Incapacidade para o trabalho: análise dos benefícios auxílio-doença concedidos no estado de Rondônia

Trata-se de um estudo epidemiológico descritivo com objetivo de estimar a prevalência e a duração dos benefícios auxílio-doença, concedidos pelo Instituto Nacional de Seguro Social, bem como dos fatores associados à incapacidade para o trabalho entre os trabalhadores empregados em Rondônia em 2008. As prevalências foram apresentadas por 10.000 trabalhadores e estratificadas por sexo, idade, diagnóstico, atividade econômica, espécie e duração dos benefícios. Os homens apresentaram maiores prevalência e duração dos benefícios. Os benefícios previdenciários mostraramse 2,5 mais prevalentes do que os acidentários e ambos aumentaram com a idade. Os acidentários foram mais prevalentes na faixa etária de 50-59 anos. Silvicultura, construção civil e locação de mão de obra apresentaram as maiores prevalências. Os principais grupos diagnósticos foram lesões; doenças do sistema osteomuscular e doenças do aparelho digestivo. A duração dos benefícios auxílio-doença foi maior entre homens, com > 40 anos e na espécie previdenciária. A atividade econômica é um importante fator de risco para a incapacidade para o trabalho, e precisa ser mais bem explorada como tal visando melhorar a prevenção de doenças e diminuir o impacto na saúde dos trabalhadores decorrentes das condições ambientais e dos processos de trabalho.

Atypical human infections by animal Trypanosomes

The two classical forms of human trypanosomoses are sleeping sickness due to Trypanosoma brucei gambiense or T. brucei rhodesiense, and Chagas disease due to T. cruzi. However, a number of atypical human infections caused by other T. species (or sub-species) have been reported, namely due to T. brucei brucei, T. vivax, T. congolense, T. evansi, T. lewisi, and T. lewisi-like. These cases are reviewed here. Some infections were transient in nature, while others required treatments that were successful in most cases, although two cases were fatal. A recent case of infection due to T. evansi was related to a lack of apolipoprotein L-I, but T. lewisi infections were not related to immunosuppression or specific human genetic profiles. Out of 19 patients, eight were confirmed between 1974 and 2010, thanks to improved molecular techniques. However, the number of cases of atypical human trypanosomoses might be underestimated. Thus, improvement, evaluation of new diagnostic tests, and field investigations are required for detection and confirmation of these atypical cases.

Structure-based drug design studies on a series of aldolase inhibitors

Human African trypanosomiasis, also known as sleeping sickness, is a major cause of death in Africa, and for which there are no safe and effective treatments available. The enzyme aldolase from Trypanosoma brucei is an attractive, validated target for drug development. A series of alkyl‑glycolamido and alkyl-monoglycolate derivatives was studied employing a combination of drug design approaches. Three-dimensional quantitative structure-activity relationships (3D QSAR) models were generated using the comparative molecular field analysis (CoMFA). Significant results were obtained for the best QSAR model (r2 = 0.95, non-cross-validated correlation coefficient, and q2 = 0.80, cross-validated correlation coefficient), indicating its predictive ability for untested compounds. The model was then used to predict values of the dependent variables (pKi) of an external test set,the predicted values were in good agreement with the experimental results. The integration of 3D QSAR, molecular docking and molecular dynamics simulations provided further insight into the structural basis for selective inhibition of the target enzyme.

Inhibitors of Trypanosoma brucei trypanothione reductase: comparative molecular field analysis modeling and structural basis for selective inhibition

Background: Sleeping sickness is a major cause of death in Africa. Since no secure treatment is available, the development of novel therapeutic agents is urgent. In this context, the enzyme trypanothione reductase (TR) is a prominent molecular target that has been investigated in drug design for sleeping sickness. Results: In this study, comparative molecular field analysis models were generated for a series of Trypanosoma brucei TR inhibitors. Statistically significant results were obtained and the models were applied to predict the activity of external test sets, with good correlation between predicted and experimental results. We have also investigated the structural requirements for the selective inhibition of the parasite's enzyme over the human glutathione reductase. Conclusion: The quantitative structure-activity relationship models provided valuable information regarding the essential molecular requirements for the inhibitory activity upon the target protein, providing important insights into the design of more potent and selective TR inhibitors.

