Predictive Ability of NGAL as a Marker of Renal Damage: evaluation of Multiple Clinical Settings

Introduction. Neutrophil Gelatinase-Associated Lipocalin (NGAL) belongs to the family of lipocalins and it is produced by several cell types, including renal tubular epithelium. In the kidney its production increases during acute damage and this is reflected by the increase in serum and urine levels. In animal studies and clinical trials, NGAL was found to be a sensitive and specific indicator of acute kidney injury (AKI). Purpose. The aim of this work was to investigate, in a prospective manner, whether urine NGAL can be used as a marker in preeclampsia, kidney transplantation, VLBI and diabetic nephropathy. Materials and methods. The study involved 44 consecutive patients who received renal transplantation; 18 women affected by preeclampsia (PE); a total of 55 infants weighing ≤1500 g and 80 patients with Type 1 diabetes. Results. A positive correlation was found between urinary NGAL and 24 hours proteinuria within the PE group. The detection of higher uNGAL values in case of severe PE, even in absence of statistical significance, confirms that these women suffer from an initial renal damage. In our population of VLBW infants, we found a positive correlation of uNGAL values at birth with differences in sCreat and eGFR values from birth to day 21, but no correlation was found between uNGAL values at birth and sCreat and eGFR at day 7. systolic an diastolic blood pressure decreased with increasing levels of uNGAL. The patients with uNGAL <25 ng/ml had significantly higher levels of systolic blood pressure compared with the patients with uNGAL >50 ng/ml ( p<0.005). Our results indicate the ability of NGAL to predict the delay in functional recovery of the graft. Conclusions. In acute renal pathology, urinary NGAL confirms to be a valuable predictive marker of the progress and status of acute injury.

Satellite and in situ data integrated analysis to study the upper ocean an coastal environment of the Italian seas

The thesis objectives are to develop new methodologies for study of the space and time variability of Italian upper ocean ecosystem through the combined use of multi-sensors satellite data and in situ observations and to identify the capability and limits of remote sensing observations to monitor the marine state at short and long time scales. Three oceanographic basins have been selected and subjected to different types of analyses. The first region is the Tyrrhenian Sea where a comparative analysis of altimetry and lagrangian measurements was carried out to study the surface circulation. The results allowed to deepen the knowledge of the Tyrrhenian Sea surface dynamics and its variability and to defined the limitations of satellite altimetry measurements to detect small scale marine circulation features. Channel of Sicily study aimed to identify the spatial-temporal variability of phytoplankton biomass and to understand the impact of the upper ocean circulation on the marine ecosystem. An combined analysis of the satellite of long term time series of chlorophyll, Sea Surface Temperature and Sea Level field data was applied. The results allowed to identify the key role of the Atlantic water inflow in modulating the seasonal variability of the phytoplankton biomass in the region. Finally, Italian coastal marine system was studied with the objective to explore the potential capability of Ocean Color data in detecting chlorophyll trend in coastal areas. The most appropriated methodology to detect long term environmental changes was defined through intercomparison of chlorophyll trends detected by in situ and satellite. Then, Italian coastal areas subject to eutrophication problems were identified. This work has demonstrated that satellites data constitute an unique opportunity to define the features and forcing influencing the upper ocean ecosystems dynamics and can be used also to monitor environmental variables capable of influencing phytoplankton productivity.

Structural and strain analysis in the Late Paleozoic coastal accretionary wedge of central Chile

