La radioterapia e le tecniche I.G.R.T. applicate

L'elaborato espone l'iter di un paziente nel reparto di radioterapia e descrive l'evoluzione delle immagini radioterapiche dai portal film alle Cone Beam Computer Tomography. Inoltre espone i vari standard e protocolli usati per archiviare e trasmettere le immagini digitali precedentemente descritte.

Per il progetto di restauro: Analisi e sintesi di esperienze diverse

È possibile delineare un percorso operativo imprescindibile e necessario ad un intervento di restauro? Alla base di questa tesi vi è la volontà di definire una traccia leggera ma chiara, un iter metodologico pratico che tuttavia non appiattisca il restauro ad una mera disciplina tecnica ma lo consideri per quello che realmente è, un atto di progettazione dell’architettura, con le relative complessità e sfaccettature che contraddistinguono questo delicato esercizio. Ho tracciato la mia ipotesi di un percorso con l'aiuto di una bibliografia di riferimento, suddividendo in tappe il percorso in modo da renderlo più chiaro e leggibile. Dopodiché ho presentato tre esperienze, fatte nel corso di questi anni di studio, e ho comparato questi lavori con la metodologia definita precedentemente. Fine ultimo di questo elaborato è andare oltre le singole esperienze svolte ed estrapolare un filo conduttore per il progetto di restauro, che possa servire di qui in avanti, in esperienze future.

Studio di nuovi processi di sintesi di anidride maleica in fase gas

Oggi il mercato mondiale dell'anidride maleica (AM) è in continua espansione grazie ad un numero sempre crescente di applicazioni finali e sviluppo di nuove tecnologie industriali. La AM viene impiegata nella produzione di resine poliestere insature e resine alchidiche e nella produzione di chemicals a più alto valore aggiunto. Il processo di sintesi è tutt’ora basato sull'ossidazione selettiva del benzene e del n-butano. Con l’aumento delle emissione di gas serra, legate all’impiego di materie di origine fossile e la loro continua diminuzione, si stanno studiando nuovi processi basati su materie derivanti da fonti rinnovali. Tra i vari processi studiati vi è quello per la sintesi di AM, i quali utilizzano come molecola di furfurale, 5-idrossimetilfurfurale e 1-butanolo; tutte queste presentano però il problema di un costo superiore rispetto alle molecole tutt’ora usate. Ad oggi una delle molecole ottenibili da fonti rinnovabili avente un costo competitivo alle materie derivanti da fonti fossili è il bio-etanolo. Essendo nota la possibilità di trasformare dell’etanolo in composti a 4 atomi di carbonio (C4) come 1-butanolo (reazione di Guerbet) e in 1,3- butadiene (processo Lebedev) su ossidi misti Mg/Si e la loro trasformazioni in AM, è’ dunque possibile ipotizzare un processo operante in fase gas che accoppi entrambi i processi. Lo scopo di questo lavoro di tesi è stato quello di effettuare uno studio su sistemi catalitici mediante differenti approcci impiantistici. Il primo ha previsto l’impiego di un sistema detto “a cascata” nel quale è stato accoppiato il sistema misto a base di Mg/Si/O, per la trasformazione dell’etanolo a C4, e il pirofosfato di vanadile (VPP), per l’ossidazione selettiva di quest’ultimi in AM. Il secondo approccio ha previsto l’impiego di un unico sistema multifunzionale in grado di catalizzare tutti gli step necessari. In quest’ultimo caso, i sistemi studiati sono stati il Mg2P2O7 ed un sistema costituito da VPP DuPont sul quale è stato depositato MgO. I catalizzatori sono stati caratterizzati mediante diffrattometria a raggi X, spettroscopia Raman e analisi dell’area superficiale mediante metodo BET, mentre i test catalitici sono stati condotti su un impianto di laboratorio con un reattore assimilabile ad un modello di tipo PFR.

Scattering anelastico di neutroni

Lo scopo della tesi è di illustrare le principali tecniche spettroscopiche per l'indagine della materia mediante l'uso dei neutroni come sonda, con particolare attenzione rivolta alla diffusione anelastica su campioni monocristallini. Nel testo vengono esposti i processi di produzione dei neutroni tramite spallazione, fissione e fusione nucleare, e si descrive il reattore nucleare dell'Institut Laue-Langevin (ILL) di Grenoble. Inoltre, viene presentato uno studio della curva di dispersione dei modi vibrazionali acustici di un campione monocristallino di β-stagno a temperatura ambiente, effettuato presso l'ILL tramite un diffrattometro a triplo-asse. I risultati sono confrontati con i modelli teorici disponibili (S. H. Chen) e con dati sperimentali noti (J. M. Rowe).