The Emergence of the Post-Socialist Welfare State - The Case of the Baltic States : Estonia, Latvia and Lithuania

This dissertation takes a step towards providing a better understanding of post-socialist welfare state development from a theoretical as well as an empirical perspective. The overall analytical goal of this thesis has been to critically assess the development of social policies in Estonia, Latvia and Lithuania using them as illustrative examples of post-socialist welfare state development in the light of the theories, approaches and typologies that have been developed to study affluent capitalist democracies. The four studies included in this dissertation aspire to a common aim in a number of specific ways. The first study tries to place the ideal-typical welfare state models of the Baltic States within the well-known welfare state typologies. At the same time, it provides a rich overview of the main social security institutions in the three countries by comparing them with each other and with the previous structures of the Soviet period. It examines the social insurance institutions of the Baltic States (old-age pensions, unemployment insurance, short-term benefits, sickness, maternity and parental insurance and family benefits) with respect to conditions of eligibility, replacement rates, financing and contributions. The findings of this study indicate that the Latvian social security system can generally be labelled as a mix of the basic security and corporatist models. The Estonian social security system can generally also be characterised as a mix of the basic security and corporatist models, even if there are some weak elements of the targeted model in it. It appears that the institutional changes developing in the social security system of Lithuania have led to a combination of the basic security and targeted models of the welfare state. Nevertheless, as the example of the three Baltic States shows, there is diversity in how these countries solve problems within the field of social policy. In studying the social security schemes in detail, some common features were found that could be attributed to all three countries. Therefore, the critical analysis of the main social security institutions of the Baltic States in this study gave strong supporting evidence in favour of identifying the post-socialist regime type that is already gaining acceptance within comparative welfare state research. Study Two compares the system of social maintenance and insurance in the Soviet Union, which was in force in the three Baltic countries before their independence, with the currently existing social security systems. The aim of the essay is to highlight the forces that have influenced the transformation of the social policy from its former highly universal, albeit authoritarian, form, to the less universal, social insurance-based systems of present-day Estonia, Latvia and Lithuania. This study demonstrates that the welfare–economy nexus is not the only important factor in the development of social programs. The results of this analysis revealed that people's attitudes towards distributive justice and the developmental level of civil society also play an important part in shaping social policies. The shift to individualism in people’s mentality and the decline of the labour movement, or, to be more precise, the decline in trade union membership and influence, does nothing to promote the development of social rights in the Baltic countries and hinders the expansion of social policies. The legacy of the past has been another important factor in shaping social programs. It can be concluded that social policy should be studied as if embedded not only in the welfare-economy nexus, but also in the societal, historical and cultural nexus of a given society. Study Three discusses the views of the state elites on family policy within a wider theoretical setting covering family policy and social policy in a broader sense and attempts to expand this analytical framework to include other post-socialist countries. The aim of this essay is to explore the various views of the state elites in the Baltics concerning family policy and, in particular, family benefits as one of the possible explanations for the observed policy differences. The qualitative analyses indicate that the Baltic States differ significantly with regard to the motives behind their family policies. Lithuanian decision-makers seek to reduce poverty among families with children and enhance the parents’ responsibility for bringing up their children. Latvian policy-makers act so as to increase the birth rate and create equal opportunities for children from all families. Estonian policy-makers seek to create equal opportunities for all children and the desire to enhance gender equality is more visible in the case of Estonia in comparison with the other two countries. It is strongly arguable that there is a link between the underlying motives and the kinds of family benefits in a given country. This study, thus, indicates how intimately the attitudes of the state bureaucrats, policy-makers, political elite and researchers shape social policy. It confirms that family policy is a product of the prevailing ideology within a country, while the potential influence of globalisation and Europeanisation is detectable too. The final essay takes into account the opinions of welfare users and examines the performances of the institutionalised family benefits by relying on the recipients’ opinions regarding these benefits. The opinions of the populations as a whole regarding government efforts to help families are compared with those of the welfare users. Various family benefits are evaluated according to the recipients' satisfaction with those benefits as well as the contemporaneous levels of subjective satisfaction with the welfare programs related to the absolute level of expenditure on each program. The findings of this paper indicate that, in Latvia, people experience a lower level of success regarding state-run family insurance institutions, as compared to those in Lithuania and Estonia. This is deemed to be because the cash benefits for families and children in Latvia are, on average, seen as marginally influencing the overall financial situation of the families concerned. In Lithuania and Estonia, the overwhelming majority think that the family benefit systems improve the financial situation of families. It appears that recipients evaluated universal family benefits as less positive than targeted benefits. Some universal benefits negatively influenced the level of general satisfaction with the family benefits system provided in the countries being researched. This study puts forward a discussion about whether universalism is always more legitimate than targeting. In transitional economies, in which resources are highly constrained, some forms of universal benefits could turn out to be very expensive in relative terms, without being seen as useful or legitimate forms of help to families. In sum, by closely examining the different aspects of social policy, this dissertation goes beyond the over-generalisation of Eastern European welfare state development and, instead, takes a more detailed look at what is really going on in these countries through the examples of Lithuania, Latvia and Estonia. In addition, another important contribution made by this study is that it revives ‘western’ theoretical knowledge through ‘eastern’ empirical evidence and provides the opportunity to expand the theoretical framework for post-socialist societies.