Abstract In this study structural and finite strain data are used to explore the tectonic evolution and the exhumation history of the Chilean accretionary wedge. The Chilean accretionary wedge is part of a Late Paleozoic subduction complex that developed during subduction of the Pacific plate underneath South America. The wedge is commonly subdivided into a structurally lower Western Series and an upper Eastern Series. This study shows the progressive development of structures and finite strain from the least deformed rocks in the eastern part of the Eastern Series of the accretionary wedge to higher grade schist of the Western Series at the Pacific coast. Furthermore, this study reports finite-strain data to quantify the contribution of vertical ductile shortening to exhumation. Vertical ductile shortening is, together with erosion and normal faulting, a process that can aid the exhumation of high-pressure rocks. In the east, structures are characterized by upright chevron folds of sedimentary layering which are associated with a penetrative axial-plane foliation, S1. As the F1 folds became slightly overturned to the west, S1 was folded about recumbent open F2 folds and an S2 axial-plane foliation developed. Near the contact between the Western and Eastern Series S2 represents a prominent subhorizontal transposition foliation. Towards the structural deepest units in the west the transposition foliation became progressively flat lying. Finite-strain data as obtained by Rf/Phi and PDS analysis in metagreywacke and X-ray texture goniometry in phyllosilicate-rich rocks show a smooth and gradual increase in strain magnitude from east to west. There are no evidences for normal faulting or significant structural breaks across the contact of Eastern and Western Series. The progressive structural and strain evolution between both series can be interpreted to reflect a continuous change in the mode of accretion in the subduction wedge. Before ~320-290 Ma the rocks of the Eastern Series were frontally accreted to the Andean margin. Frontal accretion caused horizontal shortening and upright folds and axial-plane foliations developed. At ~320-290 Ma the mode of accretion changed and the rocks of the Western Series were underplated below the Andean margin. This basal accretion caused a major change in the flow field within the wedge and gave rise to vertical shortening and the development of the penetrative subhorizontal transposition foliation. To estimate the amount that vertical ductile shortening contributed to the exhumation of both units finite strain is measured. The tensor average of absolute finite strain yield Sx=1.24, Sy=0.82 and Sz=0.57 implying an average vertical shortening of ca. 43%, which was compensated by volume loss. The finite strain data of the PDS measurements allow to calculate an average volume loss of 41%. A mass balance approximates that most of the solved material stays in the wedge and is precipitated in quartz veins. The average of relative finite strain is Sx=1.65, Sy=0.89 and Sz=0.59 indicating greater vertical shortening in the structurally deeper units. A simple model which integrates velocity gradients along a vertical flow path with a steady-state wedge is used to estimate the contribution of deformation to ductile thinning of the overburden during exhumation. The results show that vertical ductile shortening contributed 15-20% to exhumation. As no large-scale normal faults have been mapped the remaining 80-85% of exhumation must be due to erosion.

Evaluation of Silver European EEL (anguilla anguilla) for the implementation of an Effective EEL Management plan in Mediterranean Coastal Lagoons

This thesis presents SEELF (Sustainable EEL fishery) Index, a methodology for evaluation of European eel (Anguilla anguilla) for the implementation of an effective Eel Management Plan, as defined by EU Regulation No.1100/2007. SEELF uses internal and external indices, age and blood parameters, and selects suitable specimen for restocking; it is also a reliable tool for eel stock management. In fact, SEELF Index, was developed in two versions: SEELF A, to be used in field operations (catch&release, eel status monitoring) and SEELF B to be used for quality control (food production) and research (eel status monitoring). Health status was evaluated also by biomarker analysis (ChE), and data were compared with age of eel. Age determination was performed with otolith reading and fish scale reading and a calibration between the two methods was possible. The study area was the Comacchio lagoon, a brackish coastal lagoon in Italy, well known as an example of suitable environment for eel fishery, where the capability to use the local natural resources has long been a key factor for a successful fishery management. Comacchio lagoon is proposed as an area where an effective EMP can be performed, in agreement with the main features (management of basins, reduction of mortality due to predators,etc.) highlighted for designation of European Restocking Area (ERA). The ERA is a new concept, proposed as a pillar of a new strategy on eel management and conservation. Furthermore, the features of ERAs can be useful in the framework of European Scale Eel Management Plan (ESEMP), proposed as a European scale implementation of EMP, providing a more effectiveness of conservation measures for eel management.

