è ricercata la migliore tecnica di interpolazione della temperatura sull’area di studio, ottenendo una discreta precisione, con un errore in procedura di ricampionamento jack-knife raramente superiore al grado centigrado. La calibrazione del modello TUWien in approccio semi-distribuito, sia quando applicato a scala oraria sia quando applicato a scala giornaliera, ha portato a buoni risultati. La complessità del modello, dovuta in gran parte alla presenza di uno specifico modulo per la gestione di accumulo e scioglimento nivale, è stata ripagata dalle buone prestazioni delle simulazioni ottenute, sia sul periodo di calibrazione sia su quello di validazione. Tuttavia si è osservato che l’approccio semi-distribuito non ha portato benefici sostanziali rispetto a quello concentrato, soprattutto in relazione al forte aumento di costo computazionale.