Metamorfismo ercinico di bassa-pressione: evoluzione tettonico-metamorfica del complesso di mandatoriccio (massiccio della Sila - Calabria)

Low-pressure/high-temperature (LP/HT) metamorphic belts are characterised by rocks that experienced abnormal heat flow in shallow crustal levels (T > 600 °C; P < 4 kbar) resulting in anomalous geothermal gradients (60-150 °C/km). The abnormal amount of heat has been related to crustal underplating of mantle-derived basic magmas or to thermal perturbation linked to intrusion of large volumes of granitoids in the intermediate crust. In particular, in this latter context, magmatic or aqueous fluids are able to transport relevant amounts of heat by advection, thus favouring regional LP/HT metamorphism. However, the thermal perturbation consequent to heat released by cooling magmas is responsible also for contact metamorphic effects. A first problem is that time and space relationships between regional LP/HT metamorphism and contact metamorphism are usually unclear. A second problem is related to the high temperature conditions reached at different crustal levels. These, in some cases, can completely erase the previous metamorphic history. Notwithstanding this problem is very marked in lower crustal levels, petrologic and geochronologic studies usually concentrate in these attractive portions of the crust. However, only in the intermediate/upper-crustal levels of a LP/HT metamorphic belt the tectono-metamorphic events preceding the temperature peak, usually not preserved in the lower crustal portions, can be readily unravelled. The Hercynian Orogen of Western Europe is a well-documented example of a continental collision zone with widespread LP/HT metamorphism, intense crustal anatexis and granite magmatism. Owing to the exposure of a nearly continuous cross-section of the Hercynian continental crust, the Sila massif (northern Calabria) represents a favourable area to understand large-scale relationships between granitoids and LP/HT metamorphic rocks, and to discriminate regional LP/HT metamorphic events from contact metamorphic effects. Granulite-facies rocks of the lower crust and greenschist- to amphibolite-facies rocks of the intermediate-upper crust are separated by granitoids emplaced into the intermediate level during the late stages of the Hercynian orogeny. Up to now, advanced petrologic studies have been focused mostly in understanding P-T evolution of deeper crustal levels and magmatic bodies, whereas the metamorphic history of the shallower crustal levels is poorly constrained. The Hercynian upper crust exposed in Sila has been subdivided in two different metamorphic complexes by previous authors: the low- to very low-grade Bocchigliero complex and the greenschist- to amphibolite-facies Mandatoriccio complex. The latter contains favourable mineral assemblages in order to unravel the tectono-metamorphic evolution of the Hercynian upper crust. The Mandatoriccio complex consists mainly of metapelites, meta-arenites, acid metavolcanites and metabasites with rare intercalations of marbles and orthogneisses. Siliciclastic metasediments show a static porphyroblastic growth mainly of biotite, garnet, andalusite, staurolite and muscovite, whereas cordierite and fibrolite are less common. U-Pb ages and internal features of zircons suggest that the protoliths of the Mandatoriccio complex formed in a sedimentary basin filled by Cambrian to Silurian magmatic products as well as by siliciclastic sediments derived from older igneous and metamorphic rocks. In some localities, metamorphic rocks are injected by numerous aplite/pegmatite veins. Small granite bodies are also present and are always associated to spotted schists with large porphyroblasts. They occur along a NW-SE trending transcurrent cataclastic fault zone, which represents the tectonic contact between the Bocchigliero and the Mandatoriccio complexes. This cataclastic fault zone shows evidence of activity at least from middle-Miocene to Recent, indicating that brittle deformation post-dated the Hercynian orogeny. P-T pseudosections show that micaschists and paragneisses of the Mandatoriccio complex followed a clockwise P-T path characterised by four main prograde phases: thickening, peak-pressure condition, decompression and peak-temperature condition. During the thickening phase, garnet blastesis started up with spessartine-rich syntectonic core developed within micaschists and paragneisses. Coevally (340 ± 9.6 Ma), mafic sills and dykes injected the upper crustal volcaniclastic sedimentary sequence of the Mandatoriccio complex. After reaching the peak-pressure condition (≈4 kbar), the upper crust experienced a period of deformation quiescence marked by the static overgrowths of S2 by Almandine-rich-garnet rims and by porphyroblasts of biotite and staurolite. Probably, this metamorphic phase is related to isotherms relaxation after the thickening episode recorder by the Rb/Sr isotopic system (326 ± 6 Ma isochron age). The post-collisional period was mainly characterised by decompression with increasing temperature. This stage is documented by the andalusite+biotite coronas overgrown on staurolite porphyroblasts and represents a critical point of the metamorphic history, since metamorphic rocks begin to record a significant thermal perturbation. Peak-temperature conditions (≈620 °C) were reached at the end of this stage. They are well constrained by some reaction textures and mineral assemblages observed almost exclusively within paragneisses. The later appearance of fibrolitic sillimanite documents a small excursion of the P-T path across the And-Sil boundary due to the heating. Stephanian U-Pb ages of monazite crystals from the paragneiss, can be related to this heating phase. Similar monazite U-Pb ages from the micaschist combined with the lack of fibrolitic sillimanite suggest that, during the same thermal perturbation, micaschists recorded temperatures slightly lower than those reached by paragneisses. The metamorphic history ended with the crystallisation of cordierite mainly at the expense of andalusite. Consequently, the Ms+Bt+St+And+Sill+Crd mineral assemblage observed in the paragneisses is the result of a polyphasic evolution and is characterised by the metastable persistence of the staurolite in the stability fields of the cordierite. Geologic, geochronologic and petrographic data suggest that the thermal peak recorded by the intermediate/upper crust could be strictly connected with the emplacement of large amounts of granitoid magmas in the middle crust. Probably, the lithospheric extension in the relatively heated crust favoured ascent and emplacement of granitoids and further exhumation of metamorphic rocks. After a comparison among the tectono-metamorphic evolutions of the different Hercynian crustal levels exposed in Sila, it is concluded that the intermediate/upper crustal level offers the possibility to reconstruct a more detailed tectono-metamorphic history. The P-T paths proposed for the lower crustal levels probably underestimate the amount of the decompression. Apart from these considerations, the comparative analysis indicates that P-T paths at various crustal levels in the Sila cross section are well compatible with a unique geologic scenario, characterized by post-collisional extensional tectonics and magmas ascent.