Effects of artificial defences and flooding on coastal habitats and assemblages

Since large stretches of European coasts are already retreating and projected scenarios are worsening, many artificial structures, such as breakwaters and seawalls, are built as tool against coastal erosion. However artificial structures produce widespread changes that alter the coastal zones and affect the biological communities. My doctoral thesis analyses the consequences of different options for coastal protection, namely hard engineering ‘artificial defences’ (i.e. impact of human-made structures) and ‘no-defence’ (i.e. impact of seawater inundation). I investigated two new aspects of the potential impact of coastal defences. The first was the effect of artificial hard substrates on the fish communities structure. In particular I was interested to test if the differences among breakwaters and natural rocky reef would change depending on the nature of the surrounding habitat of the artificial structure (prevalent sandy rather than rocky). The second was the effect on the native natural sandy habitats of the organic detritus derived from hard-bottom species (green algae and mussels) detached from breakwaters. Furthermore, I investigated the ecological implication of the “no-defend” option, which allow the inundation of coastal habitats. The focus of this study was the potential effect of seawater intrusion on the degradation process of marine, salt-marsh and terrestrial detritus, including changes on the breakdown rates and the associated macrofauna. The PhD research was conducted in three areas along European coasts: North Adriatic sea, Sicilian coast and South-West England where different habitats (coastal, estuarine), biological communities (soft-bottom macro-benthos; rocky-coastal fishes; estuarine macro-invertebrates) and processes (organic enrichment; assemblage structure; leaf-litter breakdown) were analyzed. The research was carried out through manipulative and descriptive field-experiments in which specific hypothesis were tested by univariate and multivariate analyses.

Harnack inequalities in sub-Riemannian settings

In the present thesis, we discuss the main notions of an axiomatic approach for an invariant Harnack inequality. This procedure, originated from techniques for fully nonlinear elliptic operators, has been developed by Di Fazio, Gutiérrez, and Lanconelli in the general settings of doubling Hölder quasi-metric spaces. The main tools of the approach are the so-called double ball property and critical density property: the validity of these properties implies an invariant Harnack inequality. We are mainly interested in the horizontally elliptic operators, i.e. some second order linear degenerate-elliptic operators which are elliptic with respect to the horizontal directions of a Carnot group. An invariant Harnack inequality of Krylov-Safonov type is still an open problem in this context. In the thesis we show how the double ball property is related to the solvability of a kind of exterior Dirichlet problem for these operators. More precisely, it is a consequence of the existence of some suitable interior barrier functions of Bouligand-type. By following these ideas, we prove the double ball property for a generic step two Carnot group. Regarding the critical density, we generalize to the setting of H-type groups some arguments by Gutiérrez and Tournier for the Heisenberg group. We recognize that the critical density holds true in these peculiar contexts by assuming a Cordes-Landis type condition for the coefficient matrix of the operator. By the axiomatic approach, we thus prove an invariant Harnack inequality in H-type groups which is uniform in the class of the coefficient matrices with prescribed bounds for the eigenvalues and satisfying such a Cordes-Landis condition.

Analysis and development of ecologically based approaches to coastal defense

Climate-change related impacts, notably coastal erosion, inundation and flooding from sea level rise and storms, will increase in the coming decades enhancing the risks for coastal populations. Further recourse to coastal armoring and other engineered defenses to address risk reduction will exacerbate threats to coastal ecosystems. Alternatively, protection services provided by healthy ecosystems is emerging as a key element in climate adaptation and disaster risk management. I examined two distinct approaches to coastal defense on the base of their ecological and ecosystem conservation values. First, I analyzed the role of coastal ecosystems in providing services for hazard risk reduction. The value in wave attenuation of coral reefs was quantitatively demonstrated using a meta-analysis approach. Results indicate that coral reefs can provide wave attenuation comparable to hard engineering artificial defenses and at lower costs. Conservation and restoration of existing coral reefs are cost-effective management options for disaster risk reduction. Second, I evaluated the possibility to enhance the ecological value of artificial coastal defense structures (CDS) as habitats for marine communities. I documented the suitability of CDS to support native, ecologically relevant, habitat-forming canopy algae exploring the feasibility of enhancing CDS ecological value by promoting the growth of desired species. Juveniles of Cystoseira barbata can be successfully transplanted at both natural and artificial habitats and not affected by lack of surrounding adult algal individuals nor by substratum orientation. Transplantation success was limited by biotic disturbance from macrograzers on CDS compared to natural habitats. Future work should explore the reasons behind the different ecological functioning of artificial and natural habitats unraveling the factors and mechanisms that cause it. The comprehension of the functioning of systems associated with artificial habitats is the key to allow environmental managers to identify proper mitigation options and to forecast the impact of alternative coastal development plans.