Controllo della misura della luminosità con il canale Z -> mu+mu- in ATLAS

La misura della sezione d'urto di processi fisici prodotti negli urti fra protoni ad LHC è uno dei settori più importanti della ricerca in corso, sia per verificare le predizioni del Modello Standard, che per la ricerca di nuova fisica. La precisione necessaria per distinguere fenomeni standard e non, richiede un ottimo controllo delle incertezze sistematiche. Fra le sorgenti di errore sistematico, di particolare importanza sono quelle sulla misura della luminosità, che rappresenta il fattore di normalizzazione necessario per la misura di qualsiasi sezione d'urto. Ogni esperimento che si proponga misure di questo genere è quindi dotato di monitor di luminosità dedicati. In questa tesi sono presentate le tecniche di misura della luminosità ad ATLAS utilizzando i rivelatori dedicati e le problematiche incontrate nel corso della presa dati del 2012, sia per quanto riguarda la loro procedura di calibrazione assoluta, che per la loro stabilità in funzione del tempo e linearità di risposta, e vengono fornite le incertezze sistematiche dipendenti dal loro confronto. Per meglio comprendere tali risultati, si è studiato il canale di produzione del bosone Z nelle interazioni protone-protone, all'energia nel centro di massa s = √8 TeV mediante il suo decadimento in due muoni, utilizzando i dati acquisiti nel corso del 2012 Nel primo capitolo vengono definiti i concetti di luminosità istantanea ed integrata, sia dalla prospettiva del collider che le fornisce, che dal punto di vista delle analisi di fisica, quale quella svolta in questa tesi. Nel secondo capitolo viene descritto l'insieme dei rivelatori utilizzati da ATLAS per la misura della luminosità e i risultati ottenuti mediante il loro confronto in termini di incertezze sistematiche. Nel terzo capitolo viene infine presentata la misura della sezione d'urto di produzione del bosone Z e l'utilizzo di tale misura per il controllo della stabilità nel tempo e della linearità della misura sperimentale della luminosità.

Changing patterns of cancer incidence in the early- and late-HAART periods: the Swiss HIV Cohort Study

The advent of highly active antiretroviral therapy (HAART) in 1996 led to a decrease in the incidence of Kaposi's sarcoma (KS) and non-Hodgkin's lymphoma (NHL), but not of other cancers, among people with HIV or AIDS (PWHA). It also led to marked increases in their life expectancy.

Single-shot electron bunch length measurements using a spatial electro-optical autocorrelation interferometer

A spatial, electro-optical autocorrelation (EOA) interferometer using the vertically polarized lobes of coherent transition radiation (CTR) has been developed as a single-shot electron bunch length monitor at an optical beam port downstream the 100 MeV preinjector LINAC of the Swiss Light Source. This EOA monitor combines the advantages of step-scan interferometers (high temporal resolution) [D. Mihalcea et al., Phys. Rev. ST Accel. Beams 9, 082801 (2006) and T. Takahashi and K. Takami, Infrared Phys. Technol. 51, 363 (2008)] and terahertz-gating technologies [U. Schmidhammer et al., Appl. Phys. B: Lasers Opt. 94, 95 (2009) and B. Steffen et al., Phys. Rev. ST Accel. Beams 12, 032802 (2009)] (fast response), providing the possibility to tune the accelerator with an online bunch length diagnostics. While a proof of principle of the spatial interferometer was achieved by step-scan measurements with far-infrared detectors, the single-shot capability of the monitor has been demonstrated by electro-optical correlation of the spatial CTR interference pattern with fairly long (500 ps) neodymium-doped yttrium aluminum garnet (Nd:YAG) laser pulses in a ZnTe crystal. In single-shot operation, variations of the bunch length between 1.5 and 4 ps due to different phase settings of the LINAC bunching cavities have been measured with subpicosecond time resolution.

Efficacy of communication skills training courses in oncology: a systematic review and meta-analysis

Objective: Group training in communication skills [communication skills training (CST)] has become partly mandatory for oncology staff. However, so far, a comprehensive meta-analysis on the efficacy is lacking. Design: Included studies either compare the efficacy of a specific training with a control group or look at the additional effect of booster sessions on communication behaviour, attitudes or patient outcomes. Methods: Four electronic databases were searched up to July 2008 without language restriction, and reference lists of earlier reviews were screened. Effect sizes (ESs) were extracted and pooled in random effects meta-analyses. Results: We included 13 trials (three non-randomised), 10 with no specific intervention in the control group. Meta-analysis showed a moderate effect of CST on communication behaviour ES = 0.54. Three trials compared basic training courses with more extensive training courses and showed a small additional effect on communication skills ES = 0.37. Trials investigating participants' attitudes ES = 0.35 and patient outcomes ES = 0.13 (trend) confirmed this effect. Conclusions: Training health professionals by CST is a promising approach to change communication behaviour and attitudes. Patients might also benefit from specifically trained health professionals but strong studies are lacking. However, feasibility and economic aspects have to be kept in mind when considering providing a training of optimal length.