Comparison of model potentials for molecular dynamics simulation of crystalline silica

Simulationen von SiO2 mit dem von van Beest, Kramer und vanSanten (BKS) entwickelten Paarpotenzial erzeugen vielezufriedenstellende Ergebnisse, aber auch charakteristischeSchwachstellen. In dieser Arbeit wird das BKS-Potenzial mitzwei kürzlich vorgeschlagenen Potenzialen verglichen, dieeffektiv Mehrteilchen-Wechselwirkungen beinhalten. Der ersteAnsatz erlaubt dazu fluktuierende Ladungen, der zweiteinduzierbare Polarisierungen auf den Sauerstoffatomen. Die untersuchten Schwachstellen des BKS Potenzialsbeinhalten das Verhältnis der zwei Gitterkonstanten a und cim Quarzübergang, das von BKS falsch beschrieben wird.Cristobalit und Tridymit erscheinen instabil mit BKS.Weiterhin zeigt die BKS-Zustandsdichte charakteristischeAbweichungen von der wahren Zustandsdichte. DerÜbergangsdruck für den Stishovit I-II Übergang wird deutlichüberschätzt. Das Fluktuierende-Ladungs-Modell verbesserteinige der genannten Punkte, reproduziert aber viele andereEigenschaften schlechter als BKS. DasFluktierende-Dipol-Modell dagegen behebt alle genanntenArtefakte. Zusätzlich wird der druckinduzierte Phasenübergang imalpha-Quarz untersucht. Alle Potentiale finden die selbeStruktur für Quarz II. Bei anschliessender Dekompressionerzeugt BKS eine weitere Phase, während die beiden anderenPotentiale wieder zum alpha-Quarz zurückkehren. Weiterhinwerden zwei Methoden entwickelt, um die piezoelektrischenKonstanten bei konstantem Druck zu bestimmen. Die Ergebnissegeben Hinweise auf eine möglicherweisenicht-elektrostatische Natur der Polarisierungen imFluktuierende-Dipole-Modell. Mit dieser Interpretation scheint das Fluktuierende-DipolPotential alle verfügbaren experimentellen Daten am bestenvon allen drei untersuchten Ansätzen zu reproduzieren.

Geochronology, geochemistry and isotopic compositions of the volcanic rocks from oceanic (Hawaii) and continental (Eifel) intra-plate environments