A Web GIS Decision Support System For Coastal Risk Assessment and Mitigation Planning

Coastal flooding poses serious threats to coastal areas around the world, billions of dollars in damage to property and infrastructure, and threatens the lives of millions of people. Therefore, disaster management and risk assessment aims at detecting vulnerability and capacities in order to reduce coastal flood disaster risk. In particular, non-specialized researchers, emergency management personnel, and land use planners require an accurate, inexpensive method to determine and map risk associated with storm surge events and long-term sea level rise associated with climate change. This study contributes to the spatially evaluation and mapping of social-economic-environmental vulnerability and risk at sub-national scale through the development of appropriate tools and methods successfully embedded in a Web-GIS Decision Support System. A new set of raster-based models were studied and developed in order to be easily implemented in the Web-GIS framework with the purpose to quickly assess and map flood hazards characteristics, damage and vulnerability in a Multi-criteria approach. The Web-GIS DSS is developed recurring to open source software and programming language and its main peculiarity is to be available and usable by coastal managers and land use planners without requiring high scientific background in hydraulic engineering. The effectiveness of the system in the coastal risk assessment is evaluated trough its application to a real case study.

Dynamics of coastal aquifers: data-driven forecasting and risk analysis

This work is focused on the study of saltwater intrusion in coastal aquifers, and in particular on the realization of conceptual schemes to evaluate the risk associated with it. Saltwater intrusion depends on different natural and anthropic factors, both presenting a strong aleatory behaviour, that should be considered for an optimal management of the territory and water resources. Given the uncertainty of problem parameters, the risk associated with salinization needs to be cast in a probabilistic framework. On the basis of a widely adopted sharp interface formulation, key hydrogeological problem parameters are modeled as random variables, and global sensitivity analysis is used to determine their influence on the position of saltwater interface. The analyses presented in this work rely on an efficient model reduction technique, based on Polynomial Chaos Expansion, able to combine the best description of the model without great computational burden. When the assumptions of classical analytical models are not respected, and this occurs several times in the applications to real cases of study, as in the area analyzed in the present work, one can adopt data-driven techniques, based on the analysis of the data characterizing the system under study. It follows that a model can be defined on the basis of connections between the system state variables, with only a limited number of assumptions about the "physical" behaviour of the system.

Stratigraphic study and analysis of the barchan dunefield of the Laguna coastal zone in Santa Catarina, Brazil

The association of several favorable factors has resulted in the development of a wide barchan dune field that stands out as a fundamental element in the coastal landscape of southern Santa Catarina state in Brazil. This original ecosystem is being destroyed and highly modified, due to urbanization. This work identifies and discusses its basic characteristics and analyzes the favorable factors for its preservation, in the foreseen of both a sustainable future and potential incomes from ecotourism. The knowledge of the geologic evolution allows to associate this transgressive Holocene dunes formation to more dissipative beach conditions. Spatial differences on morphodynamics are related to local and regional contrasts in the sediment budget, with an influence on gradients of wave attenuation in the inner shelf and consequently with influence in the level of coastal erosion. The link between relative sea level changes and coastal eolian sedimentation can be used to integrate coastal eolian systems to the sequence stratigraphy model. The main accumulation phase of eolian sediments would occur during the final transgressive and highstand systems tracts. Considering the global character of Quaternary relative sea level changes, the Laguna transgressive dune field should be correlated with similar eolian deposits developed along other parts of the Brazilian coast compatibles with the model of dunefield initiation during rising and highstand sea level phases.

Zur Karbonatsedimentologie, Biofazies und sequenzstratigraphischen Architektur eines fossilen Hochenergie-Schelfs aus dem Neogen der Algarve (Miozän, Südportugal)