Lung cancer in the Swiss HIV Cohort Study: role of smoking, immunodeficiency and pulmonary infection

Immunodeficiency and AIDS-related pulmonary infections have been suggested as independent causes of lung cancer among HIV-infected persons, in addition to smoking.

Endoscopic sinus surgery training courses: benefit and problems - a multicentre evaluation to systematically improve surgical training

The aim of this multicentre study was to systematically analyse the strengths and weaknesses in the surgical training for endoscopic sinus surgery (ESS) and identify measures that may improve training.

Clinical, polysomnographic and genome-wide association analyses of narcolepsy with cataplexy: a European Narcolepsy Network study

The aim of this study was to describe the clinical and PSG characteristics of narcolepsy with cataplexy and their genetic predisposition by using the retrospective patient database of the European Narcolepsy Network (EU-NN). We have analysed retrospective data of 1099 patients with narcolepsy diagnosed according to International Classification of Sleep Disorders-2. Demographic and clinical characteristics, polysomnography and multiple sleep latency test data, hypocretin-1 levels, and genome-wide genotypes were available. We found a significantly lower age at sleepiness onset (men versus women: 23.74 ± 12.43 versus 21.49 ± 11.83, P = 0.003) and longer diagnostic delay in women (men versus women: 13.82 ± 13.79 versus 15.62 ± 14.94, P = 0.044). The mean diagnostic delay was 14.63 ± 14.31 years, and longer delay was associated with higher body mass index. The best predictors of short diagnostic delay were young age at diagnosis, cataplexy as the first symptom and higher frequency of cataplexy attacks. The mean multiple sleep latency negatively correlated with Epworth Sleepiness Scale (ESS) and with the number of sleep-onset rapid eye movement periods (SOREMPs), but none of the polysomnographic variables was associated with subjective or objective measures of sleepiness. Variant rs2859998 in UBXN2B gene showed a strong association (P = 1.28E-07) with the age at onset of excessive daytime sleepiness, and rs12425451 near the transcription factor TEAD4 (P = 1.97E-07) with the age at onset of cataplexy. Altogether, our results indicate that the diagnostic delay remains extremely long, age and gender substantially affect symptoms, and that a genetic predisposition affects the age at onset of symptoms.

Epilepsy and obstructive sleep apnea

A few publications documented the coexistence of epilepsy and obstructive sleep apnea (OSA). The extent, nature, and clinical relevance of this association remain poorly understood. We retrospectively reviewed the database of our sleep center to identify patients with both sleep apnea and epilepsy. Characteristics of epilepsy, sleep history, presence of excessive daytime sleepiness [Epworth Sleepiness Scale (ESS)] and polysomnographic data were assessed. The effect of continuous positive airway pressure (CPAP) on seizure reduction was prospectively analyzed after a median interval of 26 months (range: 2-116 months) from the diagnosis of OSA. OSA was found in 29 epilepsy patients (25 men and 4 women) with a median age of 56 years (range: 37-79). The median apnea hypopnea index was 33 (range: 10-85), the oxygen desaturation index was 12 (range 0-92), and 52% of the patients had an ESS score >10. In 27 patients, epilepsy appeared 1 month to 44 years prior to the diagnosis of OSA. In 21 patients, the appearance of OSA symptoms coincided with a clear increase in seizure frequency or the first appearance of a status epilepticus. Treatment with CPAP was continued with good compliance in 12 patients and led to a significant reduction of both ESS scores and seizure frequency in 4 patients. Our data suggest the importance of considering diagnosis and treatment of OSA in epilepsy patients with poor seizure control and/or reappearance of seizures after a seizure-free interval.