The Eifel volcanism is part of the Central European Volcanic Province (CEVP) and is located in the Rhenish Massif, close to the Rhine and Leine Grabens. The Quaternary Eifel volcanism appears to be related to a mantle plume activity. However, the causes of the Tertiary Hocheifel volcanism remain debated. We present geochronological, geochemical and isotope data to assess the geotectonic settings of the Tertiary Eifel volcanism. Based on 40Ar/39Ar dating, we were able to identify two periods in the Hocheifel activity: from 43.6 to 39.0 Ma and from 37.5 to 35.0 Ma. We also show that the pre-rifting volcanism in the northernmost Upper Rhine Graben (59 to 47 Ma) closely precede the Hocheifel volcanic activity. In addition, the volcanism propagates from south to north within the older phase of the Hocheifel activity. At the time of Hocheifel volcanism, the tectonic activity in the Hocheifel was controlled by stress field conditions identical to those of the Upper Rhine Graben. Therefore, magma generation in the Hocheifel appears to be caused by decompression due to Middle to Late Eocene extension. Our geochemical data indicate that the Hocheifel magmas were produced by partial melting of a garnet peridotite at 75-90 km depth. We also show that crustal contamination is minor although the magmas erupted through a relatively thick continental lithosphere. Sr, Nd and Pb isotopic compositions suggest that the source of the Hocheifel magmas is a mixing between depleted FOZO or HIMU-like material and enriched EM2-like material. The Tertiary Hocheifel and the Quaternary Eifel lavas appear to have a common enriched end-member. However, the other sources are likely to be distinct. In addition, the Hocheifel lavas share a depleted component with the other Tertiary CEVP lavas. Although the Tertiary Hocheifel and the Quaternary Eifel lavas appear to originate from different sources, the potential involvement of a FOZO-like component would indicate the contribution of deep mantle material. Thus, on the basis of the geochemical and isotope data, we cannot rule out the involvement of plume-type material in the Hocheifel magmas. The Ko’olau Scientific Drilling Project (KSDP) has been initiated in order to evaluate the long-term evolution of Ko’olau volcano and obtain information about the Hawaiian mantle plume. High precision Pb triple spike data, as well as Sr and Nd isotope data on KSDP lavas and Honolulu Volcanics (HVS) reveal compositional source variations during Ko’olau growth. Pb isotopic compositions indicate that, at least, three Pb end-members are present in Ko’olau lavas. Changes in the contributions of each component are recorded in the Pb, Sr and Nd isotopes stratigraphy. The radiogenic component is present, at variable proportion, in all three stages of Ko’olau growth. It shows affinities with the least radiogenic “Kea-lo8” lavas present in Mauna Kea. The first unradiogenic component was present in the main-shield stage of Ko’olau growth but its contribution decreased with time. It has EM1 type characteristics and corresponds to the “Ko’olau” component of Hawaiian mantle plume. The second unradiogenic end-member, so far only sampled by Honololu lavas, has isotopic characteristics similar to those of a depleted mantle. However, they are different from those of the recent Pacific lithosphere (EPR MORB) indicating that the HVS are not derived from MORB-related source. We suggest, instead, that the HVS result from melting of a plume material. Thus the evolution of a single Hawaiian volcano records the geochemical and isotopic changes within the Hawaiian plume.

Untersuchung zum Einfluss der ACD-CPR mit während der Dekompressionsphase blockiertem Gasfluss (ITD) im Vergleich zur Standard-Reanimationstechnik auf die Kurzzeit-Überlebensrate von Patienten mit präklinisch aufgetretenem Herzkreislaufstillstand

Untersuchung zum Einfluss der ACD-CPR (Aktive Kompressions- Dekompressions-Reanimation) mit während der Dekompressionsphase blockiertem Gasfluss (Impedance-Threshold-Device) im Vergleich zur Standardreanimationsrechnik auf die Kurzzeit-Überlebensrate von Patienten mit präklinisch aufgetretenem Herzkreislaufstillstand. Die Studie vergleicht die ACD-ITD-CPR gegen die Standard-CPR bei Patienten mit präklinischem Herkreislaufstillstand. Primär untersuchter Parameter war die Ein-Stunden-Überlebensrate nach Krankenhausaufnahme. Sekundär wurden die Tastbarkeit eines Pulses unter CPR, die Wiederkehr des Spontankreislaufs (ROSC), die Rate an Krankenhausaufnahmen, 24-Stunden-Überleben und Krankenhausentlassungen untersucht. Außerdem wurde das neurologische Outcome evaluiert. Die Studie fand in Mainz statt; Mainz bietet sich für die Durchführung notfallmedizinischer Studien in besonderem Maße an. Der Rettungsdienst der Stadt arbeitet nach dem in Deutschland üblichen zweigliedrigen System mit RA/RS auf RTWs und NA auf NAW/NEF. Die Studie wurde nach einer fünfmonatigen Pilotphase und extensivem Training beider Verfahren durchgeführt. Zusätzlich bestanden bei einigen der Beteiligten schon Erfahrungen mit ACD-CPR. Es ergaben sich signifikante Vorteile der ACD-ITD-CPR gegenüber der Standard-CPR hinsichtlich des primär untersuchten Parameters (51% vs. 32% p=0,006), außerdem statistisch auffällige Vorteile hinsichtlich der Pulstastbarkeit unter CPR (85% vs. 69%, p=0,008), der Wiederkehr des Spontankreislaufs (55% vs. 37%, p=0,016), der Rate der Krankenhausaufnahmen (52% vs. 36%, p=0.023) und des 24-Stunden-Überlebens (37% vs. 22%, p=0,033). Es ergaben sich keine statistisch auffälligen Unterschiede hinsichtlich der Rate an Krankenhausentlassungen und im neurologischen Outcome. Die Ergebnisse lassen den Schluss zu, dass die ACD-ITD die Kurzzeitüberlebensrate der Patienten mit außerklinischem Herzkreislaufstillstand verbessern kann. Eine Voraussetzung hierfür ist eine ausreichende und andauernde Ausbildung der beteiligten Helfer und/oder die Verfügbarkeit technisch verbesserter Lösungen. Weitere Untersuchungen zum Einfluss auf die Langzeitüberlebensraten und das neurologische Outcome scheinen angezeigt.

