The medical management after surgery for advanced heart failure

The aim of the Research of this Ph D Project is to improve the medical management after surgery for advanced heart failure, both after left ventricular assist devices (LVAD) implantation, and after heart transplantation in the long-term. Regarding heart transplantation (HTx), the Research Project is focused on diagnostics, classification, prevention and treatment of cardiac allograft vasculopathy (CAV), and on treatment of post-HTx cancers; the results are presented in the first part of this Thesis. In particular, the main aspect investigated are the prognostic role of information derived from coronary angiography, coronary tomography and intravascular ultrasound, and the different sensitivity of these techniques in predicting outcomes and in diagnosing CAV. Moreover, the role of mTOR inhibitors on CAV prevention or treatment is investigated, both alone and in combination with different anti-CMV prevention strategies, as well as the impact of mTOR inhibitors on clinical outcomes in the long term. Regarding LVAD, the main focus is on the role of transthoracic echocardiography in the management of patients with a continuous-flow, centrifugal, intrapericardial pump (HVAD, Heartware); this section is reported in the second part of this Thesis. The main aspects investigated are the use of echocardiography in patients with HVAD device and its interaction with the information derived from pump curves' analysis in predicting aortic valve opening status, a surrogate of the condition of support provided by the LVAD.

Advanced data deduplication techniques and their application

Data deduplication describes a class of approaches that reduce the storage capacity needed to store data or the amount of data that has to be transferred over a network. These approaches detect coarse-grained redundancies within a data set, e.g. a file system, and remove them.rnrnOne of the most important applications of data deduplication are backup storage systems where these approaches are able to reduce the storage requirements to a small fraction of the logical backup data size.rnThis thesis introduces multiple new extensions of so-called fingerprinting-based data deduplication. It starts with the presentation of a novel system design, which allows using a cluster of servers to perform exact data deduplication with small chunks in a scalable way.rnrnAfterwards, a combination of compression approaches for an important, but often over- looked, data structure in data deduplication systems, so called block and file recipes, is introduced. Using these compression approaches that exploit unique properties of data deduplication systems, the size of these recipes can be reduced by more than 92% in all investigated data sets. As file recipes can occupy a significant fraction of the overall storage capacity of data deduplication systems, the compression enables significant savings.rnrnA technique to increase the write throughput of data deduplication systems, based on the aforementioned block and file recipes, is introduced next. The novel Block Locality Caching (BLC) uses properties of block and file recipes to overcome the chunk lookup disk bottleneck of data deduplication systems. This chunk lookup disk bottleneck either limits the scalability or the throughput of data deduplication systems. The presented BLC overcomes the disk bottleneck more efficiently than existing approaches. Furthermore, it is shown that it is less prone to aging effects.rnrnFinally, it is investigated if large HPC storage systems inhibit redundancies that can be found by fingerprinting-based data deduplication. Over 3 PB of HPC storage data from different data sets have been analyzed. In most data sets, between 20 and 30% of the data can be classified as redundant. According to these results, future work in HPC storage systems should further investigate how data deduplication can be integrated into future HPC storage systems.rnrnThis thesis presents important novel work in different area of data deduplication re- search.

Esecuzione immediata di frammenti di codice sorgente C# tramite l’utilizzo della .NET Compiler Platform

.NET Compiler Platform è un compilatore per i linguaggi C# e Visual Basic realizzato da Microsoft. L’innovazione apportata da tale strumento è l’introduzione di API che permettono di accedere al compilatore; in particolare, è possibile accedere alle strutture dati utilizzate al suo interno, quali simboli o AST, e controllare e/o modificare il processo di compilazione. Una parte di questo progetto, chiamato anche progetto Roslyn, è focalizzata sull’introduzione dello scripting per il linguaggio C#. In questa trattazione si è interessati a sperimentare le possibilità offerte da tale strumento nel campo dell’esecuzione dinamica di frammenti di codice. Gli obiettivi imposti si collocano nell’ambito della re-ingegnerizzazione e dello sviluppo di software. Tali obiettivi sono la re-implementazione dei filtri di selezione contenuti nel framework Phoenix, utilizzando le API di Roslyn per migliorarne le prestazioni, e la progettazione di un componente che realizzi una console per lo scripting C# dotata della possibilità di riferire dinamicamente librerie. Le API di compilazione si rivelano essere non propriamente adatte all’esecuzione immediata di frammenti di codice, nonostante ciò, è possibile, appoggiandosi alla reflection, utilizzarle per giungere a questo risultato. Lo scripting, invece, si rivela uno strumento dalle grandi potenzialità nel suddetto ambito.