Sleep-disordered breathing and acute ischemic stroke: diagnosis, risk factors, treatment, evolution, and long-term clinical outcome

BACKGROUND AND PURPOSE: Sleep-disordered breathing (SDB) is frequent in stroke patients. Risk factors, treatment response, short-term and long-term outcome of SDB in stroke patients are poorly known. METHODS: We prospectively studied 152 patients (mean age 56+/-13 years) with acute ischemic stroke. Cardiovascular risk factors, Epworth sleepiness score (ESS), stroke severity/etiology, and time of stroke onset were assessed. The apnea-hypopnea index (AHI) was determined 3+/-2 days after stroke onset and 6 months later (subacute phase). Continuous positive airway pressure (CPAP) treatment was started acutely in patients with SDB (AHI > or =15 or AHI > or =10+ESS >10). CPAP compliance, incidence of vascular events, and stroke outcome were assessed 60+/-16 months later (chronic phase). RESULTS: Initial AHI was 18+/-16 (> or =10 in 58%, > or =30 in 17% of patients) and decreased in the subacute phase (P<0.001). Age, diabetes, and nighttime stroke onset were independent predictors of AHI (r2=0.34). In patients with AHI > or =30, age, male gender, body mass index, diabetes, hypertension, coronary heart disease, ESS, and macroangiopathic etiology of stroke were significantly higher/more common than in patients with AHI <10. Long-term incidence of vascular events and stroke outcome were similar in both groups. CPAP was started in 51% and continued chronically in 15% of SDB pts. Long-term stroke mortality was associated with initial AHI, age, hypertension, diabetes, and coronary heart disease. CONCLUSIONS: SDB is common particularly in elderly stroke male patients with diabetes, nighttime stroke onset, and macroangiopathy as cause of stroke; it improves after the acute phase, is associated with an increased poststroke mortality, and can be treated with CPAP in a small percentage of patients.

Sleep-wake habits and disorders in a series of 100 adult epilepsy patients--a prospective study

The aim of the study was to assess sleep-wake habits and disorders and excessive daytime sleepiness (EDS) in an unselected outpatient epilepsy population. Sleep-wake habits and presence of sleep disorders were assessed by means of a clinical interview and a standard questionnaire in 100 consecutive patients with epilepsy and 90 controls. The questionnaire includes three validated instruments: the Epworth Sleepiness Scale (ESS) for EDS, SA-SDQ for sleep apnea (SA), and the Ullanlinna Narcolepsy Scale (UNS) for narcolepsy. Sleep complaints were reported by 30% of epilepsy patients compared to 10% of controls (p=0.001). The average total sleep time was similar in both groups. Insufficient sleep times were suspected in 24% of patients and 33% of controls. Sleep maintenance insomnia was more frequent in epilepsy patients (52% vs. 38%, p=0.06), whereas nightmares (6% vs. 16%, p=0.04) and bruxism (10% vs. 19%, p=0.07) were more frequent in controls. Sleep onset insomnia (34% vs. 28%), EDS (ESS >or=10, 19% vs. 14%), SA (9% vs. 3%), restless legs symptoms (RL-symptoms, 18% vs. 12%) and most parasomnias were similarly frequent in both groups. In a stepwise logistic regression model loud snoring and RL-symptoms were found to be the only independent predictors of EDS in epilepsy patients. In conclusion, sleep-wake habits and the frequency of most sleep disorders are similar in non-selected epilepsy patients as compared to controls. In epilepsy patients, EDS was predicted by a history of loud snoring and RL-symptoms but not by SA or epilepsy-related variables (including type of epilepsy, frequency of seizures, and number of antiepileptic drugs).

Photon-beam subsource sensitivity to the initial electron-beam parameters

One limitation to the widespread implementation of Monte Carlo (MC) patient dose-calculation algorithms for radiotherapy is the lack of a general and accurate source model of the accelerator radiation source. Our aim in this work is to investigate the sensitivity of the photon-beam subsource distributions in a MC source model (with target, primary collimator, and flattening filter photon subsources and an electron subsource) for 6- and 18-MV photon beams when the energy and radial distributions of initial electrons striking a linac target change. For this purpose, phase-space data (PSD) was calculated for various mean electron energies striking the target, various normally distributed electron energy spread, and various normally distributed electron radial intensity distributions. All PSD was analyzed in terms of energy, fluence, and energy fluence distributions, which were compared between the different parameter sets. The energy spread was found to have a negligible influence on the subsource distributions. The mean energy and radial intensity significantly changed the target subsource distribution shapes and intensities. For the primary collimator and flattening filter subsources, the distribution shapes of the fluence and energy fluence changed little for different mean electron energies striking the target, however, their relative intensity compared with the target subsource change, which can be accounted for by a scaling factor. This study indicates that adjustments to MC source models can likely be limited to adjusting the target subsource in conjunction with scaling the relative intensity and energy spectrum of the primary collimator, flattening filter, and electron subsources when the energy and radial distributions of the initial electron-beam change.