Bedeutung der synovialen Strukturqualität für die Ernährung des Chondrozyten

In dieser Arbeit wird eine Einteilung der degenerativen strukturellen Veränderungen der Synovialmembran vorgestellt. Anhand der Kriterien Fibrosierung des Stromas, Rückgang des Gefäßnetzes, Auftreten von Hyalinose und chondroider Metaplasie mit und ohne Nachweis von CPPD Kristallen wurden Präparate der Synovialmembran von 59 Patienten mit Nachweis degenerativer strukturellen Veränderungen in 4 Stadien eingeteilt. rnHyalinose (Stadium 3) konnte in den untersuchten Schnitten nur relativ selten beobachtet werden, so dass am ehesten von einem Vorstadium zur chondroiden Metaplasie auszugehen ist. rnDie Verteilung der Erkrankungsdauer und des Alters in den verschiedenen Stadien lassen darauf schließen, dass höhere Stadien mit höherem Alter und längerer Erkrankungsdauer korrelieren. rnAus der vorhandenen Literatur ergeben sich Hinweise, welche Faktoren zu der Entstehung der strukturellen Veränderungen beitragen können: rnAus dem Netzwerk der Zytokine scheinen TGF-beta und die BMP’s an der Zunahme der Fibrose und an der Entstehung chondroider Metaplasie beteiligt zu sein. Makrophagen scheinen dabei eine wichtige Rolle zu spielen. Dies weist darauf hin, dass entzündliche und strukturelle Veränderungen miteinander vernetzt sind. rnBei der Entstehung der chondroiden Metaplasie kommen zusätzlich mechanische Einflüsse in Form von zyklischen Kompressionen als Einflussfaktor in Frage. rnDie Regulierung der Angiogenese ist noch zu wenig verstanden, um den Gefäßrückgang bei fortgeschrittenen strukturellen Veränderungen zu erklären. Erklärungsansätze sind zum einen zunehmende mechanische Schädigung bei zunehmender Inkongruenz der Gelenkflächen. Zum anderen könnte eine beginnende chondroide Metaplasie mit Expression von Chondromodulin I eine entscheidende Rolle spielen. rnInsgesamt muss man davon ausgehen, dass die zunehmenden strukturellen Veränderungen die Ernährung des Knorpels erschweren. Dabei ist an erster Stelle der Rückgang des Gefäßnetzes zu nennen. Dies erschwert nicht nur die Versorgung mit Nährstoffen, sondern auch den Abtransport von Stoffwechselprodukten. Ab einem gewissen Punkt ist aber auch davon auszugehen, dass die Funktion der Deckzellschicht beeinträchtigt wird. Wenn die Konzentration der Hyaluronsäure in der Synovia dadurch sinkt, kann dies durch eine vermehrte Permeabilität der Synovialmembran zum verstärkten Ausstrom von Wasser aus der Gelenkhöhle führen. Durch ein Ödem des umliegenden Gewebes kann dadurch der Blutfluss im Bereich des Gelenks zusätzlich vermindert werden. rnAuch die zunehmende Fibrosierung der Synovialmembran kann einen Einfluss auf die Permeabilität der Synovialmembran haben. Ob und in welchen Stadien der Veränderungen das einen relevanten Einfluss für die Ernährung der Chondrozyten hat, ist noch unklar.rn

Auswirkungen einer hypertonen, hyperonkotischen Therapie in Kombination mit chirurgischer Hämatomentfernung auf funktionelle und histologische Defizite nach akutem subduralem Hämatom der Ratte