Die neogene Lagos-Portimão Formation (Unter- bis Mittelmiozän) bildet einen Teil der Steilküste der Algarve (S-Portugal) und besteht aus einer zyklischen Wechsellagerung von Karbonaten und Sand-steinen. Die vorliegende Arbeit bietet ein Modell zur sedimentologischen, faziellen und stratigraphischen Entwicklung dieser Einheit an. Basierend auf Profilen entlang der gesamten lateralen Erstreckung der Einheit wurden verschiedene Gelände- und Labormethoden angewandt, um ein Modell entwickeln zu können. Messungen des Sr87/86-Isotopenverhältnisses sollten Klarheit bezüglich der stratigraphischen Position bringen. Die laterale Korrelation der Profile erfolgte über lithologische und fazielle Ansprachen. Unterstützend wurden einzelne Profile mit einem tragbaren Gammaray-Spektrometer gemessen. Es wurden vier Leithorizonte etabliert, die sich durch fazielle Merkmale und spezielle Fossilführung defi-nieren lassen. Die Mikrofazies wurde qualitativ und quantitativ analysiert. Als statistisches Verfahren wurde unter anderem eine hierarchische Clusteranalyse durchgeführt, über welche fünf Biofaziestypen des warm-temperierten Klimabereichs unterschieden werden. Die Fossilführung wird von Mollusken, Bryozoen und Rotalgen dominiert. Ausnahmen bilden stratigraphisch isolierte Vorkommen von kolo-nialen Korallen, die jedoch keine Riffkörper aufbauen. Die Ergebnisse aller zuvor erwähnten Untersuchungen deuten auf Ablagerungen eines nicht-tropischen Hochenergie-Schelfs hin. Sedimentäre Zyklen sind oftmals unvollständig, es treten Hartgründe und Auf-arbeitungs- bzw- Kondesationshorizonte auf. Die geochemische Altersdatierung weist Alterssprünge und -inversionen auf. Ein Vergleich mit dem SW-australischen Schelf und dem von James et al. (1994) eingeführten Modell des shaved shelf bietet sich aufgrund der Ähnlichkeit der Sedimentgesteine und des ozeanographischen Settings an. Weiterhin werden zeitgleiche bzw. faziell ähnliche Becken vergleichend diskutiert. Das Sedimentationsgeschehen der Lagos-Portimão Formation wird maßgeblich durch eine halokinetisch bedingte unregelmäßige Subsidenz und Hebung beeinflußt. Der Salzdom von Albufeira war während der Sedimentation der Einheit mehrfach in Bewegung. Rutschungspakete, Entlastungsspalten und Sanddikes zeugen davon. Die sequenzstratigraphische Interpretation bietet einen neuen Ansatz, in dem sie von Hochstand-Sandsteinen und Tiefstand-Karbonaten ausgeht.

Citizen science as a tool for the environmental quality assessment of the Mediterranean coastal habitats

The growing need to assess the environmental status of the Mediterranean coastal marine habitats and the large availability of data collected by Reef Check Italia onlus (RCI) volunteers suggest the possibility to develop innovative and reliable indices that may support decision makers in applying conservation strategies. The aims of this study were to check the reliability of data collected by RCI volunteers, analyse the spatial and temporal distribution of RCI available data, resume the knowledge on the biology and ecology of the monitored species, and develop innovative indices to asses the ecological quality of Mediterranean subtidal rocky shores and coralligenous habitats. Subtidal rocky shores and coralligenous were chosen because these are the habitats more attractive for divers; therefore mlst data are referring to them, moreover subtidal rocky bottom are strongly affected by coastal urbanisation, land use, fishing and tourist activities, that increase pollution, turbidity and sedimentation. Non-indigenous species (NIS) have been recognized as a major threat to the integrity of Mediterranean native communities because of their proliferation, spread and impact on resident communities. Monitoring of NIS’ spreading dynamics at the basin spatial scale is difficult but urgent. According to a field test, the training provided by RCI appears adequate to obtain reliable data by volunteers. Based on data collected by RCI volunteers, three main categories of indices were developed: indices based on species diversity, indices on the occurrence non-indigenous species, and indices on species sensitive toward physical, chemical and biological disturbances. As case studies, indices were applied to stretches of coastline defined according to management criteria (province territories and marine protected areas). The assessments of ecological quality in the Tavolara Marine Protected Area using the species sensitivities index were consisten with those previously obtained with traditional methods.