Oxidative stress and inflammation response after nanoparticle exposure: differences between human lung cell monocultures and an advanced three-dimensional model of the human epithelial airways

Combustion-derived and manufactured nanoparticles (NPs) are known to provoke oxidative stress and inflammatory responses in human lung cells; therefore, they play an important role during the development of adverse health effects. As the lungs are composed of more than 40 different cell types, it is of particular interest to perform toxicological studies with co-cultures systems, rather than with monocultures of only one cell type, to gain a better understanding of complex cellular reactions upon exposure to toxic substances. Monocultures of A549 human epithelial lung cells, human monocyte-derived macrophages and monocyte-derived dendritic cells (MDDCs) as well as triple cell co-cultures consisting of all three cell types were exposed to combustion-derived NPs (diesel exhaust particles) and to manufactured NPs (titanium dioxide and single-walled carbon nanotubes). The penetration of particles into cells was analysed by transmission electron microscopy. The amount of intracellular reactive oxygen species (ROS), the total antioxidant capacity (TAC) and the production of tumour necrosis factor (TNF)-alpha and interleukin (IL)-8 were quantified. The results of the monocultures were summed with an adjustment for the number of each single cell type in the triple cell co-culture. All three particle types were found in all cell and culture types. The production of ROS was induced by all particle types in all cell cultures except in monocultures of MDDCs. The TAC and the (pro-)inflammatory reactions were not statistically significantly increased by particle exposure in any of the cell cultures. Interestingly, in the triple cell co-cultures, the TAC and IL-8 concentrations were lower and the TNF-alpha concentrations were higher than the expected values calculated from the monocultures. The interplay of different lung cell types seems to substantially modulate the oxidative stress and the inflammatory responses after NP exposure.

Plasma copeptin levels before and during exogenous arginine vasopressin infusion in patients with advanced vasodilatory shock

Plasma copeptin levels before and during exogenous arginine vasopressin infusion (AVP) were evaluated, and the value of copeptin levels before AVP therapy to predict complications during AVP therapy and outcome in vasodilatory shock patients was determined.

Concomitant Cisplatin and Hyperfractionated Radiotherapy in Locally Advanced Head and Neck Cancer: 10-Year Follow-up of a Randomized Phase III Trial (SAKK 10/94)

To compare the long-term outcome of treatment with concomitant cisplatin and hyperfractionated radiotherapy versus treatment with hyperfractionated radiotherapy alone in patients with locally advanced head and neck cancer.

Intense therapy in patients with locally advanced esophageal cancer beyond hope for surgical cure: a prospective, multicenter phase II trial of the Swiss Group for Clinical Cancer Research (SAKK 76/02)

There is no standard treatment for patients with locally advanced esophageal carcinoma without systemic metastasis in whom surgery is no longer considered a reasonable option.

Continuous Sunitinib treatment in patients with advanced hepatocellular carcinoma: a Swiss Group for Clinical Cancer Research (SAKK) and Swiss Association for the Study of the Liver (SASL) multicenter phase II trial (SAKK 77/06)

Sunitinib (SU) is a multitargeted tyrosine kinase inhibitor with antitumor and antiangiogenic activity. The objective of this trial was to demonstrate antitumor activity of continuous SU treatment in patients with hepatocellular carcinoma (HCC).

High-dose melphalan with or without stem cell support before myeloablative allo-SCT for remission induction in patients with advanced relapsed or refractory AML

Treatment strategies for relapsed/refractory AML are limited and disappointing. Recently, high-dose melphalan (HDM) chemotherapy and autologous hematopoietic SCT (HSCT) has been proposed for AML re-induction. We investigated the impact of HDM remission induction in highly advanced relapsed/refractory AML patients planned for allogeneic HSCT. A total of 23 patients with relapsed/refractory AML were prospectively scheduled for HDM with or without stem cell support followed by myeloablative allogeneic HSCT. Patients included nine individuals with a history of previous HSCT (seven allogeneic, two autologous). A total of 18 patients (78%) achieved a leukemia-free state and an additional four had substantial reduction of the initial leukemia burden warranting treatment continuation. There were no differences between patients with or without immediate stem cell support regarding mucositis or other organ toxicity. A total of 20 patients proceeded to myeloablative allogeneic HSCT. Outcome of allogeneic HSCT was poor: 11 patients (55%) relapsed, 7 patients (35%) died from TRM and only 2 patients (10%) were alive at the last follow-up. Our study shows that HDM is effective in inducing a leukemia-free state in patients with highly advanced relapsed/refractory AML. Leukemia burden reduction with HDM, however, did not translate into improved OS.

Cetuximab in combination with chemoradiotherapy before surgery in patients with resectable, locally advanced esophageal carcinoma: a prospective, multicenter phase IB/II Trial (SAKK 75/06)

This multicenter phase IB/II trial investigated cetuximab added to preoperative chemoradiotherapy for esophageal cancer.

Endosonographic radial tumor thickness after neoadjuvant chemoradiation therapy to predict response and survival in patients with locally advanced esophageal cancer: a prospective multicenter phase ll study by the Swiss Group for Clinical Cancer Research (SAKK 75/02)

EUS response assessment in patients with locally advanced esophageal cancer undergoing neoadjuvant chemoradiation therapy (CRT) is limited by disintegration of the involved anatomic structures.

Mobile phone technologies and advanced data analysis towards the enhancement of diabetes self-management

Advances in the area of mobile and wireless communication for healthcare (m-Health) along with the improvements in information science allow the design and development of new patient-centric models for the provision of personalised healthcare services, increase of patient independence and improvement of patient's self-control and self-management capabilities. This paper comprises a brief overview of the m-Health applications towards the self-management of individuals with diabetes mellitus and the enhancement of their quality of life. Furthermore, the design and development of a mobile phone application for Type 1 Diabetes Mellitus (T1DM) self-management is presented. The technical evaluation of the application, which permits the management of blood glucose measurements, blood pressure measurements, insulin dosage, food/drink intake and physical activity, has shown that the use of the mobile phone technologies along with data analysis methods might improve the self-management of T1DM.