Auswirkungen einer hypertonen / hyperonkotischen Therapie in Kombination mit chirurgischer Hämatomentfernung auf funktionelle und histologische Defizite nach akutem subduralem Hämatom der Ratte: Die Zeit bis zur Behandlung eines akuten subduralen Hämatoms stellt eine der wichtigsten prognosebestimmenden Faktoren für die Mortalität und Morbidität der Patienten dar. Ein unbehandeltes akutes subdurales Hämatom im Rahmen eines schweren Schädelhirntraumas geht mit einer Sterblichkeit von weit über 50% einher. Selbst bei zeitiger chirurgischer Entlastung versterben noch ca. 30% der Patienten als Folge der Hirnschädigung. Um Therapieoptionen zur Verbesserung der schlechten Prognose nach akutem subduralem Hämatom liefern zu können, wurde in dieser Studie die frühe Therapie mit hypertonen / hyperonkotischen Lösungen (HHT) sowie die Kombination mit chirurgischer Evakuation des Hämatoms untersucht. In dem genutzten Tiermodell wurde ein subdurales Hämatom über die Infusion von 400 µl autologen venösen Blutes erreicht. Je nach Gruppe erhielten die Ratten 30 Minuten nach ASDH eine HHT oder isotonische Kochsalzlösung und ggf. eine chirurgische Entfernung des Hämatoms eine Stunde nach Induktion. Die Studie war in zwei Teile getrennt. Die akute Studie welche den intraoperativen Verlauf von Blutwerten, intrakraniellem Druck zerebralem Perfusionsdruck und zerebralem Blutfluss untersuchte und die chronische Studie welche über Verhaltenstests (Neuroscore, Beamwalk, Open Field) die funktionellen und histologischen Ergebnisse im Verlauf von 12 Tage betrachtete. Im Ergebnis konnten durch eine HHT eine Reduktion der intrakraniellen Hypertension erreicht werden. Im Langzeit Verlauf schnitten alle Behandlungen besser ab als die unbehandelte Gruppe. In Bezug auf die neurologische Erholung und das histologische Defizit zeigten die mit einer HHT behandelten Tiere jedoch die besten Ergebnisse. rnEine frühe chirurgische Intervention ist eine protektive Maßnahme bezogen auf die funktionelle Defizite und den histologischen Schaden nach akutem subduralem Hämatom, aber frühe hypertone / hyperonkotische Behandlung ist in diesem Modell sogar noch effektiver. Eine frühe Behandlung mit hypertonen / hyperonkotischen Lösungen stellt somit eine vielversprechende, sichere und kausale Therapieoption zur Verbesserung der Prognose nach akutem subduralem Hämatom dar. rn

Il dolore oncologico come malattia nella malattia. Una ricerca nazionale sulle donne con tumore al seno

L’ipotesi di fondo su cui si basa l’intero lavoro è che il dolore oncologico debba essere riconosciuto come “malattia nella malattia”: non si può considerare tale dolore mero “sintomo” del cancro ma esperienza totale che coinvolge l’intera persona. Il dolore oncologico è carico di valenze e significati personali, è associato a rappresentazioni sociali e, come ogni malattia, è disease, illness e sickness. Partendo da questo presupposto, la dissertazione si è posta come obiettivo generale quello di studiare il dolore oncologico tra le donne con tumore al seno, le sue componenti sociali, psicologiche, individuali oltre che fisiche; si è voluto inoltre studiare la specificità del vissuto e dei significati associati all’esperienza dolorosa. Il lavoro è articolato in due parti fondamentali, una teorica ed una empirica. La prima presenta un inquadramento dei principali concetti della sociologia della salute riguardanti il dolore. Per quanto riguarda la parte empirica, si è fatto ricorso ad una ricerca mista, fatta di metodi misti e fondata su un approccio metodologico di natura integrativa che si avvale di tecniche quantitative e qualitative. La parte quantitativa si basa su una parte dei dati della ricerca nazionale ESOPO - Epidemiological Study of Pain in Oncology. Dall’intero campione sono state isolate le sole donne con tumore al seno (n=846). Si è proceduto quindi allo studio di tale campione, alle elaborazioni statistiche con il programma SPSS e all’interpretazione dei risultati. Per quanto riguarda la parte qualitativa, invece, è stata condotta un’analisi delle fonti che si è avvalsa di un approccio netnografico: è stata condotta un’osservazione non intrusiva di 12 blog scritti da donne con tumore al seno, con lo scopo di indagare le narrazioni di malattia, i vissuti personali, i significati di dolore e malattia e le loro ripercussioni sulla vita quotidiana.

Granulite facies metamorphism and partial melting processes in the Ivrea Zone, Northern Italy