Polychaete fauna of the Northwest Portuguese Coastal Shelf: ecology, diversity and distribution

Polychaetes are one of the larger groups of macroinvertebrates with more than 9000 species recognised, distributed worldwide. Thanks to the broad ecological adaptability and high abundaces, this taxon plays a leading role and is considered an important component of all benthic assemblages. Our knowledge about the West Iberian Coast polychaete fauna are scarce, and the only studies are recent. In this sense, the aim of this work was to investigate the composition and the spatial distribution of the polychaete fauna along the NW Portuguese Coastal Shelf, focusing on their relationship to environmental factors (depth, grain size, longitude and latitude) and to add new data to the existing biological dataset. A total of 39 sites were analysed, collected in an area of about 5665 km², between 20 and 150 m depth, distributed in a way to cover the overall grain size gradient. A total of 9352 specimens belonging to 41 families were found, and the analysis based on the abundance of polychaete species revealed five affinity groups: (a) nearshore medium sand characterised by Pisione parapari and Hesionura elongata; (b) very coarse sand that showed the highest abundance of Syllidae and was characterised by Protodorvillea kefersteini and Syllis garciai; (c) fine sand dominated by Spiophanes bombyx and Glycera tridactyla; (d) very fine sand with Nepthys assimilis and Amage sp. and the highest abundance of Paraonidae; (d) mud characterised by Labioleanira yhleni and Ampharete finmarchica. The combination of the environmental variables and the biological data, done with BIOENV routine, demonstrated that depth, grain size and fine contents were the best related with the biological data (rho=0.598). In general, the results agree with the composition and the spatial distribution of the polychaete fauna in other parts of the world; further polychaete assemblages related to mud sediments were firstly recorded in the Northwestern Portuguese Coastal Shelf.

An examination chair to measure internal rotation of the hip in routine settings: a validation study

OBJECTIVE: To determine the performance of a newly developed examination chair as compared with the clinical standard of assessing internal rotation (IR) of the flexed hip with a goniometer. METHODS: The examination chair allowed measurement of IR in a sitting position simultaneously in both hips, with hips and knees flexed 90 degrees, lower legs hanging unsupported and a standardized load of 5 kg applied to both ankles using a bilateral pulley system. Clinical assessment of IR was performed in supine position with hips and knees flexed 90 degrees using a goniometer. Within the framework of a population-based inception cohort study, we calculated inter-observer agreement in two samples of 84 and 64 consecutive, unselected young asymptomatic males using intra-class correlation coefficients (ICC) and determined the correlation between IR assessed with examination chair and clinical assessment. RESULTS: Inter-observer agreement was excellent for the examination chair (ICC right hip, 0.92, 95% confidence interval [CI] 0.89-0.95; ICC left hip, 0.90, 95% CI 0.86-0.94), and considerably higher than that seen with clinical assessment (ICC right hip, 0.65, 95% CI 0.49-0.77; ICC left hip, 0.69, 95% CI 0.54-0.80, P for difference in ICC between examination chair and clinical assessment

Mortality associated with discordant responses to antiretroviral therapy in resource-constrained settings

Objectives: We assessed mortality associated with immunologic and virologic patterns of response at 6 months of highly active antiretroviral therapy (HAART) in HIV-infected individuals from resource-limited countries in Africa and South America. Methods: Patients who initiated HAART between 1996 and 2007, aged 16 years or older, and had at least 1 measurement (HIV-1 RNA plasma viral load or CD4 cell count) at 6 months of therapy (3-9 month window) were included. Therapy response was categorized as complete, discordant (virologic only or immunologic only), and absent. Associations between 6-month response to therapy and all-cause mortality were assessed by Cox proportional hazards regression. Robust standard errors were calculated to account for intrasite correlation. Results: A total of 7160 patients, corresponding to 15,107 person-years, were analyzed. In multivariable analysis adjusted for age at HAART initiation, baseline clinical stage and CD4 cell count, year of HAART initiation, clinic, occurrence of an AIDS-defining condition within the first 6 months of treatment, and discordant and absent responses were associated with increased risk of death. Conclusions: Similar to reports from high-income countries, discordant immunologic and virologic responses were associated with intermediate risk of death compared with complete and no response in this large cohort of HIV-1 patients from resource-limited countries. Our results support a recommendation for wider availability of plasma viral load testing to monitor antiretroviral therapy in these settings.