The Ivrea Zone in northern Italy has been the focus of numerous petrological, geochemical and structural studies. It is commonly inferred to represent an almost complete section through the mid to lower continental crust, in which metamorphism and partial melting of the abundant metapelites was the result of magmatic underplating by a large volume of mantle-derived magma. This study concerns amphibolite and granulite facies metamorphism in the Ivrea Zone with focus on metapelites and metapsammites/metagreywackes from Val Strona di Omegna and metapelites from Val Sesia and Val Strona di Postua, with the aim to better constrain their metamorphic evolution as well as their pressure and temperature conditions via phase equilibria modelling.rnrnIn Val Strona di Omegna, the metapelites show a structural and mineralogical change from mica-schists with the common assemblage bi-mu-sill-pl-q-ilm ± liq at the lowest grades, through metatexitic migmatites (g-sill-bi-ksp-pl-q-ilm-liq) at intermediate grades, to complex diatexitic migmatites (g-sill-ru-bi-ksp-pl-q-ilm-liq) at the highest grades. Within this section several mappable isograds occur, including the first appearance of K-feldspar in the metapelites, the first appearance of orthopyroxene in the metabasites and the disappearance of prograde biotite from the metapelites. The inferred onset of partial melting in the metapelites occurs around Massiola. The prograde suprasolidus evolution of the metapelites is consistent with melting via the breakdown of first muscovite then biotite. Maximum modelled melt fractions of 30–40 % are predicted at the highest grade. The regional metamorphic field gradient in Val Strona di Omegna is constrained to range from conditions of 3.5–6.5 kbar at T = 650–730 °C to P &gt; 9 kbar at T &gt; 900 °C. The peak P–T estimates, particularly for granulite facies conditions, are significantly higher (around 100 °C) than those of most previous studies. In Val Sesia and Val Strona di Postua to the south the exposure is more restricted. P–T estimates for the metapelites are 750–850 °C and 5–6.5 kbar in Val Sesia and approximately 800–900 °C and 5.5–7 kbar in Val Strona di Postua. These results show similar temperatures but lower pressure than metapelites in Val Strona di Omegna. Metapelites in Val Sesia in contact with the Mafic Complex exhibit a metatexitic structure, while in Val Strona di Postua diatexitic structures occur. Further, metapelites at the contact with the Mafic Complex contain cordierite (± spinel) that overprint the regional metamorphic assemblages and are interpreted to have formed during contact metamorphism related to intrusion of the Mafic Complex. The lower pressures in the high-grade rocks in Val Sesia and Val Strona di Postua are consistent with some decompression from the regional metamorphic peak prior to the intrusion of the Mafic Complex, suggesting the rocks followed a clockwise P–T path. In contrast, the metapelites in Val Strona di Omegna, especially in the granulite facies, do not contain any cordierite or any evidence for a contact metamorphic overprint. The extrapolated granulite facies mineral isograds are cut by the rocks of the Mafic Complex to the south. Therefore, the Mafic Complex cannot have caused the regional metamorphism and it is unlikely that the Mafic Complex occurs in Val Strona di Omegna.

Enhancing Workers’ Well-Being. Scientific and social relevance of managing stress in the workplace

Purpose. Despite work-related stress is one of the most studied topic in organizational psychology, many aspects as for example the use of different measures (e.g. subjective and objective, qualitative and quantitative) are still under debate. According to this, in order to enhance knowledge concerning which factors and processes contribute to create healthy workplaces, this thesis is composed by four different studies aiming to understand: a) the role of relevant antecedents (e.g. leadership, job demands, work-family conflict, social support etc.) and outcomes (e.g. workplace phobia, absenteeism etc.) of work-related stress; and b) how to manage psychosocial risk factors in the workplace. The studies. The first study focused on how disagreement between supervisors and their employees on leadership style (transformational and transactional) could affect workers well-being and work team variables. The second and third study used both subjective and objective data in order to increase the quality of the reliability of the results gained. Particularly, the second study focused on job demand and its relationship with objective sickness leave. Findings showed that despite there is no direct relationship between these two variables, job demand affects work-family conflict, which in turn affect exhaustion, which leads to absenteeism. The third study analysed the role of a new concept never studied before in organizational settings (workplace phobia), as a health outcome in the JD-R model, demonstrating also its relationship with absenteeism. The last study highlighted the added value of using the mixed methods research approach in order to detect and analyse context-specific job demands which could affects workers’ health. Conclusion. The findings of this thesis answered both to open questions in the scientific literature and to the social request of managing psychosocial risk factors in the workplace in order to enhance workers well-being.

Surgical treatment of upper, middle and lower cervical injuries and non-unions by anterior procedures

The goals of any treatment of cervical spine injuries are: return to maximum functional ability, minimum of residual pain, decrease of any neurological deficit, minimum of residual deformity and prevention of further disability. The advantages of surgical treatment are the ability to reach optimal reduction, immediate stability, direct decompression of the cord and the exiting roots, the need for only minimum external fixation, the possibility for early mobilisation and clearly decreased nursing problems. There are some reasons why those goals can be reached better by anterior surgery. Usually the bony compression of the cord and roots comes from the front therefore anterior decompression is usually the procedure of choice. Also, the anterior stabilisation with a plate is usually simpler than a posterior instrumentation. It needs to be stressed that closed reduction by traction can align the fractured spine and indirectly decompress the neural structures in about 70%. The necessary weight is 2.5 kg per level of injury. In the upper cervical spine, the odontoid fracture type 2 is an indication for anterior surgery by direct screw fixation. Joint C1/C2 dislocations or fractures or certain odontoid fractures can be treated with a fusion of the C1/C2 joint by anterior transarticular screw fixation. In the lower and middle cervical spine, anterior plating combined with iliac crest or fibular strut graft is the procedure of choice, however, a solid graft can also be replaced by filled solid or expandable vertebral cages. The complication of this surgery is low, when properly executed and anterior surgery may only be contra-indicated in case of a significant lesion or locked joints.